Functional Medicine Is the Foundational Place to Begin
When I think about psoriasis and other autoimmune or immune-mediated conditions, I believe functional medicine should be a first-line approach, not something a person discovers only after everything else has failed.
If you are discovering it later in your journey, you have not missed the opportunity. You can begin asking these questions at any point.
But these are questions I believe every person with an immune-mediated condition deserves to understand from the beginning.
Why? Because medical treatment and functional medicine usually focus on different parts of the problem.
Medical treatment is typically focused on controlling active disease, reducing symptoms, preventing tissue damage, or targeting specific inflammatory and immune pathways.
What is driving or perpetuating the immune response in this particular person, and which of those influences can we support or change?
That investigation can include dietary proteins, infections and pathogens, chemical exposures, stress, sleep, physical activity, metabolic health, nutrient status, gastrointestinal health, the microbiome, biological barrier integrity, medications, personal susceptibility, and broader immune regulation.
This is why the phrase root-cause medicine resonates with so many people. I do not use that phrase to mean that every person with psoriasis has one hidden cause. I use it to mean that we are looking upstream from the symptom for the combination of triggers, drivers, and physiological mechanisms that may be contributing to disease activity in that individual.
You cannot change the genes you inherited. But many of the environmental and physiological factors interacting with those genes can be changed, reduced, supported, or influenced.
That is why I see functional medicine as the place to begin.
It is the process of learning what influences and drives your immune response, identifying what is relevant to you, and addressing the things we can support and change.
That creates a very different opportunity than simply waiting for the next outbreak and reacting to the symptom.
The Three Levels of Autoimmune Support
The three-level management model has had a major influence on the way I think about autoimmune and immune-mediated health problems.
The easiest way to visualize it is as a pyramid. Foundational functional medicine and education form the broad base. Focused flare-up management builds on that foundation. Medical and pharmaceutical management can complement both.
These are complementary layers. Higher levels do not replace the foundational layer underneath them.
Level 1: Foundational Functional Medicine and Education
Level 1 is the educational and foundational layer. It is where you begin learning how autoimmunity and immune-mediated disease work and how those mechanisms may be showing up in you.
You learn how genetic susceptibility can interact with the environment. You learn about modifiable factors such as diet, lifestyle, supplementation, sleep, stress, physical activity, metabolic health, gastrointestinal health, infections, pathogens, chemical exposures, nutrient status, and biological barrier integrity.
You also learn important immunological concepts that can help make sense of the bigger picture, including immune tolerance, molecular mimicry, cross-reactivity, inflammatory signaling, and the ways environmental exposures can influence immune activity.
Most importantly, you begin learning which of these factors actually matter to you.
We may ask: What foods appear to matter? What infections or pathogens may be relevant? What chemical exposures deserve consideration? How does stress affect you? What happens when sleep deteriorates? How do you respond to exercise, travel, illness, or major life stress? What is happening with metabolic health and gastrointestinal function? Are nutrient deficiencies or other physiological problems contributing? What patterns repeatedly appear before a flare?
The goal is not to turn every possible factor into a problem. The goal is to build a clearer picture of your individual immunological susceptibility, triggers, and drivers.
That gives us a map of the factors we may be able to influence.
Level 2: Active Flare-Up Management
Sometimes psoriasis becomes more active. When that happens, we can use the same foundation with a more focused question:
Was there an infection? A period of intense stress? Poor sleep? Travel? Overtraining? A medication change? A dietary exposure? A gastrointestinal problem? A new environmental exposure? Or did several stressors occur at the same time?
Level 2 uses the information we have learned about the person and applies it to the flare. That may mean more focused attention to rest and recovery, sleep, stress, nutrition, metabolic health, barrier support, and any identifiable factor that appears to be contributing.
The flare becomes information. It can teach us more about the person's susceptibility and give us better direction for the future.
Level 3: Medical and Pharmaceutical Management
Medical and pharmaceutical care is another layer of the overall care picture and is provided by the appropriate treating healthcare professionals.
That can include diagnosis, physical examination, prescriptions, procedures, disease monitoring, and therapies that control inflammation or target specific immune pathways.
Level 3 does not make the foundational questions disappear. A person using topical therapy, a systemic medication, or a biologic still has nutrition, sleep, stress, metabolic health, gastrointestinal health, environmental exposures, infection history, nutrient status, and an immune system interacting with all of those factors.
The layers can work together.
Medical Care and Functional Medicine Can Work Together
Medical care and functional medicine can be very complementary systems.
Functional medicine gives us an opportunity to investigate the underlying physiological, environmental, and immunological factors that may be contributing to the immune response.
