Диеты кето и постоянное ограничение калорий эффективнее интервального голодания при псориазе

Keto, calorie restrictive diets outperform intermittent fasting for psoriasis management Key takeaways: - Adhering to continuous caloric restriction or a keto diet may improve psoriasis disease severity and induce weight loss. - Intermittent fasting was associated with modest psoriasis benefits. Continuous caloric restriction or a keto diet combined with systemic therapy may improve psoriasis severity, according to a systematic review published in the Journal of Drugs in Dermatology. Researchers found that adhering to one of these diets while receiving systemic dermatologic treatment resulted in substantial weight loss and reduction in inflammatory biomarkers among patients with psoriasis. Intermittent fasting showed fewer benefits for psoriasis severity. “The benefit comes primarily from sustained caloric deficit and metabolic change, not from fasting timing,” Ahmed N. Alqefari, MBBS, a medical student at the College of Medicine at Qassim University in Saudi Arabia, told Healio. “We concluded that achieving the caloric deficit makes patients more likely to experience better PASI outcomes and, thereby, better metabolic changes.” ‘Inconsistent impact’ with intermittent fasting The researchers evaluated 30 studies with 2,073 participants conducted between 2003 and 2025, including randomized parallel group trials, single-arm, open-label trials and prospective observational studies. The pooled mean age across studies was 48.4 years, and approximately half of participants were men for most studies. Patients followed an intermittent fasting protocol (n = 373), defined as an eating pattern that cycles between set periods of eating and fasting, a keto diet (n = 74), which includes abstaining from carbohydrates and instead consuming high amounts of fat and moderate amounts of protein, or continuous caloric restriction (n = 1,627), where participants eat fewer calories than their body needs every day. The studies on intermittent fasting showed that mean PASI scores dropped from 8.3 at baseline to 5.0 at week 16 and 5.7 at week 28. Other studies reported a 1-month PASI of 3.1, reflecting an average PASI reduction of -0.87 (P < .0001 to P = .001), according to the researchers. Weight remained stable among participants following an intermittent fasting diet; however, high-sensitivity C-reactive protein levels fell from a mean of 4.4 mg/L at baseline to 2.3 mg/L at 28 weeks, suggesting reduced inflammation over time, the researchers wrote. “The modest efficacy of intermittent fasting, often limited to adjunctive settings, can be explained from its reliance on time-restricted feeding without enforced caloric deficits, leading to minimal metabolic shifts compared with keto or continuous calorie restriction,” the researchers wrote. “For instance, while intermittent fasting enhances autophagy and circadian alignment, potentially dampening IL-6 and high-sensitivity C-reactive protein, its inconsistent impact on weight suggests insufficient disruption of the obesity-psoriasis axis.” Symptom improvements with keto, calorie restriction plans Participants in the keto studies saw mean PASI scores fall by 64%, with DLQI improving by a mean of 13.4 points across studies. Keto participants had average weight loss of 10.2 kg and an average 4.2 kg/m2 reduction in BMI. Multiple inflammatory markers also improved, including a mean 55.6% reduction in interleukin-6. According to Alqefari, following the keto diet resulted in only mild adverse events, such as hunger and fatigue, in 18% to 27% of participants. “In fact, there were no significant adverse events for any of these three methods,” Alqefari said. “Since the keto diet has more of a stigma, this was reassuring to see.” Continuous caloric restriction showed the highest efficacy for reducing psoriasis severity and inducing weight loss, according to Alqefari. The strongest response occurred among patients who were also receiving a biologic for their disease, with 84% reaching PASI 75. Patients lost an average of 8.5 kg, or 5% to 16% of their baseline weight and experienced a 3- to 6-unit reduction in their BMI. Researchers also observed improvement in patients’ inflammatory biomarkers. “For an obese patient with severe disease, ketogenic diets showed the largest effect,” Alqefari said. “For everyone else, continued caloric restriction had the deepest evidence base with 21 studies and substantially more patients.” Limitations of the study included a lack of head-to-head studies comparing the respective diets, a lack of long-term follow-up and limited participants in certain groups. “Patients with psoriasis consistently ask about diet, including which diet they should follow and which diet will give them the best outcomes, especially with obesity,” Alqefari told Healio. “It is important to tell patients that diet is an adjuvant for all treatments and should not substitute primary psoriasis therapies.” For more information: Ahmed N. Alqefari, MBBS, can be reached at [email protected].