Leading up to the 2010 U.S. Open at Pebble Beach Golf Links, professional golfer Phil “Lefty” Mickelson started experiencing unusual pain in his tendons and joints. Initially, he dismissed it as normal physical wear and tear. But the pain steadily worsened: A couple of days before the major tournament, he awoke with such terrible joint pain, he couldn’t move. By doing some stretching and using anti-inflammatory medications, he got the pain under control and was able to compete, ultimately tying for fourth place. But the pain worsened in the days that followed.

Soon after, doctors at Mayo Clinic determined the cause of Mickelson’s symptoms: psoriatic arthritis (PsA), a condition characterized by joint pain, swelling, and stiffness resulting from inflammation due to an overactive immune system. He wasn’t a stranger to psoriatic disease: He’d begun treatment for psoriasis years earlier. But the emergence of PsA came as a debilitating, worrisome surprise.

“I went and laid down on the couch, and it hurt so bad to move,” Mickelson said in an interview with the Golf Channel about his experience prior to the 2010 U.S. Open. “Thereafter, I went to try to play golf and the pain had gone to my shoulder. I couldn’t take the club back halfway. And I was concerned about the impact on my golf career.”

Through treatment and lifestyle changes, Mickelson continues to succeed on the links. At the age of 52, he now has 45 PGA Tour victories under his belt, including three Masters titles, two PGA Championships, and one Open Championship. Most recently, he participated in the LIV Golf Tour.

Advocating for Early Diagnosis

Following his diagnosis in 2010, Mickelson started undergoing treatment. A biologic called Enbrel (a formulation of etanercept) proved effective in controlling his condition. Enbrel, which is taken as a subcutaneous (under the skin) injection, blocks a chemical called tumor necrosis factor-alpha that’s involved in autoimmune attacks.

Mickelson soon became a spokesperson for the drug, partnering with drugmakers Amgen and Pfizer. The following year, he joined with the two companies, as well as the Arthritis Foundation and the National Psoriasis Foundation, to launch an education program called “On Course With Phil.” The initiative aimed to inspire people living with chronic inflammatory joint and skin conditions to act, educate themselves, and work with their doctors to devise the best possible treatment plan.

“This is meant to give people who have similar symptoms the tools and resources that will help them get questions of their own answered,” Mickelson said at the time. “I was so lucky, because I got on it right away, so I was able to slow or stop any further damage.”

Indeed, researchers have found that waiting even six months to see a rheumatologist after PsA symptoms first appear can result in joint erosion and worse physical function in the long run. Unfortunately, PsA can be difficult to diagnose. A 2021 study found that more than half of people diagnosed with the condition waited more than two years to receive their diagnosis.

Beyond Medication

Today, Mickelson says he’s kept his PsA under control for years now without using any medications. Mickelson — who reports losing 30 pounds in 2021 — worked with performance coach Dave Phillips to develop a fitness regimen, including some changes to his diet.

Following are some of the dietary changes Mickelson has made to improve his overall health. Note that it’s important to speak with your health care provider or a nutritionist before making dramatic changes to your diet.

Healthy Diet

Mickelson said in 2020 that being more mindful of what he puts in his body has been key to maintaining good health: “I wasn’t educated. I either wasn’t aware or didn’t want to know the things I was putting in my body, whether it was diet soda and how toxic that is, or whether it was the amount of sugar and how much inflammation it causes, or whether it was the quantity; all of those things, I just kind of shut my eyes to.”

Health experts agree that maintaining a healthy diet can help reduce pain and inflammation related to arthritis. It can also help with weight loss, if that is a goal. There are many diet types to choose from, including an anti-inflammatory diet (e.g., a Mediterranean diet), paleo, plant-based, and gluten-free diets.

However, every person is different, and a diet that works best for one person may not work well for another. Maintaining a food journal to determine food triggers can help — and working with a doctor or nutritionist is especially important. Some diets can be unsafe for people with psoriatic disease.

Intermittent Fasting

In addition to healthy eating, Mickelson practices intermittent fasting, which — as the name implies — entails going without food for extended periods of time. He told Golf magazine that he sometimes does three-day fasts every few months. More often, he does shorter 36-hour fasts: He’ll fast 1.5 days in a week and eat a healthy diet during the other 5.5 days.

He says intermittent fasting has aided in reducing PsA-related inflammation, boosting his immune system, and clearing toxins from his body. “I believe fasting has been a big part of my ability to recover, to get in better shape, to recover, to eat less, and to not be held hostage by food,” Mickelson told GolfTV. “I love food. I’ve always craved food, and now I don’t.”

