1. Project. Effectiveness.

What is the “Natural Way to Remission” project?

It’s a comprehensive project that educates patients on how to achieve remission through natural methods. The program focuses on identifying and eliminating the root causes of psoriatic disease, primarily through individualized diets, lifestyle changes, and specific treatment courses.

What is the main goal of this project?

The primary goal is to achieve long-term and sustainable remission. We identify and eliminate the root causes, which stem from an increased level of specific bacterial products (kPAMP) in the blood.

What information will I learn during my participation in the project?

You will learn about basic and individual diets, fasting diets, gastrointestinal cleansing procedures, how to estimate your psoriasis severity using PASI, necessary tests. You will learn about influencing factors like bacterial oral cavity diseases, upper respiratory tract bacterial issues etc. You will learn about two key factors
SP1 – Small Intestinal Hyperpermeability and
SP2 – Small Intestinal Bacterial Overgrowth (SIBO) with PsB and EnB bacteria.

Has this approach been proven to work?

Yes. Medical specialists and the Antipsoriatic Association developed and improved the Project over several years. Between 2013 and 2021, many patients who followed this project achieved long-term and sustainable remission.

Is achieving “long-term and sustainable remission” a guaranteed outcome?

Success depends on the patient and the ability to identify and address influencing factors on the two main factors SP1 and SP2. It depends on the patient’s persistence in following the tests and treatment recommendations, diet, cleansing procedures, lifestyle, etc.

Why is coaching paid and how does it differ from advice from the Internet?

The coach is one of the authors of the model of the pathogenesis of psoriasis, the author of a series of publications for psoriatic patients. The coach has experience in treating his psoriatic disease, as well as significant effective coaching experience with psoriatic patients.

Is there a possibility of a “test drive” or refund if I realize that this strategy is not right for me?

The first three hours of coaching are free. After that, the coaching time is paid for according to one of the selected packages. A refund by mutual agreement is possible in a situation where there was an advance payment first, and then early termination.

2. Two main factors. Pathogenesis model and terminology.

What is the scientific basis for this approach?

The approach is based on a pathogenesis model where two main factors sustain psoriatic disease: Small Intestinal Hyperpermeability (SP1) and Small Intestinal Bacterial Overgrowth (SIBO) with specific PsB and EnB bacteria.

What are SP1 and SP2?

SP1 is Small Intestinal Hyperpermeability (“leaky gut”), which allows bacterial products (kPAMP) to pass into the bloodstream.
SP2 is Small Intestinal Bacterial Overgrowth (SIBO) with PsB and EnB bacteria.
The presence of either SP1 or SP2 is enough to maintain the psoriatic disease.

What are kPAMPs?

kPAMPs are specific bacterial products that drive and support psoriatic disease according to pathigenesis model. They include LPS (lipopolysaccharide), PG (peptidoglycan), and bacterial DNA.

Why is the focus on the small intestine specifically?

The pathogenesis model states that the small intestine is the organ where the two main factors originate: hyperpermeability (SP1) and bacterial overgrowth (SP2). They allow bacterial products to enter the bloodstream and drive the systemic inflammation triggering psoriasis.

What are PsB bacteria (psoriagenic bacteria)?

What are EnB bacteria (enhancing bacteria)?

PsB bacteria (psoriagenic bacteria) are Gram+ bacteria that have a peptidoglycan similar to that of pathogenic Streptococcus pyogenes. EnB bacteria (enhancing bacteria) are Gram(-) intestinal bacteria that enhance the effect of psoriagenic. PsB and EnB bacteria are found in the small intestinal microbiome in PD. Learn more here.

Where can I find psoriasis pathogenesis model and explanations of abbreviations and terms?

You can view these by following link

The pathogenesis model appears to downplay the role of genetics. Why?

Pathogenesis model doesn’t downplay the role of genetics; it reinterprets it. Psoriasis is a disease with a hereditary predisposition: the concordance rate in identical twins is 70%. If one parent has psoriasis, the disease is diagnosed in children in 15–25% of cases; if both parents have psoriasis, the rate is more than 40–60%. The patient’s genotype determines the phenotype and severity of psoriasis manifestations (skin and/or joint). However, psoriasis cannot develop solely in the presence of genetic abnormalities. Findings from a series of genome-wide association studies (GWAS) in patients with psoriasis lead to this conclusion. These genomic studies did not identify any single nucleotide polymorphisms (SNPs) or combinations thereof that consistently (regardless of other factors) lead to the development and maintenance of psoriatic disease. Conclusion: the development and maintenance of psoriatic disease require additional non-genomic factors. According to our pathogenesis model, the presence of main factors SP1 and SP2 in the small intestine leads to high kPAMP levels in the bloodstream.

3. Patient in process and health coach role. Roadmap.

What is the role of the health coach?

The health coach analyzes your completed Guide, test results, and other provided data (on diet, sleep, exercise, etc.) to give you personalized recommendations on your individual diet, necessary additional tests, treatment courses, exercise, and lifestyle changes.

What happens after I submit my completed Guide?

After submitting, you will receive personalized recommendations regarding the optimal set of tests and procedures you should undergo. This is an important step before developing your personalized diet, lifestyle recommendations, and a customized treatment plan.

What kind of treatment courses might be recommended?

Influencing factors on SP1 or on SP2 determine the content of treatment courses. Courses may be aimed at weight loss, elimination of chronic infections (oral, URT, Helicobacter), deworming, or therapy aimed at improving intestinal motility.

How will my progress be monitored?

