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Medical nutrition therapy as a potential complementary treatment for psoriasis—five case report

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  • Mana Gardening Institute

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This research evaluated five case studies of patients with psoriasis following a dietary regimen. There is no cure for psoriasis and the multiple treatments currently available only attempt to reduce the severity of symptoms. Treatments range from topical applications, systemic therapies, and phototherapy; while some are effective, many are associated with significant adverse effects. There is a need for effective, affordable therapies with fewer side effects that address the causes of the disorder. Evaluation consisted of a study group of five patients diagnosed with chronic plaque psoriasis (two men and three women, average age 52 years; range 40-68 years) attending a 10-day, live-in program during which a physician assessed psoriasis symptoms and bowel permeability. Subjects were then instructed on continuing the therapy protocol at home for six months. The dietary protocol, based on Edgar Cayce readings, included a diet of fresh fruits and vegetables, small amounts of protein from fish and fowl, fiber supplements, olive oil, and avoidance of red meat, processed foods, and refined carbohydrates. Saffron tea and slippery elm bark water were consumed daily. The five psoriasis cases, ranging from mild to severe at the study onset, improved on all measured outcomes over a six-month period when measured by the Psoriasis Area and Severity Index (PASI) (average pre- and post-test scores were 18.2 and 8.7, respectively), the Psoriasis Severity Scale (PSS) (average pre- and post-test scores were 14.6 and 5.4, respectively), and the lactulose/mannitol test of intestinal permeability (average pre- and post-test scores were 0.066 to 0.026, respectively). These results suggest a dietary regimen based on Edgar Cayce's readings may be an effective medical nutrition therapy for the complementary treatment of psoriasis; however, further research is warranted to confirm these results.
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Alternative Medicine Review
Volume 9, Number 3 2004 Page 297
Case Report Psoriasis
Abstract
This research evaluated five case studies of
patients with psoriasis following a dietary
regimen. There is no cure for psoriasis and the
multiple treatments currently available only
attempt to reduce the severity of symptoms.
Treatments range from topical applications,
systemic therapies, and phototherapy; while
some are effective, many are associated with
significant adverse effects. There is a need for
effective, affordable therapies with fewer side
effects that address the causes of the disorder.
Evaluation consisted of a study group of five
patients diagnosed with chronic plaque
psoriasis (two men and three women, average
age 52 years; range 40-68 years) attending a
10-day, live-in program during which a
physician assessed psoriasis symptoms and
bowel permeability. Subjects were then
instructed on continuing the therapy protocol
at home for six months. The dietary protocol,
based on Edgar Cayce readings, included a diet
of fresh fruits and vegetables, small amounts
of protein from fish and fowl, fiber
supplements, olive oil, and avoidance of red
meat, processed foods, and refined
carbohydrates. Saffron tea and slippery elm
bark water were consumed daily. The five
psoriasis cases, ranging from mild to severe
at the study onset, improved on all measured
outcomes over a six-month period when
measured by the Psoriasis Area and Severity
Index (PASI) (average pre- and post-test scores
were 18.2 and 8.7, respectively), the Psoriasis
Severity Scale (PSS) (average pre- and post-
test scores were 14.6 and 5.4, respectively), and
the lactulose/mannitol test of intestinal
permeability (average pre- and post-test
scores were 0.066 and 0.026, respectively).
These results suggest a dietary regimen based
on Edgar Cayce’s readings may be an effective
medical nutrition therapy for the
complementary treatment of psoriasis;
however, further research is warranted to
confirm these results.
(Altern Med Rev 2004;9(3):297-307)
Introduction
Psoriasis is a chronic, inflammatory skin
disease characterized by thickened, silvery-scaled
patches.
1
Its cause is not yet known, but numer-
ous studies link it with inflammatory and immune
mechanisms most likely associated with a genetic
predisposition that can be triggered by stress.
2
Medical Nutrition Therapy as a
Potential Complementary Treatment for
Psoriasis – Five Case Reports
Amy C. Brown, PhD, RD; Michelle Hairfield, PhD;
Douglas G. Richards, PhD; David L. McMillin, MA;
Eric A. Mein, MD; Carl D. Nelson, DC
Amy C. Brown, PhD, RD – Assistant Professor of Human
Nutrition, Department of Human Nutrition, Food & Animal
Sciences,University of Hawaii at Manoa
Correspondence address: Department of Human Nutrition,
Food & Animal Sciences, University of Hawaii at Manoa,
1955 East West Road, Rm 216, Honolulu, HI 96822
Email: amybrown@hawaii.edu
Michelle Hairfield Stein, PhD – Senior Researcher, Tissue
Genesis Incorporated, Honolulul, HI
Douglas G. Richards, PhD – Director of Research, Meridian
Institute, Virginia Beach, VA
David L. McMillin, MA – Clinical Researcher, Meridian
Institute, Virginia Beach, VA
Eric A. Mein, MD – Clinical Researcher, Meridian Institute,
Virginia Beach, VA
Carl D. Nelson, DD – Clinical Researcher, Meridian
Institute, Virginia Beach, VA
Page 298 Alternative Medicine Review
Volume 9, Number 3 2004
Psoriasis Case Report
Copyright©2004 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission
Because there is no cure for psoriasis, the
multiple treatment options currently available only
attempt to reduce the severity of symptoms. Non-
pharmacological therapies include sunlight and
stress avoidance, while pharmacological treat-
ments are either topically applied in the form of
creams or lotions, orally ingested, or injected. Most
patients are treated with topical therapies some-
times combined with phototherapy and/or sys-
temic medications.
Topical applications include:
Anthralin – A synthetic substance made
from a coal tar derivative used since the
19
th
century; however, it is a highly
irritating substance that needs to be
thoroughly washed off after each session.
Calcipotriol – A synthetic form of vitamin
D
3
that inhibits cell proliferation but may
elevate serum calcium.
