DIET, PSORIASIS AND HYPERTENSION: CONTROLLED CLINICAL TRIAL OF PERSONALIZED FOOD AVOIDANCE DIETARY APPROACH TO STOP HYPERTENSION
Authors: Chijioke Chioli , Okafor Michael , Nubila Nkoyo , Onah Ifeoma , Chigbo Nnenna , Maduka Ignatius , Udoh Iniekong , Eleazar Clara , Gbenimachor Nwanneka , Mbadiwe Nkeiru , Anusiem Chikere , Nwosu Nnamdi , Okpe Aaron , Onwuka-Kalu Nkiruka , Muobike Angela , Nwokolo Bridget , Udorah Maria , Nnadozie Okwudili , Nwonu Patience , Ndiokwelu Chika , Okwara Chinyere , Oji Loveth , Chijioke Udunma , Okoli Uzoh , Uamai Ifeyinwa , Anakwue Raphael , Amah Christopher , Ironkwe Ngozi , Aniagor Ebele , Ayuk Clara 
Published: April 2021

Objective:
Lifelong observational study of psoriasis (with eschewal of suppressive drug treatments) and dietary dependence of its phenotypic expression.
Develop an inductive model of the diet – genome interaction that engenders chronic disease.
Test this model by conducting an open controlled trial of Personalized Food Avoidance Dietary Approach to Stop Hypertension (PFADASH).

Design and method:
Lifelong textual and photographic diary records (cpcpsoriasis.blogspot.com) inspired an inductive model of the diet – genome interaction in which amphiphilic fats promote adverse gene expression effects of flavour enhancers and non-sugar sweeteners. This promotes immune dysfunction and chronic disease. Nine eligible consenting adults with uncomplicated essential hypertension were recruited for an open trial of the PFADASH (‘phase 6’ clinical trial involving withdrawal from postulated egregious dietary exposures). Baseline and monthly assessments included BP, anthropometry, clinical, drug/toxin exposure, ADTR. Quarterly assessments included dietetic, pharmaceutic, exercise, sociological, echocardiogram and laboratory markers of ‘metabolic syndrome’.
PFADASH dietary counselors were trained by the Principal Investigator. Detailed Dietary Counselling and Compliance Assessment and Scoring (DCCAS) guidelines were developed.
Study participants were counseled on which foods to avoid (PFA) and which to take (DASH). Study participants with ‘GOOD’ dietary compliance were compared with ‘FAIR / POOR’ diet compliers (controls) as regards blood pressure (BP) control, antihypertensive drug treatment requirement (ADTR) and other outcome parameters from the assessments listed above.

Results:
Comparing four FAIR/POOR diet compliers with three GOOD compliers, differences (95% CI) between mean values were 5.5 (0–11.1) mmHg for home BP, 14.7 (7.9–24.4) mmHg for automated office BP and 1.92 (0.45–3.40) for ADTR score. 2-way ANOVA confirmed improved BP control (p < 0.0001) and reduced ADTR (p = 0.0008) in GOOD compliers. GOOD compliers exhibited more significant improvements in BMI, abdominal circumference and triceps skinfold thickness than FAIR/POOR compliers (using 2-way ANOVA and linear regression, p < 0.05).

Conclusions:
These results support the postulated diet – genome interaction model i.e. nutritoxi-epigenetic aetiopathogenesis of immune dysfunction and chronic disease. As part of personalized medicine, personalized nutrition should emphasize adverse dietary exposure avoidance, reducing current over-reliance on suppressive drug treatments.