Lupus is an autoimmune disease that causes inflammation throughout the body. For those with lupus,diet can play an important role in managing symptoms. Some experts recommend eliminating gluten, a protein found in wheat, barley and rye. But is a gluten-free diet beneficial for lupus patients? Here we’ll examine the evidence.
What is lupus?
Lupus is an autoimmune disease where the immune system attacks healthy tissue, causing widespread inflammation. This can affect any part of the body, but often impacts the joints, skin, kidneys, blood cells, brain and heart. Symptoms vary between individuals but may include fatigue, joint pain, rashes, fever and kidney problems. There is no known cure for lupus, but medications and lifestyle changes can help control symptoms.
What causes lupus?
The exact cause of lupus is unknown. Researchers believe a combination of genetic, environmental and hormonal factors trigger lupus. People are also more likely to develop lupus if they have a family history of the disease. Female hormones may explain why 90% of lupus patients are women. Flares can be triggered by sun exposure, infections, stress or certain medications.
How is lupus diagnosed?
There is no single test to diagnose lupus. Doctors look for a combination of symptoms, lab tests and clinical exam findings. Blood tests check for autoantibodies linked to lupus, like antinuclear antibodies (ANA). Doctors may also order biopsies or imaging tests to assess organ damage. Symptoms are tracked over time to distinguish lupus flares from infections or reactions to medications.
What is gluten?
Gluten is a protein found in grains like wheat, barley and rye. It helps give dough its elastic texture. Gluten is also found in many processed and packaged foods. People with celiac disease or gluten sensitivity experience digestive and health problems when they eat gluten. But gluten is generally safe for most people.
Sources of gluten
Foods containing gluten include:
- Bread, pasta, crackers, baked goods
- Beer, ale and malt beverages
- Cereals, oats
- Soy sauce, salad dressings, soups
- Meat substitutes with fillers
- Some vitamin/herb supplements
Signs of gluten intolerance
People with celiac disease or non-celiac gluten sensitivity may experience:
- Diarrhea, bloating, gas
- Abdominal pain, nausea
- Headaches, fatigue
- Skin rash (dermatitis herpetiformis)
- Joint pain
- Neurological symptoms
Symptoms typically improve quickly on a gluten-free diet. Blood tests can help confirm diagnosis.
Should people with lupus avoid gluten?
There is some controversy over whether lupus patients should go gluten-free. Here we examine the potential benefits and risks.
Potential benefits of going gluten-free
There are several reasons why eliminating gluten may help some lupus patients:
- GI symptoms: Many lupus patients have co-existing celiac disease or gluten sensitivity. Avoiding gluten can relieve associated digestive issues.
- Inflammation: Gluten prompts an immune response in sensitive individuals. Reducing inflammation may improve lupus symptoms.
- Pain: Some report less joint pain and rheumatoid arthritis activity without gluten.
- Fatigue: Going gluten-free may boost energy levels in those with gluten intolerance.
- Skin issues: Gluten is linked to some skin problems, like dermatitis herpetiformis, common in lupus.
- Kidney function: Gluten may worsen lupus-related kidney inflammation and function decline.
Potential risks of a gluten-free diet
However, there are also potential downsides of eliminating gluten:
- Nutrient deficiencies: Gluten-free versions of bread, cereals and other fortified foods often lack vitamins and minerals like B vitamins, iron and fiber.
- High glycemic index: Gluten-free products tend to be higher glycemic, which may raise blood sugar.
- Weight changes: Going gluten-free may lead to weight gain or loss in some individuals.
- Cost: Gluten-free specialty products are more expensive than regular foods.
- Social impact: Dietary restrictions can make dining out and social gatherings challenging.
- No benefit: Gluten elimination only helps those with gluten intolerance. It provides no advantage for others.
Who may benefit from going gluten-free?