You will monitor your psoriasis using the PASI (Psoriasis Area and Severity Index), as well as track your sleep quality, diet and gastrointestinal health, exercise, and overall well-being. Your health coach will use this data to formulate subsequent recommendations.
The PASI is a standardized, quantitative tool used in clinical trials and dermatology. Using it allows for objective tracking of your progress, making it easier for both you and the health coach to see if the interventions are working.

Why is it so important to provide detailed answers and medical history?

The effectiveness of the entire process relies on the health coach having a complete picture. Your past and present illnesses, treatments, and their outcomes provide crucial clues for identifying your unique “influencing factors”.

How exactly does the health coach use my filled-out Guide to create recommendations?

The coach acts like a detective. By reviewing your detailed medical history, described symptoms, and test results, they look for patterns that define your specific combination of influencing factors. They then determine the specific causes of small intestinal permeability (SP1) and specific SIBO (SP2). This allows the health coach to create your “personal roadmap” to normalizing the two main factors and ultimately achieving remission of psoriatic disease.

How long after switching to a individual diet and completing treatment courses can I expect improvements?

Time may vary. Some patients may notice positive changes within a few weeks. Others may require more time—up to several months. First, small intestinal permeability and microbiome must normalize. Only then will positive changes in skin gradually occur. Patience and consistency are keys to success.

Is the health coach the only person I will be interacting with?

The project mentions development involved “leading medical specialists.” While the coach is your primary guide, the approach is collaborative. For specific issues, you will be referred to and need to work with the appropriate medical specialist.

Will the coach be in touch in person if I have a severe flare-up or itch in the middle of the night?

Unfortunately, no. The time of online consultations should be agreed in advance. Your chat or email messages received during the daytime will be answered within 1-2 hours.

Is there a community of other members?

Yes. These are chats on Telegram and Facebook. Communication in specialized groups of social networks is also expected.

In what format is the material presented?

There are materials in the format of articles (pdf files), there are pages of the site. The main format of communication is Big Guide (aka Roadmap), along with the attached files. In this Word file, information is entered by both the patient and the coach. This is accompanied by correspondence by email, as well as in the messenger. Online communication is only by prior arrangement.

Are specific tests and studies required? Is this included in the cost of coaching?

A complete list of tests and examinations can be found in Big Guide. However, the coach decides which of them you will have to do. The fewer diseases you have of the UDP, biliary system, gastrointestinal tract, bacterial infections, the shorter the list of necessary tests will be. The patient performs all the necessary tests and examinations at his own expense or under his own insurance. If suddenly the patient has all the diseases that are listed in the Guide (sections 2, 4, 5, 7, 8, 9 and 10), then the total cost of the tests will be about 1000 euro. As a rule, expenses do not exceed 50% of this amount. This does not affect the cost of coaching.

Does the coach stay in touch in case of relapses or force majeure?

Yes. The more difficult the situation, the faster I respond. But a delay of several hours is possible. In non-working hours, the delay may be longer (I also need sleep and rest). The main format of communication is e-mail, instant messengers. Online consultations only at a pre-agreed time.….
There have never been cases of sharp sudden deterioration so far. There was a temporary deterioration. The simplest are moisturizing gels (Aloe Vera), baths with additives that relieve itching (Epsom salt, soda, etc.). Only natural remedies. A long list of such remedies is listed in the book by John Pagano, Chapter 9.

How many hours a day will I really have to spend on this?

Cooking, procedures, diaries – I need to fit this into my work and family schedule.

You will have to fill out the Big Guide (not necessarily all positions – it depends on your health and lifestyle in general). For some items in the Guide, it will be necessary to collect and digitize the survey results that are already available. And if the necessary test was performed a long time ago (more than a year ago) or was not performed at all, this test will have to be performed.
The list of items of the Guide to be filled out is determined by the coach. This happens as you read the already completed part of the Guide.
In total (in several stages) the process of filling out the Guide itself will take 2-3 hours maximum. Of course, this can be done in a few days, as well as in a dialogue with a coach (on incomprehensible positions). At different stages, the time per day will be different – from 0.5 hours (only for keeping a diary of food, sleep and rest, physical activity, psoriasis) to 2-4 hours on some days during the course of SIBO treatment.

Will I need to give up alcohol and smoking?

Alcohol has a bad effect on psoriasis. If willpower allows, then you can completely abandon alcohol. Or allow yourself a symbolic amount of wine during festive (especially important) events. Smoking is a bad habit, it is advisable to get rid of it.

Is it really necessary to do sports? What about other physical activities? Do I need to follow my sleep schedule?

Regular physical activity is indicated for almost everyone, and not only for PD. They allow you to keep the weight and waist circumference normal. It has been proven that overweight patients have more severe and torpid psoriasis. The explanation is simple – excess weight and waist circumference, as a rule, means the presence of SIBO.
It is recommended to exercise 2-3 times a week for 1-1.5 hours of physical activity. Exercises at home, in the gym or in the fresh air contribute to the normalization of weight, waist circumference and normal peristalsis. Of course, physical activity is selected individually. Taking into account the age, physical condition of the patient, his preferences. Getting enough sleep can reduce stress. And, if after a working day there is an opportunity for 1-1.5 hours of physical activity, then there will be no problems with sleep.

Where can most of the tests be performed?

The vast majority of tests can be done in network laboratories. In the United States, it is Quest Diagnostics or similar.

Where can SIBO tests be performed (module M5)?