Medical care provides another valuable set of tools, including diagnosis, physical examination, prescriptions, procedures, disease monitoring, and condition-specific treatment.
Many people are attracted to functional medicine because they want to begin by understanding and supporting the modifiable factors that may be influencing their immune system. Medical care can remain an important part of the overall picture at the same time.
If you already work with a dermatologist, rheumatologist, primary-care clinician, or other healthcare professional, continue working with them.
If you do not currently have the medical professional you need, that may also become an important part of your care team, particularly if you need an initial diagnosis or medical evaluation.
Medical care can contribute
- diagnosis and physical examination;
- prescriptions and medication management;
- procedures and condition-specific medical treatment;
- disease monitoring and urgent evaluation.
Functional medicine can investigate
- what may be influencing the immune response;
- which modifiable triggers and drivers appear relevant;
- what patterns surround disease flares;
- how diet, metabolic health, gastrointestinal function, infections, exposures, nutrients, stress, sleep, and other factors may fit into the picture;
- what information would help us make a better decision.
Together, these perspectives can give you a broader understanding of your health and more tools for supporting it.
Why Foundational Functional Medicine Still Matters When Psoriasis Is Being Medically Managed
One of the most common situations I see is someone who is already receiving psoriasis treatment but still wants to understand more about the specific mechanisms, triggers, and underlying drivers that may be contributing to their psoriasis.
That is an important question.
Medication may help control an important part of the inflammatory process, but nutrition, blood-sugar regulation, body composition, cardiovascular health, gastrointestinal function, sleep, stress, nutrient status, infections, environmental exposures, and individual trigger patterns are still part of the person's physiology.
This is why functional medicine is foundational.
You can continue investigating and supporting the factors influencing immune activity while receiving other forms of care focused on controlling disease activity.
The approaches can complement one another.
Understanding Progression in Autoimmunity
In functional immunology, the Environmentally Induced Model of Autoimmunity helps explain why foundational functional medicine is so important. It directs attention to the interaction between genetic susceptibility, environmental immune triggers, barrier integrity, and immune regulation.
A related teaching model describes autoimmune progression in three broad stages.
Silent Autoimmunity
In this model, autoimmune antibodies can be present before a person develops obvious symptoms or measurable tissue destruction.
Autoimmune Reactivity
Autoimmune antibodies are present and symptoms have developed, but measurable tissue destruction or loss of function has not yet become clinically apparent.
Autoimmune Disease
Autoimmune antibodies and symptoms are accompanied by measurable tissue destruction or loss of function.
Important distinction for psoriasis: This is a general functional-immunology teaching model of autoimmune progression. It is not an official psoriasis staging system, and psoriasis is not routinely classified using these antibody stages.
I use the model to illustrate a broader principle: immune dysfunction can develop and evolve long before severe tissue damage or advanced disease is present.
That is one of the reasons I believe learning about the factors driving the immune response should begin as early as possible rather than waiting until disease becomes more advanced and harder to control.
The earlier you understand your susceptibility, triggers, and physiological environment, the more opportunity you have to work with the factors you can change.
Do You Need One Practitioner or a Team?
Sometimes one practitioner can handle the majority of what a person needs. Sometimes several healthcare professionals contribute to the person's care.
Complex immune-mediated conditions can involve different areas of expertise.
Medical care may focus on diagnosis, disease monitoring, and medical treatment. Functional medicine can focus on modifiable physiological, environmental, dietary, metabolic, gastrointestinal, lifestyle, and immunological factors. Other professionals may contribute nutrition, rehabilitation, mental-health support, or other expertise depending on the person's needs.
Different professionals can contribute different strengths to the same overall goal: helping you understand your health, support your physiology, manage disease activity, and achieve the best outcome possible.
I see functional medicine as the foundational starting point in the autoimmune-care framework I use. It can begin at any stage of the journey and complement the other care you receive.
How Do You Find the Right Functional Medicine Doctor for Psoriasis?
Many people begin with a search such as “functional medicine doctor near me.”
They may also search for functional medicine doctor for psoriasis, psoriasis functional medicine doctor, psoriasis practitioner, or holistic psoriasis doctor.
Those searches are a reasonable place to start, but physical distance is not necessarily the most important factor when choosing a functional medicine practitioner.
Much of functional medicine involves detailed history, medical-record review, laboratory interpretation, diet, lifestyle, sleep, stress, gastrointestinal symptoms, environmental exposures, previous responses to treatment, education, strategy development, and reassessment. Much of that can be done remotely.
