Psoriatic Arthritis; How to heal reluctantly.
Psoriatic Arthritis is typically an incurable, painful, and debilitating disease. The Arthritis Foundation defines it as “a chronic, autoimmune form of arthritis that causes joint inflammation and occurs with the skin condition psoriasis.”
My first hand experience of working with someone with this complicated disease came early on in my holistic nutrition practice back in 2016. My very first client (lets call him Jim) was suffering. He was a surfer, writer, all round talented individual and was presenting very typically with pain, swelling ‘sausage fingers’ and limited mobility in his fingers, shoulders and lower back. His nails were detaching from the nail bed. His skin was red, scaly and itchy. And his stomach was usually sore and uncomfortable.
In 2016, scientists knew that cytokines activated the JAK/STAT pathway, leading to massive inflammation, and the only option offered to Jim was Methotrexate, but given that the side affects included liver damage, bone marrow suppression, lung inflammation and scarring (fibrosis)
I, wearing my holistic hat, was desperate to keep him off these hugely damaging drugs for as long as possible.
What made Jim a particularly exciting person to work with was also the factor that made him particularly difficult to work with - he was a wonderfully funny, cynical, un-holistic, Australian, who was still determined to continue with his fast-paced, toxin ingesting lifestyle. I knew I had to provide him with the science to support my ‘hippy dippy’ nutrition & mindfulness based approach.
At our first meeting, I presented him with a case study from one of my lecturers Dr Mark Hyman. He had worked with a 4 year old girl who had been plagued by psoriatic arthritis since she was 6 months old. She was on immune-suppressing drugs and consequently had ended up in hospital with a staph infection. He eliminated gluten, treated her candida with antifungals, and incorporated anti inflammatories, healthy fats and supplements like Vitamin D, vitamin A & Zinc to heal her skin. Within weeks her skin settled.
I had promised Jim a flexible approach, but told him in my ideal world he would eliminate foods causing this painful internal and external inflammation. I wanted him to give gluten, dairy, sugar, and alcohol a rest for a month.
‘Is life worth living?’ he asked me. ‘ Are you really living life now?’ I replied. He tried to shrug but winced with pain.
Again, I had to show him the science to get him on board. Studies such as the UC Davis Health Study, show that a Western diet rich in fat and sugar may lead to inflammatory skin diseases. I explained to him that in order to get that external inflammation under control, (given the skin is our biggest organ and an extremely helpful radar for what is going on inside the body) we needed to take down all inflammation in his gut. And my belief was that once this inflammation abated, those broad receptor fields would no longer be creating the sensation of pain in his lower back. He swore to (at) me that he had ALWAYS had back pain, and that there was NO WAY it was connected to what he was eating. I had to explain to him how Visceral Pain worked. This is described as ‘pain experienced in your internal organs and it can be harder to centralise or identify.” and yes, it is much harder to understand pain-wise than a visible surfboard injury.
His protocol involved adding a plain protein powder to his nut milk that he was using on his Gluten Free Porridge. I explained to him that it was essential for him to increase his protein and greens to compensate for the removal of sugary starches he was living on. I also insisted he must ingest a phytonutrient, anti inflammatory green smoothie, with added probiotics and a cup of chicken broth to line his tender, damaged gut before he went out drinking his vodka sodas (ok we weren’t winning on the elimination of alcohol, but we managed to get rid of the glutenous sugary beer).
In recent years studies such as the “Role of Skin and Gut Microbiota in the pathogenesis of psoriasis, an inflammatory skin disease’ show that advanced technologies have enabled researchers to characterise critical microbiomes for the research of psoriasis. But in 2016 I struggled to find actual studies of the composition of the microbiome, and instead focused on encouraging him to increase the diversity of what he was eating, asking him to eat over 30 different kinds of vegetables a week.
We met again after 2 weeks and, bingo, he excitedly admitted he was feeling less itchy, more comfortable in his skin, and he was even able to showed me previously itchy areas that had seemed to have calmed completely.
Time to notch it up a bit, whilst my nutrition based approach had caught him by surprise, he didn’t know what had hit him when I explained we were going to embark on MBSR, Mindfulness Based Stress Reduction to compliment the anti-inflammatory diet. “How in gods name is giving my pain MORE attention by being mindful going to make it less painful” Surfer Jim asked.
I explained that “Non Judgemental Acceptance” of his pain, would help with the depression that was starting to plague him. That if we could get him out of that ‘angry’ state at the injustice of what he was going through, his inflammation, and consequent pain, would also drop.
MBSR developed more than 40 years ago by Jon Kabat Zinn , taught patients in chronic pain how to meditate and pay close attention to the pain. He believed that patients needed to be active participants in their own healing.
We started slowly, with a focus on the breath, and then moved to taking any intrusive thoughts onto ‘leaves on a stream’, watching them without judgement.
One wonderful day, 6 months after we had started working together, he declared that he "noticed something” in the weekend, when he was playing cricket with his son; he noticed he could lift his arm high enough to bowl. AND his lower back was no longer preventing him from getting out on his surfboard.
He reluctantly admitted that maybe these processes were working. He could live for a bit longer without baguettes and beer.
He managed to take alcohol out for a month. And then another. He moved from ‘gluten free’, which was still high in carbohydrate starchy sugars, to a more paleo based diet, but still with the ‘green sludge smoothie’ alongside every meal.
And we introduced a body scan at night when he climbed into bed; Not only did this help him focus on little wins, but it layered onto his mindful practice.
We worked together for a year, and at the end of that year his initial ‘presenting health concerns’ had all but abated.
So whilst he was still susceptible to flare ups when he strayed from the path we had laid, he truly believed a pain free living was in his hands; His ‘sausage free’ hands