I have a 59-year-old female patient with severe psoriasis, cracked palms, and plaques behind the ears, elbow flexors, tibia. Food sensitivity includes many foods. Candida screen shows elevated levels. Food sensitivities are removed. Did a month of berberis and grapefruit seed extract and now a month with tincture of matricaria, filipendula, mentha, and althea. No GI complaints, however. Topically made an avocado-infused calendula with beeswax, lavender, and liquid ghee, and she’s getting 20 minutes of sun outdoors. Any good protocols on how to deal with psoriasis?

Chris Kresser: Psoriasis is almost always gut related. I hate to sound like a broken record here, but I had a patient with extremely severe psoriasis who was using prednisone and other anti-inflammatory drugs for years and was actually a friend from high school. He contacted me because he became aware of my work over the years and asked if I could help and I told him—He’s a pretty conservative guy and wasn’t really into functional medicine or anything like that, and I said, “We’re going to test your gut, and we’re going to focus there to start because that’s where I’ve seen the biggest difference.” And he’s like, “Oh I don’t have any symptoms. It doesn’t make any sense.” I explained it to him, and he trusted me enough to go for it. We tested his gut and found dysbiosis, fungal overgrowth, and SIBO, and we treated that stuff, and then we cleaned up his diet, of course. He was still eating dairy and grains and did a Paleo reset, and I think even then did autoimmune Paleo after that, and his psoriasis was 95 percent gone at the end of that protocol. I would keep going on all this stuff we’re talking about with testing and treating that in the ADAPT content, and I think you’ll make good progress there.