Corticosteroid treatment – Common
steroids such as Diprolene, Psorcon,
Temovate, and Ultravate improve psoriatic
lesions, but side effects include skin
thinning, hair follicle infections, facial
redness, rosacea, a worsening of diabetes
mellitus, and reduced endogenous steroid
production.
Topical retinoids – Some patients
experience partial clearing of psoriasis
with topical retinoids, but often abandon
therapy due to skin reddening and
irritation.
Topical Tacrolimus and Pimecrolimus –
These topical treatments represent a new
class of nonsteroidal topical
immunomodulators; however, only a few
studies have been performed and side
effects include a burning sensation.
Oral medications are usually reserved for
severe psoriasis cases because of potentially seri-
ous side effects. Among the systemic therapies
associated with significant side effects are
acitretin, methotrexate, cyclosporine, hydroxy-
urea, and thioguanine. Individuals on these medi-
cations must be closely monitored and the medi-
cations cannot be used for long-term treatment.
3
Other systemic therapies include monoclonal an-
tibodies,
4
protein specifically targeting memory T
cells,
5
fumaric acid esters,
6
novel retinoids, and
macrolactams.
7
In addition to potential side effects,
current oral and topical treatments are often only
a partial or temporary solution.
Annual medical treatment costs for pso-
riasis in the United States are estimated at approxi-
mately $1.6-3.2 billion. The need exists for more
effective treatment options with fewer side effects.
One such option is medical nutritional
therapy. Although the American Dietetic Associa-
tion promotes no specific diet for psoriasis, re-
searchers have reported the effect on psoriasis of
modifying various aspects of the diet. Strong sci-
entific evidence exists for a gluten-free diet;
8,9
some scientific evidence exists for a vegan diet,
10
rice diet,
11
and supplementation with fish oil
12
and
vitamin D;
13
and weak scientific evidence exists
for a low protein diet,
14
fasting/starvation,
15
and
supplementation with evening primrose oil,
16
tau-
rine,
17
and zinc sulfate.
18,19
Psoriasis patients showed significant im-
provement after six months when fed a gluten-
free diet.
8
Naldi et al and Kavli et al noted in epi-
demiological studies that increased intake of fresh
fruits and vegetables is linked with a decreased
prevalence of psoriasis.
20,21
Pagano published a
book for the general public (partially based on
Edgar Cayce’s readings) describing a diet com-
posed primarily of fresh fruits and vegetables, with
small amounts of fish, fowl, and lamb.
22
The present study explores the effective-
ness of a treatment protocol, based on Edgar
Cayce’s readings on psoriasis, that includes a di-
etary regimen, herbal supplements, and address-
ing intestinal permeability. Several lines of re-
search support this systemic approach.
Comorbidity studies link intestinal pathology with
a variety of skin conditions, including psoriasis.
23-25
Alternative Medicine Review
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Case Report Psoriasis
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Although there is evidence in cases of psoriasis
for structural abnormalities in the intestine,
26-28
the
data specifically linking intestinal permeability to
psoriasis is mixed. Humbert et al compared intes-
tinal permeability of psoriasis patients with healthy
controls using the
51
Cr-labeled EDTA absorption
test, and found the psoriasis group had signifi-
cantly increased bowel permeability.
29
On the other
hand, Hamilton et al used the cellobiose/mannitol
differential sugar absorption test, and although
these latter researchers found an abnormal recov-
ery ratio in seven of 29 psoriasis patients, they
concluded this rate was similar to a control popu-
lation.
30
The present study continues to explore
this question.
The concept of increased intestinal per-
meability as a cause of psoriasis is based on the
premise that substances from the diet larger than
those normally absorbed can enter the circulation
and initiate an immune system response resulting
in psoriatic lesions. Until the early 20
th
century,
“autointoxication” was widely accepted and vari-
ous therapies (such as colonic irrigation) were
commonly used for a variety of systemic disor-
ders. Unsupported by scientific evidence, autoin-
toxication fell out of favor several decades ago.
31
However, the growing body of information link-
ing intestinal disease, excessive intestinal perme-
ability, and systemic illness has revived the
theory.
32,33
The concept of autointoxication gains
support from several case studies suggesting he-
modialysis and peritoneal dialysis are effective in
the treatment of psoriasis.
34-37
The conceptual basis of the present study
is derived from the systems approach of Edgar
Cayce, as described by Landsford and McMillin
et al. In essence, the model focuses on excessive
intestinal permeability (or the “leaky gut syn-
drome”) as a primary factor in the pathogenesis
of psoriasis.
38,39
According to this theory, various
factors cause the walls of the small intestine to
“thin” or become disturbed in some way that al-
lows “toxic” substances to be absorbed into cir-
culation. These substances eventually find their
way into the superficial circulation and lympha-
tics and are eliminated through the skin, produc-
ing the plaques of psoriasis.
39
This study is based
on a slightly different hypothesis, in that the cur-
rent researchers suggest it is the immune system
reacting to larger-than-normal substances ab-
sorbed by a compromised intestinal tract actually
causing the skin to react in much the same way it
does to common allergens. The approach in the
present study combines the dietary treatment ap-
proach of Edgar Cayce, based on Meridian Insti-
tute publications, with evaluation of psoriasis
symptoms and the measurement of intestinal per-
meability.
Subjects
This study was undertaken at the Merid-
ian Institute, Virginia Beach, Virginia, involving
five participants recruited by a notice in Venture
Inward magazine. The criteria for inclusion in-
cluded a medical diagnosis of psoriasis and the
ability to travel to the clinic for required appoint-
ments; there were no exclusionary criteria. Some
subjects were using treatments before and during
the study (noted specifically under each case), and
the protocol did not require them to change treat-
ments. Accordingly, no one changed a previous
course of treatment during the study, but simply
added the study protocol. Subjects consisted of
five patients diagnosed with chronic plaque pso-
riasis (two men and three women; mean age 52
years; range 40-68 years).
