Ep. 03 Nutrition for Psoriasis and the Role of Exclusion Diets with Sally Duffin

– article currently being updated :-)-

If there is one thing I have found the most valuable when it comes to healing naturally, it is working with what I eat. This is why in the first interviews for the podcast we talk about the best diet to improve psoriasis.

What I eat makes a huge difference to how I feel in myself, my energy levels and the severity of my psoriasis. Since working on my diet I have almost entirely eliminated flaking and my plaques are calm, flat and happy. Well, not happy…but they look happy compared to what was there before!

Sally is a great resource (as well as a great person) and we talk about common dietary changes that can help psoriasis and discuss some of the things we need to watch out for. We talk about my favourite supplement for psoriasis at the end so make sure you listen all the way, you won’t regret it!

Who is Sally Duffin?

She also is a clinical supervisor and module leader for clinical practice on the Masters of Nutrition Science at the Northern College of Acupuncture.

The most important thing you need to know is she is my nutritionist (therefore I trust her opinions- because I have quizzed her extensively about her advice and she has given comprehensive evidence-based responses every time.)

Find more from here at:Facebook page  https://www.facebook.com/nutritioninyork/Facebook group  https://www.facebook.com/groups/nutritioninyorkTwitter  https://twitter.com/nutritioninyork

Listen Now

You can also listen to this episode (and subscribe so you don’t miss an episode on iTunes / Stitcher / Castbox

If you have a minute, please can you leave a review? It helps us to rank higher in search so more people can find us. Let’s face it- would you type psoriasis into a podcast search? We are not your average podcast 🙂 If you share your review on social media- make sure you tag me! @gemma_boak so I can say thank you.

One last thing!

In this episode we talk about Food and Mood Diaries – you can download a template from the members resource area (its free to join) or you download this one from Sally http://www.nutritioninyork.co.uk/does-food-affect-your-mood-find-out-with-this-free-food-mood-movement-tracker/.

Gemma: So today we’re talking to Sally Duffin. She is a nutritional therapist and runs nutrition in York. She writes for a number of publications including the nutrition column for the York press and is the guest expert frequently on BBC Radio York. She also is a clinical supervisor and module leader for clinical practice on the Masters of nutrition science at the Northern College of acupuncture. In addition the most important thing you need to know is she is my nutritionist. Today we’re going to be talking about how nutrition can help with psoriasis and just a reminder the content of this discussion, our opinions and not to be taken as personal advice. You should always speak to your medical professional before making medical decisions. So let’s get on with the show. Hi Sally and welcome. I thought we would start off by talking about some of the things that we can think about when we have a long term chronic condition and like psoriasis.

Sally: Ok so I think the first thing to do particularly with something like psoriasis which is not ramune condition is try and see what underlying causes and triggers there are that are making your condition worse. So keeping something like a food and mood diary for a month or so can really help. Because you can pick up on any patterns there with either foods or emotional situations. Things like environmental toxins that might be and worsening the condition. So that can be helpful. Stress is a big trigger, both for an autoimmune condition itself. But also which you’ve got it. It can make the flare-ups worse as well. So looking at ways to calm the stress down and then really paying attention to your diet and if you notice any trigger foods and seeing if they belong to any particular family or if you can look at ways to modify your diet accordingly.

Gemma: Fantastic. So touching on stress because I know for psoriasis sufferers that is a really really big trigger. If you do live a stressful lifestyle of the additional nutrient requirements that somebody who’s stressed might have.

Sally: There are yes. When you’re under ongoing stress your body uses up a lot of things like vitamin b5, vitamin C, magnesium and zinc. they’re all needed to help your adrenal glands produce a stress hormones and to kind of maintain your body’s stress response and but equally those nutrients are important the things like energy and skin health and dealing with inflammation, supporting an immunity and so there are extra demands when you endure ongoing stress yeah.

Gemma: And what kind of foods would somebody want to be eating then if they do have a stressful lifestyle?

