Gluten and acne

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Many acne victims say eating a slice of bread or a bagel gives them horrible breakouts. They blame gluten for this. But are these just individual cases or is there really something to the gluten-acne connection?

Wheat bread with gluten. Can acne patients eat it?

Can this give you acne?

Give me a few minutes and you’ll find out. I went thought all the published medical research on gluten and skin problems I could find, and I explain what it all means on this page. This way we can have as reliable answer as possible.

The short answer is that we can’t say for sure that gluten causes acne, but it’s very likely that it is an issue for a minority of acne patients. Maybe something like 1 in 5 acne patients could have problems with acne.

What is gluten and gluten sensitivity

Gluten is a protein found in wheat and related grain species, such as barley and rye. It’s also used as an ingredient in many processed foods and personal care products (there can be gluten in your shampoo and toothpaste).

Gluten sensitivity and celiac disease are conditions where you suffer a negative reaction to gluten. Symptoms can include digestive problems, headaches, skin problem, neurological issues and joint and muscle pain.

Doctors have usually dismissed people who claim gluten triggers their acne. Their reason is that gluten allergy is usually linked with visible and measurable problems in the small intestine, also known as gluten-sensitive enteropathy. And people who complain about gluten don’t usually exhibit any other symptoms of small intestine problems.

But it’s now becoming obvious there’s more to the story. Researchers have identified a ‘silent’ form of gluten sensitivity. These people don’t exhibit the normal symptoms of celiac disease (such as digestive problems). Yet, gluten can trigger skin problems in these people. Wikipedia article says that gluten sensitivity can affect approximately 6% of the population. Whereas celiac is much rarer, affecting less than 1% of the population.

So this means that gluten may be a problem even if you don’t get any noticeable symptoms after eating it.

Gluten and acne

Unfortunately I was able to find a whopping zero studies on gluten and acne. So we have no credible evidence either for or against gluten in acne. You can find plenty of anecdotal reports at acne forums, but we can’t rely on those too much.

But let’s not throw away hope yet. There are quite a few studies done on gluten and other skin conditions. While these are not 100% relevant for acne they can give us clues. After all most of those skin conditions are inflammatory in nature. So if gluten inflames the skin of psoriasis patient who’s to say it doesn’t do the same for acne patients?

With that in mind let me show you what I found. Skip down to the conclusion if you just want the short version.

Gluten and psoriasis

One of the most telling psoriasis studies was done in University Hospital in Uppsala, Sweden. In a previous study the researches had identified that 16% of psoriasis patients we gluten sensitive; this means they had antibodies against gluten (knows as anti-gliadin antibodies or AGA for short). We can call the people are gluten sensitive as AGA positive and the people who had not as AGA negative.

So they took 33 AGA positive and 6 AGA negative people to this study. And they put them on a gluten-free diet for three months. After three months on gluten-free diet the AGA positive people showed a significant decline in psoriasis area and severity. AGA negative people didn’t improve.

And even more telling is what happened after they resumed their normal diet. Psoriasis started getting worse in 18 of the AGA positive people.

So, take gluten sensitive people off gluten and their skin gets better. Put them back to gluten and their skin starts to get worse. Hmmm… maybe there’s something there.

A study done in Egypt compared psoriasis patients with healthy controls. It found that psoriasis patients were much more likely to be gluten sensitive than those with healthy skin. An Indian study of 56 psoriasis patients and 60 healthy controls found similar results.

A study done in the Belfast City Hospital found that psoriasis severity correlates with gluten sensitivity (gluten antibody levels).

Now, results from medical research are rarely as black and white as I’ve given to understand here. And such is the case with psoriasis also. A few studies found no correlation between psoriasis and gluten sensitivity. So we can’t take these studies as the definitive proof that gluten is involved in psoriasis. However these studies certainly suggest it. Also keep in mind that maybe only 16% of psoriasis patients have gluten antibodies. So it’s likely that gluten is an issue for a portion of psoriasis patients but not for everybody.

Gluten and dermatitis herpetiformis

Dermatitis herpetiformis (DH) is an extremely itchy rash made of bumps and blisters. It normally doesn’t hit your face, but if you look at images of dermatitis herpetiformis (not pretty) some cases can be confused with acne.

The link between gluten and HD is very strong; so strong that DH is sometimes called as the celiac disease of the skin. Just to keep this post at manageable length I’m not going to list all the studies here. Wikipedia page for dermatitis herpetiformis lists some of them.

