Is a Gluten-Free Diet Good for Psoriasis?

Psoriasis, a disorder that primarily affects the skin, and celiac disease, an allergy to gluten, may be connected according to some experts — and some patients agree. Megan Ancheta of Wasilla, Alaska, has no doubt about this.

Ancheta has had psoriasis since she was 14 and was diagnosed with psoriatic arthritis in 2009. She says adhering to a strict anti-inflammatory diet, which includes no gluten, has given her back her life.

Antibodies are proteins that are formed when your body attempts to fight what it suspects are foreign substances, and gliadin is the protein in wheat that cannot be properly digested by people who have celiac disease and gluten sensitivities.

Still, the relationship between psoriasis and celiac disease — both autoimmune disorders — remains controversial.

Valori Treloar, MD, a dermatologist and certified nutrition specialist at Integrative Dermatology in Newton, Massachusetts, notes that some of the controversy may be due to the fact that some people with psoriasis have a sensitivity to gluten, but don't necessarily have celiac disease.

“I think gluten sensitivity occurs along a spectrum, and that celiac disease is at the far end of the spectrum," Dr. Treloar explains. "Not everyone who has gluten sensitivity has celiac disease.”

Jerry Bagel, MD, director of the Psoriasis Treatment Center of Central New Jersey in East Windsor, New Jersey, believes that as many as one-quarter of the 7.5 million Americans with psoriasis may benefit from a gluten-free diet. “A 12- week trial can’t hurt,” Dr. Bagel says.

Pros and Cons of a Gluten-Free Diet

Here are the possible benefits of a gluten-free diet:

It could relieve psoriasis symptoms. “Some people get better and some don’t,” Treloar says. The only way to find out whether you might benefit is to try it. She says that people with pustular psoriasis, a type of psoriasis that causes blister-like pimples on the palms of the hands and soles of the feet, are most likely to have gluten sensitivity. A gluten-free diet seems to make a big difference to them in particular, she notes.

Ancheta says she's been tested for celiac disease and doesn’t have it, but she is gluten-sensitive. Before she went on her anti-inflammatory diet, she had trouble getting out of bed most mornings.

She still has pain from her psoriatic arthritis and secondary Raynaud’s phenomenon, which is also an autoimmune disease, but now she’s able to function. This makes a big difference, since “life can get pretty hectic raising two small girls and a puppy,” she says.

Treloar warns that if you’re going to try a gluten-free diet, you should give it time — know that it could take four to six months to see a clear difference.

You’ll be eating a healthier diet. Eating a gluten-free diet means eliminating most processed foods and making room for more fresh fruits and vegetables, lean meats, and dairy.

As a huge plus, you’ll also help reduce your risk for other diseases that can accompany psoriasis, such as diabetes, heart disease, and obesity. “It might also help with digestion,” Bagel says.

You’ll likely have more energy. “Lots of patients tell me they feel much better after a few weeks,” says Treloar, adding that many didn’t realize their problems with digestion were likely caused by their sensitivity to gluten, until they stopped eating it.

Many also report a boost in energy. “That makes it easier for people to stick to the diet, because they’re feeling better,” she adds.

Here are the possible drawbacks of following a gluten-free diet:

It’s not easy to follow. No more bread, bagels, pizza, cookies, or cake — and you'll also have to say no to many processed foods, from lunch meats to salad dressings, because they often contain gluten. You’re limited to foods that are 100 percent gluten-free, and you have to shop carefully to be sure of what you’re buying. Many people find these limitations to be particularly challenging.

You can’t cheat. “For the diet to work, you have to be nuts about it,” Treloar says.

Gluten-free foods can be high in sugar and other empty calories. To improve taste, many manufacturers add sugar, saturated fats, and preservatives to packaged gluten-free products. “They tend to be made with refined grains, so they have a high glycemic load," Treloar says. "That can push up your blood sugar.”

Some people find they gain weight because they think gluten-free eating is good for them — and they can eat more. “But you can’t eat more, especially baked goods, just because they’re gluten-free," Treloar cautions.

It can take you longer to shop. You have to read food labels carefully to hunt for gluten. “There’s a learning curve,” Treloar says. You’ll be surprised to find that gluten lurks in many foods you never suspected. Of course, the more you stick to fresh foods, the less hassle you’ll have.

Shopping for Gluten-Free Foods

“In the 1980s, it was impossible to ask people to eat gluten-free,” Treloar says. “Nowadays it’s a much easier proposition.” You don’t have to shop exclusively in health food stores anymore; most supermarkets and even restaurants offer lots of gluten-free options.

When navigating the supermarket aisles, try these tips:

Shop the perimeter. That's where you’re most likely to find fresh fruits and vegetables, fish, poultry, and other meats, and dairy — and where you have the widest choices of naturally gluten-free foods.

Talk with the store manager. Although stores are stocking more gluten-free items, including waffles, cereals, pastas, cookies, and pretzels, they may not have a food you want. Make friends with the manager, and he or she might be able to order it for you.

Read labels. Just because something is marked “wheat-free” doesn’t mean it’s gluten-free. It could contain traces of gluten that may aggravate your psoriasis symptoms. Avoid foods that have even trace amounts of wheat, barley, rye, or malt.

Go online. Before you head to the store, go online to see what brands offer gluten-free foods. If you’re just starting out, you may want to prepare a list of gluten-free foods so you know what to look for in each department of the grocery store.

Don’t go overboard. Some gluten-free foods can be expensive; others might taste bland. Before you stock up, be sure you like them.

A gluten-free diet can be very restrictive, and following it takes a big commitment. Talk with your doctor and make sure it’s a good option for you before you try it.

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