What is bad about gluten?

Everything you need to know about gluten — and why it isn’t as bad as you think

  • Gluten has become a hot topic in weight loss communities, but many people don’t know exactly what gluten is.
  • Essentially, gluten is a protein found in wheat, barley, and rye. It gives dough its characteristic stretch and helps give breads structure.
  • INSIDER spoke with registered dietitian Rachel Hartley to clear up confusion about the protein and its role in a nutritious diet.

When you think of gluten, foods like pizza, pasta, and bread probably come to mind. But aside from knowing its vague connection to carbs, you may not understand exactly what gluten is.

Despite its steadfast role in our food-related vocabulary, many people tend to confuse gluten with wheat or remain unsure about its role in a nutritious diet. INSIDER turned to registered dietitian Rachel Hartley for a crash course on the basic substance.

Gluten is a protein found in wheat, barley, rye.

It’s also found in ancient wheats, like spelt and einkorn, and ingredients made from these types of grain, like malt. So although connecting gluten with carbohydrates makes sense, it’s important to remember that gluten is more than just pasta and bread.

“Gluten is the protein that gives dough its characteristic stretch and helps give bread its structure,” Hartley told INSIDER. “Wheat is a grain, while gluten is a protein that’s found in wheat, and other grains related to wheat.”

People with celiac disease and wheat allergies may avoid similar foods, but they’d have different reactions. Sarah Schmalbruch/INSIDER

While people who suffer from a wheat allergy would likely experience typical allergic reactions — symptoms like swelling, hives, and difficulty breathing — celiac disease is largely gastrointestinal. It can cause diarrhea, bloating, fatigue, malnutrition, and damage to the lining of the gut, with the potential to damage the small intestine if left untreated. Going gluten-free is imperative for the health of the disease’s sufferers.

“People with celiac disease may experience severe reactions from just a dusting of wheat flour contaminating their food,” Hartley said. “Celiac disease can be diagnosed with a blood test or biopsy.”

While it is possible to simply be intolerant to gluten, those sensitivities are less widely understood and far less serious, according to Hartley.

Very few people cannot eat gluten — and cutting it out unnecessarily may cause additional problems.

Although less than 1% of Americans need to avoid gluten, gluten-free fad diets have been rising in popularity over the years as part of a weight loss and health craze. But plenty of evidence suggests that this may be an unrewarding decision.

“Gluten is only bad for you if you have celiac disease, a wheat allergy, or a gluten intolerance, which is a small minority of people,” Hartley told INSIDER. “If you’re not sure, it’s helpful to work with a dietitian or gastroenterologist to get definitively diagnosed. Needlessly going gluten-free can be harmful, and has been linked to a higher risk of certain chronic diseases, like type 2 diabetes.”

A recent study by Harvard Medical School also indicated that an unnecessary gluten-free diet can cause heart problems.

Healthy, gluten-free grains include quinoa and brown rice.

Hartley noted that many gluten-free foods are highly processed and contain fewer nutrients than their gluten counterparts. In fact, the complex carbohydrates found in food containing gluten are vital to the body. They provide fiber, antioxidants, vitamins, and minerals that the body craves to stay full and satisfied.

Eliminating gluten can even slow down the metabolism, burning off fewer calories, according to previous INSIDER article.

“While there aren’t any benefits to going gluten free if you don’t need to, if you need to follow a gluten-free diet, use it as an excuse to try lots of different grains and flours … like almond meal, teff, chickpea flour and millet,” Hartley said.

Ultimately, it’s most important to resist diet trends and demonizing certain foods and proteins without fully understanding them.

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With a recent surge in gluten-free food options, you’d think there was a massive epidemic of people getting sick when they ingest gluten. Not so, if you pay attention to, well, facts.

First Things First — What Is Gluten?

Gluten is the spongy complex of proteins found in wheat, barley and rye that allows dough to rise.
The main cause of all the hype is Celiac disease, which can cause patients to develop headaches, tingling, fatigue, muscle pain, skin rashes, joint pain and other symptoms because the autoimmune attack at the root of the disease gradually erodes the wall of the small intestine, leading to poor absorption of iron, folate and other nutrients that affect everything from energy to brain function.

