What is the best diet for managing psoriasis symptoms?

Best Diet for Psoriasis

There is no single "best" universal diet for psoriasis, but a gluten-free diet should be implemented only in patients with confirmed celiac disease or positive celiac antibodies, while omega-3 fatty acid supplementation and curcumin may be considered as adjunctive therapies to standard treatment. 1

Gluten-Free Diet: Targeted Approach Only

A gluten-free diet is recommended exclusively for psoriasis patients with confirmed celiac disease or positive celiac antibodies. 1

• Patients with moderate to severe plaque psoriasis should be screened for celiac disease by asking about gastrointestinal symptoms. 1, 2
• If celiac antibodies are positive, consultation with a gastroenterologist is advised for formal diagnosis and management. 1
• A 3-month trial of strict gluten-free diet may improve PASI scores in antibody-positive patients, though improvement is not guaranteed. 1
• Critical caveat: Gluten-free diets are highly restrictive and can negatively impact quality of life. 1
• For patients already following restricted diets (vegetarian, vegan, nut-free), nutritionist consultation is mandatory before eliminating gluten to prevent nutritional deficiencies. 1

Omega-3 Fatty Acids: Adjunctive Therapy

Fish oil/omega-3 supplementation is not effective as monotherapy but may augment other treatments. 1

• Omega-3 fatty acids can be added to topical, oral-systemic therapies, or phototherapy for chronic plaque psoriasis. 1, 3
• Patients must select supplements free of mercury, dioxins, and polychlorinated biphenyls (PCBs) due to contamination risk. 1
• Exercise caution in pregnant women. 1
• The bleeding risk with fish oil has been determined to be negligible and does not increase surgical bleeding. 1

Curcumin: Limited Evidence for Adjunctive Use

Oral curcumin supplementation may benefit patients with psoriasis of varying severity as adjunctive therapy, though evidence is limited. 1, 3

• Curcumin modulates T-helper type 22 cell activity and decreases epidermal proliferation. 1
• Piperine from black pepper enhances curcumin absorption. 1
• Curcumin has low toxicity but poor bioavailability. 1

What Does NOT Work

Oral vitamin D supplementation does not improve psoriasis disease activity at safe dosages. 1

• While topical vitamin D analogues are effective, oral supplementation does not directly improve disease activity at doses that avoid hypercalcemia and calciuria. 1
• Excess vitamin D supplementation may cause hypercalcemia toxicity. 1

Oral zinc supplementation does not improve PASI scores and is not recommended. 1

General Dietary Patterns from Patient Data

While not formally recommended in guidelines, patient-reported outcomes suggest certain dietary patterns may be beneficial:

• Reducing alcohol consumption showed skin improvement in 53.8% of patients surveyed. 4
• Diets rich in omega-3 polyunsaturated fatty acids, vegetables, and dietary fibers may ameliorate psoriasis through anti-inflammatory pathways. 5, 6
• Limiting saturated fatty acids, simple sugars, and red meat may reduce disease exacerbation. 5, 6
• Mediterranean, Paleolithic, and vegan diets showed favorable patient-reported responses (68.9-72.2% improvement). 4

Important Clinical Pitfalls

• Do not recommend gluten-free diets to all psoriasis patients—only those with confirmed celiac disease or positive antibodies benefit. 1
• Do not recommend oral vitamin D supplementation for psoriasis treatment—use topical vitamin D analogues instead. 1
• Do not use dietary interventions as monotherapy—they should only be adjunctive to evidence-based topical, phototherapy, or systemic treatments. 1, 3
• Weight management, smoking cessation, and alcohol limitation should be emphasized to improve disease severity and reduce comorbidity risk. 2