Sally: So to keep your body managing stress you’d be looking at things like reducing any unnecessary stimulants. Things like tea, coffee and you know the energy drinks that have the caffeine and because if you endure a lot of stress, your body’s already producing enough adrenaline and cortisol. [03:28 inaudible] those things and so gradually cutting down on those can be helpful. Switching from less of the processed foods that give you those the sugary highs. You know so whenever we’re stressed we always want the dairy milk, we don’t want the Apple. Looking for that quick sugary fix to keep our energy going. But long term that amount of sugar not helpful for a chronic inflammatory condition. so looking at ways of modifying that, so for example and if you love your chocolate and I love my chocolate you know and if you need to have a little chocolate fix a day when doing things like having the small little chocolate bits that you use to decorate cakes and mix those in with some nuts in there kind of trail mix and using chocolate bits with notes rather than dried fruit. So you’re still getting your chocolate fix. But you’re getting all the nutrients and protein from the nuts. So looking at little tweaks like that.

Gemma: Okay that seems quite manageable. I like the idea of maybe I’m talk into pretty much everything. So I like the idea of a food and mood diary. Is it that something that’s relatively simple to do?

Sally: Yeah I mean the templates out there and I actually have a template on one of my blog posts or you can just… or just using a normal diary and just noting what you eat in the day and how you’ve felt. So if you woke up feeling exhausted or if you had stomach aches for example after certain meals or if you found that your energy was really low at certain points of the day, you ended it with a headache end of work something like that. You know so just noting down certain factors if your skin had really flared up if you’re managing psoriasis. You know how long that flare-up lasts. Is it a week, is it just a couple of days and you can really start to see patterns emerge. But just trying to remember it in your head it’s not an accurate way of doing it. Because I mean I can remember what I ate last week and I can remember which days I had a headache and that’s writing it down so whether that’s on pen and paper or using an app on your phone. It’s just a good way of keeping track.

Gemma: Yeah that’s really good advice. I know when I found out I was sensitive tomatoes, that was quite an instant reaction. So it didn’t take very long for me to notice that. But when I found the sensitivity to wheat that was a food diary that I used. Because my symptoms lasted for five days afterwards. So I really wouldn’t have noticed that. Because I ate wheat so often I wouldn’t have noticed that pattern.

Sally: Exactly with some sensitivities they take a day or two to actually manifest. So you wouldn’t instantly recognize it like you did with the tomatoes you could tell within minutes or an hour or so of eating them. But other things can take longer to be a trigger.

Gemma: And in terms of environmental toxins this is an area I am NOT an expert in at all.  Probably in denial of.  What kind of things do I need to be looking at in terms of…? I’m trying to reduce inflammation from reducing toxins.

Sally: Okay so some things we don’t really have much control over. So you know living in a city, you’re going to be exposed to the environmental pollution that comes with living in a city and that’s just something that you have to accept. But other things so for example body care products, they’re quite a big one so trying to switch to the more natural and body care products. Really paying attention to natural ingredient list. Because a body care product can claim to be natural if it has less than 3% of you know a naturally sourced ingredient in. so it can still have lots of chemicals in there right. So excuse me looking at the labels is really important. Just keeping a track of actually how many body care products you use over the day. Because it can really taut up actually. particularly women if we’re using makeup and things like that and before you know it you’ve actually put about 20 to 50 chemicals onto your skin before you’ve even left the house in the morning and a lot of these products only have small amounts of kind of less friendly chemicals in. but they have an accumulative effect and so you’ve got a little bit in this product, a little bit in another product. but by the time you’ve used five products you know you’ve actually put quite a few of different chemicals on your body and so that’s one area that we do have control over. Equally with things like household cleaning products as well. So what we spray in our house will be used to clean work surfaces, clean the sink; those kind of things. So you’re inhaling a lot of those chemicals all the times. So looking for natural and more homemade cleaning products there can be helpful too.

Gemma: Okay so things like ecover would that be a relatively easy thing or is that another one of those products where…

Sally: No it’s not that actually. But there’s recently being some comtroivery. Because [08:04 inaudible]. But there is plenty of books and resources online about making your own things. Like making your own surface cleaner, your own laundry, you know your laundry washer, your own fabric conditioner and some very simple basic ingredients. So you know exactly what has gone in there. So you would know if it was one of those ingredients that had caused a problem for you. Whereas the ones that you buy in the shop they’ve got a whole cocktail of chemicals and then it’s a bit harder to elucidate which one was problematic.

Gemma: Oh yeah looking at bicarbonate of soda and vinegar is much easier than looking at you know 1-3 benzoyl…

Sally: Yeah you can’t go wrong there.