Is Celiac Disease Common?

Despite being a primary reason why many people claim they can’t have gluten, Celiac disease is still exceedingly rare.
Percentage of U.S. population with given disease or disorder
Celiac disease 1%
Bipolar disorder 2.6%
Diabetes 8.3%
Arthritis 20%
Cancer 4.2%
Heart disease 11.5%
Non-celiac gluten sensitivity 8%*
Note: Some rates listed are for adults only
* Estimates place the number between 5% and 10%.
Remember: Gluten sensitivity is not a form of Celiac disease. Celiac is an autoimmune disease in which the body triggers an attack on the intestines every time gluten is eaten. People with sensitivity may have similar symptoms, such as headaches, but they don’t experience the same type of intestinal damage as those with the disease.

Gluten-Free Everything

Estimated size of gluten-free industry by year
2012 2015 2017
$1.9 billion $5 billion $6.6 billion
How much more expensive gluten-free food is compared to its counterparts
North America’s share of global gluten-free market

Why Not Go Gluten-Free Anyway?

Unless you’re one of the unlucky few who actually have Celiac disease or gluten sensitivity, removing gluten from your diet won’t necessarily make you healthier.
If you suspect you have either condition, contact your doctor; you can’t self-diagnose either one. And don’t eliminate gluten “just in case.” Cutting out gluten before getting tested will cause test results to be inaccurate.
Think going gluten-free will help you lose weight? It may not. Following a gluten-free diet doesn’t guarantee you’ll drop the pounds. Many gluten-free products contain more sugar and fat than gluten-heavy counterparts.
And some foods that are naturally gluten-free, like potato chips and rice, can be unhealthy in large portions.

  • Why is Gluten Bad? The Shocking Dangers of Today’s Gluten

    Why is gluten bad? Less than one percent of the world’s population suffers from celiac disease, which is a life-threatening allergy to gluten. However, most people only think of the dangers of gluten or wheat in relation to gut health issues and other common symptoms associated with “gluten intolerance.”

    It has not been confirmed, but healthcare leaders estimate anywhere between 5 and 35 percent of Americans are gluten intolerant and more than 80 percent of people have non-celiac gluten sensitivities (NCGS). (1, 2, 3) The journal Nutrients states that “NCGS frequency is still unclear.” (4)

    Substances other than gluten may be causing irritable bowel syndrome and other gastrointestinal issues. Fermentable, Oligo-, Di-, Mono-saccarides and PolySfermentable, are poorly absorbed short chain carbohydrates for FODMAPS. The Monash University in Australia has created a low-FODMAP diet to treat patients with irritable bowel syndrome and other GI complaints. (5)

    This important because:

    1. There are a large number of scientists who actually deny that gluten sensitivity even exists.
    2. It explains why people still have gut health issues after going gluten-free.
    3. It goes against the information we have received over the past 30 years about wheat gluten-containing grains.

    It is highly unlikely that a patient will be diagnosed with gluten intolerance after eating a multi-ingredient meal without clear biomarkers proving NCGS.

    So, Why Is Gluten Bad for You? What Are the Dangers of Gluten?

    If we assume that the FODMAP philosophy is trustworthy, is it ok to eat gluten? No!

    Even if you are not “gluten sensitive,” is it still beneficial to cut out gluten? Yes, absolutely, 100 percent!

    Why? Why is gluten bad?

    Because of a farming technique called crop desiccation and a provocative chemical named glyphosate.

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    Why is Gluten Bad – A Gluten Paradox in Italy

    When you think of “Italian cuisine,” more likely than not you instantly think of pizza, pasta, and bread. However, you don’t hear about NCGS all over Italy.

    Research shows that less than 1 percent of the Italian population suffers from the dangers of gluten related disorders. (6) When 5 to 35 percent of Americans suffer from NCGS, you know that something must be terribly, terribly wrong.