Methods and Materials
Each subject attended a 10-day, live-in
program during which time bowel permeability
and psoriasis symptoms were assessed by a der-
matologist, and the subjects were trained to carry
out the therapy protocol at home for six months.
The dietary protocol included a diet rich in alka-
line-forming fresh fruits and vegetables (Table 1)
and daily use of saffron tea and slippery elm bark
water. The raw herbs, American yellow saffron
(Carthamus tinctorius) and slippery elm bark
(Ulmus fulva) were packaged by and obtained
from The Heritage Store, Virginia Beach, and pre-
pared according to instructions, as follows:
Page 300 Alternative Medicine Review
Volume 9, Number 3 2004
Psoriasis Case Report
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Saffron tea: 4 ounces of boiling water
poured over a pinch of saffron and steeped
for 15 minutes, consumed one-half hour
before a meal.
Slippery elm water: a pinch of raw herb
placed in a glass of cool water, allowed to
sit for five minutes, stirred, and consumed
without straining.
An initial cleansing included external cas-
tor oil packs applied over the abdomen to improve
elimination via the bowel,
40
colon hydrotherapy
(colonic irrigations) to further assist with elimi-
nation, and spinal adjustments for each subject
during the 10-day live-in program. Subjects also
received instruction on maintaining regular use of
castor oil packs, and were encouraged to receive
further colonic irrigations and spinal adjustments
(based on availability of local clinicians). Partici-
pants were advised on the importance of regular
Table 1. Dietary Regimen Employed in the Study
Food Type
Meat
Fruit
Vegetables
Starch/grains/cereal
Dairy/Fats
Dessert
Beverages
Nuts
Supplements
Include
Fish, fowl, lamb
All fruits
All vegetables except
nightshade family (see
avoid)
Whole grain bread and
cereals
Limited amounts of nonfat
or low-fat dairy products
Fruit
Water, fruit and vegetable
juices, saffron tea
All nuts
Saffron tea and slippery
elm water (daily)
Avoid
Red meat, fried meat, high fat meats
Combinations of citrus fruits and
cereals at the same time
Tomatoes (and their derivatives),
white potatoes, eggplant, peppers
(except the seasoning black
pepper), paprika
High sugar foods, high starch foods,
combinations of two or more starchy
foods at the same time
Salted, processed, or imitation
butter; hydrogenated fats such as
margarine
High fat foods
High fructose and/or artificial drinks;
alcoholic beverages
None
Slippery elm water is contraindicated
for pregnant women
Alternative Medicine Review
Volume 9, Number 3 2004 Page 301
Case Report Psoriasis
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elimination and were encouraged to maintain regu-
larity with the high fruit and vegetable diet (Table
1). Emotional counseling was also encouraged,
with special emphasis on developing a positive
attitude toward healing and viewing physical heal-
ing as part of a holistic process. The participants
returned home, applied the protocol on a daily
basis, and kept daily log sheets for six months.
Outcome Measures
The following four measurable outcomes
were administered immediately before and after
six months of therapy: Psoriasis Area and Sever-
ity Index (PASI) scores assessed by a medical doc-
tor, Psoriasis Severity Scale (PSS) self-assessed
by subjects,
41
before/after photograph comparisons
by a medical doctor, and the lactulose/mannitol
test of intestinal permeability.
The PASI standardized evaluation is a
single number calculation representing severity of
symptoms and area of coverage.
1
PASI scores
range from 0-72, with lower scores indicating less
severe symptoms and/or a smaller area of cover-
age. The PSS is a six-item subjective evaluation
of psoriasis symptoms by the patient,
41
which is
significantly correlated with objective measure-
ment by a physician.
42
A lower score indicates less
severe symptoms. The lactulose/mannitol test of
intestinal permeability involves drinking a solu-
tion of two sugars; the normal bowel is relatively
impermeable to lactulose, but relatively perme-
able to mannitol. A high lactulose/mannitol ratio
in the urine indicates excess leakage of lactulose
across the intestinal wall. This test is sensitive,
low cost, simple to perform, and has the advan-
tage of a simple enzyme assay.
43
It has been shown
to have good repeatability and to be a reliable in-
testinal permeability test for sugars.
44
After an
overnight fast, the participants voided a pre-test
urine sample and then ingested the test solution
provided by Great Smokies Laboratory (63
Zillicoa Street, Asheville, NC 28801). Urine was
collected at the Meridian Institute for six hours in
polyethylene bottles. Intake of at least 100 mL of
water each hour was encouraged to ensure ad-
equate urine production; food was allowed after
four hours. The analysis was performed by Great
Smokies Laboratory.
Table 2. Individual Values for Bowel Permeability, PASI Scores, and PSS Scores for Study
Participants
Pre-therapy
0.134*
0.084*
0.034
0.047
0.029
0.066* ±
0.044
Post-therapy
0.038
0.022
0.019
0.024
0.026
0.026 ±
0.007
Case Number PASI Scores** PSS Scores** Lactulose/Mannitol Ratio
Pre-therapy
7.0
30.7
14.0
2.3
37.0
18.2 ± 15.0
Post-therapy
4.8
18.4
0.7
0
19.8
8.7 ± 9.7
Pre-therapy
7.0
14.0
21.0
7.0
24.0
14.6 ± 7.8
Post-therapy
6.0
5.0
3.0
1.0
12.0
5.4 ± 4.2
1
2
3
4
5
Mean ± SD
* Outside normal range for lactulose/mannitol ratio of 0.01-0.06.
** For PASI and PSS, higher scores indicate more severe symptoms; all patients showed a decrease in scores.
Page 302 Alternative Medicine Review
Volume 9, Number 3 2004
Psoriasis Case Report
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Results
Five participants returned for the six-
month assessment and all showed improvement
in PASI and PSS scores, and decreased intestinal
permeability. The mean PASI score dropped from
18.2 to 8.7; the mean PSS score dropped from 14.6
to 5.4; and the mean lactulose/mannitol ratio
dropped from 0.066 to 0.026. Because statistical
analysis is not meaningful with five participants,
each is addressed as a separate case study with
the results for each participant summarized in
Table 2.