Gemma: Okay fantastic in terms of other foods that I’ve got anti-inflammatory properties. Because we see articles all of the time on the internet. You should be in this, you should be in that. I know I’ve  emailed you before about an adaptive I saw written about our mind body greed and you messaged me back, how did you know it contains was it nicotine or caffeine or something and I was a little bit horrified. So can we have some sound advice on foods that we could eat, try and reduce inflammation?

Sally: Okay some good anti-inflammatory foods. Well started with the gut. Yes this is where it’s your gut bacteria that are regulating a lot of the inflammatory response in your body. Because they regulate a lot of your immune response. So eating things that look after your gut bacteria are going to be helpful. So we have prebiotic foods like onions, garlic, leeks, chives and you’ve got certain types of artichokes and soluble fibers like porridge oats and ground flax seeds. They all help to feed and nourish the good bacteria in the gut and you’ve also got your fermented foods as well. So things like sauerkraut kaffir for example. They can be helpful just to keep nourishing and supporting the gut bacteria there and then you’re looking at things like your rainbow fruit and vege. So trying to get a lot of different colors into the day and so rather than just thinking I need to have you know five portions of fruit and veg. but actually they were all quite similar colors. Look for the diversity of colors that you can get. So things like your carrots, your squashy yellow peppers. They were bringing in beta carotene and flavonoids that actually convert, the beta carotene converts to vitamin A in the body. Which is really good for the membranes and things like skin health and then you’ve got your darker colored berries or blueberries, blackberries, raspberries. Again the darker the color the more potent they are for their antioxidants nutrients. So they’re really helpful for managing inflammation and things like your Omega 3 foods. So if you’re a meat-eater, fish eater or you’ve got your oily fish. So salmon, sardines, mackerel, anchovies, herrings. They’re all really good sources. Trout, that’s another ones. You’ve got the ready to use Omega three oils and they convert to anti-inflammatory compounds in the body. If you’re a vegetarian or vegan then you’re looking at things like pumpkin seed, oil, chia seeds, flax seeds, hemp oil and they’re the’s called the sources of the parent fatty acid. Which eventually gets converted down to the Omega three oils.  So making sure you’ve got good continual amounts of those in the diet, they’re all going to be really helpful for supporting the anti-inflammatory response.

Gemma: Okay so we’re not short of options then.

Sally: And the more diversity that you can get [11:52 inaudible] then the better.

Gemma: Okay brilliant and touching on being short of options. I know that quite a lot of people who have chronic inflammatory conditions do experiment a lot with diet. So no I for example have tried being dairy free, gluten free, and nightshade free. I’ve tried the autoimmune Pale. I’m not being quite brave enough to try the keno. It drives a lot of things. But I am very aware particularly when added the AIP, I did make myself quite ill. When it comes to trying exclusion diets, could we talk about some of the benefits and the right time to use an exclusion diet and then perhaps touch on specific diets and some of the pitfalls that we might find ourselves in.

Sally: Yeah okay so they can be helpful. Particularly if you’ve done your food and mood diary and you’ve got a couple of suspect’s maybe. Foods that you think may be causing problems and I’d suggest just taking out one at a time and trying to avoid it as much as you can for at least a month. It may need to be longer. Sometimes it’s more like three to six months. So if it is causing problems in the body for that to really settle down and so just doing one thing at a time, because you take out lots of things all at once. A, you can be unnecessarily restricting your diet. But also and you don’t know which one it was that may have been causing a problem. So you may be unnecessarily cutting things out. So just taking out one at a time and taking it steady that way. As well as taking out a potential trigger food, you still need to be doing things to look after their goat and try and reduce inflammation in the body. Because if a food has been a trigger, then basically you’ve taken away the petrol from the fire as it were. But you’ve still got the fire going on. But you still got the inflammation in your body. So you do still need to be working on good health, the anti-inflammatory foods, to try and be balanced outside of your system. Some of the most common ones you mentioned there are things like wheat, gluten, dairy. Yep they’re all common triggers particular with autoimmune or inflammatory conditions and so again I would start with one at a time and see how you go taking that out and sometimes people can be sensitive as you are to members of the nightshade family. So you’ve got you tomatoes, [14:14 inaudible], peppers, potatoes things like that. That’s a little bit more unusual. Because sometimes people I’m only sensitive to one or two in the family, not necessarily all of them. Sometimes it’s just in the raw state and not in the cup state. So it can be very much a mushroom individual experimentation to see what’s going on there and then the other group of, it’s not really a group of foods. It’s a compound that we found naturally in foods is histamine and that can sometimes be problematic for people with inflammatory conditions. So we have histamine in our bodies any way, we need it. But we all have kind of what’s called the histamine bucket. We have our own capacity for handling histamine and if that becomes too much, if our bucket starts to overflow; then it can be worsening inflammatory conditions. So sometimes looking at the foods that are rich sources of histamine that can help as well. So those would be things like your fermented foods, anything pickled like vinegars, anything that’s aged like aged cheeses or aged meats. Fish that’s been tinned for example. so if it’s animal or fish flesh, once it’s left and put in the tin or it’s aged and the histamine really starts to develop in that product. So having fresh meat or fresh fish is usually okay. But if it’s teenaged or teens and it’s got higher levels of histamine.

