Psoriasis and diet: Is there a connection?

Eating well can improve anyone's health.
But can it heal psoriasis?
Scientists say there's little evidence that diet has a major impact on the disease. But some people with psoriasis swear they've found relief by changing what they eat—and some medical professionals are taking diet into account in treating psoriasis.

Clear after 50 years

Now in her 60s, Louise D.—who doesn't want her last name used because, she says, psoriasis is something she took pains to hide for most of her life—credits a change in diet with helping clear up her plaque psoriasis. She developed the disease at age 10. The only treatments at the time, she says, were sunlight and coal tar ointment. Later, the powerful drug methotrexate cleared her skin, but she didn't want to take a drug for the rest of her life.
Vacations in sunny Hawaii and ultraviolet light B (UVB) treatments helped some, but psoriasis often covered more than half her body.
Then, four years ago, she read "Win the War Within" by Dr. Floyd Chilton, a professor of physiology and pharmacology at Wake Forest University. The book described Chilton's theory that following a diet designed to reduce inflammation could improve the symptoms of diseases such as psoriasis.
Beginning with the guidelines in the book, Louise stopped eating foods she suspected might be causing inflammation, including eggs, liver and fatty meat. She switched to cooking with olive oil and butter, and cut out fried foods and processed sugar. She ate less of high-carbohydrate foods like white flour, white rice and potatoes, and began eating lots of colorful fruits and vegetables.
She also added fish oil and other supplements believed to inhibit inflammation, and several vitamins and minerals. She tried to avoid infection and other potential sources of inflammation.
To Louise's surprise, it worked. Her skin was improving steadily until a bout with breast cancer and the chemotherapy that followed left her with a severe outbreak of guttate psoriasis, which is characterized by small, spotlike lesions. She tried a retinoid drug, but side effects made her nervous and uncomfortable. She renewed her efforts at reducing inflammation through diet.
Three years after the cancer, Louise's skin is now "99 percent clear," she said. She maintains the diet and manages minor flares with a few sessions in her home UVB unit.
"I never thought there was anything I could do other than take a drug, which I didn't want to do," she said. "I didn't realize it was in my hands to clear myself up. It's like you have been in a leper colony and all of a sudden you see the way out."

Controversial regime

Most of the diets that proponents say will help psoriasis claim to do so by preventing or counteracting inflammation. One controversial regime was devised by Dr. John Pagano, a New Jersey chiropractic physician who developed an interest in psoriasis 40 years ago.
The basic diet Pagano describes in his two books about psoriasis—one is a cookbook—looks much like the one Louise D. followed and is recommended by many naturopathic doctors (physicians trained and certified in natural medicine). In addition to cutting out alcohol, refined carbohydrates and most red meats, Pagano recommends avoiding nightshade vegetables such as tomatoes, peppers, eggplant, white potatoes and paprika, and taking several supplements.
More unusual, however, are several practices Pagano says will rid the body of toxins and correct the digestive problems he believes cause psoriasis—including colon cleansing, drinking special herbal teas and receiving spinal alignments from a chiropractor.
Pagano says patients can ignore those recommendations and heal anyway. "All the other aspects are adjuncts to the principles of good elimination and proper diet," he said. "If you set [those things] in motion for a long enough period, in most cases the skin will take care of itself."
Aggie DeBartolo, of Battle Ground, Wash., says Pagano's regimen has helped clear up her 9-year-old daughter Maria's psoriasis, which at one time covered more than 70 percent of Maria's body. Diagnosed when she was 5, Maria at first used prescription steroid creams. Worried about potential side effects, DeBartolo looked for other treatments, heard about Pagano's ideas and contacted him.
Implementing his recommendations, she stopped feeding Maria nightshade vegetables as well as other potentially inflammatory foods. She incorporated more root vegetables such as carrots, yams and beets into the little girl's diet.
At first, Maria's psoriasis worsened—an effect Pagano describes in his book and attributes to the body's clearing of toxins. But they stuck with the diet. Within six months, Maria's psoriasis had cleared. "We kept her on the strict diet for about six more months after that," DeBartolo said, "But we have relaxed the diet a lot since then. She probably has about 10 small spots now."
A registered nurse, DeBartolo had always believed in conventional medicine, but this experience has changed her mind. She now looks to holistic medicine as the first course of action. "If Maria's psoriasis seemed to me like it was getting out of hand, I would go back and start (the Pagano diet) in a minute," she said.