Case 1
Case 1 was a 40-year-old woman exhibit-
ing mild psoriasis on hands, elbows, and feet be-
ginning in 1991. She used no other treatments,
systemic or topical, throughout the course of the
study. In the before/after pictures, Case 1 demon-
strated major improvement. Her most prominent
symptom – rough, red areas on her hands and el-
bows – were completely cleared. Psoriasis was still
present on her feet. She also showed improvement
on the two measures of psoriasis symptoms (Table
2). Her lactulose/mannitol ratio, which had been
high (0.134) at the beginning, was normal (0.038)
after six months. Regarding compliance with the
protocol, Case 1 showed excellent compliance
with the diet and the teas, good compliance with
the colonics, and minimal compliance with the ad-
justments and castor oil packs.
Case 2
Case 2 was a 68-year-old man exhibiting
moderate-to-severe psoriasis, initially presenting
in 1985. Case 2 used no medications during the
study. Photography showed large areas of red-
dened skin, with prominent white scaly areas. The
before/after pictures of Case 2 revealed substan-
tial healing. Most notable was the complete dis-
appearance of the white scales on his back, al-
though there were still large red areas. He also
showed improvement on the two measures of pso-
riasis symptoms (Table 2). His lactulose/manni-
tol ratio, which had been high (0.084) at the be-
ginning of treatment, was normal (0.022) after six
months. Case 2 had excellent compliance with the
diet, teas, and adjustments; good compliance with
the colonics; and minimal compliance with the
castor oil packs.
Case 3
Case 3 was a 47-year-old woman with
moderate psoriasis beginning in 1997. She also
presented with general health problems, specifi-
cally hepatitis C. She was overweight and noted
her diet was poor and she craved and consumed
many sweets. Case 3 used Clobetasol propionate
(topical for scalp), Diprolene cream, Gingko, oc-
casional UV light, and Allegra for allergies, both
prior to and during the study. Improvement was
difficult to detect in the before/after photographs.
Her before photos revealed some psoriasis, while
her after photos revealed no psoriasis. At the start
of the study, she had moderate psoriasis over half
her body, specifically her trunk and lower extremi-
ties, and slight psoriasis on the head and upper
extremities. She showed substantial improvement
on the two measures of psoriasis symptoms (Table
2). Her lactulose/mannitol ratio, which was in the
normal range (0.034) at the onset of the study, was
still normal, but lower (0.019), after six months.
Case 3 also noted much improvement in her hepa-
titis C condition, although no medical record of
the improvement was provided. Case 3 demon-
strated excellent compliance with the castor oil
packs; good compliance with the diet and the teas;
and minimal compliance with the adjustments and
colonics.
Case 4
Case 4 was a 44-year-old man, demon-
strating mild psoriasis on scalp and fingers that
had begun when he was five years old. He also
complained of arthritis (type not specified). Prior
to and during the study, Case 4 used Lipitor
for
high triglycerides, Dovonex ointment, and one
aspirin daily as a blood thinner. In the before/af-
ter pictures, change was difficult to perceive as
his symptoms were barely visible. He showed
improvement on the two measures of psoriasis
symptoms (Table 2). The PASI score was zero,
Alternative Medicine Review
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Case Report Psoriasis
Copyright©2004 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission
indicating no psoriasis symptoms at follow-up. His
lactulose/mannitol ratio, which was in the normal
range (0.047) at the beginning, was still normal,
but lower (0.024), after six months. Case 4 main-
tained excellent compliance with the teas; fair
compliance with the diet; and minimal compliance
with the colonics, adjustments, and castor oil
packs.
Case 5
Case 5 was a 59-year-old woman with
severe psoriasis covering 60 percent of her body,
initially presenting in 1953. Her psoriasis symp-
toms at the onset of the study were the most se-
vere in the group. She also reported problems with
osteoarthritis and abdominal bloating, especially
at night. Case 5 reported using a steroid cream
(type not specified) topically. In the before/after
photographs, Case 5 had clearly visible improve-
ment. Her most prominent symptom, red patches
covering much of her back, had diminished in size
and redness. She also showed improvement on the
two measures of psoriasis symptoms (Table 2).
Her lactulose/mannitol ratio was at the low end of
the normal range (0.029) at the beginning and re-
mained low (0.026) after six months. Regarding
compliance with the protocol, Case 5 had excel-
lent compliance with the diet, teas, and castor oil
packs; and minimal compliance with the adjust-
ments and colonics.
Discussion
The five psoriasis cases, ranging from mild
to severe at the beginning of the study, improved on
all measured outcomes over a six-month period when
measured by the PASI criteria, the PSS, and the
lactulose/mannitol test of intestinal permeability.
These results suggest a treatment regimen based on
Edgar Cayce’s readings on diet and herbal teas or a
related type of medical nutritional therapy may be
an effective alternative or complementary (not ex-
clusionary of conventional intervention) treatment
for psoriasis. This study used a protocol including
diet (high in fresh fruits and vegetables, small
amounts of protein from fish and fowl, fiber supple-
ments, olive oil, and avoidance of red meat, processed
foods, and refined carbohydrates) and herbal teas.
Two of the five participants had abnor-
mally high permeability; the intestinal permeabil-
ity of all five decreased. The most difficult aspect
of the treatment protocol for most participants was
compliance with dietary restrictions. When, for
various reasons such as travel, they did not ad-
here to the diet, the psoriasis symptoms partially
returned, confirming the importance of this aspect
of the treatment approach.
Psoriasis is characterized by epidermal
hyperproliferation.