Non-invasive (breathing) tests for SIBO – there are fewer offers, but they can be found. Their reliability is about 70-80%. Moreover, the breath test does not provide information about which bacteria are the cause of SIBO. In this situation, only a universal course of treatment is possible within the framework of module M6.
At the same time, the probability of success (achieving remission) is lower than with accurate knowledge of the spectrum and sensitivity of the bacterium of the small intestinal microbiome. However, this probability can be increased by increasing the total volume and assortment of phages accepted and/or the duration of the universal course.
An invasive test (during gastroduodenoscopy) is a rare opportunity. A preliminary agreement with the management of the endoscopy department is required. Potentially this examination is possible in any place where there is an endoscopy department and a microbiological laboratory. The best option is a capsule SIBO test (so far only within the framework of clinical trials). At the moment, it is available only in Canada and the United States, provided that the patient is included in one clinical trial.

What should I do if I “snap”?

The strategy is complicated – is there support for rollbacks, or will I just be expelled?

The support of the coach is guaranteed at all stages of cooperation. Including in case of failure. In case of failure, it is optimal to take a break (2-4 weeks) in order to continue cooperation again.

4. Modular strategy. General questions.

Will this strategy help with my form of psoriasis?

It will help with any form of psoriatic disease. However, the depth of remission depends on its initial severity. For example, changes in the joints in psoriatic arthritis are often irreversible. The help in this situation is to stop the deterioration of these changes.

What is considered a “success”: complete remission or just a reduction in the affected area?

Long-term and stable remission. Reducing the severity of PASI by 50-75% or more.

Are there any diseases (except for PD itself) in which the strategy is contraindicated?

For example, gallstones, an ulcer in the exacerbation stage or kidney failure? Or is the correction of the small intestinal microbiome a “foundation” that will help to heal the entire body in parallel? How “universal” is your approach for people with many health problems?

Depending on the complexity of other diseases. There are diseases in which, for example, Matkevich lavage is contraindicated. And this lavage is an essential component of SIBO phagotherapy course. But this situation does not negate the possibility of selecting an individual diet.
However, there may be more serious situations. Therefore, at the very beginning, there should be complete clarity about the state of health in general (module M1). And there were cases when, in a dialogue with the patient, a decision was made about the impossibility of his participation in the project.

Why does the formation of an individual diet (module M3) occur BEFORE the diagnosis and treatment of SIBO (modules M5 and M6)?

An individual diet helps to normalize the permeability of the small intestine and at the same time reduces the severity of SIBO. The profile of the small intestinal microbiome can also change. Firstly, thanks to an individual diet, remission can be achieved (perhaps insufficient, but noticeable). And this will help the patient realize the role of an individual diet and continue to adhere to it further. Second, it is rational to diagnose SIBO after the severity of SIBO and, probably, the profile of the small intestinal microbiome have changed. By agreement, parallel passage of modules M2, M3 and M4 is allowed (but not recommended).

Why is it necessary to run module M4 before module M5?

SIBO always has causes. The main thing is to identify all potentially correctable (eliminated) causes. And then try to eliminate (weaken) them. This is bound to lead to a decrease in the severity of SIBO and likely a change in the profile of the small intestinal microbiome. In this case, PD remission may occur (possibly insufficient, but noticeable). The coach helps to identify all possible causes of SIBO. And, if there are simple solutions to eliminate them, then recommend them. If there are no simple solutions, then the coach will recommend specialists. It is better to diagnose SIBO after the concentration and profile of the small intestinal microbiome have stabilized at a new level after eliminating (correcting) all causes.

Is it possible to achieve a stable remission ahead of schedule, i.e. after completing module M3 (formation of an individual diet) or module M4 (detection and elimination of risk factors for SIBO)?

Yes, this is possible. Read again about the model of pathogenesis. Small intestinal SIBO is an SP2 factor. But there is also the SP1 factor. Increased small intestinal permeability to bacterial products with PAMP. For chronically elevated blood levels of kPAMP (and thus support for psoriasis), one of two factors, SP1 and SP2, is sufficient. With the help of a well-chosen individual diet, you can completely (or almost completely) eliminate the SP1 factor. Potentially problematic substances such as gluten, glycoalkaloids, lactose can greatly affect the permeability of the small intestine.
When forming an individual diet, it is checked whether or not a particular patient has sensitivity to one or more of the PPS. And, if so, then switching to an individual diet after a while can lead to a situation where the SP1 factor will return to normal. And, if the level of SIBO is not very high, then the rate of intake of bacterial products from psoriagenic bacteria will decrease so much that remission will occur.
And one more thing. If you are overweight, then you can also lose it and significantly reduce SP2 with the help of a diet. Since being overweight usually means an increased waist circumference, and this is an obvious sign of SIBO.

Can relapse occur during the long-term individual regimen (module M7).

There is no 100% guarantee that, for example, after a year of following an individual regimen, relapse is impossible. Unfortunately, everyone can encounter URD disease or food bacterial poisoning. And, if a specific SIBO occurs as a result, then PD may deteriorate again. But the patient already has experience in achieving remission. The patient can independently repeat all or some of the actions that have already led to remission once. Or he can turn to the coach again.

How long does it take for me to see the first changes in my skin?

It is important for me to know when to expect “light at the end of the tunnel”.