    One example is the story of an American Celiac patient who suffered from gluten intolerance but had no side effects from eating while in Italy. Taken from celiac.com Forum, How Come Gluten Didn’t Bother Me In Italy?: (7)

    I recently traveled to Italy, and although I’ve read they have many gluten-free options, I decided that I was going to eat whatever I wanted, even if it had gluten. When I mentioned this to my doctor, he said it actually may not bother me since the wheat outside of the US is typically less genetically modified and more “natural.” So after 2 weeks in Italy eating pasta daily, pizza, and all kinds of baked goods, I felt great. No headaches, upset stomach or any symptoms of gluten digestion. Has anyone else had a similar experience outside of the US? If that’s the case, could I buy imported flours and pasta made in Italy that aren’t “gluten-free” and be okay eating them at home?

    Is it possible that American wheat is different than Italian wheat? Not necessarily. GMO wheat is not grown anywhere in the world. (8) However, wheat harvesting practices are very different in the United States than they are in Italy, which is why people regularly suffer when they eat wheat in the U.S.

    TRYING TO CUT GLUTEN? Don’t think for some second that giving up gluten means giving up taste. Mama Z has developed an amazing Italian cooking class that specializes in gluten-free and allergy-free ingredients. Register for the free viewing today!

    Why is Gluten Bad – Desiccation Roundup

    Non-organic wheat fields are soaked in Monsanto’s signature Roundup before harvest. This method is referred to as “desiccation.” This accomplishes the following:

    • It makes wheat die early and go “to seed,” which increases production.
    • It kills competing rye grass and other weeds, which makes it easier to harvest.

    Keith Lewis is a wheat farmer who explains pre-harvest desiccation: (9)

    I have been a wheat farmer for 50 years and one wheat production practice that is very common is applying the herbicide Roundup (glyphosate) just prior to harvest. Roundup is licensed for pre-harvest weed control. Monsanto, the manufacturer of Roundup claims that application to plants at over 30% kernel moisture result in roundup uptake by the plant into the kernels. Farmers like this practice because Roundup kills the wheat plant allowing an earlier harvest.

    A wheat field often ripens unevenly, thus applying Roundup pre-harvest evens up the greener parts of the field with the more mature. The result is on the less mature areas Roundup is trans located into the kernels and eventually harvested as such.

    This practice is not licensed. Farmers mistakenly call it “desiccation.” Consumers eating products made from wheat flour are undoubtedly consuming minute amounts of Roundup. An interesting aside, malt barley, which is made into beer, is not acceptable in the marketplace if it has been sprayed with pre-harvest Roundup. Lentils and peas are not accepted in the market place if they are sprayed with pre-harvest roundup … but wheat is ok. This farming practice greatly concerns me and it should further concern consumers of wheat products.

    Why is Gluten Bad – Concerns About Glyphosate Health

    Farmer Keith is worried about glyphosate. According to the Environmental Protection Agency (EPA):

    (Glyphosate) is a non-selective herbicide registered for use on many food and non-food crops as well as non-crop areas where total vegetation control is desired. When applied at lower rates, it serves as a plant growth regulator. The most common uses include control of broadleaf weeds and grasses in: hay/pasture, soybeans, field corn; ornamentals, lawns, turf, forest plantings, greenhouses, rights-of-way. (10)

    Ultimately, glyphosate is a very dangerous chemical that is everywhere and is unavoidable if you live in America.

    Glyphosate is the active ingredient in Monsanto’s signature Roundup, and is the most common pesticide in the world. About 6.3 million pounds of glyphosate were used in the U.S. in 1986, which grew to 11.6 million in 1990. Now, almost 20 million pounds of glyphosate are used every year. (11)

    Sadly, the use of glyphosate has made hundreds of millions of people susceptible to developing new illnesses. Dr. Stephanie Seneff is a senior research scientist at the Massachusetts Institute of Technology (MIT). She says that the use of glyphosates to desiccate wheat fields is most likely the reason people are gluten intolerant or developing celiac disease. Inflammation is the number one cause of disease today, and it can be connected to glyphosates

    ut dysbiosis, brought on by exposure to glyphosate, plays a crucial role in the development of celiac disease. Many CYP enzymes are impaired in association with celiac disease, and we show that glyphosate’s known suppression of CYP enzyme activity in plants and animals plausibly explains this effect in humans. (12)

    There is nothing good about eating wheat and gluten-containing foods because of how they are farmed. Reuters says that “The EPA is conducting a standard registration review of glyphosate.” In the meantime, refrain from eating non-organic grains unless you grow them yourself. I recommend cutting them out of your diet completely.