Gemma: Right that’s really interesting and I have seen quite a lot on psoriasis forums that people do take antihistamines when their skin is itchy and that [15:47 inaudible] the symptom. So what you’re saying here is it could be to do with the amount of histamine they be in that specific day.

Sally: It can be yeah or we throw into a lot of stress. Because stress alters our ability to process histamine. But also we produce more histamine we’re under stress. so if you happen to be under a lot of stress that week and you ate quite a few foods that were rich in histamine for that length of time, it could have been a problem for you. But under normal circumstances if you’re very relaxed and calm and you’re not eating masses of foods with histamine and then actually you’re processing it. It’s fine. So it’s not something that you can cut out and avoid altogether in virtually be living on rice I think. If you decided on a histamine free diet. It’s incredibly restrictive. It’s more about managing and how your body processes it your stress levels you know and the levels in certain foods.

Gemma: Right so if somebody is finding the need to use anti histamine. What would you recommend? Would you recommend a visit to a doctor or a nutritionist or just experiment with trying to relieve stress and reducing the amount of histamine in the diet?

Sally: Yeah so there’s a couple of basic things you could do yourself which would be looking at managing your stress levels definitely and then keeping the food diary for a few weeks and noticing when you do eat foods that are higher in histamine and whether that correlates with your symptoms becoming worse. so for example if you’d had tinned tuna and then you had had you know like an aged cheese and a meal later on in the day followed by like a vinegary salad dressing. You know that’s three things that’d be quite high in histamine and if that major symptoms worse, it would be looking at alternatives and to those, definitely yeah. I think if you go to your GP, it may not have much of an understanding about the histamine foods and they may give you an antihistamine which like you say that can I leave that your symptoms. But really to get to the underlying cause it’s finding your ways of managing it. So yes a nutritionist may be better able to help with that.

Gemma: okay now when we look at more extreme diets like the autoimmune Pale where you are removing several food groups or at the same time the idea there is, it’s difficult to identify multiple food intolerance is if you’re still eating a food that you’re sensitive to. So for example if you’re sensitive to dairy and gluten and anyway only cut out dairy, would you still see a lightening of the load so to speak and then you can cut out gluten all or is it completely masked.

Sally: I think it’s very individual there may be a lightening of the load. But you possibly you wouldn’t expect all your symptoms to suddenly resolve themselves. So if you still got under the trigger going on and that you may notice that certain symptoms improve. It may then be easier to identify a second food trigger and by doing it that way. I mean I think the thing with the autoimmune Pale diet, it can be very good and kind of just removing everything and giving you that clean slate to start with. But you have to do a lot of work about the variety of foods that you can include. So if it’s not well guided you’re going to have a very very restricted diet and that’s not really going to help to support your body to then be able to reintroduce those foods again. Because it’s such a restrictive diet, it’s not intended for a long-term use at all.

Gemma: No no not at all. Would not recommend that. Okay so can we touch on juice cleanses. Because I know that there are quite a few programs for psoriasis which kick start with a multiple day juice cleanse. Is that a healthy way to start a diet?

