In “Healing Psoriasis: The Natural Alternative,” Dr. John O.A. Pagano describes a method that he believed could cure psoriasis from the inside out using nutrition alone. The book’s many fans include members of MyPsoriasisTeam, and some health care providers recommend Dr. Pagano’s diet for people with psoriasis. However, there isn’t enough clinical research to scientifically support the book’s claims.

Here’s the evidence behind the Pagano diet, along with thoughts shared by MyPsoriasisTeam members who’ve tried it.

What Is the Pagano Diet?

Dr. Pagano was a chiropractic physician who conducted more than 50 years of psoriasis research and advocacy. Billed on the book’s cover as “the drug-free program that really works,” the Pagano diet is based on the premise that people with psoriasis have a condition called leaky gut syndrome that can be healed with specific whole foods, beverages, and nutrients. Several principles form the diet’s approach, and Dr. Pagano also discusses the benefits of stress management as part of a healthy lifestyle to reduce inflammation.

The Pagano diet’s recommendations include:

• Avoiding “acid-forming” foods, like most red meat and processed foods
• Consuming an alkaline diet full of certain fruits and vegetables
• Drinking fresh fruit and vegetable juices, along with plenty of water
• Eliminating nightshade vegetables (tomatoes, peppers, eggplant, and white potatoes)
• Limiting dairy (cow’s milk, yogurt, and cheese)
• Replacing coffee and alcohol with herbal tea

Protein on the Pagano diet comes from wild-caught fish, up to four eggs a week, poultry, and lamb (the only acceptable red meat on this eating plan). Grains with gluten (wheat, barley, and rye) are off-limits, and some brown rice is allowed. Although followers are advised to eat lots of fruits and veggies, some aren’t allowed, such as citrus and strawberries. Finally, added sugar and fried foods should be avoided.

Evidence Behind the Pagano Diet

No peer-reviewed studies focus on Dr. Pagano’s diet, so no clinical research results are available to establish its effectiveness. Instead, the plan is based on his personal journey with psoriasis, interactions with people he treated, and testimonials from those who have followed his advice. Nonetheless, certain aspects of the diet are evidence-based.

Psoriasis is an autoimmune disease, and inflammation is the underlying cause of symptoms and flare-ups. Therefore, avoiding inflammatory foods offers one way to avoid worsening inflammation. Many doctors and dietitians generally advise people with psoriasis to stay away from many of the types of foods and drinks discussed by Dr. Pagano, including those with:

• Added sugar
• Alcohol
• Dairy
• Gluten
• Refined carbohydrates
• Saturated and trans fats

However, not all of Dr. Pagano’s off-limit foods are widely considered harmful to people with psoriasis. For example, nightshade vegetables, shellfish, coffee, and even moderate alcohol consumption are part of the Mediterranean diet, which researchers frequently cite as one of the best anti-inflammatory diets for severe psoriasis.

In addition, researchers often criticize the theory behind the “alkaline diet” because the kidneys tightly regulate the body’s acid-base balance. Although it’s unlikely that consuming more alkaline foods will significantly alter your body’s pH, most of these foods are generally considered healthy. Alkaline foods include fruits, vegetables, whole grains, and healthy fats from nuts and seeds.

Finally, leaky gut syndrome, which Dr. Pagano blames for psoriasis breakouts, is not well understood. Researchers acknowledge the likely associations between gut health and systemic inflammation, but no official protocol is proven to diagnose or treat a leaky gut.

Should You Follow the Pagano Diet?

Dr. Pagano’s diet makes several recommendations that overlap with widely accepted dietary wisdom and research for treating psoriasis. However, it’s not clear that all the listed food triggers — particularly coffee, shellfish, nightshade vegetables, strawberries, and citrus fruits — apply to everyone. Needlessly restricting your diet may make life with psoriasis more difficult and less enjoyable. Cutting out nutritious foods that aren’t proven to negatively affect your skin may also put you at risk of malnutrition.

One MyPsoriasisTeam member explained their process for identifying food triggers through keeping a food diary: “Sometimes, you feel like you’re playing a game of Whac-A-Mole trying to figure out which food you react to. You may only react to a few items listed or maybe several. For instance, I don’t react to nightshades. I do react to nuts like cashews and almonds but not peanuts.”

Another member explained, “I found out I can’t eat yeast or excess sugars because they seem to make my psoriasis flare up. At first, I tried to eliminate gluten and go gluten-free but was still having flare-ups. So, I added it back into my diet and removed all yeast, which seemed to help out a ton.”

Even common psoriasis food triggers, like gluten, don’t apply to everyone. Keeping track of your symptoms and writing down what you eat can offer insight into your individual problem foods.

Perspectives From MyPsoriasisTeam Members

Members of MyPsoriasisTeam often discuss different lifestyle changes, including diets, to help improve their symptoms.

“Did anyone try a diet for their psoriasis, and did it give any relief?” asked a member of MyPsoriasisTeam. “I just started the diet of John Pagano and was curious about anyone’s experiences.”

One member responded, “I swear by Dr. Pagano and Edgar Cayce’s theories. I’m a strong believer. It’s a difficult lifestyle, but you should at least incorporate some of their theories.”

“I’ve been researching the diet aspect of psoriasis for a while — John Pagano and also Jason Vale, who suffered with psoriasis but used juicing to become 100 percent clear,” shared another member. “I think we get prescribed medicines too quickly without looking at lifestyle or alternatives. … I’m convinced psoriasis is a symptom of other health issues.”

Another explained their general approach to healthy eating: “My dermatologist said to stay away from sugar and carbs. I have also found that avoiding nightshade vegetables helps, such as tomatoes, potatoes, bell peppers, eggplant, and paprika. It also helps to incorporate more anti-inflammatory foods into your diet, such as carrots, tuna, sweet potatoes, eggs, and nuts. But stay away from alcohol.”

Next Steps

When dealing with an inflammatory condition like psoriasis, it’s important to remember that not everyone has the same triggers. Making some healthy changes may help, but there’s no proven one-size-fits-all diet to cure psoriasis. Keeping this chronic condition under control requires ongoing management and monitoring. Learning from others and reading up on different theories is a good starting point for your journey to a better life with psoriasis.

Always discuss any major changes to your diet with your health care provider. You can also ask for a referral for a registered dietitian nutritionist to explore different aspects of your eating plan. Dietary changes can complement other therapies, but don’t discontinue your prescribed psoriasis treatments without speaking with your dermatologist. Psoriasis can progress to psoriatic arthritis and other complications. Make your dermatologist your partner in treatment decisions, and get their feedback on any diets or lifestyle changes you’re considering.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 117,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Have you tried the Pagano Diet or other diets — like a Mediterranean-style, vegan, or gluten-free diet — for psoriasis? How have dietary changes affected your psoriasis flare-ups? Post your suggestions in the comments below, or start a conversation on your Activities page.