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    Can your diet and nutrition affect psoriasis?

    Psoriasis is a chronic inflammatory skin complaint that can cause a red rash, mainly around the elbows, knees, hands, the lower back and the scalp. It can be very difficult to treat clients with the condition as the cause can be complex.

    As with any autoimmune condition, the body’s normal defence mechanism gets confused and this leads to immune cells beginning to behave differently. With psoriasis, this causes inflammation, which then alters skin cell reproduction and differentiation. Thicker patches of skin then form where new cells build up faster than old skin cells are shed. In some cases, psoriasis can be so severe that these itchy patches cover a large percentage of the skin.

    What to do next

    If your client suffers from psoriasis, they may ask you whether dairy causes inflammation, or if eliminating gluten from their diet would help them manage psoriasis symptoms.

    The truth is that diet appears to have a substantial role in causing the inflammation that triggers psoriasis, and food intolerances may play a part. However, it’s important to remember that each person is unique, so there may be many other foods that are causing your client’s food sensitivity; for example, wheat, eggs or nuts.

    A simple IgG food intolerance test may help to determine whether a food intolerance* is the root cause of your client’s psoriasis.

    Psoriasis and gut health

    If your client has a food intolerance, then eating certain foods may be aggravating their gut. This could cause inflammation and encourage psoriasis.

    Identifying food intolerances and then allowing the gut time to heal can be very relevant for those with an autoimmune condition. What a person chooses to eat is very important. As individuals, our reactions to foods and drinks that we consume varies a great deal. An ingredient which may cause problems for one person could be completely acceptable for another.

    For clients with persistently itchy skin, discovering and understanding their food and drink intolerances* and the effects they have on their health and wellbeing can be a very important step. Once individual food triggers are identified, informed choices can be made to optimise diet and quality of life.

    Contact the Lorisian team today to learn more about food intolerance* and find out about our IgG testing services.

    *Lorisian define food intolerance as a food-specific IgG antibody reaction. Our information is intended to provide nutritional advice for dietary optimisation. Lorisian do not claim to treat or cure symptoms and recommend that your client discusses any medical concerns they have with a GP before undertaking one of our programmes.

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    Angela Barber, 64: Severe Psoriasis

    In utter desperation, Angela began to research food intolerance symptoms online. However after suffering for so long, she was doubtful that anything would help her, and had given up on advice from doctors completely. It was through online research that Angela discovered YorkTest.

    The YorkTest process involves sending a finger-prick blood sample to the company’s laboratory to test IgG antibody reactions to up to 208 foods. The colour-coded results customers receive (red for reaction, amber for borderline and green meaning no reaction) outline the ‘trigger’ foods and degree of intolerance.

    Angela’s results revealed several trigger foods, but her biggest reactions were to dairy, eggs and yeast. Determined to find answers, she spoke to the Nutritional Therapist and began her elimination diet.

    “Within 48 hours my skin started healing, literally before my eyes. Between dressing in the morning and undressing in the evening, my skin was visibly improving!” Suddenly Angela was sleeping better and after a lifetime of chronic insomnia, she began sleeping through the night. Later, Angela visited her GP for a health check. She was pleased to discover that her borderline high blood pressure and cholesterol levels were drastically lower.

    When asked how this has affected her life, Angela said: “My whole life has changed! It has affected everything!” Angela is now planning to walk part of the Camino de Santiago and is so relieved that taking her own bedding or worrying about skin care won’t be an issue for her.

