Ask the Dietitian: What Do I Need to Know About Gluten and Psoriasis?

Laura Krebs-Holm, a dietitian living with psoriasis, dives into what the research says about gluten and psoriasis.

If you live with psoriasis or psoriatic arthritis (PsA), you may have heard advice about limiting the amount of gluten in your diet. Over 8 million people in the United States have psoriasis, but does everyone living with psoriasis need to fully cut gluten out of their diet?

In this article, we review some of the recent research surrounding gluten and psoriasis and discuss who may benefit from going gluten-free.

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What is gluten?

Gluten is a type of protein that can be found in wheat, barley, and rye products. Common foods containing these ingredients include pasta, bread, pastries, and anything made with wheat flour. Rye bread, soups with barley, and beer all contain gluten as well.

Some foods, like oatmeal, may be contaminated with gluten, because they’re processed in a factory that also processes wheat or other gluten-containing foods.

Sauces, dressings, gravies, and pre-cooked meals may also contain gluten, because they contain wheat-based ingredients. It’s important to check labels to see if foods contain gluten or are fully gluten-free.

What about celiac disease?

Celiac disease is an autoimmune disorder in which the body’s immune system attacks the inner lining of the small intestine when gluten is consumed.

For most, this results in gastrointestinal distress. If left untreated, celiac disease can cause long-term issues, like anemia, vitamin and mineral deficiencies, and other serious complications.

Other people may live with non-celiac gluten sensitivity. They may notice symptoms, like bloating, cramping, constipation, or diarrhea. However, gluten sensitivity is not an autoimmune disorder.

It’s important to talk with a doctor if you suspect you have either celiac disease or non-celiac gluten sensitivity.

How might gluten and psoriasis be connected?

The relationship between psoriasis and gluten is complicated.

As many as 34 percent of people who have been diagnosed with one autoimmune disease will be diagnosed with another. This is referred to polyautoimmunity.

A review from 2016 found that genetic mutations are often shared between different autoimmune disorders, which can increase the risk for polyautoimmunity.

A meta-analysis from 2014 noted that many studies have found similar genetic and inflammatory pathways between celiac disease and psoriasis.

Some studies referenced in the meta-analysis found an association between psoriasis and celiac disease markers. Additional studies have found that the levels of celiac disease antibodies rise when a patient also has more severe psoriasis or psoriatic arthritis.

However, another study found that only 3 of 328 psoriasis patients showed elevated immunoglobulins associated with celiac disease, but it showed no psoriasis symptom improvement after 6 months of following a gluten-free diet.

With this range of evidence, more research is needed in this area.

It’s important to remember that gluten-containing products can be a good source of whole grains and fiber. The Mediterranean diet and a general heart-healthy diet have shown some promise to be beneficial for psoriasis patients.

Needlessly eliminating whole grain foods, even if they contain gluten, might not help you unless you have a gluten sensitivity or celiac disease.

My own experience

A few years ago, I found myself wondering if my body reacted to gluten or if consuming gluten influenced my psoriasis. I took photos of my psoriasis plaques and then cut gluten out of my diet completely for a few weeks.

I made no other changes to my medication or skin care regimen. Within the first week, I saw marked improvement in my plaques. They were smoother, flatter, and less scaly.

So for me, it’s possible that I have some sort of inflammatory response to gluten.

However, there are certain foods that I love to eat that do have gluten. When my medication is managing my psoriasis and PsA, I include more gluten-containing foods in my diet, both for the taste and the fiber.

There’s a certain whole wheat bread with flaxseeds that’s full of protein, fiber, omega 3 fatty acids, and it’s so versatile to cook with. I love to have it in my pantry.

When I experience a flare, I find that cutting out gluten-containing foods helps my body heal until a flare subsides.

The takeaway

It’s important for you to work with your doctor to determine whether or not you have celiac disease or a non-celiac gluten sensitivity. Before I tried eliminating gluten from my diet I made sure to check in with my doctors.

Both my dermatologist and rheumatologist are on board with my approach, but it’s important to be open with your care team about any lifestyle changes you make to try to manage your condition symptoms.