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Psoriasis and vegetarian diets: A role for cortisol and potassium?

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Abstract

Vegetarian diets improved psoriasis symptoms in some studies. Beneficial effects of these diets are believed by others to be a result of better eicosanoid profile. However, the relation of a potassium deficiency to psoriasis is much less well documented; specially considering the fact that increased potassium is a key consequence of vegan and vegetarian diets. The conventional approach to psoriasis consists of utilizing corticosteroids including glucocorticoids. Higher potassium intake leads to higher cortisol secretion and biosynthesis. There are no qualitative differences between the effects of endogenous cortisol and exogenously applied synthetic glucocorticoids, all effects are transmitted via the same receptor. Recently, in a pilot study of patients with rheumatoid arthritis, potassium supplementation resulted in higher serum cortisol levels. I hypothesize that the improvement in psoriasis following vegetarian diets may be in part related to concomitant increases in dietary potassium intake which consequently increases cortisol biosynthesis and/or secretion.
Psoriasis and vegetarian diets: A role for cortisol and potassium?
Psoriasis is considered as a T-cell-mediated inflammatory skin
disease which is characterized by hyperproliferation and poor dif-
ferentiation of epidermal keratinocytes. The conventional ap-
proach to psoriasis consists of utilizing topical and/or oral
corticosteroids including synthetic glucocorticoids [1]. Glucocorti-
coids are potent anti-inflammatory and immunosuppressive
agents that are known to affect T-cell-mediated inflammation
by the inhibition of cellular proliferation and cytokine production
[2].
Vegetarian diets improved psoriasis symptoms in some studies
[3]. Beneficial effects of these diets are believed by others to be a
result of better eicosanoid profile [4], so that inflammatory pro-
cesses are suppressed. However, the relation of a potassium defi-
ciency to psoriasis is much less well documented; specially
considering the fact that increased potassium is a key consequence
of vegetarian diets [5].
Higher potassium intake leads to higher cortisol biosynthesis
[6]. There are no qualitative differences between the effects of
endogenous cortisol and exogenously applied synthetic glucocorti-
coids, which are used to treat psoriasis. The beauty of this is that all
effects are transmitted via the same receptor [7].
Results of a recent clinical trial showed that the elevated serum
cortisol followed potassium supplementation [8]. Briefly, thirty
two hypokalaemic patients (48.6 ± 6 y) with active rheumatoid
arthritis were investigated in a parallel randomized design for 28
days. In addition to their usual medication, the control group re-
ceived placebo, and the intervention group received 6000 mg chlo-
ride potassium dissolved in grape juice on 28 consecutive days. The
total potassium intakes, including dietary potassium and taking
compliance into account, were 1540 ± 260 (95% CI: 1397–1679)
and 6495 ± 285 (95% CI: 6342–6648) mg/day in placebo and inter-
vention group, respectively (P< 0.001). In the intervention group,
mean serum potassium and serum cortisol were significantly
raised by 1.51–1.75 mmol/L (P< 0.001) (95% CI) and 81.00–
115.20 nmoles/L (P< 0.001) (95% CI), respectively, at the end of
supplementation [8].
I would like to suggest a ‘‘Cortisol–Potassium” theory as a novel
mechanism for beneficial effects of vegetarian diets while not pre-
cluding the possibility of previously proposed mechanism of better
eicosanoid profile. I hypothesize that the improvement in psoriasis
following vegetarian diets may be in part related to concomitant
increases in dietary potassium intake which consequently in-
creases cortisol biosynthesis and/or secretion.
Disclosure statement
The author has nothing to disclose. No outside funding/support
was received for this study.
Acknowledgement
The author extends his sincere gratitude to Charles Edward We-
ber for review of the current letter and invaluable comments.
References
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Reza Rastmanesh
Shaheed Beheshti University of Medical Sciences,
Department of Human Nutrition,
Faculty of Nutrition and Food Sciences,
Arghavene Gharbi, Farahzadi Blvd,
Shahrake Gharb, P.O. Box 19395-4741,
Tehran, Iran
Tel.: +98 21 22357484; fax: +98 21 22360660
E-mail addresses: r.rastmanesh@sbmu.ac.ir, macarized@yahoo.com
doi:10.1016/j.mehy.2008.09.031
Gentamicin-induced deafness may be reversed by restarting cell cycle
So far, the acoustic hair cells of mammalian cochlea are consid-
ered as terminal cells, without the ability of regeneration after dam-
aged. Gentamicin-induced deafness is believed to be irreversible
due to damaged acoustic hair cells [1]. Artificial cochlea and gene
therapy are considered as valuable ways of treating gentamicin-in-
duced deafness, and both of them are aiming at replacing the func-
tions of damaged acoustic hair cells. However, more and more
clinical data show that the theory is becoming doubtful.
Recent reports showed that there are hair cell progenitors exist-
ing in the cochlea. The characteristic of hair cell progenitors is keep-
ing in resting state of cell cycle because lacking some special factors,
which will promote the regeneration of cell cycle and cell prolifer-
ation [2,3]. Clinical data showed that cyclin A2 may promote the
regeneration of cardiac muscle cells, which are considered as termi-
nal cells, by cell cycle regulation. It is interesting that the morphous
and function of regenerated cardiac muscle cells are similar to the
primary ones [4,5].
These studies lead to the hypothesis that gentamicin-induced
deafness may be reversed by restarting cell cycle. Actually, hair cell
progenitors may differentiate to hair cells with the stimulation of
368 Correspondence / Medical Hypotheses 72 (2009) 359–371
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