Amy Brown1 & Padmini Shankar2 PSORIASIS, DIET AND DIETARY SUPPLEMENTS – A REVIEW Amy Brown1 & Padmini Shankar2 1Department of Complementary and Alternative Medicine, John A Burns School of Medicine, University of Hawaii, Honolulu, HI 96813 2Department of Health and Kinesiology, Georgia Southern University, Statesboro, GA 30460 ABSTRACT STRONG SCIENTIFIC EVIDENCE WEAK SCIENTIFIC EVIDENCE RISK FACTORS RISK FACTORS: Genetic Immunology Other factors Stress Obesity Alcoholism Streptococcal infection Certain medications Cigarette smoking HIV Type 2 diabetes Metabolic syndrome Crohn’s or celiac disease GLUTEN FREE DIET (if AGA positive): Increased risk of celiac disease in psoriasis patients Test for higher antibody levels of transglu- taminase and gliadin for IgA VITAMIN D SUPPLEMENTATION: Calcitriol is the biologically active form Inhibits proliferation of keratinocytes This down regulation and induction of differentiation are vitamin D3 mediated mechanisms in treatment of psoriasis Potential side effects of vitamin D include hyper- calciuria, hypercalcemia and kidney stones FASTING/STARVATION DIET: Fasting may have therapeutic benefits for alleviating psoriasis symptoms Obesity seems to be a risk factor for psoriasis PAGANO DIET (Elimination Type Diet): ALLOWS: Fish, lean poultry and lamb, fresh fruits & vegetables, almonds, fiber supple- ment, low-fat yogurt, gelatin, omega-3 foods and teas AVOIDS: Sugar, soda, grains and flour, high-fat and fried foods, red meats, and shellfish EVENING PRIMROSE: Efamol Marine is capsule containing evening primrose and marine fish oil Treatment produced no significant reduction of psoriasis symptoms TAURINE RESTRICTION: Taurine is naturally occurring sulfonic acid derived from cysteine ZINC SULFATE SUPPLEMENT: Mixed results from 5 studies   BACKGROUND: Psoriasis is the most prevalent autoimmune disease in the United States afflicting approximately 2% of Americans. An overgrowth of skin cells results appearing as thickened, red, scaly, silvery patches. No specific dietary recommendations from the American Dietetic Association exist. PURPOSE: The purpose of this narrative review was to search for studies testing the effectiveness of any diets or dietary supplements in reducing psoriasis symptoms. METHODS: A literature search on Medline (1950 to January 2011) was conducted using the key words “psoriasis and diet,” “psoriasis and supplement,” “psoriasis and herb,” cross-referencing, and general searching. A summary table was used to categorize treatments as either “strong scientific evidence,” “some scientific evidence”, or “weak or no scientific evidence.”   SOME SCIENTIFIC EVIDENCE RICE DIET: AKA Kemper diet, consists of large amounts of carbohydrates in the form of rice, with little protein, sodium and fat LOW-PROTEIN DIET Protein is necessary for the proliferation and exfoliation growth of cells in psoriatic plaques Limiting protein will limit cell growth VEGETARIAN DIETS Increased ingestion of vegetables related to decreased psoriatic symptoms Increased dietary fiber decreases transit time, which prevents harmful substances from being absorbed into the bloodstream LOW-FAT DIET High dietary fat may exacerbate psoriasis FISH OIL SUPPLEMENTATION: Arachidonic acid levels high in psoriatic patients Leukotriene B4, a metabolite of AA, may be a mediator of inflammation Fish oil decreases L B4 synthesis by neutrophils CONCLUSIONS Certain elimination diets and dietary supplements may reduce psoriasis symptoms Translating the research into clinical practice suggests that a customized elimination diet tailored for people with psoriasis would be: Low-protein Low-fat Gluten-free (if AGA positive) Vegetarian Supplements: vitamin D and fish oil Clinical research needed to confirm above