As was the case with psoriasis most DH patients are ‘silent’ celiac sufferers. Their small intestines often look normal under a microscope, but yet eating gluten triggers gluten antibodies. Gluten-free diet often helps.

Risk factors and testing

Currently there is no home test for gluten sensitivity (that I know of). However some people are more prone to it than others. Common risk factors are:

  • Caucasians are more prone to gluten sensitivity than other races, especially people from Northern European origin
  • You are at a high-risk group if you have a first-degree relative with celiac disease.
  • Obviously if you get digestive problems after eating wheat you should get yourself checked

You can talk to your doctor about getting tested for gluten sensitivity.

Oats should be ok

When we talk about gluten issues people often ask if they can eat oats. I found studies on effect of eating oats on celiac disease and dermatitis herpetiformis. The short answer is that gluten sensitive people can eat oats but they should do this with caution. A study by Health Canada concluded the following (emphasis mine).

Based on the majority of the evidence provided in the scientific database, and despite the limitations, Health Canada and the Canadian Celiac Association (CCA) concluded that the majority of people with celiac disease can tolerate moderate amounts of pure oats.

Introduction of oats in the diet of individuals with celiac disease: a systematic review.

The two studies on oats and DH didn’t find any problems after eating oats.

That said, there are potential problems. Oats can be contaminated with wheat. So if you are gluten sensitive, look for oats that are labelled gluten free. Also some people do react negatively to eats.

In conclusion, gluten-free oats should be safe for the skin. However proceed carefully and keep an eye on your skin as you start eating oats.

Probiotics might help

There’s some limited evidence that probiotics can help with these problems.

One reason gluten is problematic is that the inflammation it causes damages the small intestine. Small gaps between cells in the intestines appear and inflammatory substances can escape to the blood through these. There’s also evidence that gluten can disturb the bacterial balance in the gut.

Probiotics may give some protection against these issues. That said, the evidence is scarce. We don’t know for sure how or why they help. Or what strains to use, how much to use them and how long. So I wouldn’t recommend supplementing with probiotics. A better option is to eat fermented foods, such as homemade yogurt.

Conclusion

We can’t say for sure that gluten causes acne. But it sure does look like a bad guy. Given that it’s linked to other somewhat similar skin problems and the abundance of anecdotal user reports at acne forums.

It’s likely that gluten is a big issue for some acne patients. I can’t tell how many emails I’ve gotten from people who say their acne got better almost immediate after cutting gluten from their diet. But it’s hard to believe gluten will cause problems for all or even majority of acne patients. Remember that only about 16% of psoriasis patients had gluten sensitivity. And for those who are not sensitive gluten-free diet offers no help.

Ideally you should talk to your doctor about getting tested for gluten sensitivity. If that’s not possible then try going gluten-free for 4 to 6 weeks. If you don’t see improvements during that time then gluten is probably not an issue for you.

If you want to play it safe you can also avoid oats. Though research shows that most people who are gluten sensitive can tolerate moderate quantities of pure oats (not contaminated with wheat). Eating fermented foods that contain probiotic bacteria might be able to protect your gut from the damage that gluten causes. At least to some degree.

References

  1. Gluten-Sensitive Enteropathy (Celiac Disease): More Common Than You Think
  2. Coeliac disease in the year 2000: exploring the iceberg.
  3. Psoriasis patients with antibodies to gliadin can be improved by a gluten-free diet.
  4. Estimation of (IgA) anti-gliadin, anti-endomysium and tissue transglutaminase in the serum of patients with psoriasis.
  5. Celiac disease-associated antibodies in patients with psoriasis and correlation with HLA Cw6.
  6. Coeliac disease-associated antibodies correlate with psoriasis activity.
  7. Prevalence of antigliadin antibodies in patients with psoriasis is not elevated compared with controls.
  8. Antigliadin antibodies in psoriasis.
  9. IgA antibodies to gliadin and coeliac disease in psoriatic arthritis.
  10. Serologic markers of celiac disease in psoriatic patients.
  11. Dermatitis herpetiformis: coeliac disease of the skin.
  12. Introduction of oats in the diet of individuals with celiac disease: a systematic review.
  13. Can oats be taken in a gluten-free diet? A systematic review.
  14. Absence of toxicity of oats in patients with dermatitis herpetiformis.
  15. Tolerance to oats in dermatitis herpetiformis.

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