Sally: I think it’s very much to do with individual circumstances. So if you’re somebody who’s very busy and under a lot of stress, you haven’t really got no capacity in your life to be taking the time out to do a juice fast and actually deal with how that can affect the body? Because it’s a very intensive cleanse. So actually it can make a slim a lot worse before they start to get better. Because you’re really stirring up the body cells and the cleansing and eliminatory mechanisms in the body and equally if you’re under ongoing stress, you need that ongoing support every day from different foods and nutrients and sometimes that juice cleanse isn’t going to give you enough to carry on. so if you can afford to take two weeks off work and go and lie on a beach somewhere, you know have juiciest made for you; then you would have a very different experience than if you are trying to do it while still running a job, running home, you know and all the other demands happening in your life and equally some of the juices, yet they can give you that very quick short-term relief. But as soon as you start reintroducing foods again, unless you’ve done the groundwork to improve you got health and deal with information, then the symptoms can start to come back again. So sometimes it can be a bit like stirring up the pond water just for it to settle down again.

Gemma: Okay so no longer-term benefits.

Sally: Not without a lot of ground work other than just the juices no.

Gemma: Yeah so you want to be doing the food diary eating anti-inflammatory foods try and calm the fire and then you’re on a healthy diet, then maybe you could try it on a long bank holiday weekend.

Sally: Yes certainly. if you can rest at home and drink the water you know and give your body that time and space it needs to manage the toxins that are going to be coming up, you know and to allow the healing processes to take place and that’s fantastic. But equally juices can be used alongside your regular foods. You know so if you want an intense nutrient shots, you could be doing some carrot juice or some green juices and have those alongside your meals. That’s a great way to get an extra extra boost. It’s like a multivitamin in a glass really.

Gemma: Okay but the key there is with meals isn’t it?

Sally: Yes yes that was still alongside the food.

Gemma: Yeah and is that to balance out the sugars from the juices or is that just?

Sally: Yeah yes so that helps if you’re having lots of juices on their own. Particular if they’re quite fruit based. You’re not getting the fiber in there. so it does give your blood sugar levels a bit of a spike and so having them alongside meals helps that to be slowed down and go into your system more slowly and equally it’s just about that those extra nutrients on of what should be your already brilliant diet. You know extra boost.

Gemma: So what are your thoughts on smoothie is then?

Sally: Is a smoothie better than having a juice?

Gemma: If in terms of as an alternative to a meal then yes a smoothie can be better. Because certainly with the juice it’s all the kinds of sugars and the nutrients and things, but no fiber in there. Whereas a smoothie you’ve got all the fiber and from whatever you put in there and you can easily add other bits of protein. So you could add some ground seeds in there. Some people put a bit of porridge oats in just to bulk it out a bit and so you can make it more of a balanced drink and yeah I quite like smoothies. Particularly people have pushed for time on a morning and if they’re not used to having breakfast and they don’t want to sit down and eat something, smoothie can be helpful and my only caveat with smoothies is I always tell people to chew them, which sounds really weird. but if you just gulped down a smoothie, your stomach’s not had any warning and you know that the chewing sends messages to your stomach to say food is on its way and if you just gulped down a big glass of smoothie, everything that you’ve put in there is just landed all at once in your stomach and that can cause a lot of bloating and discomfort.

Sally: That’s really good advice and [23:31 inaudible]

Gemma: It is the message to you.

Sally: It definitely is a message to me. Because I normally do a smoothie when I’m in a rush and I am chugging it on my way to the car.

Yes [23:48 inaudible] put a little bit of hot water in mine to take the edge off. Cause I don’t like it really cold.

Gemma: Really good idea. I’m definitely going to have to start doing that. Well this smoothie balls isn’t there I was thinking maybe that’s the way for ways to slow down a little bit and eat.

Sally: Just [24:02 inaudible] you’ve got that physical message going to your stomach.

Gemma: Okay and then intermittent fasting. I’m not entirely sure what this is. y sometimes people talk about it in terms of having your dinner really early and just having a really long break before you have your break yep and then some people talk about it as if it it’s for a couple of days. What is it? Can it be useful to people with chronic inflammatory diseases and yeah what is it?

