Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic inflammatory skin condition characterized by skin abscesses and sinus tracts, primarily in areas with skin folds. While there is no cure for HS, dietary modifications can play a significant role in managing symptoms and preventing flare-ups. This article consolidates existing dietary recommendations from both scientific literature and patient communities to provide a comprehensive guide for individuals with HS.
Understanding the Link Between Diet and HS
HS is an inflammatory skin disease, and diet can either contribute to or alleviate inflammation in the body. Certain foods are known to cause inflammation, while others have anti-inflammatory properties. By making informed dietary choices, individuals with HS can potentially reduce the severity of their symptoms and improve their overall quality of life.
General Dietary Guidelines for HS
Following a balanced diet to help lower skin flare-ups is similar to eating a balanced diet to prevent chronic conditions such as diabetes and heart disease. Here are some general dietary guidelines that may benefit individuals with HS:
- Eat a variety of foods: A well-balanced diet ensures that you receive all the necessary nutrients for overall health and well-being.
- Focus on whole, minimally processed foods: These foods are generally more nutrient-rich and less likely to contain inflammatory additives.
- Consider eliminating specific foods: Some foods are known to trigger inflammation or exacerbate HS symptoms in certain individuals.
- Supplement if there is a known deficiency: Addressing any nutrient deficiencies can help support overall health and potentially improve HS symptoms.
Foods to Consider Eliminating or Reducing
While individual responses to different foods may vary, certain foods have been identified as potential triggers for HS flare-ups. It's important to keep a food diary to identify your specific trigger foods. Some common culprits include:
Dairy
Dairy products contain proteins and hormones that have been linked to inflammation in follicular ducts below the surface of the skin and increased sebum (i.e., oil) production. Some HS patients notice an improvement in their symptoms within weeks of eliminating dairy. High-fat dairy products, in particular, can be inflammatory due to their saturated fat content. Consider eliminating or reducing your intake of milk, cheese, ice cream, butter, and heavy cream. Lower-fat dairy options like yogurt, which contains probiotics, may be better tolerated and can even have anti-inflammatory effects.
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Added Sugars and Refined Carbs
Added sugars and highly refined simple carbohydrates break down into sugar, which can increase blood sugar and spike insulin. This can promote inflammation, blockages of the follicular ducts, and HS flares. In one study, HS patients listed sweets, bread, pasta, and rice as the foods that most commonly exacerbated symptoms. Limit your intake of sugary drinks, high-fructose corn syrup, white bread, white rice, pasta, noodles, biscuits, cookies, cakes, doughnuts, pastries, and potato chips.
Brewer's Yeast
Brewer's yeast (Saccharomyces cerevisiae) is a common ingredient in baked goods and fermented foods. Some people make antibodies against this yeast, a phenomenon linked to Crohn's disease, and there's a known association between hidradenitis suppurativa and Crohn's disease. In one study, 70 percent of people with HS who eliminated brewer's yeast from their diets showed an improvement in HS symptoms, perhaps due to a reduction in inflammation. Brewer's yeast can be found in beer, wine, fermented spreads, some soy sauces, some stock cubes, some dried or canned soups, some breads, cakes, pizzas, some gravies and dips, and some vinegars and salad dressings.
Nightshades
Some people with HS find relief when they cut out foods in the nightshade family, such as potatoes, tomatoes, eggplant, and peppers. The theory is that these foods may increase gut permeability and lead to a leaky gut, which can put your body in a more inflammatory state. While more patients benefit from a diet free of brewer’s yeast than one free of nightshades, this one could be worth a try because it’s easier. You can substitute with other nutritious veggies that aren’t in the nightshade family.
Alcohol
Alcohol is known to be inflammatory and can have various negative effects on the body. Limiting or eliminating alcohol consumption may improve HS symptoms.
Foods to Emphasize
Incorporating anti-inflammatory foods into your diet can help reduce inflammation and potentially improve HS symptoms. Some beneficial foods include:
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Fiber-Rich Foods
Foods that are high in fiber help balance blood sugar and hormone levels. Fiber also helps you feel full faster and may reduce unhealthy food cravings. Consider replacing simple, sugary carbohydrates with whole foods and complex carbohydrates, such as fresh and frozen fruits and vegetables, fresh and dried herbs, beans, brown rice, barley, oats, couscous, and quinoa.
Omega-3 Fatty Acids
Omega-3 fatty acids - found in high amounts in fatty fish, such as salmon and tuna - are an important component of a healthy diet, thanks to their anti-inflammatory properties. The American Heart Association recommends eating two servings of fatty fish per week. There are no specific studies looking at omega-3 intake in people with HS, but the inflammation-reducing powers of these fats could, in theory, help. Other good sources of omega-3 fatty acids include sardines, walnuts, flaxseed and flaxseed oil, avocados, pumpkin seeds, and chia seeds.
