FROM THE ACADEMY

Question of the Month

Is There Research to Support a Specic Diet for

Psoriasis?

PERSONS SKIN CONSTANTLY

sheds dead cells and produces
new ones in a process called
cell turnover. Normally, it
takes about a month for new cells that
grow deep in the skin to rise to the
surface, but in psoriasis this process is
accelerated and new cells rise from
below the skin surface in a matter of
days.1 Overgrowths of cells accumulate
on the skin surface resulting in red, aky, crusty patches covered with silvery
lesions. Despite the fact that it is not a
contagious disorder and the patches
are not infectious, people with the condition can suffer from social exclusion.
According to the National Psoriasis
Foundation (NPF), psoriasis is the most
prevalent autoimmune disease in the
United States, and studies indicate as
many as 7.5 million Americans suffer
from it.2
As is often the case in patients with
chronic diseases, people with psoriasis
turn to diet in hopes of a positive
impact on their condition. A poster
session presented at the 2011 Food &
Nutrition Conference & Expo in San
Diego, CA, summarized a literature
search on Medline (1950 to January
2011) for studies testing the effectiveness of any diets or dietary supplements
in
reducing
psoriasis
symptoms.3 Approximately 228 articles were found, including articles on
the impact of obesity on psoriasis and
the effectiveness of a gluten-free diet
on psoriasis, among other factors. The
meeting abstract for the poster session
noted some evidence supportive of a
low-calorie/low-energy diet. In 2013, a
small clinical trial based in Denmark

This article was written by Eleese

Cunningham, RDN, of the Academy
of Nutrition and Dietetics Knowledge
Center Team, Chicago, IL. Academy
members can contact the Knowledge
Center by sending an e-mail to
knowledge@eatright.org.
http://dx.doi.org/10.1016/j.jand.2014.01.003

508

reported what they believed to be the

rst results of a study on the effects
of weight loss using the severity
of psoriasis as a primary endpoint.
The researchers found that obese patients with psoriasis who lost weight
through a low-calorie diet experienced
a signicant improvement in their
quality of life compared with obese
psoriasis patients who didnt lose
weight. In the randomized clinical
trial, 27 patients were assigned to
an intervention group that followed
a low-calorie diet, and 26 patients
were assigned to a control group
that continued to eat ordinary healthy
foods. The participants met every 2
weeks for a total of eight group sessions led by the study dietitian. The
patients on a low-calorie diet ended
up losing nearly 34 lb in 16 weeks,
and reported improvements in both
their psoriasis symptoms and their
overall quality of life.3
There are data that suggest that
following a gluten-free diet may
ameliorate symptoms in individuals
with chronic autoimmune disease
conditions such as psoriasis.4 However, the NPF states that the jury is
still out on this topic. In some cases,
eliminating gluten does seem to help
reduce psoriasis. In a smaller number
of cases, eliminating gluten can lead
to dramatic improvements.5 If celiac
disease or gluten sensitivity is suspected, a registered dietitian nutritionist should coordinate care with a
physician to evaluate the patient for
either of these conditions in order to
determine the appropriateness of a
gluten-free diet. For the client with
psoriasis who does not also have celiac disease or gluten sensitivity, it is
not advised to follow a gluten-free
diet.
The Incident Health Outcomes and
Psoriasis Events (iHOPE) Study, which
examined the prevalence of major
medical comorbidity in patients with
mild, moderate, or severe psoriasis
classied objectively based on body
surface area involvement compared

JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS

with that in patients without psoriasis,

found a denite link between the
severity of a persons psoriasis and the
odds that person may develop several
other diseases,6 including:

chronic pulmonary disease;

diabetes;
mild liver disease;
myocardial
infarction
and
peripheral
vascular
disease
(cardiovascular disease);
peptic ulcer disease;
renal disease; and
other rheumatological diseases.6,7

According to Mark Lebwohl, MD, a

dermatologist commenting on the
iHOPE study, Many of the other diseases linked to psoriasis are linked to
obesity, and several of the diseases
indicated in the study are already
linked to obesity, too, like diabetes and
hypertension. Exercising, eating right,
quitting smoking, and treating psoriasis can help prevent comorbidities.7

References
1.

MedlinePlus. Psoriasis. http://www.nlm.nih.

gov/medlineplus/psoriasis.html. Accessed
December 23, 2013.

2.

National Psoriasis Foundation. Frequently

Asked Questions. http://www.psoriasis.org/
page.aspx?pid375. Accessed December
23, 2013.

3.

Brown AC, Shankar P. Psoriasis, diet,

and dietary supplementsA review [abstract]. J Am Diet Assoc. 2011;111
(suppl 2):A33.

4.

Jensen P, Zachariae C, Christensen R, et al.

Effect of weight loss on the severity of
psoriasis: A randomized clinical study.
JAMA Dermatol. 2013;149(7):795-801.

5.

Gaesser GA, Angadi SS. Gluten-free diet:

Imprudent dietary advice for the general
population? J Acad Nutr Diet. 2012;112(9):
1330-1333.

6.

Yeung H, Takeshita J, Mehta NN, et al. Psoriasis severity and the prevalence of major
medical comorbidity: A population-based
study. JAMA Dermatol. 2013;149(10):
1173-1179.

7.

National Psoriasis Foundation. Study: Risk of

serious medical events increases with psoriasis severity. http://www.psoriasis.org/
news/stories/2013/08/08/risk-of-seriousmedical-events-increases-with-psoriasisseverity. Accessed December 23, 2013.

2014 by the Academy of Nutrition and Dietetics.