Can the Pagano Diet Heal Psoriasis?

More than 8 million Americans have psoriasis, a chronic autoimmune disorder characterized by patches of sore, itchy, inflamed, or scaly skin, according to the National Psoriasis Foundation (NPF).

The condition occurs when skin cells turn over more quickly than usual, resulting in a buildup of scaly patches that are most commonly found on the elbows, knees, scalp and trunk.

Typically treated with oral or injected medication, topical creams or exposure to ultraviolet light, psoriasis may also respond to dietary changes that can help drive down inflammation and alleviate symptoms, according to the NPF.

One meal plan that claims to heal psoriasis is called the Pagano diet. Here, experts explain what the Pagano diet is, whether it's backed by science, and if you should try it.

What Is the Pagano Diet?

The Pagano diet was created by John Pagano, a chiropractor who authored the book Healing Psoriasis in 2008. In the book, Pagano describes psoriasis as a manifestation of leaky gut syndrome, which causes toxins to leak out of the gastrointestinal (GI) tract via holes in the intestinal lining.

Pagano says psoriasis is the body's attempt to rid itself of these toxins via the skin.

The gut microbiome does play a role in how psoriasis develops, and patients with psoriasis can have associated inflammatory bowel disease, says Saakshi Khattri, MD, associate professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York. "Gut inflammation from inflammatory bowel disease can impair [intestinal] permeability and changes in the normal gut microbiome can impair the local milieu, but 'toxins' is not the right word."

Rather, the autoimmune condition is considered an immune-mediated disease, according to the NPF. A dysfunctional immune system causes inflammation throughout the body, leading to skin changes as well as affecting other organs.

What Can You Eat on the Pagano Diet?

Foods to Eat

• Fruits (except for citrus and strawberries)
• Vegetables
• Wild-caught fish
• Poultry
• Lamb
• Small amounts of dairy
• Brown or wild rice in moderation
• 2 to 4 eggs per week (not fried)
• Oils, such as coconut, olive, sesame, grapeseed, and flaxseed
• Herbal teas

Foods to Avoid

• Red meat
• Margarine, shortening
• Nightshade vegetables — e.g., eggplant, peppers, tomatoes, white potatoes
• Shellfish
• Coffee
• Gluten
• Fried foods
• Added sugars
• Alcohol

"While there are studies investigating the relationship between the gut and psoriasis, at this time there is not enough evidence to suggest that a diet that helps with leaky gut will necessarily [improve psoriasis]," says Marisa Garshick, MD, a board-certified dermatologist at MDCS Dermatology and assistant clinical professor of dermatology at New York-Presbyterian/Weill Cornell Medical Center in New York.

That's not to say there's no connection between what we put in our mouths and what shows up on our skin. However, "evidence of the relationship between diet and disease severity is limited" when it comes to psoriasis, Dr. Garshick says.

At the core of the Pagano diet is the concept of inflammation. Inflammation is the body’s response to injury or illness, according to Cleveland Clinic. An example of acute inflammation is when swelling occurs at the site of an injury. With autoimmune diseases such as psoriasis, there is chronic inflammation in the body’s tissues; essentially, the immune system is attacking itself.

"While there is not a great deal of evidence to suggest that diet has a big impact on this condition, there are those that experience improved symptoms with a more anti-inflammatory approach to eating since psoriasis is a chronic inflammatory condition," says Sharon Palmer, RDN, a registered dietitian and author of The Plant-Powered Diet.

An anti-inflammatory diet features fresh fruits and vegetables, healthy sources of fats like olive oil, avocado, fatty fish and nuts, whole grains, and legumes. It’s also low in processed foods, added sugars and animal products, such as meat and dairy products.

The Pagano diet in particular emphasizes eating alkaline foods, like fruits and vegetables, and reducing acidic foods like meat and grains to heal the gut. But the science on alkaline and acidic foods is lacking.

"There is little research to prove that the alkalinity or acidity of foods impacts health," Palmer says. "The human body has the ability to maintain a steady pH in the body despite dietary intake."

Is the Pagano Diet Healthy?

Despite the fact that there's little research to support its use for the management of psoriasis, the Pagano diet is generally healthy thanks to its emphasis on nutrient-rich fruits and vegetables and a reduction in processed foods that can contain loads of added sugar and sodium.

"This part of the diet makes sense, as these are eating patterns linked with lower inflammation," Palmer says.

A focus on healthy eating is particularly key for individuals with psoriasis since the condition is linked to a greater risk of cardiovascular conditions, obesity and metabolic syndrome, all of which are linked with chronic inflammation, according to Cleveland Clinic.

Dr. Khattri says she makes sure to counsel patients about the importance of eating a nutrient-dense diet, especially if they have psoriasis in addition to metabolic syndrome markers like abdominal obesity and insulin resistance.

"People have reported feeling better by cutting out nightshades; however, this isn't backed by science," says Palmer. "Indeed, many nightshade vegetables are anti-inflammatory."

Pros of the Pagano Diet

1. It May Help Improve Symptoms

"One survey found that people reported improvements in psoriasis symptoms with the Pagano diet, though similar improvements were reported with vegan and paleo diets," Palmer says.

Following a Mediterranean diet may also help improve psoriasis symptoms, according to a study.

It may be that these diets reduce calorie intake, leading to weight loss, which is a key factor in symptom improvement for people who are overweight or have obesity, according to Mayo Clinic.

2. A Gluten-Free Diet Is Helpful for Some

It's not uncommon for people to have both psoriasis and celiac disease, according to a meta-analysis. For these patients, the Pagano diet's strict restriction of gluten is necessary. "Especially in patients with confirmed celiac disease and psoriasis, a gluten-free diet reduces psoriasis severity," Khattri says.

People with psoriasis who test positive for antibody markers of gluten sensitivity may also benefit from trying a three-month gluten-free diet in conjunction with standard medical therapies for psoriasis, Garshick adds.

Cons of the Pagano Diet

1. More Research Is Needed

While there's some anecdotal evidence to support consuming less sugar, dairy, and alcohol for psoriasis symptom improvement, currently no research specifically supports the use of the Pagano diet for psoriasis, according to the NPF.

2. It's Very Restrictive

Another major pitfall of the Pagano diet is the plan's stringent rules. Following any highly restricted diet comes with potential for feelings of deprivation and the development of disordered eating patterns, and cutting out entire food groups in the Pagano diet is no exception.

Should You Try It?

At this time, science only suggests following a gluten-free diet for psoriasis if you also have celiac disease, which is like having a gluten allergy. If you have a gluten sensitivity, avoiding gluten can also help, and anecdotally some patients have improvement with avoiding gluten. “There’s also a strong recommendation of weight reduction with a low-calorie diet in people with psoriasis who have overweight and obesity,” Khattri says.

But as for following the Pagano diet itself, there’s no need to nix entire food groups from your diet just yet.

“Ultimately, research has shown that medical treatments are more successful at treating psoriasis than diet,” Palmer says.

So, while the healthful foods emphasized on the Pagano diet may contribute to improvements in skin symptoms, more research is needed to determine if the meal plan is as effective for psoriasis management as Pagano claims.

Talk to your dermatologist or a registered dietitian before changing your diet to treat your psoriasis.