The closest practitioner is not automatically the best fit. A practitioner twenty minutes away who uses essentially the same prewritten protocol for everyone may not be the best match when another practitioner has deeper training, direct experience with your condition, and a systematic framework for assessing the underlying problem.
The more useful questions are: Does this practitioner understand autoimmunity and immune-mediated disease? Do they have meaningful training and experience with the type of problem you have? Do they individualize the investigation? Can they explain why they recommend a particular test or intervention? Do they reassess what happens and adjust the strategy based on what they learn?
Finding the right practitioner is ultimately about expertise, approach, communication, and fit, not simply distance.
What Should You Look for in a Psoriasis Functional Medicine Practitioner?
Functional medicine varies considerably from practitioner to practitioner. If you are considering working with someone, I would look for several things.
- Meaningful training in autoimmunity and immunology. Psoriasis is an immune-mediated disease. The practitioner should understand more than nutrition and supplements. They should understand immune regulation, inflammatory signaling, environmental triggers, barrier systems, and the mechanisms involved in immune-mediated disease.
- An individualized process. A good process should not automatically give every client the same fixed laboratory bundle, diet, or supplement protocol simply because they share a diagnosis.
- A reason for testing. The practitioner should be able to explain what they are trying to learn, why the test is being considered, and how the result could change what they do.
- Attention to the major environmental and physiological categories. Dietary proteins, pathogens, chemicals, stress, lifestyle, sleep, metabolic health, barrier integrity, gastrointestinal function, nutrient status, physical activity, and individual immune regulation may all deserve consideration when relevant.
- Reassessment. A plan should evolve as new information is learned. Supplements, dietary strategies, and other interventions should not continue indefinitely simply because they were part of the original plan.
- Ability to work alongside medical care. Functional medicine should fit comfortably with the person's existing healthcare team and respect the role of the professionals already involved.
Is Telehealth Functional Medicine for Psoriasis a Good Option?
For many people, yes.
A large part of functional medicine is based on information that does not require the practitioner and client to be physically sitting in the same room.
Well suited to telehealth
- detailed health-history review;
- psoriasis timeline and flare-pattern analysis;
- review of previous laboratory work;
- diet and food-response discussion;
- gastrointestinal history;
- sleep and stress assessment;
- metabolic-health review;
- environmental-exposure history;
- education, planning, and reassessment;
- coordination of many laboratory tests through local draw sites or home collection when appropriate.
Services that stay with local or medical professionals
- hands-on physical examinations;
- skin biopsy and procedures;
- prescriptions and medication management;
- urgent medical evaluation;
- other hands-on medical services.
Visible skin changes can also be reviewed over video or photographs as part of the history-gathering process, while diagnosis and hands-on medical examination remain with the appropriate healthcare professionals.
I encourage clients to maintain a primary medical clinician and any specialists already involved in their care.
My functional medicine consulting is performed remotely. I have worked with clients across the United States and internationally, which is one reason I do not think geography alone should determine whether a practitioner is the right fit.
How My Psoriasis Consulting Process Works
My process is intentionally simple to understand:
Detect
We begin by gathering the information that helps us understand your individual immunological triggers and drivers. That includes your health history, psoriasis timeline, flare patterns, diet, digestion, metabolic health, sleep, stress, medications, supplements, previous testing, other diagnoses, environmental exposures, and anything else that appears relevant. Then we decide what additional information is worth gathering.
Support
Next, we work on the modifiable factors that appear most important. That might involve nutrition, lifestyle, metabolic health, sleep, stress, gastrointestinal health, nutrient status, food-related questions, environmental exposures, or other areas identified during the assessment.
Reassess
Then we evaluate what happened. Did symptoms change? Did flare patterns change? Did energy, digestion, sleep, or other relevant areas change? Did laboratory markers change? Did the information support the original hypothesis? What should continue? What should change? What have we learned? That feedback determines the next step.
Want the deeper explanation of this approach?
Understand Functional Medicine for Psoriasis →
Which Care Path Is Right for You?
A useful way to think about psoriasis care is to ask:
Begin with foundational functional medicine.
Foundational functional medicine.
Foundational functional medicine with an emphasis on flare-management strategies. Medical care can continue alongside that layer.
Foundational functional medicine can continue alongside medical treatment.
Functional medicine can provide foundational support for understanding the potential triggers, drivers, and physiological factors contributing to your psoriasis.
A coordinated team can bring together the expertise that best fits your individual situation.
Functional Medicine Should Be the First Foundational Step
I think this is one of the most important ideas on this page:
In the framework I recommend, functional medicine should be the first foundational step when you have psoriasis or another immune-mediated condition because it is the part of care specifically focused on understanding the triggers, drivers, susceptibility, and physiological mechanisms that may be contributing to the immune process.