1
In normal skin, the cells of
the epidermis continually divide and move to the
surface of the skin, and are then sloughed off. This
process normally takes approximately 28 days. In
psoriatic skin, however , this process is acceler-
ated and occurs in four days, with a 30-fold in-
crease in new epidermal cells. The skin is thicker
and the cells are less mature, resulting in scaling.
Psoriatic skin is red and inflamed due to dilation
of capillaries in the dermal layer surrounded by
white blood cells.
45
The biochemical basis for the
control of cell proliferation is via a delicate bal-
ance between two signaling compounds, cyclic
adenosine monophosphate (cAMP) and cyclic
guanosine monophosphate (cGMP). Increased lev-
els of cAMP and decreased levels of cGMP are
associated with enhanced cell maturation and re-
duced cell proliferation,
46
advantages in the care
and management of psoriasis. Compared to unaf-
fected skin, psoriatic plaques have been shown to
contain decreased levels of cAMP and increased
levels of cGMP,
46
which may contribute to epi-
dermal hyperproliferation.
The improvement of psoriasis symptoms
in all five subjects may have been due to lowering
overall protein intake. Because epithelial prolif-
eration relies on protein, reducing dietary protein
may limit the potential amount of epithelial repli-
cation. Also, excess dietary protein may lead to
incomplete protein digestion, leading to the for-
mation of toxic polyamines as bowel bacteria
break down the superfluous polypeptides.
47-49
Polyamines are elevated in the urine and skin of
individuals with psoriasis, providing support for
the concept of autointoxication.
50,51
Polyamines
then inhibit the production of cAMP, leading to
increased cell proliferation.
47-49
Although
Page 304 Alternative Medicine Review
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Psoriasis Case Report
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polyamine and cAMP levels were not measured
in this study, the authors suggest that by lowering
protein intake, polyamine levels in the subjects
may have been reduced, resulting in higher levels
of cAMP, decreased cell proliferation, and ulti-
mately, symptom improvement.
In addition, allergic reactions often occur
due to dietary proteins. If a compromised gas-
trointestinal tract allows protein substances larger
than amino acids to pass into the bloodstream, then
the body may react in an allergic-type fashion,
resulting in one of the symptoms of allergies – a
skin manifestation. Since allergic reactions are
inflammatory responses involving the immune
system, it is interesting to note psoriasis is an in-
flammatory condition that appears to benefit from
newer immune therapies. The fact that a gluten-
free diet improves the condition of some people
with psoriasis
8
indicates the gastrointestinal tract
may be involved.
Another important aspect of this diet was
elimination of alcohol. Consumption of alcohol
is a known trigger of psoriasis flare-ups. Although
the mechanism is unknown, possible reasons for
an alcohol trigger include stress on the liver or
alcohol-induced increase in gut permeability. The
fact that dialysis is effective in the treatment of
psoriasis
34-37
indicates there may be substances in
the blood, removed through dialysis, that can ex-
acerbate psoriasis, such as endotoxins, immune
complexes, or other substances related to the
body’s immune reaction. The authors believe this
elusive mechanism involving the gastrointestinal
tract, liver, and bloodstream holds the key to the
core cause, and therefore effective treatment, for
psoriasis. If this is the case, topical treatments or
systemic anti-inflammatory medications are do-
ing little to treat the cause of psoriasis. Perhaps
this is why so few psoriasis treatments are suc-
cessful.
Generous consumption of fresh fruits and
vegetables was also a significant feature of the diet
of the test subjects. The resulting boost in con-
sumption of fiber may have aided in diminishing
psoriasis symptoms. Both bacteria and yeasts in-
habit the bowels and produce byproducts that may
be carried away by fiber components
52
for elimi-
nation. Further hypothesizing the autointoxication
theory, some of these byproducts from the intes-
tine, such as endotoxins, may enter the systemic
circulation due to intestinal hyperpermeability,
leading to higher skin cGMP levels and the re-
sulting rapid skin cell proliferation seen in
psoriatics.
52
By increasing daily fiber intake it is
possible to decrease the absorption of endotox-
ins, which could reduce cGMP levels in skin. Some
researchers suggest a high-fiber, vegetarian diet
also supports a healthy balance of normal intesti-
nal microflora. Conversely, a diet high in animal
protein encourages the growth of the microorgan-
isms that produce endotoxins.
53,54
Another aspect of diet that has been re-
searched among psoriasis patients is the use of
omega-3 fatty acid supplementation. Overall, fish
oil consumption results in mild-to-modest im-
provement in psoriatic symptoms,
16,55-57
although
some studies show fish oil was not superior to corn
oil
58
or olive oil.
59
Psoriatic plaques have been
shown to increase arachidonic acid and leukotriene
levels
60
compared to normal skin. Arachidonic acid
is an omega-6 fatty acid contained in animal prod-
ucts that, when metabolized, produces potent in-
flammatory leukotrienes. Leukotrienes are pro-
moters of increased cGMP levels.
16,60
On the other
hand, eicosapentaenoic acid (EPA), one of the
active components of fish oil, serves as a substrate
for the production of anti-inflammatory prostag-
landins.
61
In most of the studies employing fish
oil supplementation, the diets of the subjects in-
volved were not altered
55,57,62
and results have
shown only slight improvement. This may have
been due to the fact that study subjects continued
to eat red meat; hence, arachidonic acid was in
competition with the EPA. In the present study,
however, all meat from sources other than fish,
fowl, and lamb were excluded. Although arachi-
donic acid levels were not measured in this study,
decreasing the intake of red meat and therefore
arachidonic acid, and substituting protein from
fish, consequently increasing EPA levels, may
have contributed to decreased levels of
leukotrienes, cGMP, and cellular proliferation.