While gluten restriction is a popular health trend, it only provides clear benefits for those with celiac disease or non-celiac gluten sensitivity. About 10-15% of lupus patients may fall into those categories. Gluten avoidance may also help a subset of patients with significant digestive symptoms, inflammation, pain or other issues that improve on a gluten-free diet.
However, there is no strong evidence that eliminating gluten universally helps lupus patients. Many experience no difference on a gluten-free diet. Unless advised by a doctor for medical reasons, most people with lupus likely do not need to cut out gluten completely.
Signs you may benefit from going gluten-free
Talk to your doctor about gluten elimination if you have:
- Chronic diarrhea, constipation, bloating or abdominal pain
- Headaches or ‘brain fog’ that improve after going gluten-free
- Unexplained iron deficiency anemia, fatigue
- Skin rashes like dermatitis herpetiformis
- Joint pain or arthritis that waxes and wanes
- Positive blood tests for celiac disease
Symptoms that recurrently appear and fade with gluten consumption indicate possible gluten intolerance or celiac disease.
Signs a gluten-free diet may not help
Avoiding gluten is unlikely to provide benefits if you have:
- No digestive symptoms when consuming gluten
- Chronic lupus symptoms that persist despite a gluten-free diet
- Kidney inflammation not linked to gluten intake
- Negative blood tests for celiac disease
- No improvement in energy, pain or other issues on a gluten-free diet
In such cases, restricting gluten provides little advantage. Focus instead on an overall balanced anti-inflammatory diet.
Tips for following a gluten-free diet with lupus
If you and your doctor decide a gluten-free diet may be beneficial, here are some tips to make the transition easier:
- Consult a dietitian knowledgeable about gluten alternatives, lupus nutrition needs and potential pitfalls of going gluten-free.
- Add more lean proteins, fruits, vegetables and gluten-free whole grains like quinoa, buckwheat, rice and millet to replace gluten sources.
- Check labels carefully for hidden gluten in sauces, dressings, soups, meat substitutes and questionable products.
- Look for gluten-free swaps to favorite foods like bread, pizza, pasta and baked goods.
- Be wary of most oats, unless certified gluten-free, due to cross-contamination risks.
- Consider taking supplements to prevent deficiencies in iron, B12, folate, calcium, fiber and other nutrients.
- Allow time for your body to adjust. Symptoms often improve within weeks on a strict gluten-free diet.
With some adaptation, those with gluten issues can follow a lupus-friendly diet without gluten. For those who don’t benefit, limiting processed foods and emphasizing more fruits, vegetables, lean proteins and whole grains provides greater advantage.
Should lupus patients get tested for celiac disease?
Active screening for celiac disease in lupus patients is somewhat controversial. About 3-10% of those with lupus also have celiac disease. Diagnosing gluten problems allows appropriate treatment with a gluten-free diet. However, testing everyone is expensive and most will have negative results.
Professional groups differ in their recommendations about celiac disease screening in lower risk populations. But many suggest screening lupus patients with potential symptoms like:
- Chronic GI complaints – diarrhea, nausea, bloating, pain
- Unexplained weight loss, nutritional deficiencies
- Mouth ulcers
- Joint pain, arthritis
- Persistent fatigue, headaches or ‘brain fog’
- Abnormal liver enzyme tests
Diagnosis involves blood tests for antibodies such as:
- Tissue transglutaminase (tTG)
- Deamidated gliadin peptide (DGP)
- Endomysial antibodies (EMA)
A small bowel biopsy showing intestinal damage can confirm celiac disease. Patients also feel significantly better on a gluten-free diet.
Who should consider celiac disease testing?
Discuss screening with your doctor if you have:
- Ongoing diarrhea, constipation, gas or abdominal pain
- Chronic fatigue, headaches or mental fogginess
- Unexplained iron deficiency anemia
- Skin issues like dermatitis herpetiformis rash
- Joint swelling and pain that comes and goes
- Mouth ulcers
- Abnormal liver enzymes of unknown cause
Prompt diagnosis allows treatment with gluten restriction. Periodic follow-up testing checks that antibody levels normalize on a gluten-free diet.
