Could Psoriasis Begin in the Gut?
Updated: Aug 28
Psoriasis appears on the skin, so naturally this is where most attention goes. We see the redness, plaques and scaling, and the obvious question is what we can put on them to make them disappear. John O. A. Pagano asked a rather different question: what if the skin is not where the problem begins?
For more than forty years, Pagano developed an approach to psoriasis that looked inward, particularly toward the digestive tract, elimination, nutrition and the intestinal barrier. His central idea was that the visible eruption could be the end result of a much deeper process taking place within the body.
An Inside-Out Approach
John O. A. Pagano was a chiropractic physician based in Englewood Cliffs, New Jersey. He spent much of his professional life working with people suffering from psoriasis and eczema and became particularly well known within natural-health circles for his alternative approach to these conditions.
His best-known book, Healing Psoriasis: The Natural Alternative, presented psoriasis as something that should be approached “from the inside out.” He later expanded the underlying theory considerably in One Cause, Many Ailments: The Leaky Gut Syndrome, published by A.R.E. Press in 2008.
Pagano lectured internationally on psoriasis and described his work as the result of decades of observation and clinical experience. His ideas eventually took him well beyond skin disease and toward a much broader question: could apparently unrelated chronic illnesses sometimes share a common internal disturbance?
The Influence of Edgar Cayce
Pagano openly acknowledged that much of his thinking began with the medical readings of Edgar Cayce. Cayce had described psoriasis as being connected with abnormalities in the intestinal tract, assimilation, lymphatic circulation and elimination many years before Pagano began his own work.
Pagano took those ideas and tried to develop them into a practical clinical system. He combined Cayce's descriptions with his chiropractic background, dietary ideas, intestinal-permeability research and observations of his own patients. Pagano himself referred to what eventually became the Cayce-Pagano regimen.
If you would like to explore that background in more detail, read my article Edgar Cayce and Psoriasis. The Edgar Cayce organisation also has an overview of Cayce's original psoriasis material and its influence on Pagano's approach. Edgar Cayce: Psoriasis and the Cayce-Pagano approach
One Cause, Many Ailments
Pagano's later book, One Cause, Many Ailments: The Leaky Gut Syndrome, is particularly interesting because it moves beyond psoriasis. The book asks whether apparently unrelated conditions might sometimes share a common denominator. Pagano's proposed denominator was increased intestinal permeability, more popularly known as leaky gut syndrome. Psoriasis was one of the conditions through which he had originally developed this theory.
What interests me about this book is not simply the phrase “leaky gut.” That term is now used so frequently that it can become almost meaningless. Pagano was proposing something broader. He was asking whether the location of a symptom and the origin of a disturbance might be two different things. In other words, a skin problem does not necessarily have to begin in the skin.
The Intestinal Barrier
Pagano began with a simple physiological principle. The intestine has to allow certain substances to pass through its wall while preventing others from entering the body's internal environment. It must therefore be permeable, but selectively so. Pagano believed that chronic irritation could eventually make this barrier excessively permeable. Substances that should remain within the digestive tract could then pass through the intestinal wall and enter the lymphatic and blood circulation.
He described this as intestinal permeability or leaky gut. From there his model developed into a chain: intestinal irritation leads to abnormal permeability; unwanted substances enter the circulation; the body's normal mechanisms of elimination become overloaded; and eventually other tissues begin to express the disturbance. In psoriasis, he believed that tissue was frequently the skin.
The Skin as an Organ of Elimination
This is probably Pagano's most distinctive idea. He described psoriasis as the external manifestation of the body's attempt to dispose of internal toxins. In his model, the liver, kidneys and intestines ordinarily handle waste, but if the internal burden becomes too great, the skin begins acting as an additional route of elimination.
This turns the usual treatment question around completely. Instead of asking only, How do we remove these plaques?, Pagano asks, Why is the body producing them?
The psoriasis itself becomes a clue rather than the whole problem.
That does not mean the skin should be ignored. Pagano used oils, bathing, shampoos and other external treatments to make the skin more comfortable. But these were supporting measures. His main interest remained what was happening internally.
Assimilation and Elimination
Two ideas occur repeatedly in the Cayce-Pagano system: assimilation and elimination.
Assimilation concerns what happens to food after we eat it. Is it being properly digested? Are useful nutrients being absorbed? Is the digestive system functioning efficiently?
Elimination concerns what happens at the other end of the process. Is waste being removed effectively through the bowels, kidneys and other channels?
Pagano believed that disturbances in either direction could contribute to an unhealthy internal environment.
This is a more interesting concept than simply saying the body needs to “detox.” It asks us to consider the entire movement of nutrition through the body: digestion, absorption, utilisation and finally elimination.
Diet Was Central
Diet therefore occupied a major place in Pagano's psoriasis programme.
He favored a predominantly fresh, plant-rich diet and discouraged many foods he believed placed an unnecessary burden on the system. Refined sugar, heavily processed foods, fried foods and excessive alcohol were among the things he wanted considerably reduced or eliminated.
Pagano also became particularly well known for avoiding nightshade vegetables, especially tomatoes, white potatoes, peppers and eggplant. One of his patients later described being asked to remove nightshades, refined flour and refined sugar while following an alkalising dietary programme.