Alternative Medicine Review
Volume 9, Number 3 2004 Page 305
Case Report Psoriasis
Copyright©2004 Thorne Research, Inc. All Rights Reserved. No Reprint Without Written Permission
Supplementation with certain herbal teas
can improve inflammatory conditions. Yellow saf-
fron (Carthamus tinctorius) has been shown to
possess anti-inflammatory
63,64
and immune-modu-
lating properties.
65
Slippery elm (Ulmus fulva) is
an herb used traditionally for digestive difficul-
ties, stomach and intestinal ulcers, and colitis. It
is a demulcent, high in mucilage, noted for its
ability to soothe or protect irritated mucous mem-
branes, and perhaps acts as an inflammatory
agent.
66
In all five cases in this study, intestinal
permeability improved during the course of treat-
ment according to the lactulose/mannitol test
(Table 2). However, interpretation of the role of
permeability is complicated by the fact that in only
two cases was initial permeability outside the
norms provided by the testing laboratory. It is pos-
sible the dietary regimen employed in this study
reduced intestinal permeability to previously
present dietary compounds, despite the fact per-
meability was in the normal range in several cases.
Further research could be directed toward analy-
sis of skin cAMP, cGMP, and polyamine levels,
as well as intestinal permeability in response to
the Edgar Cayce diet.
These preliminary results are interesting
and further research is warranted in order to de-
termine if diet can truly play a significant role in
the observed reduction of psoriatic symptoms. The
study should employ a specific “psoriasis diet”
combined with a diet diary prior, during, and after
the study to ensure compliance and to allow di-
etary analysis of total nutrients. Measurable out-
comes should be evaluated again four weeks after
the diet’s cessation to determine the frequency and
severity of relapse.
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... Psoriasis has a multifactorial inheritance and the severity of disease may depend on environmental, dietetic, genetical, geographical, and psychological factors. Incidence of psoriasis among total skin patients range between 0.44% and 2.2%, with an overall incidence of 1.02%, in India. 1 The onset of psoriasis is found to have a bimodal pattern of onset (18)(19)(20)(21)(22) and 57-60 years), 2 with almost equal distribution among both sexes. 3 Psoriasis affects the physical, psychological, and social state of the individual owing to the stigmata associated with it. ...
... Many patients with aggressive disease remain unresponsive to existing methods and hence effective and tolerable therapy, which can be used long-term, is needed to address the physical stigmata of psoriasis. The comprehension that plaque psoriasis is a chronic immune-mediated disease which involves a complex interplay of T cells, natural killer cells, dendritic cells, macrophages, and other leukocytes; and the studies, with an unknown etiology and link to inflammatory and immune-mediated mechanisms, 20 suggest the need of a therapy that can act from deep within the body such as Panchakarma to expel the toxic accumulates in affected tissues and to clear the body channels. ...
... Brown et al. (19) reported a series of five case reports, each of which was unique. ...
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Background: When it comes to barrier and pore creation in metazoans, especially vertebrates and tunicates. Claudins are an important family of transmembrane proteins. In epithelia and endothelia's apical junctional complex, chordate claudins are crucial architectural proteins for tight junction strands. Psoriasis patients often have some degree of subclinical intestinal irritation. In gastrointestinal mucosal biopsies, lymphocytic infiltration is found in about 60% of patients. Intestinal absorption is hampered by structural and functional changes in the colon caused by inflammatory cells. Those who have psoriasis have abnormalities in fecal fat excretion, decreased D-xylose absorption, and impaired lactase activity.Objective: To assess the relation between CLAUDIN-3 protein with dermatological diseases. Conclusion: Claudin-3 is a key component of tight junctions, which may serve as marker of gut barrier integrity. Claudin-3 level may be altered in patients with psoriasis. © 2021, Ain Shams University Faculty of Medicine. All rights reserved.
... 13 Based on Edgar Cayce's readings on psoriasis, treatment protocol should include a dietary regimen and herbal supplementation, and should address intestinal permeability. 14 Ford and colleagues recommend dietary weight reduction in overweight and obese psoriasis patients. They suggest that selection of foods, nutrients, and dietary patterns may affect psoriasis, and argue that dietary interventions should always be used in conjunction with standard medical therapies. ...
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Background: Currently, there is no effective long-term treatment for psoriasis by conventional medicine. Thus, several alternative treatments are currently used to attenuate the severity, including herbal and dietary supplements. Primary study objective: The aim of this study was to investigate the effect of a mixture of traditional Jordanian herbal supplements on psoriasis treatment. Methods/design: A retrospective case study was conducted at The Herbal Dynasty Medical Center, Jordan. Three psoriasis patients were selected to participate (2 males; 1 female); patients obtained their diagnosis by a physician. Participants were prescribed a specific dose of 2 capsules daily of the herbal supplement, which consisted of dandelion, olive leaf, nettle leaf, and turmeric, along with 2 capsules of milk thistle half an hour before breakfast. Participants were instructed to follow therapy protocol for 5 consecutive months. The psoriasis area and severity index score was calculated pretreatment and posttreatment. Results: The 3 psoriasis cases were diagnosed as mild, moderate, and severe at the study onset. The severity index scores were 3.2, 14, and 16.2, respectively, and improved posttreatment to 0, 0.8, and 2, respectively. Conclusion: Traditional herbal supplementation was shown to be beneficial for the treatment of psoriasis.
... Ulmus rubra is used in wounds, boils, cystitis, and irritable bowel syndrome. A study conducted on five patients, ranging from mild to severe psoriasis at the study onset, improvements in all measured outcomes were observed over a 6-month period when measured by the Psoriasis Area and Severity Index (Brown et al., 2004). ...
... 35 These findings corroborate the results of a study carried out in Hawaii with five patients who showed improvement in PASI of 47.8% when submitted for ten days to a diet rich in fish, whole foods, fruits, vegetables, nuts, and herbal teas. 36 In the present study, the prevalence of obesity was 48%. Obesity is a growing public health challenge, and is more prevalent among individuals with psoriasis (34%) than in the general population. ...