Studies have shown that intermittent fasting may have potential benefits — and risks — for people living with PsA. Researchers have found through human and animal studies that intermittent fasting may:

• Promote weight loss, which can lessen pressure on your joints and reduce your chances of developing other health conditions
• Increase metabolism
• Optimize autophagy — the body’s process of “recycling” old and damaged cell parts — which may prevent mental decline and slow cellular aging
• Help flush out precancerous or cancerous cells

The potential risks of intermittent fasting, according to Harvard Health Publishing, include:

• Developing symptoms such as headaches, lethargy, irritability, or constipation
• Overeating following periods of fasting
• Losing too much weight, particularly among older adults
• Developing health problems if you have other conditions, such as diabetes, or take certain medications for heart disease or blood pressure

Some MyPsoriasisTeam members have shared their experiences with intermittent fasting and healthy eating. “I’ve been intermittent fasting for a while and watch what I put in my mouth that triggers my psoriasis,” one member wrote. “So far, I’m psoriasis free.”

Although some people do benefit from intermittent fasting, check with a health care professional or nutritionist before trying it — and also let them know if you start to experience any unwanted symptoms.

Coffee and Supplements

Mickelson has garnered a reputation in the golfing world for continually sipping coffee as he plays. In a 2021 interview on “The Pat McAfee Show,” Mickelson said he approached a health practitioner and asked what he could do to help improve his health. One piece of advice he received was to “drink coffee all day.”

Researchers have found that coffee has positive effects on the immune system, thanks particularly to the caffeine and polyphenols it contains. Among the benefits: Caffeine can help reduce inflammation by reducing immune system activity, including the proliferation of T cells (a type of white blood cell) associated with psoriatic disease.

Drinking coffee can yield other health benefits, including decreasing your chances of developing certain conditions, such as heart failure, Parkinson’s disease, and colon cancer, according to Johns Hopkins Medicine. It may also help protect your liver.

Excessive coffee consumption can also pose health risks, including headaches, sleeping difficulties, anxiety, irritability, rapid heartbeat, and muscle tremors. Caffeine can also interfere with some medications and supplements. Mayo Clinic recommends that most healthy adults limit caffeine to 400 milligrams a day — the equivalent of 4 cups of brewed coffee.

Mickelson has talked about the various supplements he adds to his coffee. These include:

• C-8 medium chain triglycerides (MCT) powder — MCT powder is composed of MCT oil (which comes from coconut oil) along with dairy proteins, carbohydrates, fillers, and sweeteners, according to Cleveland Clinic. Studies of the benefits of MCT powder are inconclusive, but some suggest it may help with weight loss, provide quick energy, and improve athletic performance.
• L-theanine — This amino acid comes from tea leaves and some types of mushrooms. Some research suggests it may help improve sleep, lower anxiety and stress, maintain a healthy weight, and boost cognitive abilities such as memory and concentration.
• Collagen — A key building block for skin, bones, muscles, tendons, and ligaments, collagen accounts for around 30 percent of the body’s total protein. Research on the effectiveness of collagen supplementation is limited, but some studies indicate it could help with skin hydration and elasticity and may relieve pain and joint function in people with knee osteoarthritis, according to Cleveland Clinic.
• Cinnamon — Some research suggests cinnamon has anti-inflammatory benefits, may help lower blood sugar levels, and may aid in improving cholesterol and triglyceride levels.
• Himalayan pink salt — Although Himalayan pink salt has garnered a reputation for offering significant health benefits because of its relatively higher mineral content, researchers have found that it provides essentially the same benefits and risks as any other salt.

Mickelson and trainer Phillips founded a company in 2020 called For Wellness that sells what they call “antioxidant coffee,” as well as a mixture containing most of the supplements listed above.

A Warning About Supplements

Some research supports the potential health benefits of supplements for people living with PsA. However, only prescription medications have been proven to slow joint damage. If you’re considering trying supplements, bear in mind that they aren’t regulated by the U.S. Food and Drug Administration (FDA) the same way drugs are. The FDA doesn’t have the authority to approve supplements for safety or effectiveness.

Moreover, mixing some supplements with certain medications can cause health problems. Taking too much of some types of supplements can also be dangerous.

The Arthritis Foundation recommends the following for people considering adding supplements to their diet:

• Do not use them as a replacement for any arthritis drugs you’re taking. Only medications are proven to slow joint damage.
• Speak with your doctor before trying a new supplement and learn what the right dose is.
• Make sure any supplements you take don’t interfere with any medications you use. You can review the labels yourself or speak with a doctor or pharmacist.

Find Your Team

MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis and their loved ones. On MyPsoriasisTeam, more than 114,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriatic arthritis.

How has diet affected your psoriasis or psoriatic arthritis? Have you and your doctor discussed the pros and cons of certain dietary changes? Share your experience in the comments below, or start a conversation by posting on your Activities page.