Modules M2 and M3. The initial period of cooperation will be devoted to weight loss (in case of excess weight) and the formation of an individual diet. When an individual diet is formed, and you begin to follow it, the positive effect on the skin will appear in 2-4 weeks.
Module M4. Much depends on concomitant diseases. If there are diseases (conditions) that affect the severity of psoriatic disease (directly or indirectly), then the initial courses of treatment will be designed to reduce their severity (elimination). And, if this (these) courses are successful, then the positive effect on the skin will be 2-4 weeks after the completion of the first of these courses.
Module M5. You will also have to perform a SIBO test (optimally classic or capsule). The results of this test will identify an excess of psoriagenic and/or enhancing bacteria in the small intestinal microbiome.
Module M6. The subsequent course of treatment (7-10 days) will be aimed at normalizing the small intestinal SIBO. The course includes the intake of antimicrobials and, possibly, antifungals (if they are detected in the microbiome). As a rule, after such a course, the small intestinal microbiome normalizes and has a positive effect on the skin in 2-4 weeks. Before improvement, there may sometimes be a temporary deterioration (Herzheimer effect).
The cumulative time to achieve long-term and sustained remission is generally proportional to the severity and duration of psoriatic disease. Total duration of modules M1-M6 . The minimum is 20-24 weeks, the maximum is determined individually – the duration of modules M2, M3 and M4.

Will there be tips for external skin care?

Everyone has their own experience in external skin care, shampoos, creams, ointments. Such recommendations are given by all dermatologists and cosmetologists. But, of course, if the patient has questions about external remedies (non-hormonal!), then they will be answered.

What is the lead time for module M5 (SIBO diagnostics)?

The term is up to 10 days. With gold standard diagnostics, the results are usually known in a maximum of 10 days. During this time, bacteria are cultured from the biomaterial and the sensitivity of the identified psoragenic and pathogenic to antibiotics and phages is determined. Fungi can also be identified and their sensitivity to antimycotics can be determined.

Are specific tests required and are they included in the price?

Yes, they are. A complete list of tests and examinations can be found in the Big Guide. However, the coach decides which of them you will have to do. The fewer diseases you have of the URT, biliary system, gastrointestinal tract, bacterial infections, the shorter the list of necessary tests will be. All tests and examinations are performed by the patient at his own expense or under his own insurance. This does not affect the cost of coaching.

How does following a modular strategy fit in with my other illnesses?

The strategy may include treatment courses (individual plans) aimed at reducing the severity (elimination) of other chronic diseases (module M4). Especially if they affect SIBO. Examples are bacterial chronicles of URT, carriage of Helicobacter pylori, etc.
If the diseases are not related to SIBO, then their presence is still taken into account when forming individual plans.

5. Individual diet and nutrition.

What are basic diets?

Basic diets are general eating patterns that the author has personally tried over many years (vegetarianism, veganism, and the John Pagano diet). But there are also others listed in the article.
Your base diet may be different from those listed in the article. You’ve been following it for a long time, and it may be good for your overall health (except for psoriasis). Start creating your new personalized diet with your base diet.

What is the role of an “individual diet” compared to a “basic diet”?

A “basic diet” provides general principles, while an “individual diet” is tailored to your specific food sensitivities and factors influencing on SP1 and SP2 . This “individual diet” is key to effectively reducing kPAMP levels in bloodstream exactly for you.

How complex will a individual diet be? Will I have to give up many foods?

The diet can be highly individualized. Developing a diet doesn’t involve arbitrary restrictions, but rather identifying your personal food triggers that can increase intestinal permeability or contribute to the development of SIBO. For some, this may be gluten and/or lactose, for others, foods high in FODMAPs. The goal is to create a complete diet based on eliminating (or limiting) your personal food triggers. Learn more here.

The Guide mentions “fasting diets.” What is their purpose in this context?

A fasting diet is a short-term diet (up to 10 days) with strict restrictions (for example, only fruit is allowed). A fasting diet is not starvation! A fasting diet can help reduce small intestinal bacterial overgrowth (SIBO) and intestinal permeability, which can lower blood kPAMP levels. During a fasting diet, cleansing procedures and SIBO treatment with antibacterial agents are also performed.

What are PPS?

PPS (Potentially Problematic Substances) are substances in foods that can negatively affect small intestinal permeability or contribute to SIBO. These include gluten, glycoalkaloids (from nightshades), lactose, and some FODMAP carbohydrates.

What are the official dietary guidelines of the National Psoriasis Foundation (NPF) in the US?

The NPF strongly recommends a gluten-free diet (GFD) for patients with celiac disease, as well as a 3-month trial of a GFD for those with latent celiac disease. The Foundation also recommends weight loss for those with a BMI greater than 25 and a Mediterranean diet.

Why can gluten be harmful for psoriasis?

According to research, some patients with psoriasis (approximately 16%) have a genetic predisposition (celiac disease or latent celiac disease). Gluten damages enterocytes in these patients, causing villous atrophy and increasing small intestinal permeability (SP1), which worsens psoriasis.

What are glycoalkaloids and what foods contain them?

Glycoalkaloids are natural substances found in plants of the nightshade family: tomatoes, potatoes, eggplants, and peppers. With a genetic predisposition, they can increase small intestinal permeability

What methods are there for diagnosing lactose intolerance, and which is the most reliable?

There are genetic diagnostics, a hydrogen breath test (not helpful for SIBO), a rapid biopsy test, and blood glucose testing after lactose ingestion. The most reliable test used in the US is repeated blood glucose testing for 1-3 hours after ingestion of 50 g of lactose.

What does the acronym FODMAP stand for?

FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. This group of short-chain carbohydrates is poorly absorbed in the small intestine and can be fermented by bacteria, aggravating SIBO.

What is a “low-microbial diet” and why is it needed?

This is a diet that limits the consumption of foods containing live bacteria and fungi. It is designed to prevent SIBO.

What are the different methods for following a low-microbial diet?

There are three methods: “sterile” (all foods containing live bacteria/fungi and probiotics are excluded), “selective” (only foods containing PsB and/or EnB bacteria are excluded), and “normal” (the author’s choice, general adherence to the principles of a low-microbial diet).