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Background Psoriasis is a chronic inflammatory disease with systemic repercussions and an association with comorbidities such as metabolic syndrome, cardiovascular diseases, and obesity. Psoriasis patients have a higher prevalence of obesity compared to the general population. Diet is a relevant environmental factor, as malnutrition, inadequate body weight, and metabolic diseases, in addition to the direct health risk, affect the treatment of psoriasis. Objectives To evaluate food intake patterns, anthropometric, and metabolic syndrome-related aspects in psoriasis patients. Methods Cross-sectional study through anthropometric assessment and food frequency questionnaire. Food frequency questionnaire items were evaluated by exploratory factor analysis and identified dietary patterns were analyzed by multivariate methods. Results This study evaluated 94 patients, 57% female, with a mean age 54.9 years; the prevalence of obesity was 48% and of metabolic syndrome, 50%. Factor analysis of the food frequency questionnaire identified two dietary patterns: Pattern 1 – predominance of processed foods; Pattern 2 – predominance of fresh foods. Multivariate analysis revealed that Patterns 1 and 2 showed inverse behaviors, and greater adherence to Pattern 2 was associated with females, eutrophic individuals, absence of lipid and blood pressure alterations, and lower waist-to-hip ratio and skin disease activity. Study limitations Monocentric study conducted in a public institution, dependent on dietary memory. Conclusion Two dietary patterns were identified in a Brazilian sample of psoriasis patients. The prevalence of obesity and metabolic syndrome were greater than in the adult Brazilian population. The fresh diet was associated with lower indicators of metabolic syndrome in this sample.
... Natural treatment: A study on five cases of psoriasis over a six month period validated the beneficial role of diet which is rich in fresh fruits and vegetables, small amounts of protein from fish and fowl, fiber supplements, olive oil and herbal teas when assessed by PASI (psoriasis area and severity index) score and PSS (psoriasis severity scale) score [44]. Some studies suggested the beneficial role of 'Gluten' free diet in different dermatological disorders including psoriasis [45][46][47]. ...
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The main objectives of this review article are to discuss different aspects of psoriasis including its etiology, pathogenesis, co-morbidities, complications and management etc. and to discuss about psychosocial impact & quality of life in the patients of psoriasis. Psoriasis is one of the most common dermatologic diseases affecting upto 2.5 % of world population. The disease psoriasis, most commonly manifests on the skin of the elbows, knees, scalp, lumbosacral areas, intergluteal clefts and glans penis. In 30% of patients, the joints are also affected. The skin is the important organ of communication with the external world and have an eternal relationship with mind (psyche). Therefore, more than a cosmetic nuisance, psoriasis produces anxiety, depression and other psychological problems that affect the quality of life. Psychological factors have traditionally been associated with the onset, development and persistence of psoriasis. Stress is emphasized as one of the major important factors in the initiation or exacerbation of psoriasis. Patients of psoriasis always experience physical, mental and socioeconomic embarrassment in the society. This embarrassment leads to mental stress which further causes aggravation of pre-existing disease. Psoriasis is now considered a complex, chronic, multifactorial, inflammatory disease with involvement of immunological, genetic and environmental factors.
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Maintaining healthy skin is important for a healthy body. At present, skin diseases are numerous, representing a major health problem affecting all ages from neonates to the elderly worldwide. Many people may develop diseases that affect the skin, including cancer, herpes, and cellulitis. Long-term conventional treatment creates complicated disorders in vital organs of the body. It also imposes socioeconomic burdens on patients. Natural treatment is cheap and claimed to be safe. The use of plants is as old as mankind. Many medicinal plants and their parts are frequently used to treat these diseases, and they are also suitable raw materials for the production of new synthetic agents. A review of some plant families, viz., Fabaceae, Asteraceae, Lamiaceae, etc., used in the treatment of skin diseases is provided with their most common compounds and in silico studies that summarize the recent data that have been collected in this area.
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Increased intestinal permeability, known as leaky gut syndrome, occurs when the intestinal lining of the gastrointestinal tract has been damaged. The influx of unwanted material in the bloodstream can induce an immune response releasing proinflammatory cytokines that have been thought to be correlated with dermatologic conditions. We aimed to evaluate the role of leaky gut in dermatological conditions. PubMed and Embase were systematically searched through September 2020 for clinical studies that measured intestinal permeability in participants with a dermatological condition. We identified 20 studies including participants with dermatitis herpetiformis, atopic dermatitis/eczema, systemic sclerosis, psoriasis, bullous pemphigoid, and pemphigus vulgaris/foliaceus. Atopic dermatitis was the most well studied. Studies utilized a range of measures of intestinal permeability, including sugar excretion tests and serum markers. For all disorders reviewed, except bullous pemphigoid and pemphigus vulgaris/foliaceus, there was evidence of increased intestinal permeability in the disease state compared with controls. The range of methodology across clinical studies makes it difficult to draw conclusions across results. In addition, studies tended to be small, and only one study included an intervention to target leaky gut syndrome. We have found preliminary evidence of a relationship between leaky gut and certain dermatological conditions.
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Psoriasis is a chronic autoimmune condition characterized by patches of abnormal skin. Currently, there is no cure for psoriasis, and treatment strategies aim to reduce the severity of symptoms. We report the case of a 71-year-old female with severe psoriasis under treatment with topical steroids, ultraviolet light, and immunosuppressants for 13 years. After receiving intravenous nutritional therapy, antihistamines, and adrenal extract, the patient experienced almost complete resolution of psoriatic patches on her body.
