Beer

Beer is made through brewing, a process where grains (usually malted barley) are soaked in water to release the natural sugars. Yeast is then added to the sweet liquid to ferment the sugars, converting them to alcohol and carbon dioxide.

Across the world beer is the most popularly consumed alcoholic drink, but what effect does drinking beer have on psoriasis?

What do we know about beer and psoriasis?

Researchers started to notice links between alcohol intake and psoriasis in the 1980’s1, when they found that in men with psoriasis, those who drank a lot of alcohol had the most severe cases of psoriasis2.

Since then studies have confirmed that people who drink a lot of alcohol appear to have a stronger risk of developing psoriasis3, and that drinking lots of alcohol appears to make psoriasis worse 4,5 .

Experts think alcohol may aggravate psoriasis by:
  • Activating an overgrowth of skin cells6
  • Triggering inflammation7,8
  • Increasing the risk of skin infection9
  • Reducing how well psoriasis mediations work10

It’s possible that different types of alcohol affect psoriasis in different ways. In a recent study, beer, but not other types of alcohol, was linked with an increase in developing psoriasis11.

This link might be due to the fact that beer is made with barley, which contains gluten12, a type of protein found in cereal grains. Some studies have found an association between gluten and psoriasis13,14,15, with a gluten free diet found to be helpful in psoriasis sufferers who have raised levels of antibodies (proteins produced by immune cells) against gluten16.

What does the science tell us?

Investigating the relationship between beer and psoriasis is difficult because it’s not ethical or safe to ask people with psoriasis to drink lots of beer in order to see whether their psoriasis gets worse.

It’s also difficult to say how long it might take for psoriasis to develop or change in response to drinking beer, which means it might be necessary to monitor people for many years before any patterns emerge. This means we have to look at data from studies that assess how much alcohol people drank in the past (a retrospective study), or monitor their drinking habits over a number of years (prospective studies).  

In a recent prospective study11, the drinking habits of over 80,000 American women with no previous history of psoriasis were monitored between 1991 and 2005. During the study period the women were asked to report on how much and what sort of alcohol they drank using questionnaires at various time points.  

At the end of the study the researchers looked at how many women had gone on to develop psoriasis, and if there was any link with drinking habits. They found that compared to women who did not drink alcohol, there was an increased risk of psoriasis in women drinking more than 2.3 alcoholic drinks per week. When they looked further, they found a strong association between beer intake (more than 5 drinks a week) and psoriasis risk, but not red wine, white wine, or spirits11.

To date, this is the only study which has looked specifically at beer and psoriasis risk. Other studies have looked at the effects of all types of alcohol on psoriasis. In these studies more than 80-100 grams of alcohol per day (one pint of beer is equivalent to around 20 grams of alcohol) was associated with an increased risk of psoriasis and less improvement from treatment1,10.

Are there any risks associated with drinking beer?

Drinking a lot of alcohol is thought to increase the risk of a wide range of diseases including heart disease, cancer and liver disease17. It can also have negative effects on mood and sleep.  

Because both alcohol and medications are processed in the liver, the two can interact. There is some evidence that alcohol can reduce the effectiveness of some medications, and can increase the risk of liver disease in people who are taking methotrexate, a medication used in psoriasis therapy18.

How much is too much?

It’s not clear how much alcohol might increase psoriasis severity. Some studies have found that drinking more than 80-100 grams of alcohol a day is linked with adverse effects on psoriasis severity and treatment. One beer is equal to ~20 grams of alcohol.

For people taking methotrexate, the British Association of Dermatologists advise people with psoriasis taking methotrexate should not drink more than four to six units per week – one pint of beer is equal to 2.3 units.

In the UK, the alcohol guidelines have recently been updated19. Previously, the allowance for men was greater than for women, but these have now been lowered, and the advice is now that men and women stick to no more than 14 units of alcohol per week, with several alcohol free days each week.

Learning points

  • Drinking lots of alcohol is associated with an increase in the risk and severity of psoriasis.  
  • A small amount of research has suggested that beer may be more strongly linked with psoriasis risk than other types of alcohol. This may be due to the fact that beer is a source of gluten (a type of protein found in wheat rye and barley), which has been associated with psoriasis in some people with the condition.  
  • Staying within the recommended guidelines for alcohol intake (no more than 14 units a week, one beer = 2.3 units) is advisable for both men and women.