How long does it take to form an individual diet?

In the article “Individual diet for psoriatic disease.” there is Table 7. If a strictly eliminated diet is selected (i.e., when foods containing PPS are completely excluded), then the maximum duration of module M3 is 12 weeks. If you form a diet with a selectively limited intake of foods with PPS), then it will be much longer (up to 36 weeks).

What is the function of a coach in the formation of an individual diet, if there is an article?

The article lists specific tests (including variants) that need to be done to determine PPS. As well as ways to select an individual diet when there are no tests or it is not possible to perform tests. The coach explains the meaning of each of the tests, advises where they can be performed, and helps to interpret the results. The coach helps to build an individual diet, monitors the patient’s actions, and provides psychological support.

How is an individual diet formed?

T1) Blood tests for gluten sensitivity are performed. T2) Lactose tolerance tests are performed.
Running T1 and T2 tests and getting results takes a few days.
T3) However, it is impossible to determine sensitivity to glycoalkaloids (contained in nightshades) using the test. Here it is necessary to assess the effect of nightshades using an eliminative diet. Such a check can last up to 12 weeks. As a result, an individual complete diet is formed. At the same time, it is formed on the basis of your usual diet (vegetarian, vegan, lowFODMAP, or something else). In terms of timing – at least 12 weeks. Less (within a week) – only if the patient knows exactly how his PD reacts to nightshades.

How strong can the restrictions be in an individual diet?

If lactose intolerance is detected, then it will need to be eliminated forever (or its consumption should be minimized as much as possible). The same is true for gluten and nightshades. That is, intolerance, hypersensitivity of psoriasis are detected – products containing these substances are maximally (or completely) excluded from the permanent diet. Not for three months, but permanently. As for recipes. That is, good books and resources with recipes and full weekly menus. And for a gluten-free diet and lactose-free and nightshade-free. And for their different combinations.
The coach himself was a vegetarian for a long time, then he was a vegan, then he followed a nightshade-free diet (while remaining vegan)… Each period was very long. Of course, sometimes there were violations. And patients will also sometimes inevitably violate a little. But, if after 2-4 weeks of following an individual diet, there is a clear improvement in the skin. And if this diet is violated, after 1-3 days there is a clear deterioration… Then gradually the patient himself will understand the role of an individual diet. And he will explain it to relatives and friends.

What is the recommended sequence for testing PPS sensitivity?

The recommended sequence is: 1. Gluten. 2. Lactose. 3. Glycoalkaloids (nightshades). 4. FODMAP carbohydrates (except lactose).

What is the simple PPS sensitivity testing regimen?

This involves completely eliminating foods containing certain PPS (such as gluten or nightshades) for up to 3 months and assessing their impact on psoriasis.

What is the complex PPS sensitivity testing regimen and when is it used?

This is a longer regimen (12-36 weeks) that includes a phase of elimination followed by a gradual reintroduction of the food in increasing portions. This allows us to determine not only the actual sensitivity but also the tolerable portions and frequency of consumption.

What are the general dietary recommendations?

Avoid overeating, increase the number of meals to 4-6 per day, reducing portion sizes. Dinner should be the lightest and finished 2-3 hours before bedtime. Maintain a regular meal schedule (±30 minutes). Drink 6-8 glasses of clean water per day and maintain regular bowel movements.

How does developing a standard low-FODMAP diet (LFD) differ from developing a version for patients with psoriasis (LFDP)?

The main difference is the timeframe. Because the skin reacts to dietary changes more slowly than the gastrointestinal tract, all stages of the LFDP (elimination, challenge, integration) take significantly longer.

How long does the “Challenge” phase of the single FODMAP carbohydrate in the LFDP last?

The maximum time for challenging a single carbohydrate is 3 weeks: Week 1 – half a serving, Week 2 – a standard serving, Week 3 – a double serving. There should be at least a week between testing different carbohydrates.

Why is it important to keep a food diary?

This is the only way to accurately track the relationship between the consumption of certain foods, gastrointestinal health, and the dynamics of psoriasis (according to the PASI scale).

How often should skin assessment be performed when developing an indiet?

It is recommended to perform PASI skin assessment and photograph characteristic areas at the end of each week

What should be done if an external factor (e.g., a cold or sunburn) impacts the patient during the PPS assessment?

This PPS assessment should be discontinued. It should not be resumed until at least 2-4 weeks after the external factor has ceased to be active.

Why is it important to monitor the nutritional composition of the diet when developing an indiet?

Excluding entire food groups (e.g., those containing gluten or lactose) increases the risk of vitamin and micronutrient deficiencies. It is essential that the indiet be complete.

What is the key takeaway regarding the role of diet?

Diet is not just an adjunct, but a powerful tool for managing the two main pathogenic factors of psoriasis (SP1 and SP2). Following the indiet may be sufficient to achieve long-term and sustainable remission.

6. Influencing factors and their elimination (treatment) – module M4.

What are influencing factors?

These are all the abnormalities in your body, diet, and lifestyle that trigger or exacerbate the two primary factors (SP1 and SP2). Influencing factors are excess weight, chronic oral and upper respiratory infections, Helicobacter pylori, helminths, impaired peristalsis, and much more.

How does eliminating influencing factors, such as chronic oral infections or upper respiratory tract infections, improve skin condition?

