More than 8 million Americans suffer from psoriasis, a chronic autoimmune disorder characterized by patches of sore, itchy, inflamed or scaly skin, according to the National Psoriasis Foundation.
The condition occurs when skin cells turn over more quickly than usual, resulting in a buildup of scaly patches most often 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.
One "psoriasis healing" meal plan is called the Pagano diet. Sounds like a tall order, no? Below, experts explain what the Pagano diet is, whether it's backed by science and if you should actually 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 GI tract via holes in the intestinal lining, per the Healing Psoriasis website.
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, assistant professor of dermatology at the Icahn School of Medicine at Mount Sinai. "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 often referred to as an immune-mediated disease, per the National Psoriasis Foundation. A dysfunctional immune system causes inflammation throughout the body, leading to skin changes as well as affecting other organs.
Can Diet Changes Improve Psoriasis Symptoms?
When it comes to whether a meal plan for leaky gut will solve skin woes, the jury is still out.
"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, board-certified dermatologist at MDCS Dermatology and clinical assistant professor of dermatology at New York Presbyterian-Cornell.
That's not to say there's no connection between what we put in our mouths and what shows up on our skin (hence that pesky zit after a birthday weekend full of cake).
In fact, it's not uncommon for psoriasis patients to report trying special diets, per a May 2017 survey published in Dermatology and Therapy. 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 idea of inflammation.
"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.
What Is an Anti-Inflammatory Diet?
This kind of diet is packed with 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 (think: beef, pork, butter, cheese).
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, to say the least.
"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."
What Do You Eat on the Pagano Diet?
Foods to Eat
- Fruits (except for citrus and strawberries)
- Wild-caught fish
- 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, flaxseed
- Herbal teas
Foods to Avoid
- Red meat
- Margarine, shortening
- Nightshade vegetables — eggplant, peppers, tomatoes, white potatoes
- Fried foods
- Added sugars
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, per the 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.
The bottom line: The Pagano diet is largely a health-promoting meal plan that may help manage weight and potentially improve cardiometabolic markers like high LDL cholesterol and blood sugar. But the diet is not evidence-based, meaning there are no guarantees it will make a difference for people with psoriasis.
"In one survey, people reported improvements 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.
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 obese, according to the Mayo Clinic.
2. A Gluten-Free Diet Is Helpful for Some
It's not uncommon for people to have both psoriasis and celiac disease, per a June 2020 meta-analysis published in The Journal of the American Academy of Dermatology. 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," Dr. 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, Dr. Garshick adds.
Gluten needs to be in the diet at the time testing is performed, otherwise false negative results can occur.
Cons of the Pagano Diet
1. More Research Is Needed
While there's some anecdotal evidence to support eating 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 National Psoriasis Foundation.
2. It's Very Restrictive
Another major pitfall of the Pagano diet is the plan's extremely 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.
Remember: It's important to evaluate the costs and benefits before diving into a therapeutic meal plan, especially one that has not actually been confirmed to ameliorate symptoms. Talk to your dermatologist or a registered dietitian before changing your diet to treat your psoriasis.
Should You Try It?
Science suggests you should follow a gluten-free diet if you have psoriasis in addition to celiac disease or a gluten sensitivity. “There’s also a strong recommendation of weight reduction with a hypocaloric diet in overweight and obese patients with psoriasis,” Dr. 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.
Is This an Emergency?
- The National Psoriasis Foundation: "Statistics"
- Healing Psoriasis: "John O.A. Pagano"
- The National Psoriasis Foundation: "The Immune System and Psoriasis"
- Dermatology and Therapy: "Dietary Behaviors in Psoriasis: Patient-Reported Outcomes from a U.S. National Survey"
- JAMA Dermatology: "Association Between Mediterranean Anti-inflammatory Dietary Profile and Severity of Psoriasis"
- The Cleveland Clinic: "Why You Should Pay Attention to Chronic Inflammation"
- Journal of the American Academy of Dermatology: "Association Between Psoriasis and Celiac Disease: A Systematic Review and Meta-analysis"
- JAMA Dermatology: "Dietary Recommendations for Adults With Psoriasis or Psoriatic Arthritis From the Medical Board of the National Psoriasis Foundation: A Systematic Review"
- The National Psoriasis Foundation: "How Does Your Diet Affect Psoriasis?"
- Mayo Clinic: "Psoriasis diet: Can changing your diet treat psoriasis?"