 

Sources

  1. Poikolainen K, Reunala T, Karvonen J, Lauharanta J, Kärkkäinen P. Alcohol intake: a risk factor for psoriasis in young and middle aged men? BMJ 1990;300(6727):780-3. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1662565&tool=pmcentrez&rendertype=abstract.
  2. Monk BE, Neill SM. Alcohol consumption and psoriasis. Dermatologica 1986;173(2):57-60. doi:10.1159/000249219.
  3. Chaput, J. C, Poynard, T, Naveau S et al. Psoriasis, alcohol, and liver disease. Br. Med. J. (Clin. Res. Ed). 1985;291(July):1985.
  4. Vincenti GE. Psoriasis and Alcohol Abuse. J. R. Army Med. Corps 1987;133:77-78.
  5. Kirby B, Richards HL, Mason DL, Fortune DG, Main CJ, Griffiths CEM. Alcohol consumption and psychological distress in patients with psoriasis. Br. J. Dermatol. 2008;158(1):138-40. doi:10.1111/j.1365-2133.2007.08299.x.
  6. Farkas ??rp??d, Kem??ny L, Sz??ll M, Dobozy A, Bata-Cs??rgo Z. Ethanol and acetone stimulate the proliferation of HaCaT keratinocytes: The possible role of alcohol in exacerbating psoriasis. Arch. Dermatol. Res. 2003;295(2):56-62. doi:10.1007/s00403-003-0399-2.
  7. Ockenfels HM, Keim-Maas C, Funk R, Nussbaum G, Goos M. Ethanol enhances the IFN-gamma, TGF-alpha and IL-6 secretion in psoriatic co-cultures. Br J Dermatol 1996;135(5):746-751. Available at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8977675.
  8. Farkas Á, Kemény L. Psoriasis and alcohol: Is cutaneous ethanol one of the missing links? Br. J. Dermatol. 2010;162(4):711-716. doi:10.1111/j.1365-2133.2009.09595.x.
  9. Higgins EM, du Vivier  a W. Cutaneous disease and alcohol misuse. Br. Med. Bull. 1994;50(1):85-98. Available at: http://www.ncbi.nlm.nih.gov/pubmed/7908595.
  10. Gupta MA, Schork NJ, Gupta AK, Ellis CN. Alcohol intake and treatment responsiveness of psoriasis: a prospective study. J. Am. Acad. Dermatol. 1993;28(5 Pt 1):730-2. doi:10.1016/0190-9622(93)70101-X.
  11. Qureshi A a, Dominguez PL, Choi HK, Han J, Curhan G. Alcohol intake and risk of incident psoriasis in US women: a prospective study. Arch. Dermatol. 2010;146(12):1364-1369. doi:10.1001/archdermatol.2010.204.
  12. Tanner GJ, Colgrave ML, Blundell MJ, Goswami HP, Howitt CA. Measuring Hordein (Gluten) in Beer – A Comparison of ELISA and Mass Spectrometry. PLoS One 2013;8(2). doi:10.1371/journal.pone.0056452.
  13. Kaimal S, Thappa DM. Diet in dermatology: revisited. Indian J. Dermatol. Venereol. Leprol. 2010;76(2):103-115. doi:10.4103/0378-6323.60540.
  14. Michaelsson G, Gerden B, Ottosson M, et al. Patients with psoriasis often have increased serum levels of IgA antibodies to gliadin. Br. J. Dermatol. 1993;129(6):667-673.
  15. Lindqvist U, Rudsander  a, Boström  a, Nilsson B, Michaëlsson G. IgA antibodies to gliadin and coeliac disease in psoriatic arthritis. Rheumatology (Oxford). 2002;41(1):31-7. doi:10.1093/rheumatology/41.1.31.
  16. Bhatia BK, Millsop JW, Debbaneh M, Koo J, Linos E, Liao W. Diet and psoriasis, part II: Celiac disease and role of a gluten-free diet. J. Am. Acad. Dermatol. 2014;71(2):350-358. doi:10.1016/j.jaad.2014.03.017.
  17. Pelucchi C, Tramacere I, Boffetta P, Negri E, Vecchia C La. Alcohol Consumption and Cancer Risk. Nutr. Cancer 2011;63(7):983-990. doi:10.1080/01635581.2011.596642.
  18. Laharie D, Terrebonne E, Vergniol J, et al. The liver and methotrexate. Gastroenterol. Clin. Biol. 2008;32(2):134-142. doi:10.1016/j.gcb.2007.11.002.

19. Department of Health. UK Chief Medical Officers ’ Alcohol Guidelines Review Summary of the Proposed New Guidelines.; 2016. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/489795/summary.pdf.

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