Chronic oral infections or upper respiratory tract infections promote a constant flow of pathogenic bacteria into the small intestine. This contributes to SIBO. This flow is limited by the barrier function of gastric acid (with normal or increased acidity). Eliminating chronic oral infections and upper respiratory tract infections can promote spontaneous resolution of SIBO and, of course, facilitate SIBO treatment. Conquer SIBO and psoriasis will go away on its own!

What should I do if I’ve been diagnosed with Helicobacter pylori, for example, but my doctor believes it doesn’t affect my psoriasis?

This is a common problem. The pathogenesis model suggests that one of the key factors is a specific type of SIBO. Carrying Helicobacter pylori typically leads to decreased gastric acidity. As a result, the stomach’s barrier function is weakened against bacteria entering the gastrointestinal tract from the mouth and upper respiratory tract, as well as with food. This leads to persistent SIBO. Several studies also show that psoriatic patients with Helicobacter pylori have more severe psoriasis.

What is the role of “impaired peristalsis” as an influencing factor?

Peristalsis is the wave-like muscle contractions that move digested food (chyme) through the intestines. Impaired peristalsis leads to stagnation in the small intestine, promoting bacterial overgrowth (SP2) and increasing the likelihood of developing hyperpermeability (SP1).

What does “normalizing the levels of the two main factors SP1 and SP2” mean?

This is a multifaceted approach based on identifying all influencing factors and then eliminating (or normalizing) them, in particular:
* SP1 (hyperpermeability): restoring normal permeability by eliminating (reducing consumption) problematic (specifically for you) foods from the diet, etc.
* SP2 (SIBO): using targeted antimicrobials, restoring gastrointestinal motility, etc.
It should also be noted that factor SP2 typically negatively impacts factor SP1.

What are the deadlines for completing module M4?

It is very individual. Data are collected on all diseases and conditions that are risk factors for SIBO. Some of them are potentially eliminated or there is an opportunity to reduce their severity. The patient’s efforts should be directed specifically at the correctable risk factors for SIBO. Each of the eliminated factors is a diagnosis and a course of treatment. Sometimes several courses may be needed (as with Helicobacter pylori) or intestinal parasites. Therefore, it is impossible to accurately predict the duration of this module. Therefore, it is possible to carry out actions on module M5 in parallel. Although this is irrational…
Let’s limit the duration of module M4 to 4-6 weeks. During this time, there should be a complete picture of risk factors. The simplest thing is if there are no correctable risk factors. Then let’s move on to the M5 module. And if there are? Then, in a dialogue with the patient, a decision is made: either to remain in module M4 , or to continue to perform modules M4 and M5 in parallel.

Is it possible to run module M4 in parallel with module M3?

Yes, you can do it in parallel. If, for example, the patient has a chronic infection of the URD (maxillary sinusitis), then it must be treated and eliminated as much as possible before the diagnosis of SIBO. And this can be done in parallel with the M3 module.
There was such a patient with severe psoriasis and chronic sinusitis. He treated and completely cured maxillary sinusitis with phage therapy. After 4-6 weeks, a stable remission of psoriasis began. And we said goodbye 🙂

7. Cleansing procedures (module M6).

The Guide mentions gastrointestinal cleansing procedure. What are these?

These are specialized protocols designed to cleanse the gastrointestinal tract, reduce bacterial load, promote healing of the intestinal mucosa, and create a healthier microbial environment. One such procedure is intestine lavage.

What is Intestine Lavage (Matkevich Lavage)?

Intestine Lavage is a medical procedure for cleansing the entire gastrointestinal tract (GIT) by having the patient drink a special Enteral Solution (ES). It works in the natural direction of digestion to remove toxins from the body.

How is intestine lavage different from colonics or laxatives?

Unlike colonics (which only clean the colon) and laxatives, Intestine Lavage cleans both the small and large intestine. It is more physiological, helps normalize gut microflora, improves blood and metabolic indicators, and requires no equipment.

What is the ES solution?

ES is a patented, balanced saline enteral solution. Its mineral content (including Sodium, Potassium, Calcium, Magnesium, and Chloride) is similar to that found in the empty intestine, making it physiologically compatible.

How is the procedure intestine lavage performed?

The patient drinks 150 ml of ES every 5-10 minutes. Within 0.5-1.5 hours, the bowel begins to empty itself softly and without pain. The procedure continues until the intestinal washings become clear yellowish, typically taking 2-3 hours in total.

How many procedures intestine lavage are needed?

A full course consists of no fewer than 4 procedures, conducted with intervals of 2 to 7 days. The exact treatment program is determined individually.

What are the main preventive benefits of intestine lavage?

Preventive benefits include an influx of energy, improved skin and hair quality, sleep normalization, enhanced immunity, increased libido, and better preparation for surgeries or endoscopic examinations.

What are the main medical indications for intestine lavage?

It is indicated for conditions like intestinal dysbacteriosis, obesity, type 2 diabetes, chronic skin diseases (psoriasis, eczema, acne), allergic diseases, constipation, hangover syndrome, and for recovery after antibiotics, food poisoning, or stress.

What are the absolute contraindications for intestine lavage?

Absolute contraindications include gastrointestinal or other internal bleeding, the second half of pregnancy, and any condition requiring urgent surgery or intensive care.

What are the relative contraindications for intestine lavage?

Relative contraindications (requiring doctor’s caution) include erosive gastritis, the first half of pregnancy, gallbladder/kidney stones, type 1 diabetes, hypertensive crisis, and hemorrhoids exacerbation.

Why is body detoxification necessary?

The body accumulates toxins from food, cellular metabolism, and gut microbes. When the natural detoxification organs (liver, kidneys, etc.) are overwhelmed, self-poisoning occurs, leading to fatigue, skin problems, and chronic diseases.