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Background Gut dysbiosis and increased intestinal permeability play a significant role in the pathogenesis of psoriasis and its comorbidities. Claudin‐3 is a key component of tight junctions, which may serve as marker of gut barrier integrity. Objectives The aim of the study was to investigate circulating plasma claudin‐3 in patients with psoriasis and to evaluate clinical and metabolic factors, which determine its concentration. Methods This cross‐sectional study included 60 patients with psoriasis (39 men and 21 women, mean age: 45.6±12.1 years) and 30 healthy controls (18 men and 12 women, mean age: 46.3±15.5 years) age, sex and body mass index‐matched. Plasma claudin‐3 concentration was measured using an enzyme‐linked immunosorbent assay. Results Plasma claudin‐3 concentration was significantly higher in patients with psoriasis in comparison to healthy control [median (interquartile range), 50.7 ng/ml (47.3‐54.2) vs 43.3 ng/ml (42.3‐44.2), p < 0.001]. Patients who achieved ⊗PASI90 response after 16 weeks of treatment showed tendency to decrease in circulating claudin‐3 plasma concentration. Positive correlations between claudin‐3 concentration and the PASI score (r = 0.828; p < 0.001) as well as claudin‐3 and neutrophil‐to‐lymphocyte ratio (r = 0.847; p < 0.001) were found. A multivariable linear regression analysis confirmed association of claudin‐3 with the PASI score (p < 0.001), neutrophil‐to‐lymphocyte ratio (p < 0.01) and active smoking (p < 0.05). Conclusion Claudin‐3, a biomarker for gut permeability, is increased in psoriasis and correlates with disease severity and smoking. Further investigations are needed to determine whether reinforcing intestinal barrier may be a new therapeutic target in psoriasis. This article is protected by copyright. All rights reserved.
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We have conducted a case-control study to explore the relation between the consumption of selected foods and psoriasis. The out-patient services of nine teaching hospitals and five general hospitals in northern and southern Italy took part. Cases were newly diagnosed psoriatics with a history of skin problems of no more than 2 years. As controls, we selected subjects with newly diagnosed skin conditions, other than psoriasis, who were seen in the same out-patient clinics. Inclusion of cases and controls was limited to the age group 16-65 years. A total of 316 psoriatics and 366 controls were recruited. Anthropometric measures, including height and weight, were obtained. Diet was assessed by a semiquantitative food frequency questionnaire. Psoriasis appeared to be positively associated with body mass index (chi(1)(2) trend 4.3, P < 0.05). Significant inverse relations with psoriasis were also observed for the intake of carrots (chi(1)(2) trend 4.8, P < 0.05), tomatoes (chi(1)(2) trend 26.3, P < 0.01), fresh fruit (chi(1)(2) trend 11.7, P < 0.01) and index of beta-carotene intake (chi(1)(2) trend 9.1, P < 0.01). Although largely explorative, these results provide some evidence for a potential role of diet in psoriasis.
Article
plaque-type psoriasis has been successfully treated with oral calcitriol. but there has been no long-term follow-up on the safety and efficacy of this calciotropic hormone for psoriasis. In a single centre study, patients were enrolled in an open trial to evaluate the efficacy and safety of oral calcitriol for psoriasis. Of the 85 patients who received oral calcitriol, 88.0% had some improvement in their disease: 26.5, 36.2 and 25.3%. had complete, moderate and slight improvement in their disease. respectively. The mean baseline psoriasis area severity index score (PASI) of 18 4 ± 1.0 was reduced to 9.7 ±0.8 and 7.8±1.3 after 6 and 24 months on oral calcitriol therapy. Serum calcium concentrations and 24 h urinary calcium excretion increased by 3.9% and 148.2%, respectively. but were not outside the normal range. Bone mineral density remained unchanged. The clearance of creatinine decreased by 13 4% from baseline during the first 6 months of treatment, and thereafter. remained unchanged after 3 years of follow up. An evaluation of creatinine, inulin and para-aminohypurate (PAH) clearance was performed in eight patients. After 6 months on oral calcitriol. there was a 22.5% decline in creatinine clearance but no significant changes were observed in either inulin or PAH clearance, suggesting that calcitriol alters creatinine metabolism or secretion hut does not affect renal function. Oral calcitriol is effective and safe for the treatment of psoriasis.
Article
The purpose of this study was to investigate whether fish oil and/or corn oil had a beneficial effect on the clinical state of atopic dermatitis, and to evaluate the dietary intake of nutrients in this group of patients. In a double-blind, multicentre study lasting 4 months, during wintertime, 145 patients with moderate to severe atopic dermatitis were randomly assigned to receive either 6 g/day of concentrated n-3 fatty acids, or an isoenergetic amount of corn oil. As local treatment, only an emollient cream or hydrocortisone cream was allowed. The fatty acid pattern in serum phospholipids, and the dietary intake of nutrients were monitored in a subgroup of patients, and the results were compared with a group of patients with psoriasis. The overall clinical score, as evaluated by the physicians, improved during the trial by 30% in the fish oil (P < 0.001) and 24% in the corn oil group (P < 0.001). This was also consistent with the results from a selected skin area, and it was further confirmed by the total subjective clinical score reported by the patients. There were no significant differences in the clinical scores between the two groups at baseline, and at the end of the study. In the fish oil group, the amount of n-3 fatty acids in serum phospholipids was significantly increased at the end of the trial, compared with pretreatment values (P < 0.001), whereas the level of n-6 fatty acids was decreased (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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In this issue of the Archives (page 945), Proctor et al report additional data that strongly support the proposition that polyamines may be of importance in the pathophysiology of psoriasis. Since polyamines play a key role in cell proliferation, a potentially productive approach to psoriasis therapy may be the inhibition of polyamine production in lesions. Interest in polyamine research is very recent. The biochemistry texts used by most of us in medical school did not mention polyamines. However, lack of familiarity should not be a deterrent to an appreciation of this exciting new field. The polyamines are low molecular weight organic amines. Putrescine, a simple diamine, is the precursor of the two polyamines, spermidine and spermine. The first polyamine was discovered in 1678 by Antony van Leeuwenhoek, who used his primitive microscope to observe the crystallization of spermine phosphate in human semen. We now know that polyamines are involved in
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