When screening is unnecessary
Celiac disease testing provides little useful information if you have:
- No digestive complaints
- Stable chronic lupus symptoms unaffected by diet
- Kidney involvement not linked to gluten intake
- Normal vitamin/mineral levels
- Negative antibody blood tests
Rather than blanket testing, physicians try to identify at-risk lupus patients with signs of possible gluten issues. Those with positive antibody tests need an intestinal biopsy for celiac disease confirmation.
The takeaway on lupus and gluten
It’s clear gluten restriction helps the subset of lupus patients with celiac or non-celiac gluten sensitivity. However, there is little solid evidence that avoiding gluten universally benefits those with lupus. Eliminating gluten may help certain patients with digestive woes, inflammation, pain or other symptoms improved on a gluten-free diet. But most lupus patients likely see minimal effect. Gluten avoidance only proves useful for those with an underlying gluten intolerance.
Rather than arbitrary gluten restriction, lupus patients should consider getting tested for celiac disease if they have suggestive symptoms. This allows treatment of gluten problems. Those with negative results can focus on an overall anti-inflammatory diet, without needless elimination of gluten-containing healthy staples like whole grains. Any symptomatic lupus patients starting a gluten-free diet should ensure adequate nutrition and add alternative gluten-free whole grains. With the right modifications, both gluten and lupus can be managed for better health.
The bottom line
- Only a subset of lupus patients have gluten intolerance that warrants a gluten-free diet.
- Benefits may include reduced inflammation, pain, fatigue and GI and skin symptoms.
- But gluten restriction also carries some risks like deficiencies and higher costs.
- Those with potential celiac symptoms should get screened but blanket testing is not needed.
- Most lupus patients don’t require strict gluten elimination for benefit.
Frequently asked questions
Should you avoid gluten with lupus?
Only some lupus patients need to avoid gluten completely. About 10-15% have celiac disease or gluten sensitivity that requires a gluten-free diet. For those with no evidence of gluten issues, eliminating gluten rarely helps manage lupus.
Can gluten cause lupus flares?
For those with gluten intolerance, consuming gluten can trigger lupus flare-ups with worsening symptoms. However, gluten itself does not cause flares in people who tolerate it normally. Many lupus patients eat gluten with no problems.
Do you lose weight on a gluten-free diet?
Some people lose weight initially on a gluten-free diet, especially if eliminating gluten reduces inflammation or digestive issues. But gluten-free products are often higher in sugar and fat, which can promote weight gain. The impact on weight varies individually.
Is gluten-free healthier?
For those with celiac disease or gluten sensitivity, avoiding gluten is healthier and reduces complications. But for people who tolerate gluten well, gluten-free diets confer no additional health benefits. Gluten-free junk foods are still unhealthy.
Are headaches a sign of gluten intolerance?
Headaches are a possible symptom of gluten intolerance, along with brain fog and fatigue. Celiac disease is linked to migraines and headaches that resolve on a gluten-free diet. But many other things can also trigger headaches.
Sample gluten-free lupus meal plan
When transitioning to a gluten-free diet, planning meals and snacks helps ensure nutrition. Here is a sample one day gluten-free lupus diet.
| Meal | Foods |
|---|---|
| Breakfast | Gluten-free oatmeal with berries and pecans; scrambled eggs; decaf coffee/tea |
| Lunch | Mixed greens salad with chickpeas, avocado, tomatoes; chicken breast; balsamic vinaigrette; fresh fruit |
| Snack | Low-fat Greek yogurt with nuts and apple slices |
| Dinner | Broiled salmon; quinoa pilaf; steamed broccoli; glass of milk |
| Snack | Gluten-free crackers with nut butter; berries |
Focus on lean proteins, fruits/veggies, dairy, gluten-free whole grains and healthy fats. Avoid processed gluten-free products high in carbs, sugar and fat that promote inflammation.