Gluten and Psoriasis: What’s the Relationship?

The relationship between gluten and psoriasis isn’t clear, but some people report a decrease in symptoms after following a gluten-free diet.

Most research suggests that gluten may worsen psoriasis symptoms in people with a high level of an antibody known as anti-gliadin antibodies (AGA), which is a sign of gluten sensitivity (4).

Antibodies are released when the body is trying to fight a foreign invader, suggesting that in some individuals, gluten results in an immune response (4).

It’s quite common for people with psoriasis to have concurrent immune diseases, especially those that relate to the gut or joints. For example, people with psoriasis are at a higher risk of having Crohn’s disease, ulcerative colitis, and psoriatic arthritis (4, 5).

Further, psoriasis patients are 2.16 times more likely to have celiac disease, which is a condition in which gluten damages the villi of the intestine (6).

What’s more, one study found that 14% of people with psoriasis had high levels of AGA compared with only 5% of the general population (5).

Interestingly, people who don’t meet the diagnostic criteria for celiac disease may still have high AGA levels, suggesting that psoriasis patients may have gluten sensitivity in absence of celiac disease (4, 5).

However, one study in 85,185 people found that there was no dose-response relationship between gluten intake and onset of psoriasis, which suggests that gluten does not cause psoriasis. However, they didn’t assess a strict gluten-free diet, which is a minor limitation (7).

Therefore, it’s plausible that gluten may worsen psoriasis symptoms in some individuals with psoriasis who also have high AGA levels. But it does not appear to trigger or be the root cause of psoriasis.

Following a gluten-free diet may reduce psoriasis symptoms in some people, but not all.

Having a gluten sensitivity or allergy may elicit an immune response in the body, which may also simultaneously spur a psoriasis-related immune response (4).

Some studies have shown that those with high AGA levels benefit from a gluten-free diet.

In a 2018 study, researchers analyzed AGA levels in 97 patients with psoriasis, of which 13 people (14%) had high AGA levels. These participants followed a strict gluten-free diet for greater than 12 months (8).

After 12 months, those with very high (>30 U/ml) AGA levels saw an average 56% decrease in Psoriasis Area and Severity Index (PASI) scores after following a gluten-free diet. Those with high (11.5–30.0 U/ml) AGA levels saw an average 36% decrease in scores (8).

A review of 1,408 patients across 87 studies with non-celiac autoimmune diseases (including psoriasis) found that a gluten-free diet helped reduce symptoms in 64.7% of people. One limitation is the study was not exclusive to psoriasis (9).

Older studies have also shown a gluten-free diet to be effective in reducing psoriasis symptoms for people with gluten sensitivity or celiac disease (10, 11).

In 2018, the medical board for the Psoriasis Foundation reviewed 55 studies to make dietary recommendations for the treatment of psoriasis (12).

The organization gave a weak recommendation for a gluten-free diet to treat psoriasis but noted those with celiac disease or gluten sensitivity will benefit from a gluten-free diet from a digestive standpoint (12).

That means any reduction in psoriasis plaques and other symptoms after eliminating gluten can likely be attributed to the management of the digestive condition (12).Ultimately, people with psoriasis who have a concurrent gluten sensitivity or celiac disease will likely benefit from a gluten-free diet. However, a gluten-free diet is unnecessary for psoriasis patients without gluten sensitivity or celiac disease (13).

The only people who need to follow a gluten-free diet are those with celiac disease or gluten sensitivity. In some cases, people with autoimmune conditions may have a higher likelihood of gluten sensitivity or celiac disease (14).

Though the public perception of gluten has worsened over recent years, most of the claims (e.g., promoting weight loss, decreasing risk of heart disease, improving gut health) surrounding gluten-free diets aren’t backed by scientific research (14).

In fact, there are numerous downsides to removing gluten from your diet, such as nutrient deficiencies, difficulty purchasing and preparing foods, increased cost, and negative social experiences (14).

A gluten-free diet is very difficult to follow since gluten is found in so many foods, beverages, and over-the-counter products. Therefore, unless you absolutely need to, there is no need to put additional burden on yourself.

If you believe you may have a sensitivity to gluten, it’s best to work with a healthcare professional to help you ease into an elimination diet so you can safely determine whether removing gluten helps you.

Here are some questions people often ask about the relationship between psoriasis and gluten.

Is psoriasis a symptom of gluten intolerance?

Psoriasis symptoms may worsen with gluten consumption in those with a gluten intolerance or celiac disease.

However, gluten does not cause psoriasis. Rather, it can trigger an immune response that may worsen psoriasis symptoms, but only in those with gluten sensitivity or celiac disease.

What triggers psoriasis flare-ups?

There are many potential triggers that can lead to psoriasis flare-ups, such as stress, illness, environment (e.g., weather), smoking, alcohol, diet, and other lifestyle factors (15).

Not everyone with psoriasis will have the same triggers, so it’s important to work with a dermatologist or another healthcare provider to identify your individual triggers.

Is there a relationship between psoriasis and celiac disease?

Those with psoriasis are 2.16 times more likely to have celiac disease compared with the general population (6).It’s thought that psoriasis and celiac disease have similar inflammatory and genetic pathways, leading to the development of both conditions (5).

Research suggests that gluten may worsen psoriasis symptoms in people who also have a gluten sensitivity or celiac disease. Following a gluten-free diet may help improve their symptoms.

However, gluten doesn’t cause psoriasis, and following a gluten-free diet probably won’t improve psoriasis symptoms if you don’t have gluten sensitivity.

Considering how difficult it is to follow, it’s best to avoid a gluten-free diet unless absolutely necessary.

Ultimately, if you suspect you have a gluten sensitivity or celiac disease, talk with a qualified healthcare provider like a registered dietitian. They may recommend you try a gluten-free diet and can offer support as you transition to that eating style.