    Angela found her symptom improvements continued for about 3 months. She now has very mild psoriasis which hardly bothers her at all, and she no longer needs her prescription ointment. She also lost over a stone in weight, and has almost reached her target weight.

    Still following her diet, she says: “It was mentally easy because the results were so immediate and dramatic. I’ve had to reform my cooking, but that’s easy now.”

    “I’m healthier, fitter and have more energy, and am more mentally positive. I wish I’d been tested earlier, it would have transferred my confidence in my youth.”

    When asked to sum up her experience, Angela said: “I feel 10 years younger”.

    Angela followed a Food&DrinkScan programme.

    Psoriasis and Hidden Food Allergies

    Before using an elimination diet to find out if hidden food allergies are causing your psoriasis flare-ups, it is wise to seek advice from a medical doctor or a certified dietitian or nutritionist. Cutting out a wide range of foods for a long period time means you might not be getting enough nutrients from a sufficient variety of foods, and that’s where a professional can help. What’s more, a knowledgeable nutritionist or dietitian can design a sustainable, personalized anti-psoriasis diet for you after your have uncovered your hidden food allergies.

    For More on Diet & Psoriasis

    Make it a habit to visit HealWithFood.org’s online Guide to Healing Psoriasis on a regular basis. Updated once a week, the sidebar on the home page of the guide contains tons of links to interesting diet-related articles hand-picked for psoriasis sufferers. It also contains a weekly smoothie recipe featuring ingredients with psoriasis-fighting potential, as well as a book tip. Visit Page

    Book You May Like

    Drawing upon cutting-edge research and her own battle with autoimmunity, scientist and New York Times bestselling author Sarah Ballantyne has developed a Paleo-based elimination diet specifically designed for people with autoimmune diseases such as psoriasis. Outlined in her book The Paleo Approach, Ballantyne’s diet not only cuts out allergenic and pro-inflammatory foods but it also emphasizes foods that help heal tissues damaged by autoimmunity. In addition to explaining how eating certain foods and avoiding others can help put autoimmune diseases into remission, this 400-plus page tome provides expert tips on how to “go Paleo” easily and economically. To learn more, or to order a copy, .

    More to Explore

    8 Foods That Affect Psoriasis

    Psoriasis is a chronic autoimmune skin disease that causes a red, scaly rash most commonly over the elbows, knees, hands, lower back, and scalp. There is no scientific evidence that any special psoriasis diet is beneficial, says Paul Yamauchi, MD, of the Dermatology Institute and Skin Care Center in Santa Monica, California. But as long as you eat a healthy diet, he adds, there’s no harm in exploring whether avoiding some foods and eating others might help you manage psoriasis flares and reduce inflammation.

    Many people with psoriasis wonder whether dairy causes inflammation, or if eliminating gluten from their diet would help them manage psoriasis symptoms. Gluten is a type of protein that’s found in grains, such as wheat, barley, and rye. While gluten is found in breads and pastas, it’s also in processed meats and sauces and other products.

    According to the Mayo Clinic, some people who have the chronic skin condition psoriasis might also be sensitive to gluten. For these people, following a gluten-free diet might improve psoriasis symptoms. If you believe gluten is a psoriasis trigger, talk to your doctor about tests for celiac disease, which is an immune reaction to gluten. Also avoid eating gluten by checking the food labels on products to make sure they don’t contain gluten.

    In a dietary behavioral study published in 2017 in the journal Dermatology Therapies, which followed of 1206 psoriasis patients, the most commonly reported food triggers were:

    • Alcohol
    • Dairy
    • Gluten
    • Sugar
    • Tomato

    In this same study, less common food triggers that worsened symptoms of psoriasis included meat, eggs, processed foods, bread, beer, wine, soda, and spicy foods. To find out if these foods trigger your symptoms, try a psoriasis diet that eliminates these foods.