Antioxidant-Rich Foods
Antioxidants are beneficial compounds that can be found in plant foods and they may help improve blood sugar regulation and reduce inflammation. A plant-based diet consists of healthy fresh foods of a plant-based nature including vegetables, fruits, legumes, nuts and whole-grains. Vitamin K found in green leafy veg such as kale, spinach and broccoli has a positive effect on reducing inflammation.
Specific Diets to Consider
Several specific diets have shown promise in managing HS symptoms:
Mediterranean Diet
The Mediterranean diet, rich in olive oil, fish, fruits, vegetables, and whole grains, could be a good choice. Research has found that people who followed a Mediterranean diet had less severe HS than others. This diet is rich in antioxidants and other nutrients that may help reduce inflammation. The diet is based on eating plenty of fresh fruit, vegetables, whole grains and healthy fat like olive oil and avocados every day. Other foods central to the diet is a variety of fish and other seafood. Poultry, beans and eggs are eaten in moderation. Dairy products and red meat are only eaten occasionally.
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Paleo Diet
The Paleo diet, which is often recommended for other immune disorders, such as Crohn’s disease, may also be beneficial for HS. People with HS have a higher risk of Crohn’s than those without HS. In popular terms, it’s a paleo diet, but it’s very similar to what a Crohn’s-specific diet is: nut-free, gluten-free, grain-free, legume-free, and nightshade-free. While all the claims of a Paleo diet have not been confirmed, there is evidence that a diet rich in lean protein and plant-based foods can make you feel more satiated, help control blood sugar and promote weight loss.
Autoimmune Protocol (AIP) Diet
The autoimmune protocol (AIP) is believed to reduce inflammation in the body that’s is caused by leaky gut syndrome. The AIP diet proposes a very thorough elimination diet, wherein foods that contribute to leaky gut are removed and the gut lining has time to heal. The diet is very restrictive to start off, eliminating most foods except fresh meat, organ meat, animal fats, bone broth and vegetables. Once your HS symptoms improve, you start reintroducing different foods slowly. The AIP diet can be somewhat considered a very restricted version of the paleo diet. There is little scientific research into the AIP diet for hidradenitis suppurativa, however hundreds of people with HS have seen an improvement in their symptoms by following this diet. Some people follow the diet for 6 months or a year, others make a lifelong commitment to the diet, and live relatively HS free. Eating out can be an issue for people following this diet, and even certain types of seasonings and cooking oil are excluded.
Keto Diet
The keto diet, which is low in carbs and high in fat, could be beneficial if it helps you reduce excess weight. Research has shown that losing weight for people with obesity can significantly lower symptoms.
Supplements to Consider
Supplements may help some people with HS, but, just as with food changes, it’s important to talk to your doctor before taking any.
Zinc
Some people with mild to moderate HS benefit from a zinc supplement, which can boost immune system activity. It can also contribute to nausea and diarrhea in some people, though, and zinc may react with medications like blood pressure drugs and antibiotics. If you take a supplement with zinc, you may also have to supplement with copper, because zinc supplementation can lead to a copper deficiency.
Vitamin D
A review of research notes that high rates of vitamin D deficiency (75 to 100 percent) were consistently observed among HS patients and that several studies showed improved outcomes with vitamin D supplementation. More research is needed to determine how beneficial vitamin D supplementation is and what the optimal dosing would be, but if you are truly deficient in vitamin D - something your doctor can measure with a blood test - it may be recommended.
Vitamin B12
A systematic review of research theorized that vitamin B12 supplementation might help HS treatment through modulating the immune system. There aren’t any randomized controlled trials that evaluate vitamin B12 supplementation in HS patients. However, there are a few reported cases of HS lesions clearing up in patients who also had Crohn’s disease after biweekly supplementation with vitamin B12.
The Importance of Consulting with a Healthcare Professional
It’s critical to work with a healthcare provider to make sure that you’re not engaging in a dietary change that may negatively affect health overall. Some patients need to take in certain food groups for various reasons, and we don’t want to compromise overall health by engaging in certain diets. A registered dietitian can guide you in planning a diet that is anti-inflammatory and can also help you identify which foods are triggers for symptoms in your individual case. They’ll also make sure you’re still getting all the vitamins and nutrients your body needs.
Other Lifestyle Adjustments
In addition to dietary changes, other lifestyle adjustments can help manage HS symptoms:
- Maintain a healthy weight: Excess weight increases insulin resistance and can lead to hormonal changes, which may contribute to HS symptoms.
- Quit smoking: Tobacco use is associated with hidradenitis suppurativa, so quit smoking to reduce the likelihood of HS flare-ups.
- Manage stress: Stress can worsen HS symptoms. Find healthy ways to manage stress, such as exercise, yoga, or meditation.