Sally: So it is a form of fast. I mean there’s lots of different forms of fasting and cultures all over the world and it’s been used for thousands of years in various different ways the intermittent fasting is the more recent one and it’s mostly popularized by the five-two. Where you have your five days of eating normally and two days during the week where you’re restricting your calorie intake. The idea is that those two days are separate from one another. So it’s not two consecutive days. So you might do you know three days and one of you days bit more than any other day and the idea is that it’s particularly good. Well it’s being used a lot with people with things like diabetes and excess weight. Because it’s giving the body chance to use up glycogen stores and actually kind of shift the metabolic rate a little bit. So that you can encourage weight loss and better blood sugar balance and so with things like chronic inflammatory conditions, if you’re also dealing with something like diabetes or excess weight; then yes it can be helpful. If you’re not then I’m not sure exactly how that’s really going to help in terms of managing the inflammation. Because actually you could put additional stress on your body. But like you mentioned the overnight fast is a really simple one that nearly everybody can do. So the idea is that you pick your 12 hours of the day, in which you’re going to have all your meals. So if you have your breakfast at 8 o’clock in the morning, then you’ve finished all your other meals and you’re not eating anything else after 8 o’clock at night and you can have drinks and things that you’re not eating any solid food. So then your body gets this 12 hour break overnight and that’s good in terms of giving the digestive system a rest. Actually allows the micro biome to kind of do its thing and a lot of your cells in your body are doing a lot of cleansing and healing and repair overnight. Your brains doing a lot of sorting out for Mama Day’s thoughts and memories and actually your brain cells do alter in size over night as well. That’s when your research coming out there. You’ve got this whole system in your brain, called the lymphatic system which is like a drainage and cleansing system. So all that’s happening overnight. So if your body’s not having to process food as well it can get on with all these activities while you’re sleeping and resting. So actually the 12-hour window is a fairly simple one for people to implement.

Gemma: So people could do that every day and just a whole ream of benefits to that. I can manage that.

Sally: That sounds a bit easier isn’t it?

Gemma: If you’re getting a break then in your digestive system overnight presumably if you’ve got something like leaky gut, would it help your gut to heal. Is that something that you would…?

Sally: Yeah it’s giving it a rest. Because it’s actually quite hard to rest the gut.  It’s not like when you break your leg you can sit down for six weeks with your leg up and you know the healing can take place there. A digestive system is working pretty much all the time. So if we can give it that rest and space overnight, then yes that can be helpful.

Gemma: Okay great now leaky gut is something that has been linked to psoriasis. What are your opinions on that? Someone thinks they’re suffering with leaky gut, what would they do?

Sally: so intermittent fasting overnight is probably helpful. First of all I think I would take a deep breath and think well actually is it leaky gut. Because I think there’s been a bit of a misconception around this and people seem to think you go from having a normal gut having a leaky gut. Actually, it’s more of a spectrum. So I got does have an element of permeability anyway. Because we want to absorb nutrients from our food. So if you’re thinking of it as more of a spectrum, then you can see that actually there’s various levels of increased intestinal permeability and you’re never really going to know where you are on that spectrum and if for example you’re dealing with a lot of food sensitivities, autoimmune condition. You know lots of different foods that are causing problems for you, then you could suspect quite reasonably that there is a fair amount of increased permeability. But just to think well you know I get a little bit of bloating. Sometimes oh I’ve got leaky gut doesn’t really stack up. Well there is a test that you can do, it’s not very pleasant test and that kind of investigates the permeability of the gut. but it’s quite surprising in my clinical experience I’ve had clients who  wanted to do the test and I have to say it’s not really one I urge people to do. because it’s not the pleasantest of tests and they’ve got all these symptoms and you think yes it’s going to come back and it comes back clear and they don’t have any increased permeability above what is normal. So it doesn’t necessarily suck up that you’ve got these symptoms and therefore you’ve got a leaky gut. But having said that with autoimmunity looking after the gut micro biome and your digestive health is one of the really important things to do and certainly in the kinds of foods that help and support that gut integrity, they’re not going to do you any harm. You know if you haven’t got a really geeky good so it’s not a problem to be doing them just too kind of reassure yourself about it really and see if it does make a difference. so things that your prebiotic foods that we talked about before, so the onions, garlic, leeks the different kinds of soluble fibers and they can be helpful because you’ve got bacteria play a role in maintaining that integrity of the gut lining and you’ve got things like the collagen rich foods like bone stock, bone broth that’s a really popular one. there’s like a million recipes online for different… and you have to put [30:14 inaudible] you have to put this in. actually just boiling the bones in the water is the main part of it and  there is a version available online. I forget the website. But I can always send you a copy of it which doesn’t use bones it uses lots of different vegetables and things like seaweeds. Which supply the nutrients that your body uses to help make collagen which supports your connective tissue in the body. So those kinds of things they’re good .you’ve got glutamine, that’s an amino acid that helps to support the integrity of the gut and cabbage, cabbage juice is a very rich source of glutamine. So that can be helpful as well and then equally all your [31:01 inaudible] we’ve been talking about in vain both fruits and veg, omega-3 things like, that they can of support with the gut integrity. The one thing that you possibly can’t always get enough from food is your vitamin D. we do get some from dietary sources so things, like oily fish, butter and eggs. But we only really get a tiny amount. so we rely on the sunshine for that and in the northern hemisphere and particularly here in Yorkshire, [31:25 inaudible] having your vitamin D levels checked and then considering a supplement is going to be the way forward there.

