Sandra Ishkanes is a Functional Medicine specialist. She takes a whole-body approach to healthcare, combining nutrition, lifestyle and cutting-edge medical testing.
Find out if it’s right for you.
DF was 32 when he came to see me about the psoriasis that he had been suffering with for almost 10 years:
”Sometime between 2009 and 2010 I started developing psoriasis. Mostly on my scalp, plus a few other patches. Notably that year my father fell ill and died. At the same time I was ‘stuck’ in an unhappy relationship and I was doing a stressful Master’s degree. All of these factors made that year my first experience of significant, prolonged stress.
Since then I have had psoriasis consistently over a large portion of my scalp. I’ve used a few different creams and oils to manage or reduce the flaky skin, to varying levels of success. I’ve found the discomfort bearable most of the time. I can live with a few patches of dry skin. However now I have been diagnosed with psoriatic arthritis which I do not want to live with. So far it is limited to one stiff knuckle, but I want to do everything I can to stop it developing further.”
DF had seen a GP, a rheumatologist and dermatologist. He had been prescribed a vitamin D cream and was being monitored for future prescriptions of steroid injections and biologics. Osteopathic manipulation had cleared one lesion on his back.
Multiple courses of antibiotics as a teenager
Stomach upset in India
Chronic stress started
Psoriasis began, mainly on scalp
Psoriatic arthritis began
Loose, pale stools
Some bloating and gas
No dream recall
Standard British Diet, high in processed food
High intake of sugars
High intake of alcohol
Psoriasis is a chronic auto-immune skin condition that causes red, flaky, crusty patches of skin covered with silvery scales. Here the immune system triggers T cells to drive inflammation which results in hyper formation of skin cells. Additionally DF began experiencing arthritic symptoms 7 years after the onset of psoriasis. Psoriatic arthritis can be extremely disabling and DF was concerned as worked as farmer and gardener.
Every autoimmune condition requires 3 factors:
a genetic predisposition
intestinal permeability (otherwise known as a leaky gut)
one or more triggers
The environmental triggers and mediators of psoriasis include:
physical and/or psychological trauma
vitamin D deficiency and/or vitamin D receptor malformations
digestive disorders with associated low bile and low stomach acid production
imbalance of gut bacteria which can be triggered by antibiotics, small intestine bacterial overgrowth, and lead to intestinal permeability
inflammatory diet, high in sugars, grains, and processed food
DF reported all of these factors at different levels, and his protocol was individualised to his specific requirements.
Personalised anti-inflammatory diet focusing on
seafood, vegetables and some fruit
avoidance of all grains and dairy
avoidance of the nightshade vegetables: potatoes, tomatoes, aubergines and peppers
reduction of alcohol and caffeine
This was followed by a low vitamin A nutritional protocol.
Personalised supplement program to support:
Vitamin D metabolism
Low bile production
Small intestine bacterial overgrowth
Therapeutic baths, alternating apple cider vinegar and epsom salts
Severe psoriatic lesions cover both sides of the scalp.
The knuckles are inflamed, painful and stiff.
Significant arthritic inflammation in the chest.
Scalp psoriasis has significantly improved
Arthritis is slowly improving
Still some chest pain
Scalp psoriasis almost resolved, some shadows of the lesions can be seen.
Knuckles are looking much less swollen and feeling good.
Rheumatologist has recommended an ultrasound scan of the arthritic joints.
Chest pain is hardly noticeable
Scalp psoriasis virtually resolved, and lesions are reduced to the few spots where it originally started.
Inflammation in joints and chest has virtually resolved, now only noticeable if DF does hard physical work.
Joints have full range of motion.
No inflammation has been found on the scan, where previously it was noticeable.
DF has started to re-introduce foods such as rye bread, dairy and beer with no ill effects.
It was immensely gratifying to be able to help DF find his way to resolving his psoriasis and the associated arthritis. These chronic conditions involve multiple biological systems and are impacted by environmental factors such as stress, nutrition and infections. Unravelling these connections and pathways is the aim of my functional medicine approach. Once root causes are found, they can be systematically addressed and the healing journey can begin.
“I'd been living with persistent psoriasis for a decade or so. I'd become complacent, but when I started developing arthritis (which I assumed to be psoriatic), I decided to do something about it, and a friend recommended Sandra.
After my first consultation, which was an enlightening experience in itself, she recommended a strict eliminatory diet and a course of supplements, as well as other things to reduce stress and enhance health like phototherapy.
Sticking to the diet has been in turn both surprisingly easy and deeply frustrating. But Sandra has been excellent at keeping me in a positive frame of mind and helping me see the progress I've been making, so I don't lose motivation to keep going with the diet and supplements regimen.
It took about four months to see really substantial improvements, but it's been worth it, as my scalp has not been this clear since the psoriasis started, and the arthritis (which turned out to be unrelated to the psoriasis) has eased significantly.
In the process I've also learnt a lot about my own optimal health, thanks to Sandra's warmth, enthusiasm, and her ability to relate to my own situation and explain some of the complex and interconnected ways that metabolisms work.”