The link between gluten and sinus congestion.
Nearly 30 years ago, celebrated gluten-free cookbook author Carol Fenster noticed her sinus infections were getting more frequent and more debilitating. The skin under her eyes was puffy and swollen and the constant congestion and trouble breathing, which was worse lying down, made her sleep fitful.
“I was missing more and more work and it was very frustrating because I couldn’t see any pattern to the infections,” Fenster says. Doctor after doctor prescribed decongestants and antibiotics. At one point, she was on antibiotics continuously for an entire year.
A sympathetic co-worker suggested Fenster meet with her allergist, who at the time was considered to be on the fringe of traditional medicine. “Other doctors warned me he was a quack,” Fenster says. Indeed, his recommendation for Fenster was unconventional—avoid wheat. “He ran some tests, which were definitely not mainstream in 1988, and told me that I had a wheat intolerance.”
Initially, Fenster just cut down on wheat—the daughter of a wheat farmer, she had a hard time eliminating it completely—but even the reduction made a big difference. Her antibiotic use plummeted. Eventually, Fenster, who doesn’t have celiac disease, cut out all wheat and gluten and her chronic sinus problems virtually disappeared.
“In the 27 years I’ve been gluten-free, I’ve had only a handful of sinus infections and those were the result of a bad cold,” she says.
Spectrum of Sinus Problems
Fenster isn’t alone. It’s not uncommon for patients to report that since going gluten-free or since they were diagnosed with celiac disease, their sinus infections have disappeared or symptoms from airborne allergies are gone, says Amy Burkhart, MD, RD, an integrative medicine and celiac specialist in Northern California. But it’s unclear why so many find themselves breathing easier.
“A large new study just showed allergies, hay fever and rhinitis all improved with probiotics,” says Burkhart. “Could this be parlayed into gluten issues? If gluten has some effect on the microbiome, are you manipulating it when you go gluten-free and is that improving sinus issues?”
In fact, there’s been no direct research on gluten and sinus issues. So officially, experts can’t say that going gluten-free will benefit your sinuses. And Burkhart notes that not everyone with sinus issues notices improvement by eliminating gluten. It’s not the first thing she recommends for sinus problems, she says.
Sinusitis is just a fancy term for inflammation of the sinuses, which are hollow cavities in the face and around the nose.
“When people talk about ‘sinus problems,’ there’s really a spectrum,” explains Burkhart. “You can have rhinitis (inflammation of the nasal cavity, not the sinuses), nasal congestion (like from a cold), allergies (such as hay fever) or full-blown sinusitis (sinus infection).”
A full-blown sinus infection comes with fever, congestion, headache and pressure. Saline rinses that thin the mucus and anti-inflammatory pain medications can offer relief, as can antibiotics. But new guidelines released by the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) stress antibiotics should only be used in clear-cut cases of bacterial infection—congestion plus colored discharge and/or pain that hasn’t relented after ten days. Even then, it’s OK to wait to see if things improve on their own.
“In an acute situation, we may need antibiotics—but wouldn’t it be great if we could manipulate the diet so these things don’t recur or become chronic?” says Burkhart.
Indeed, chronic sinusitis, which is characterized by congestion and inflammation that lasts at least three months, is hard to kick and even harder to keep from recurring.
There’s no real data on preventing chronic sinusitis, says Richard Rosenfeld, MD, chairman of otolaryngology at SUNY Downstate Medical Center in Brooklyn and lead author of the new AAO-HNSF guidelines. “In general, anything you can do to reduce inflammation will help chronic sinusitis,” he says. “If you smoke, stop. If you have allergies, try to reduce exposure to your allergens. If you have celiac disease or a gluten-related problem, avoid gluten.”
Food Triggers for Sinus Infections
Gluten isn’t the only food some tie to sinus problems. Even more people try cutting out cow’s milk, according to Payel Gupta, MD, an adult and pediatric allergy specialist at New York Allergy and Sinus Centers in Manhattan. “Some people think milk increases the viscosity of mucus,” says Gupta. “Some doctors have their patients avoid milk if they’re having a cold or their allergies are really bad. But there’s no medically known mechanism for why this might occur. The bottom line is adults don’t need milk or gluten, so if avoiding these foods makes them feel better, I have no problem with it.”
However, Gupta recommends first ruling out the things known to contribute to sinus symptoms, like a deviated septum, polyps or allergies, before eliminating dairy or gluten. (Anecdotally, sugar and yeast are also reported to exacerbate sinus problems.)
And don’t make more than one change—diet or otherwise—at a time, advises Gupta. “If you tweak multiple things at once, like eliminating dairy and gluten and you start keeping your windows closed if you have pollen allergies, it’s hard to figure out the trigger or thing that’s affecting you the most.”
A diet elimination trial of four to six weeks should be sufficient, Gupta says. But people often know much sooner than that if the dietary change is helping them breathe easier.
Editor’s note: Experts strongly recommend screening for celiac disease before going gluten-free. Celiac tests require regular gluten in the diet to work correctly. If you don’t test for celiac disease, you won’t be able to tell if improvements in your health are the result of celiac disease, gluten sensitivity or something else.
Health editor Christine Boyd lives in Baltimore, MD.