Diet as part of treatment

Some traditionally trained physicians also rely on diet as a component of treating psoriasis.
Dr. Valori Treloar, a Boston-area dermatologist and certified nutrition specialist, says she tells psoriasis patients first and foremost to eat 10 fist-sized servings of raw and cooked vegetables a day, starting with breakfast. Like Pagano, she then recommends replacing white carbohydrates including flour, potatoes and white rice with whole grains and starchy vegetables, cutting out sugar, and eating a small meal every few hours.
Treloar says sensitivity to gluten—a protein found in some grass-related grains including wheat, rye, and barley—seems to be a factor for many of her patients.
Removing gluten from her diet has made a difference for Gina Puluse, a 40-year-old mother of two from Hawthorne, N.J. After the birth of her daughter five years ago, Puluse was diagnosed with palmar-plantar psoriasis, a rare form of the disease that causes blisters on the hands and feet. She tried various topical remedies but the pustules on her feet and hands continued to worsen. She noticed a post on the National Psoriasis Foundation message board from someone using a gluten-free diet similar to the one she was already feeding her autistic son.
"I thought, 'I could do this, I have all the materials, I know what this is,'" she remembered. "After one month, my foot had cleared maybe 40 or 50 percent."
Puluse also stopped eating anything that contained casein, a protein found in cow's milk. She then saw a naturopath, who tested her for food sensitivities and suggested soy and eggs might also contribute to her psoriasis. She cut down on these foods and added several supplements. A few months later, the psoriasis was nearly gone.
"When I cheat it comes back," she said. "I started the diet around March and I was clear by Thanksgiving. I said, 'I am going to cheat, it's Thanksgiving.' Then I kept cheating every weekend between Thanksgiving and New Year's, and by New Year's I was back to having psoriasis."
Puluse returned to the diet, and her skin cleared again. She says she now eats gluten and other trigger foods occasionally, but she can immediately feel the effects.
Another proponent of using diet as a primary tool in treating inflammatory disease is Dr. Andrew Weil, a Harvard-trained physician who has gained prominence as the author of numerous books and articles. Weil directs the Center for Integrative Medicine at the University of Arizona—one of a growing number of university-based centers where scientists are studying the intersections between natural and conventional medicine.
"The response to any medical intervention will vary based on individual circumstances, compliance to the recommendations, and genetics," he wrote in an e-mail. "However, in my experience most people respond well to dietary and lifestyle modifications aimed at controlling chronic inflammation."

For some, frustration

But even with major changes in diet, some people see no change in symptoms.
Kurt Lemon first developed psoriasis as a teenager, and was recently diagnosed with psoriatic arthritis. Not wanting to take systemic drugs, he consulted a naturopath, who advised a strict diet.
For seven months, Lemon has eliminated sugar, dairy products, grains other than brown rice and quinoa, fruit except one papaya and one lemon per day, meat other than free-range chicken, turkey and beef, and nuts other than almonds or pecans. He eats mostly vegetables and chicken or turkey, drinks only coffee, black tea, green tea or water, and cooks only with olive oil.
The results? "Zero," said the 51-year-old Kailua, Hawaii, resident, who deviated from the diet only once, on his birthday. Nonetheless, he plans to give it a few more months.
Other patients say diet has helped, though not healed, their psoriasis.
Ever since he developed the disease 26 years ago, John Kenul, 58, has experimented with his diet. While he hasn't followed any regime strictly—for example he still drinks red wine, though not beer or whiskey—he has incorporated many of the recommendations included in Pagano's book.
Largely vegetarian for several decades, Kenul eats mainly fruit, vegetables and fish, along with limited quantities of whole grains. He avoids wheat and dairy, and says his skin immediately flared when he recently tried eating red meat again. "The diet hasn't cured me, but it does help to reduce symptoms. In my case it gives me less plaque," said the Long Island resident, who says his body is still 50 percent covered at times. "It's not my silver bullet, but it helps."

Not an easy road

Alternative medicine practitioners say that patients must change their diets significantly to have any real chance of improving. "It's a mindset," said Dr. Valori Treloar. "You can't eat the way typical Americans eat. It's not what you see other people doing."
Kurt Lemon definitely feels deprived. "It can be downright depressing. It's awkward at social or company functions when you can't participate. And it takes a lot of logistics—you have to carry your prepared food everywhere you go."
Aggie DeBartolo says having one child with a special diet meant restrictions for the whole family. Because she didn't want Maria to feel left out, she fed all eight of her children the same things.
"It was overwhelming and time consuming to eat that strictly all the time," she said. "If we were out on the road and we did go for fast food, it meant saying 'Everybody, we are going to have grilled chicken salads.' Obviously they would rather have a cheeseburger and fries."
But both patients and practitioners say dietary changes have benefits beyond psoriasis. Treloar makes the point to her patients that, regardless of other outcomes, eating better will help them live a healthier life and reduce their risk of the other diseases that can accompany psoriasis—including diabetes, heart disease and obesity.
Kurt Lemon says he'll keep most of his new eating habits—even if they don't help his psoriatic disease. "I have lost most of my surplus weight. My cholesterol and blood sugar went from marginal to optimal. You have to do something [like this] to realize how empowering it can be."
Gina Puluse says it's all about priorities. She didn't want to take medications, but psoriasis was making day-to-day life painful. She was willing to try anything. "It's not that bad. You just have to cook, and I was one who never wanted to cook. I do miss bagels and pizza, but now when I eat a slice it's not even worth it—unless it's really good New York pizza."
University of Pennsylvania psoriasis researcher Dr. Joel Gelfand supports patients following a healthful diet, but says people should keep their medical doctors informed about the changes they are making—and be careful not to do anything that might actually cause harm. "The downside [of changing] is the time, cost and energy to follow a diet you may not enjoy, and that won't have proven benefits for your health."