    Participants reported other dietary approaches that improved psoriasis symptoms, including:

    • Gluten-free
    • Low carbohydrate, high protein
    • Mediterranean
    • Vegetarian

    Across all these diets, 69 percent of patients reported weight loss, which is supported by scientific evidence as a method to lower psoriatic symptoms in obese and overweight patients. Participants also used over-the-counter dietary supplements to reduce inflammation and manage symptoms of psoriasis, including:

    • Fish oil, or omega-3s
    • Probiotics
    • Turmeric capsules
    • Vitamins A, B, C, D, and E

    Additionally, study volunteers found certain dietary items helped improve psoriasis symptoms, including:

    • Fish
    • Fruits
    • Vegetables
    • Water

    If you’re considering a diet for psoriasis to manage this health condition, it’s important to talk with your doctor or rheumatologist about certain foods that may trigger your symptoms, and to avoid those foods. A licensed dietitian can work with you on a psoriasis diet that helps you avoid triggers and stay healthy.

    Eating a Lot of Gluten Doesn’t Increase the Risk of Psoriasis or Psoriatic Arthritis

    Fans of gluten-free diets often say that shunning this protein found in many grains can help you lose weight, ease headaches, and fight depression. Some proponents of cutting out gluten claim that gluten is bad for your skin, and that people with psoriasis, eczema, or other skin problems would see them clear up if they cut out gluten.

    While there’s no good proof that eating gluten could harm your skin unless you have celiac disease (which is an autoimmune disease that primarily leads to damage in the intestines if you eat gluten), some people with psoriasis and eczema report that their skin improves when they eat a gluten-free diet. The only way to find out if this might be true for you is to try an elimination diet that excludes gluten. Gluten is found in wheat, rye, and barley.

    If you find that your skin gets better or you feel better when you give up gluten, that cutting it out may makes sense. But can eating too much gluten lead to developing a skin condition in the first place?

    According to a new study, published in the Journal of the American Academy of Dermatology, women who ate the highest amounts of gluten were no more likely to develop psoriasis, psoriatic arthritis, or atopic dermatitis (eczema) compared to those who ate very little gluten. The researchers determined that there was no association after analyzing food questionnaires that were completed by more than 85,000 participants in the Nurses’ Health Study II between 1991 and 2015.

    “Our findings do not support the amount of dietary gluten intake as a risk factor for psoriasis, psoriatic arthritis, or atopic dermatitis in adult women,” the authors concluded.

    One important limitation of this study is that the researchers did not have input from women who ate no gluten at all. It’s also worth noting that having one autoimmune disease increases the risk of developing celiac disease, so if you have any symptoms of celiac (such as chronic diarrhea, constipation, bloating, or unexplained weight loss) you should talk to your doctor and get tested.

    Keep Reading

    • How to Follow a Psoriatic Arthritis-Friendly Diet
    • Does a Gluten-Free Diet Ease Arthritis Symptoms?
    • How Obesity Affects Arthritis

    Weight reduction, gluten-free diet recommended in PsO

    A recent review by the National Psoriasis Foundation’s medical board suggests that adults with psoriasis and/or psoriatic arthritis (PsA) may use dietary interventions to supplement standard medical therapies to reduce disease severity.

    Authors strongly recommend the hypocaloric diet for overweight and obese patients with psoriasis, and the gluten-free diet for patients with confirmed celiac disease. Other interventions may help specific patient groups, but authors emphasized that no dietary intervention stands alone. The review appeared online June 20 in JAMA Dermatology.

    For patients with psoriasis who are overweight or obese, benefits of a hypocaloric diet (800-1400 kcal daily) include significant improvements in psoriasis severity, dermatologic life quality and weight loss versus consuming a regular diet. However, dietary modifications alone may not suffice for maintaining psoriasis remission. A study in which patients who had maintained remission during 12 weeks’ methotrexate therapy discontinued methotrexate and were randomized to a hypocaloric or regular diet showed that the former did not produce statistically significant differences in maintenance of psoriasis remission. Thus, study authors strongly recommend a hypocaloric diet, based on level A evidence, in conjunction with standard medical therapies.

