Dietary and Lifestyle Considerations
Diet and Exercise
Mediterranean diet. The Mediterranean diet is a healthy eating pattern characterized by generous amounts of fruits and vegetables, whole grains, legumes, fish, seafood, and nuts. Few dairy foods and little meat and meat products are consumed. The diet is rich in extra virgin olive oil, and also includes moderate alcohol intake in the form of wine with meals (Barrea 2015).
A 2015 study found strict adherence to a Mediterranean-style diet reduces severity of psoriasis. Notably, higher consumption of extra virgin olive oil and fish were independently associated with lower psoriasis severity (Barrea 2015; Steffen 2014).
Gluten-free diet. Compared with the general population, patients with psoriasis and psoriatic arthritis have a greater frequency of concurrent autoimmune diseases, including celiac disease. A 2014 review concluded that a gluten-free diet may benefit psoriasis patients who have elevated celiac disease antibodies. In some cases, complete clearance of psoriatic skin was reported following a gluten-free diet (Bhatia 2014; Wu 2012; Addolorato 2003).
Weight loss. A rigorous review and analysis of the medical literature determined that weight loss by means of diet and lifestyle interventions reduces the severity of psoriasis in overweight or obese patients (Upala 2015). Several healthy weight loss strategies are described in the Weight Loss protocol.
Environmental therapy comprises the utilization of environmental factors (eg, sunlight, salt and mineral baths, unique properties of certain geographic regions and climates) to modify the course of a disease. These therapies have been in use for thousands of years, including by the ancient Greeks and Romans. Climatotherapy and balneotherapy are overlapping treatment strategies shown to be beneficial in psoriasis (Riyaz 2011; Kopel 2013; Klein 2011; Roos 2010; Harari 2012).
Climatotherapy. Climatotherapy is based on the healing capacities of environmental factors associated with certain climatic locations, including air, temperature, humidity, barometric pressure, and light. Climatotherapy at the Dead Sea in particular is an effective natural treatment for psoriasis. The low altitude of the Dead Sea—the lowest human-inhabited place on earth at 419 meters below sea level—results in lower-intensity ultraviolet radiation, reducing risks associated with greater exposure duration; also, the unique spectrum of radiation in this region may be particularly beneficial for skin diseases. Bathing in the Dead Sea, which is the saltiest sea in the world and has extremely high mineral concentration, may normalize skin cell proliferation rate (Kazandjieva 2008; Riyaz 2011; Kopel 2013).
Studies of psoriasis patients undergoing Dead Sea climatotherapy have reported impressive results: high response rate, long periods of remission, and partial to complete plaque clearance (Kazandjieva 2008). In one study, Dead Sea climatotherapy improved plaque psoriasis disease severity by 95% in up to three-quarters of subjects. Patients with early-onset psoriasis responded better than late-onset patients (Harari 2012). In another study, Dead Sea therapy resulted in significant improvement in the quality of life of patients with psoriasis and psoriatic arthritis (Kopel 2013).
Balneotherapy. Balneotherapy is the medical use of mineral water and mud baths (Riyaz 2011). In a randomized clinical trial, synchronous balneotherapy—artificial balneotherapy that simulates conditions at the Dead Sea—was superior to UVB phototherapy after 35 treatment sessions and six months of follow-up (Klein 2011). A review of studies found positive clinical results and long remission periods for both natural and artificial balneotherapy (Roos 2010).
Moderate sun exposure (heliotherapy). Two studies, which included a total of 30 patients with moderate-to-severe psoriasis, demonstrated that exposure to sunlight resulted in substantial clinical improvement. All patients stopped taking psoriasis medication four weeks before beginning heliotherapy. The treatment began with 45 minutes of sun exposure on both front and back of the body, with a gradual increase in exposure over the following days. The trials lasted 16 days. No sunburn occurred in these studies. A dramatic reduction of inflammatory cell numbers preceded the skin improvements, suggesting sunlight may act through immune system modulation (Heier 2011; Søyland 2011).
It is important that sun exposure be limited to a duration that does not result in sunburn. While moderate sun exposure may be beneficial in psoriasis, skin damage caused by sunburn may be detrimental (PAPAA 2015).
The American Academy of Dermatology has called the use of unmedicated topical moisturizers “ an internationally accepted standard adjunctive therapeutic approach to the treatment of psoriasis.” In fact, in controlled trials of corticosteroid topical treatments, in which placebo is essentially an unmedicated moisturizer, placebo response rates of up to 47% have been found, suggesting moisturizers alone have a beneficial effect in psoriasis (Menter 2009).
Various preparations can be used as moisturizers or emollients, including creams, ointments, and oils. Patients should incorporate topical moisturizers into their routines, with application twice daily and after bathing. Using fragrance-free products and washing with moisturizing soaps is also recommended (Schalock 2014; NPF 2015a). Moisturizers promote skin rehydration by reducing water loss through evaporation (Ferri 2015).
Chronic sleep deprivation impairs the skin’s integrity, weakens its function as a protective barrier, and exacerbates the inflammation of psoriasis (Oyetakin-White 2015; Hirotsu 2012; Kahan 2010; Axelsson 2010).
Melatonin, a hormone produced mainly by the brain’s pineal gland, may play a role in the increased risk of psoriasis associated with sleep disruption. Secreted only during darkness, melatonin regulates the circadian sleep-wake cycle, promotes sleep, and modulates inflammation and immune function (NIH 2015; Li, Qureshi 2013; Esposito 2010; Radogna 2010). Studies have shown that nighttime melatonin levels are significantly lower in psoriasis patients compared with controls (Li, Qureshi 2013; Kartha 2014; Esposito 2010; Mozzanica 1988). Some researchers propose that sleep loss and circadian rhythm disruption should be considered risk factors for the development of psoriasis (Hirotsu 2012; Ando 2015).
A number of strategies for improving sleep quality are described in Life Extension’s Insomnia protocol.
Emotional stress is often a consequence of dealing with psoriasis, but increasing evidence suggests stress also contributes to the development and exacerbation of psoriasis (Ni 2014; Brunoni 2014; Hall 2012; Hunter 2013). Stressful life events have been reported to precede the onset of psoriasis in 44% of patients and trigger flare-ups in 88% of psoriasis patients (Hall 2012). Research suggests the body’s stress response may be impaired in psoriasis (Richards 2005). Therefore managing stress is an important goal for psoriasis patients. More information is available in Life Extension’s Stress Management protocol.