Gemma: Yeah right okay and there’s a famous doctor in this psoriasis community doctor Pagano, whose name I may have mispronounced. One of the things he is a big advocate of is slippery elm and I know that you have prescribed that to me and it made quite a significant difference, can we touch on that.

Sally: Oh it’s a lovely herb. it was massive history of traditional use by the Native American, Indians in North America and as you buy it as a powder and you just mix it teaspoon per mug, add hot water, mix it up and as soon as it becomes a drinkable temperature drink it down and I’m sure you notice that if you leave it, it goes really thick and gloopy and like wallpaper paste and you stand your spoon up in it. That’s all the new collage in there. So it’s an herb that’s very rich in [32:23 inaudible] which has a soothing anti-inflammatory effect throughout the digestive system. So yes it’s great if you’re suspecting leaky gut is fantastic for that. Also good if you’ve got nausea and if you’ve got any problems and gastritis for example. So inflammation higher up in the stomach rather than down in the intestines. It works all the way through particularly good balancing effect on bowel movements. so constipation or diarrhea it can help regulate that and so yeah it’s a really low-cost intervention and the only caveat with that is if you’re taking it and you’re on any prescription medication, you need to leave a gap and there’s some medications you can’t take it with and others that you just need to have a gap of about an hour or so. Just because if you swallowed your medication with it, it would buy into it and take it through and you won’t get the effect of your medicine. But generally is a lovely soothing herb yeah.

Gemma: Okay so if you had to give three top tips. You can maybe sneak two into one, what would they be?

Sally: Okay so let’s say everybody’s already doing the food and mood diary and trying to track any links and take that as a given. I would get your vitamin D levels checked. Because that is really really important in terms of both immune balance and inflammation in the body and it’s something that you can start to work on straight away. So if you’ve got a lower level and we’re looking for optimal health levels in adults need to be about 75 to 100 Nano moles per liter. So do ask for your results if you get it checked out the doctors and all there are home test kits that you can use yourself. It’s a really simple one to do so I would investigate vitamin D levels and look at that. I would look at the kinds of fats that you’re having in your diet actually. So we’ve talked about the Omega three oils and so your fish [34:25 inaudible] those kinds of things. But equally moving away from processed fats things like Marjorie use for example. The harmful fats and having more things like coconut oil extra virgin olive oil for example and fats are very important for our cell membranes and also for that maintenance of the skin barrier. So I’m looking at your fats in your diet and oh if I have to choose another one, I will do two into one. Make sure you drinking plenty and looking after your gut bacteria.

Gemma: Now drinking water is a bit boring.

Sally: But I do understand it can be Redo. So adding some fruit slices or some herbs that can make a big difference. I’ve been trying to wean my son away from cordials and we have a glass bottle in the fridge and I’ve been putting slices of fresh lemon and some lemon balm out with the gardens. Just an easy herb to grow and it just flavors the water a little bit. So that’s quite nice. Mint cucumber, pomegranates, berries; they all can just be added to plain water and that gives it a nice nice flavor. So try that and if you are wrong cordials and you like that sugary taste and just start to gradually reduce them down and add more of the fruit slices. So you’re weaning yourself onto it, because it can be a quick a drastic difference otherwise. Yeah so try that.