How does intestine lavage help with detoxification?

The procedure intestine lavage provides deep, physiological purification. It removes toxins from the GIT, which interrupts their circulation between the intestine and liver (enterohepatic) and between the blood and the GIT (enterohematic), reducing the toxic load on the entire body.

Is medical supervision required?

Yes. The first procedure should be performed under a doctor’s supervision. Subsequent procedures in the course can be performed independently.

How does it enhance the effect of other medications?

The procedure significantly increases the absorption and effectiveness of medications taken right after the lavage or with one of the last portions of SES. This is particularly beneficial for drugs aimed at normalizing small intestinal permeability and microbiome.

Why is Matkevich lavage so important for the course of phage therapy?

Can’t phages cope on their own, without preliminary “washing”? And how realistic is it to carry out this lavage at home on your own, or does it require the presence of doctors?

Read more about Matkevich lavage here. Phages are taken as part of a course that includes several lavage procedures. The effectiveness of phage therapy is significantly higher due to the increased availability of the parietal microbiome to phages. The main intake of phages is carried out at the end of the lavage procedure. Phages quickly enter the small intestine (the pylorus between the stomach and the small intestine is open). Therefore, a significantly larger proportion of phages that are not destroyed by gastric juice enter the small intestine.
The first lavage procedures are carried out after consultation with a specialist. The complexity of performing Matkevich lavage is the same as when cleansing the gastrointestinal tract before colonoscopy (Fortrans, Eziklen, Suprep, Sutab).

8. Phagotherapy as an optimal method for treating SIBO (module M6).

What is the main advantage of phagotherapy’s narrow spectrum of action?

It allows for the targeted elimination of pathogenic bacteria while preserving the beneficial normal flora. This is a significant advantage over broad-spectrum antibiotics, which can wipe out good bacteria and cause severe side effects.

How does phage “self-replication” benefit the treatment?

Phages multiply at the site of infection as they infect and kill bacteria. This means a initially small dose can achieve a high concentration precisely where it is needed, unlike antibiotics whose concentration decreases over time.

Is bacterial resistance to phages linked to antibiotic resistance?

No. Resistance to antibiotics and resistance to phages are, to a significant degree, unrelated phenomena. This makes phage therapy a potent option for treating infections caused by multi-drug resistant bacteria.

Is the science behind phagotherapy well-understood?

Yes. The clinical mechanism of action and the biology of phages are well-studied, providing a solid scientific foundation for their therapeutic application.

How can the narrow spectrum of a single phage be overcome?

This limitation can be compensated for by using phage cocktails —mixtures of different phages that target a broader range of bacterial strains or species.

In summary, what makes phagotherapy a compelling alternative?

Phagotherapy offers a targeted, self-amplifying treatment that is effective against antibiotic-resistant bacteria and spares the beneficial microbiome, all based on a well-studied biological principle.

What is the primary goal of 10-day treatment course?

The goal is to eliminate (lower the level as much as possible) SIBO with psoriagenic bacteria and/or enhancing bacteria.

How is the specific phage choice determined?

The choice is based on a culture of a smear or aspirate taken from the Treitz ligament area during a duodenogastroscopy, followed by determining psoriagenic and/or enhancing bacteria and their sensitivity to specific phages.

What dietary regimen is followed during the treatment?

The patient follows an “apple fast,” which includes natural apple juice (unlimited), raw apples (2-3 per meal), and stewed apples (preferably in the evening). Water intake must be over 1.5 liters per day.

How often is procedure intestine lavage performed?

It is performed 3-5 times of the 10-day course.

What happens to meals on intestine lavage days?

Breakfast is canceled on lavage days because the procedure itself takes 3-4 hours to complete in the morning.

Why is a soda solution recommended before phages?

A soda solution is taken before the phages to temporarily neutralize stomach acidity. This helps preserve the phages as they pass through the stomach, ensuring they reach the intestines intact.

What is the rationale behind combining these therapies?

The combination is designed for a synergistic effect: the apple fast and lavage cleanse the GI tract and reduce bacterial load, while the phages specifically target and kill the remaining psoriagenic and pathogenic (including enhancing) bacteria.

What are the sleep recommendations?

Total sleep should be no less than 8-9 hours. If feeling unwell, an additional 1.5-2 hours of daytime sleep between lunch and dinner is recommended.

Module M6. What is the duration?

The term is up to 7 weeks.
We provide information on the results of SIBO tests for a coach. Then – 1 week to prepare recommendations for the course of treatment (individual plan).
According to this plan, the patient buys phages, antimycotics, possibly antibiotics (for example, rifaximin). Because there may be target bacteria that are insensitive to phages, as well as bacteria to which there are simply no phages.
And the course itself (maximum 7-10 days). Then a gradual exit from the course (3-5 days, half the duration of the course). The final result on the skin can be assessed only 4 weeks after the end of the course of treatment. During this period, there should be no extraneous factors affecting PD (both positive – for example, sunbathing, and negative – acute respiratory infections, influenza or poisoning or severe violations in an individual diet).
Only in this case it will be possible to objectively assess the effect of the course of treatment.
So the total duration of module M6 is no more than 7 weeks (2 active and 5 passive).

9. Difficult questions.

How does your approach differ from standard dermatological treatment?

Standard treatment is aimed at suppressing skin symptoms (e.g., with topical agents or biologics). Our approach is aimed at identifying and addressing the causes of two key factors: SP1 (increased small intestinal permeability) and SP2 (specific SIBO). This can achieve long-term and sustainable remission, reducing or eliminating the need for drug therapy with topical agents or biologics.