I am less interested in turning this into another rigid list of forbidden foods than in Pagano's underlying reasoning.
He believed that if something repeatedly contributes to the internal disturbance, it makes little sense to keep adding it while simultaneously trying to heal the effects.
Remove, Replace, Reinoculate and Repair
In One Cause, Many Ailments, Pagano broadened his treatment philosophy into what became a gut-restoration programme.
The basic aim was to remove suspected irritants, improve digestion, support beneficial intestinal organisms and allow the intestinal lining an opportunity to repair itself.
The emphasis was therefore not simply on taking a supplement or eliminating one food.
Pagano wanted to change the intestinal environment.
This is an important distinction because it moves the discussion away from searching for one miraculous psoriasis remedy and toward improving the conditions in which the body is functioning.
Slippery Elm and Safflower Tea
Two traditional remedies became closely associated with the Pagano programme.
One was slippery elm, which he used with the intention of soothing and supporting the intestinal lining.
The other was what Cayce had called American yellow saffron, generally understood in this context to mean safflower rather than culinary saffron.
These remedies make sense within Pagano's theory because neither was principally being used to treat the skin.
The target was further upstream.
If the intestinal wall was part of the problem, he believed the treatment should help restore the intestinal environment while improving digestion and elimination.
The Nervous System and the Spine
Pagano was a chiropractor, so it is not surprising that the nervous system also entered his model.
He believed that disturbances in spinal function could affect the autonomic nerves supplying the digestive organs. Poor digestive function could then contribute to abnormal assimilation, circulation and intestinal integrity.
This produces a surprisingly broad model of psoriasis.
Rather than simply gut causes skin, Pagano was thinking about relationships between the nervous system, digestive tract, circulation, nutrition, elimination and skin.
Whether every connection applies in every individual is another matter, but I find the systems approach itself valuable.
Candida and the Intestinal Environment
Pagano also devoted considerable attention to yeast and fungal overgrowth, particularly Candida albicans.
Again, his interest was not primarily in Candida as an isolated infection. He was concerned with the effect that an unhealthy intestinal environment might have on the integrity of the gut and, ultimately, the rest of the body.
This reflects another characteristic of Pagano's thinking.
Rather than repeatedly asking, What disease does this person have?, he often seems to have asked, What kind of internal environment has allowed this problem to develop?
That is a subtle but important difference.
One Cause Does Not Mean One Disease
The title One Cause, Many Ailments can sound as though Pagano believed every chronic illness had exactly one cause.
His argument is more interesting than that.
He proposed that abnormal intestinal permeability might act as a common underlying mechanism, while the eventual expression varied according to the individual.
One person's vulnerability might appear in the skin. Another person's might appear in the joints, digestive system or elsewhere.
The book discusses psoriasis alongside conditions as varied as arthritis, migraine, chronic fatigue, celiac disease and lupus as possible manifestations associated, in Pagano's model, with this common intestinal disturbance.
Why One Person Develops Psoriasis
This naturally raises another question.
If two people have similar diets and similar digestive disturbances, why does one develop psoriasis while another does not?
Pagano's model never completely reduces the individual to the gut. Constitution, heredity, nervous-system function, environment, diet, emotional life and personal susceptibility all enter the picture.
This is why I think his work is more interesting when read as a whole-person model rather than merely “the leaky gut diet.”
The gut may be central, but the person remains larger than the gut.
The Mind Was Part of the Treatment Too
Pagano also retained Cayce's emphasis on mental and emotional life.
His psoriasis programme included what he called right thinking, determination and persistence. He did not regard psoriasis simply as a psychological illness, but neither did he separate the mind completely from physical healing.
This matters because chronic skin conditions can themselves be stressful.
The discomfort, appearance and unpredictability of psoriasis can affect confidence and emotional wellbeing, while periods of emotional strain can in turn aggravate the condition in some people.
Once again, the relationship works in both directions.
Looking for Internal Causes of Psoriasis
What I take from Pagano is not the idea that everyone with psoriasis should follow exactly the same diet, drink exactly the same tea or assume that every plaque proves the existence of intestinal permeability.
It is the willingness to look behind the symptom.
If psoriasis repeatedly returns, it seems reasonable to ask what else is happening.
How is digestion?
What is the diet like?
Are the bowels functioning normally?
Did the condition begin after an illness?
Are there obvious food aggravations?
What is happening with sleep, stress and general resilience?
What medications are being taken?
What happened shortly before the latest flare?
There may not be one answer.
In my experience, there rarely is.
The Skin May Be Telling Only Part of the Story
The value of Pagano's work lies in shifting our attention.
The skin is where psoriasis becomes visible, but perhaps it should not automatically be where our investigation ends.
Sometimes external care is exactly what the skin needs. At other times nutrition, digestion, stress or another aspect of health may deserve attention too.
The challenge is discovering which pieces matter for the individual in front of us.
That is where a whole-person approach becomes useful.
What Is Behind Your Psoriasis?
If you have been treating the plaques but still feel that something is being missed, it may be worth looking at your psoriasis from the other direction. Give me a call and we can look at that pattern together: your psoriasis, digestion, nutrition, stress, general health and what you have already tried.
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