Gemma: And in terms of how much water, there’s lots of different formulas online and then it’s just the straight drink two liters a day. But obviously we’re all different shapes and sizes. Is two liters like roughly the right amount or?

Sally: It’s a really difficult questions. Actually one of the hardest questions there you asked. Because doing the research isn’t anything. You know I was reading something that was talking about where this idea of eight glasses a day is come from. You know and I think it was one of these things it was just made up and you know like we’ve got the five [36:24 inaudible] Californian fruit Marketing Board, they came up with a marketing slogan and there are various formulas. Usually you need at least a liter, yeah at least a liter and if you’re very active you’re going to need more and that’s the liter of water. So that’s not really including things like teas and coffees and things like that. Herbal teas, they’re a bit more borderline. So they do bring the water in and but everything but isn’t plain water needs to be digested whereas your plain water gets assimilated into your cells a lot easier. There I would just encourage people to carry a water bottle around. You can easily get through a liter of water a day and then in warm weather start increasing that and it might be nearer to two and you can tell by what your urine is like. So if your urine passes easily, you’re going several times a day and it’s pale in color and that’s a good sign that you’re hydrated and also you should have and smooth comfortable bowel movements as well if you were well hydrated.

Gemma: Right okay and that’s going to have a clear knock-on effect with the skin as well isn’t it?

Sally: It does. It really does yeah so water is what is the basis of the fluid that plumps up all ourselves. So you can be taking all these fantastic things to build the collagen to help your skin structure. But you actually need water to plump up the cells and it helps to regulate kind of the natural moisture balance on your skin as well. Yeah a bit dehydrated it’s a bit like an orange that’s been sat in the fruit bowl for too long and it goes all shriveling and wrinkly. That’s what’s happening and to your body.

Gemma: Yeah okay and then just touch it on the vitamin D thing. I do see quite often people recommending high-dose vitamin D3 regimens. Is there a reason you have suggested that you get the vitamin D checked instead of just taking high-dose vitamin D every day for the rest of your life.

Sally: Yeah because it is one that can be toxic if you have too much. So there’s the high level of toxicity. If your levels are above 200 then it starts to affect things like your calcium balance in the body. So it’s not something that you can just take freely and it’s stored in the body. It’s a fat soluble vitamin. So it’s a good idea to get your levels checked. So you’re no way about as a starting point and then you can supplement accordingly just to get that up and it’s a good idea to test it before winter. Because according to nature we are meant to make all our vitamin D from sunshine during summer. So that we have enough to last us through the winter. But obviously British summers we don’t really do that and in fact that most people aren’t outdoors for a long time during the day as well. So you just don’t get that sunlight exposure. So a testing round about kind of late summer early autumn time is a good idea. because then you know how much you need to get your stores up to get you through the winter and sometimes you may just then need a lower dose to keep that maintenance level during the summer and but yes it’s a good idea to get it checked in so you know where you’re starting from.

Gemma: Right okay and I know I’ve done a private check before. It’s not expensive. I think I paid 35 pounds.

Sally: Yes it’s around about twenty-eight thirty pound ish. If you go to vitamindtest.org. That’s the website for the fund well and West Birmingham NHS Trust and they supply home test kits that you can order yourself online or you can see our local nutritionist who may have a kit in her.

Gemma: Which of course I highly recommend.

Sally: But it’s really [39:45 inaudible] just a fingerprint test and you squeeze out four droplets of blood onto a little bit of special paper, send it back and they email you the result a few days later yeah.

Gemma: Okay brilliant well that has been very informative, thank you very much. If people would like to find out more about you or book an appointment with you where’s the best place for them to look?

Sally: So my website is www.nutritioninyourk.co.uk. You can also find me on twitter. I am @nutritioninyork. There is a Facebook page and we have quite a [40:18 inaudible] Facebook group as well. So you just search nutrition in your in Facebook and I will show up there.

Gemma: You post quite a recopies there as well. [40:30 inaudible]

Sally: No I think I am quite normal. [40:33 inaudible] immaculate kitchen and I don’t love on kale juice all day long. I am human.

Gemma: Okay so thank you very much.

Sally: You’re welcome Gemma thanks for speaking to me.

I hope you enjoyed today’s interview if you have any questions I would love to hear from you. Simply head over to Instagram and let me know. You can find me @gemma_boak. [Music]