    Patients with psoriasis have increased risk of serum antibodies that are used to screen for celiac disease; higher antibody levels are associated with greater psoriasis severity. For patients who have undergone duodenal biopsy to confirm the presence of celiac disease, research shows that a gluten-free diet reduces psoriasis severity and gastrointestinal symptoms. Therefore, study authors strongly recommend a gluten-free diet for this patient group. For patients who test positive for serologic markers of gluten sensitivity regardless of duodenal biopsy results, authors suggest a three-month trial of a gluten-free diet as adjunctive therapy. “It’s important to note that we don’t recommend screening all patients with psoriasis for these serologic markers of gluten sensitivity. That’s because there can be false positives with these tests, and the evidence is still relatively weak in this area,” said lead author Adam R. Ford. He is a fourth-year medical student and research fellow at the University of Southern California.

    In one survey, 86 percent of patients with psoriasis reported having tried special diets to improve their disease. However, data showing a relationship as between dietary patterns and disease severity are limited and conflicting. Review authors concluded that based on low-quality evidence, adults with psoriasis may consider trying a Mediterranean diet, and consuming extra-virgin olive oil as the main culinary lipid, along with eating at least two servings of vegetables and three servings of fruit daily, plus legumes, seafood and tree nuts at least three times weekly. Also based on low-quality evidence, patients may consider consuming more omega-3 PUFAs, monounsaturated fatty acids and fruit or complex carbohydrates, while consuming fewer calories, simple carbohydrates, saturated fatty acids and PUFAs (total and in particular omega-6 PUFAs).

    Ford et al. do not recommend or found insufficient evidence to make recommendations regarding the following interventions for psoriasis:

    • Omega-3 fatty acids/fish oil — Whereas omega-6 PUFAs metabolize into leukotriene B4, an inflammatory mediator that is elevated in psoriatic plaques, metabolites of omega-3 PUFAs oppose its proinflammatory effects. But in seven of nine double-blinded, randomized controlled trials, oral supplementation with fish oil proved ineffective in reducing psoriasis.
    • Micronutrients — A single 34-patient study showed that patients treated with methotrexate and vitamin-mineral supplementation for three months had significantly greater improvement in psoriasis severity than those treated with methotrexate alone.
    • Vitamin D — Studies showing that the severity of plaque and erythrodermic psoriasis can improve after vitamin D supplementation for six months or longer were uncontrolled. And investigators found no clear evidence to support one form of vitamin D over another, or adequate data regarding the effects of vitamin D supplementation in vitamin D-deficient patients with psoriasis.
    • Vitamin B12
    • Selenium

    Researchers recommend weight reduction via hypocaloric diet here because studies show that patients with PsA who start treatment with TNF blockers (etanercept, adalimumab or infliximab) are significantly more likely to achieve minimal arthritis activity and weight loss after a six-month hypocaloric diet than after a regular diet. Based on uncontrolled studies, authors also recommend a trial of oral vitamin D supplementation (0.5 µg alfacalcidol or 0.5-2.0 µg calcitriol daily) as adjunctive therapy. Ford et al. do not recommend fish oil supplementation or selenium supplementation for PsA in adults.

    “Prior to the review,” said Mr. Ford, “few studies had summarized literature regarding diet and psoriasis. So if patients were to ask their provider if there’s anything they can do about their diet that might help their psoriasis, providers were unable to give patients any evidence-based advice. Armed with the study’s findings, providers can now begin to answer those questions.”

    The review included a total of 77,557 participants, of which 4,534 had psoriasis. Authors performed a systematic literature review using the MEDLINE database and examined literature identified by prior systematic reviews to select 55 studies for analysis.
    The study’s main limitation is that researchers could only make recommendations based on currently available evidence, which leaves many unanswered questions. “Until we get better primary studies in these areas, we won’t have answers for those questions.”


    Adam R Ford BS, Michael Siegel PhD, Jerry Bagel MD MS, et al. “Dietary Recommendations for Adults with Psoriasis or Psoriatic Arthritis from the Medical Board of the National Psoriasis Foundation: A Systematic Review,” JAMA Dermatology. June 2018.

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