Psoriasis, Psoriatic Arthritis Patients Benefited from Mediterranean-Ketogenic Diet Program

Credit: Pexels

A 22-week combination Mediterranean–Ketogenic diet program designed for individuals with psoriasis (PsO) and psoriatic arthritis (PsA) may result in benefits reflected in the indices of disease activity, according to recent findings.¹

The ketogenic diet element of the program was the primary diet attributed to these benefits, though beneficial tendencies were also seen with the Mediterranean diet element.

The 22-week diet program in patients with PSO and PSA led to beneficial results in markers of inflammation and disease activity, which were mainly attributed to ketogenic diet. The investigators of this research highlighted that the impacts of such diets on psoriatic disease are still relatively unknown.²

This research was led by Vaia Lambadiari, MD, PhD, from the second department of internal medicine at Attikon University Hospital of the National and Kapodistrian University of Athens, Greece. Lambadiari and colleagues wrote that their goal was to assess the efficacy of a Mediterranean and ketogenic diet for both psoriasis and psoriatic arthritis.

Background and Methods

“Our objective is to investigate the hypothesis that beyond the weight loss, the overall management of inflammation, achieved with (ketogenic diet) for a short period of time, may lead to faster beneficial results for patients with obesity and psoriasis,” Lambadiari and colleagues wrote.

The study involved 16 subjects with psoriasis and psoriatic arthritis, and they had met the inclusion criteria such as having a BMI of 30 kg/m2 or more, being aged 18 or older, and being given continuous systemic treatment with biologic agents and/or synthetic DMARDs for a minimum of 3 total months.

Study participants also had to have a Psoriasis Area and Severity Index (PASI) score improvement of less than 75% and moderate to severe joint activity, the latter of which was defined by the investigators as having >3 swollen and >3 tender joints or Disease Activity Index of Psoriatic Arthritis (DAPSA) of < 14. Criteria for exclusion from the study included participation in other research, malignancy, eGFR < 60 mL/min/1.73 m2, having a severe hepatic disorder, HbA1C > 10%, and the current use of glucagon-like-peptide-1 analogues.

The design itself was a randomized, open-label, controlled crossover trial design, and it occurred from May 2020 - January 2022. It was conducted at the Unit of Diabetes, Second Department of Internal Medicine and was done in collaboration with the Attikon University Hospital dermatology department, at which evaluations, medical assessments, and lifestyle intervention meetings took place.

The investigators randomly divided participants into 2 cohorts, providing them either with a Mediterranean diet or a ketogenic diet for 8 weeks. After a 6-week washout period, the research team switched each cohort to the alternate diet for another 8-week period of study.

The team collected various types of baseline data such as participants’ gender, age, smoking habits, consumption of alcohol, levels of physical activity, dietary patterns, and medical history. They gave each subject a physical examination, taking their anthropometric measurements, giving them a PASI and DAPSA assessment, and doing blood sampling for inflammatory and hormonal markers.

The main outcome measure the investigators evaluated was the change observed in subjects’ disease activity clinical scores (PASI, DAPSA) following 8 total weeks of ketogenic diet compared to the same period with the other diet. Some of the team’s secondary endpoints they assessed included inflammatory marker changes (IL-6, IL-17, IL-22, IL-23) as well as anthropometric parameters.

Findings

Overall, the investigators ended up reporting that both the Mediterranean and ketogenic diets led to major reductions in participants’ BMI (P = .006, P < .001, respectively), weight (P = .002, P < .001, respectively), total fat mass (P = .007, P < .001, respectively), circumference of waste (P = .001, P < .001, respectively), and levels of visceral fat (P = .01, P < .001, respectively) as opposed to the levels at baseline.

Individuals involved who used the ketogenic diet were also shown to have substantial PASI score decreases (P = .04) as well as decreases in IL-6 (P = .047), IL-17 (P = .042), DAPSA (P = .004), and IL-23 (P = 0.037). The research team noted that no major shifts were observed in these markers after following the Mediterranean diet (P > .05) compared to the point of baseline.

“Although the effects of (Mediterranean diet) and (ketogenic diet) are well established in a range of cardiometabolic diseases, their possible efficacy as an adjunct treatment to conventional pharmacological therapy in patients with psoriasis is a novel clinical implication,” they wrote. “These findings further establish the association between dietary interventions and auto-inflammatory disorders and emphasize the need for more, large-scale interventional trials to compare different dietary patterns.”

References

1. ^{Lambadiari V, Katsimbri P, Kountouri A, et al. The Effect of a Ketogenic Diet versus Mediterranean Diet on Clinical and Biochemical Markers of Inflammation in Patients with Obesity and Psoriatic Arthritis: A Randomized Crossover Trial. International Journal of Molecular Sciences. 2024; 25(5):2475. https://doi.org/10.3390/ijms25052475.}
2. ^{Itsiopoulos C, Mayr HL, Thomas CJ. The anti-inflammatory effects of a Mediterranean diet: A review. Curr. Opin. Clin. Nutr. Metab. Care 2022, 25, 415–422.}