It is where you learn what influences your immune system, what your individual susceptibility looks like, which triggers seem relevant, which physiological systems deserve attention, what can be changed or supported, and how your body responds when you change those things.
Focused flare-up support can build on that foundation. Medical and pharmaceutical care can complement it. Neither removes the value of understanding what is happening underneath the disease expression.
That is why I believe foundational functional medicine should be part of the support strategy for every person with psoriasis.
Without asking these questions, the triggers and drivers of the immune process may never be systematically explored. Functional medicine gives you the opportunity to ask them.
Ready to Explore What May Be Driving Your Psoriasis?
If this way of thinking about psoriasis is new to you, the next step is to understand the functional medicine approach in more depth. If you already understand the approach and want me to review whether your situation appears to be a good fit for my consulting process, you can apply for care.
Frequently Asked Questions
What is the best first step in a functional medicine approach to psoriasis?
In the framework I use, the first foundational step is functional medicine education and assessment. The goal is to understand the immune-mediated nature of psoriasis, identify the triggers and physiological drivers that may be relevant to you, and begin supporting the factors that can be changed while continuing any medical care already in place.
What does functional medicine look for in psoriasis?
Functional medicine looks upstream for factors that may influence immune activity and disease expression. Depending on the person, that can include dietary proteins, infections or pathogens, chemical exposures, gastrointestinal health, barrier integrity, metabolic health, nutrient status, sleep, stress, physical activity, medications, and individual susceptibility.
Can functional medicine be used with psoriasis medications or biologics?
Yes. Functional medicine can be used alongside topical medications, systemic medications, or biologic treatment. The functional medicine layer focuses on understanding and supporting modifiable triggers, drivers, physiology, nutrition, lifestyle, and immune-related factors, while medication decisions remain with the clinician responsible for prescribing them.
What is Level 1 functional medicine for psoriasis?
Level 1 is foundational functional medicine and education. It is the place to begin learning how genetic susceptibility, environmental influences, physiology, and immune regulation may interact in your case, and which modifiable factors are most worth addressing first.
Can functional medicine be used during a psoriasis flare?
Yes. During a flare, the same functional medicine foundation can be used with a more focused look at what changed and which factors may be contributing, such as infection, sleep disruption, stress, diet, gastrointestinal changes, metabolic strain, environmental exposures, or recovery. Medical care can continue alongside that process.
How do I find the right functional medicine doctor for psoriasis?
Look for meaningful training in autoimmunity and immunology, experience with immune-mediated conditions, an individualized process, a clear reason for testing, attention to multiple categories of triggers and physiology, and a structured process for reassessing what happens after changes are made.
Is a functional medicine doctor near me better than a telehealth practitioner?
Not necessarily. Distance can matter for some services, but much of functional medicine can be performed remotely. For psoriasis, expertise, training, individualization, communication, and a systematic framework may be more important than simply choosing the closest practitioner.
Can psoriasis functional medicine be done by telehealth?
For many people, yes. Detailed history, record review, laboratory review, nutrition and lifestyle assessment, flare-pattern analysis, environmental history, education, planning, and reassessment are well suited to telehealth. Hands-on examinations, biopsies, procedures, prescriptions, and urgent medical services still require the appropriate local medical professional.
Does Dr. Shook work with clients outside North Carolina?
Yes. My functional medicine consulting is performed remotely, and I have worked with clients across the United States and internationally. Location alone does not determine whether someone is a good fit for this type of consulting.
How do I apply to work with Dr. Shook?
Start with the Application for Care. There is no charge to apply. I review the application before deciding whether the situation appears appropriate for the type of functional medicine consulting I provide, and a private scheduling link is only offered after that review.
Important Health Information
This information is educational.
Psoriasis and psoriatic arthritis can require medical treatment. Functional medicine can be incorporated alongside medical care.
Medication decisions should be made with the clinician responsible for prescribing them.
Selected References and Framework Notes
- Kharrazian Institute functional immunology course materials. Three-level autoimmune management framework, Environmentally Induced Model of Autoimmunity, and three-stage autoimmune progression teaching model are used as conceptual educational frameworks on this page. The three-stage model is not an official psoriasis clinical staging system.
- American Academy of Dermatology: Psoriasis Causes.
- American Academy of Dermatology: Psoriasis Triggers and Flares.
- National Psoriasis Foundation: About Psoriasis.
- National Psoriasis Foundation: Psoriasis Guidelines and Comorbidities.
- American Academy of Dermatology: Psoriatic Arthritis Signs and Symptoms.