I don’t have any obvious gut problems. Is this appoach still relevant for me?

Yes. The pathogenesis model explains that one of two main factors (SP1 or SP2) is sufficient to maintain the systemic psoriatic process. You may have subclinical small intestinal hyperpermeability, or SIBO, without overt symptoms, but it can still contribute to the development of psoriatic disease.

I am already on biologic medication. Can I participate in your project?

No. The project aims to eliminate the suspected root causes, while biologics relieve the symptoms of psoriatic disease. While developing an individualized diet and eliminating the causes of factors SP1 and SP2, it’s important to monitor your psoriatic disease to identify any patterns. And ultimately, after following all of the health coach’s recommendations, evaluate the effectiveness of the “Natural way to Remission” project for your specific psoriatic disease. Identifying patterns and evaluating effectiveness are both impossible when taking biologics. Please contact us after completing your course of biologics (at least 2-3 months).

Do I need to cancel my current treatment (hormones, biologics)?

This is the most terrible question that needs a clear answer.

If we are talking about the treatment of other chronic diseases, then this treatment does not need to be stopped. But, of course, you should inform the coach about these diseases and the medications you are taking. If you are undergoing treatment for psoriatic disease, you need to complete it first. Evaluate its effectiveness and only then, after 2-4 weeks, start cooperating with a coach.

How do you define remission in psoriatic disease?

It is a long-term, stable skin condition without psoriasis or with very mild psoriasis (PASI no more than 3) with no tendency to relapse. This condition is maintained by a healthy lifestyle, a personalized diet, a balanced gastrointestinal tract, and moderate physical activity. It ensures an energetic and balanced state of health and does not require medications that suppress the immune system.

This seems like a lot of work. What is the ultimate motivation for going through this process?

The main motivation is to become an active creator of your own health. You’ll gain new knowledge and achieve stable, long-term remission without the use of potent drugs with serious side effects. This knowledge and experience will allow you to maintain remission completely independently in the future.

10. Guide (Questionnaire). Completion and access.

What is the “Psoriatic Patient Guide (Individual Roadmap)”?

It is a comprehensive questionnaire and guide designed for psoriatic patients. It is part of the “Natural Way to Remission” project and serves as a foundational tool to help identify the personal factors influencing your psoriatic disease and create a tailored path toward remission.

Who is this Guide for?

This Guide is intended for psoriatic patients who believe that their disease is a consequence of an increased level of kPAMP (LPS, peptidoglycan, and bacterial DNA) in their blood.

What is the first step I need to take?

The first step is to download the Guide (questionnaire) and fill it out thoroughly (skipping any sections or items for which you don’t have information). Then, send this Guide (questionnaire), along with your test results and medical reports, to your health coach via email or Google Drive.
If you have any doubts, download MiniGuide only, answer the questions and send it by email.

Where can I download MiniGuide or Guide?

You can download these Word files in English or Russian using the links at the top (or bottom) of this page.

How should I fill out Guide (Questionnaire)?

How do I fill out the guide (questionnaire)? You must answer all questions in detail by filling in the blanks. You can add additional lines if necessary. It is especially important to describe any past and current illnesses, their treatment, and their results. If you don’t understand a question, please clarify it with your health coach (via chat or email). If you cannot answer a question due to missing information, leave the line blank.

What should I do with my medical test results and reports?

You need to attach scanned copies or photos of these documents. You can either include them in a Google Drive folder along with your Guide or send them as email attachments.

The Guide asks to “attach files with scanned copies.” What if my results are in an online patient portal?

The instruction provides for this: “provide read access to your account in a relevant application.” You can take screenshots of your results or, ideally, download the PDFs from the portal and save them in your designated Google Drive folder. The key is to ensure the health coach can easily view them.

How should I name my file?

Please include your name or nickname in the file name like this: `Guide_NNN.docx` (e.g., `Guide_JohnDoe.docx`).

What are the options for submitting my completed Guide with attachments?

You have three options:
1. Save and fill out the Guide on Google Docs in a dedicated folder and share that folder with healh coach’s email.
2. Store everything on your computer, then upload the entire folder to Google Drive and share it link with healh coach’s email.
3. Send the completed Guide and all additional files as email attachments directly.

What is the email address for submission?

All documents should be sent to or shared with: psorias.info@gmail.com.

Can I use cloud services other than Google Drive?

The document specifies Google Drive as the preferred method. You should follow this instruction to ensure compatibility and a smooth process with the health coach.

I filled out a previous version of this Guide. What should I do?

You need to transfer all your information from the old version to this new one and update it with any new data.

What if I cannot perform some of the recommended tests or procedures?

You should discuss this directly with your health coach. They can likely adjust your roadmap based on what is feasible for you, prioritizing the most critical tests and interventions.

How long does it take to initially complete Big Guide? What about MiniGuide?

It will require a significant investment of time, as it involves gathering medical records, recalling your health history, and providing detailed answers. You should set aside several hours to complete Big Guide thoroughly. It takes only 30 minutes to complete the MiniGuide.

What if I cannot answer some of the questions because I don’t have the information or don’t remember?

Be transparent. Write “Unknown” or “Do not remember” instead of leaving it blank. This shows the coach that you saw the question but lack the data. They can then advise if it’s a critical piece of information that needs to be investigated.

What is the single most important piece of advice for filling out the Guide successfully?

Brutal honesty and thoroughness. Do not omit information you think is irrelevant. Seemingly minor issues like occasional bloating, a history of frequent antibiotic use, or chronic stress are all critical pieces of the puzzle for the health coach.