Unlock Relief: The Ultimate Hidradenitis Suppurativa Diet Guide to Manage Symptoms Through Smart Food Choices

Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic autoinflammatory skin condition affecting hair follicles in flexural sites. Characterized by deep, inflamed skin lesions or sores that may look like boils, HS usually develops after puberty and may be genetic. It is also more common in people with obesity. The condition can affect one spot or multiple areas of the patient’s body. Excess weight, stress, hormonal changes, heat or humidity may worsen symptoms. While there’s no cure for this condition, dietary measures may help soothe symptoms and prevent flare-ups. A doctor may also recommend treatments such as antibiotics, laser treatments, or surgery.

Research suggests that diet can reduce or worsen symptoms of hidradenitis suppurativa. Certain foods may trigger flare-ups, while others may help lower inflammation. Learning more about what foods may trigger flare-ups and which may help lower inflammation can be an important step in managing this condition.

Understanding the Connection Between Diet and HS

Hidradenitis suppurativa can either worsen or benefit depending on various dietary influences, either included, or excluded by the patient. A literature review on the impact diet has on hidradenitis suppurativa (HS) proposed potential links between them, suggesting diet alterations could improve symptoms.

Keratinocyte differentiation as well as genetic, environmental, hormonal, and lifestyle factors could influence the etiology of HS. Obesity has been labeled has a major risk factor of HS, especially present in women of color. Metabolic syndrome (MetS) and obesity join in the progression of HS through meta-inflammation. Weight loss is a significant alteration in improved HS symptoms because it controls the general inflammation associated to HS and any MetS-induced inflammation.

Nutrition and inflammatory skin diseases are closely connected. If you have hidradenitis suppurativa, the way you eat can have an impact on whether your symptoms are better or worse. The speed at which sugar is absorbed into blood stream has a huge impact on the body. People with HS have been found to increased susceptibility to developing metabolic syndrome, including type 2 diabetes and cardiovascular disease. Research has shown that adipose tissue cells (fat) contribute to increased inflammation in the body. Fat cells secrete little proinflammatory molecules, and this contributes to low-level inflammation throughout the body. Certain foods can improve your mood, and this doesn’t mean comfort food! Some foods like protein rich foods can even help you to sleep better! And sleep is so important for the body to recover and heal.

It’s important to note that inﬂammation is not necessarily a bad word, inﬂammation is the body’s natural response to protect itself when tissue has been damaged or when a harmful substance is perceived by the body. Chemicals are released from white blood cells which increase the blood ﬂow to the area of injury or infection causing redness, warmth, swelling and triggering pain, the increased blood ﬂow promotes the natural healing process of the body. The problem arises when the body continues to send signals that there is still a threat and healthy cells become damaged.

Dietary Strategies for Managing HS

Registered dietitian Devon Peart, RD, MHSc, BASc, explains how your diet can affect your hidradenitis suppurativa, and shares which foods to embrace and which to avoid in the ongoing quest to manage symptoms.

Elimination Diet

Peart suggests removing certain foods from your diet temporarily - a minimum of two weeks - to see how your HS reacts. This is called an “elimination diet.” In particular, she recommends, “Try avoiding gluten, brewer’s yeast and alcohol for a trial period to see if your symptoms improve.”

Foods to Limit or Avoid

Certain foods are thought to make hidradenitis suppurativa worse. As with most conditions, there are individual differences with respect to food sensitivities and what foods might trigger inflammation. By keeping a food journal or diary, you may be able to identify triggers for your flare-ups so that you can minimize or avoid those foods.

Highly Processed Foods: Highly processed foods and foods with lots of additives negatively impact your gut flora. By “gut flora,” we mean the “good” bacteria that live in your gut and keep your immune system healthy. Gut bacteria ferment dietary fibers to make short-chain fatty acids, which play an important role in reducing inflammation.
Dairy: Milk and other dairy products may raise levels of certain hormones that lead to hidradenitis suppurativa symptoms. Limited research has demonstrated that eliminating dairy products may help lower hidradenitis suppurativa symptoms in some people. Peart says high-fat dairy products can be inflammatory because of their saturated fat content. This includes ice cream, butter, whole milk, cheese and heavy cream.Dairy foods that are lower in fat don’t appear to be inflammatory. And yogurt actually reduces inflammation because of its high probiotic content, which is good for your gut. (Just be sure you’re not reaching for sugary sweet versions. Plain, nonfat yogurt is best.)
Sugary Foods: Sugary foods and refined, simple carbs can cause a spike in blood glucose. According to research, this may trigger inflammation and cause symptoms. Studies show that simple sugars are a common trigger for inflammation and may worsen HS symptoms.Sugary foods spike insulin which can lead to inflammation, as well as potentially more stored fat and weight gain,” Peart explains. It may be helpful to limit simple carbohydrates and foods that are high in added sugars, such as: high-fructose corn syrup, soda and other sugary drinks like fruit juice, bread, rice, or pasta made from white flour, noodles, biscuits and cookies, cake, doughnuts, and pastries and potato chips.
Brewer’s Yeast: Brewer’s yeast may be a trigger for hidradenitis suppurativa symptoms. This may happen because the yeast causes a reaction in your immune system.A 2020 study of 185 participants found that people who excluded brewer’s yeast (along with other foods) from their diets had a 70% improvement in symptoms. When participants added brewer’s yeast back to their diet after some time, 87% of them experienced symptom recurrence.If you have hidradenitis suppurativa, you may want to check your food labels and avoid anything that may contain brewer’s yeast, including: beer, wine, fermented spreads, some soy sauces, some stock cubes, some dried or canned soups, some breads, cakes, and pizzasome gravies and dips and some vinegars and salad dressings.
Refined Carbs: There are various types of carbs, but refined carbs are those that contain processed (white) flour or added sugar. “Refined carbs are not as nutrient-rich as less processed carbs like whole grains and sweet potato for example. Refined carbs include desserts, white bread, white rice, pasta, chips, crackers and pretzels,” Peart says. “They lack fiber and other nutrients.”Foods like these lead to a greater insulin response and affect other factors that can lead your cells to produce too much sebum - an oil your body makes to keep your skin moist. “This can lead to blocked follicles that can trigger acne and hidradenitis suppurativa,” she adds.
Alcohol: Alcohol can have all kinds of effects on your body, impacting everything from your liver to your pancreas to your heart. And it can also play a role in your hidradenitis suppurativa.“Alcohol is known to be inflammatory,” Peart warns. Drinking less or eliminating alcohol entirely may improve your HS symptoms.
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, says Paek.

Anti-Inflammatory Diet

An anti-inflammatory diet is exactly what it sounds like: An eating plan designed to reduce inflammation in the body. But what this means for you is specific to your body and its individual needs, so it’s important to work with a professional.

Read also: Diet and Hidradenitis Suppurativa

“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,” Peart says. They’ll also make sure you’re still getting all the vitamins and nutrients your body needs.

Mediterranean Diet

Certain foods - like fruits, veggies, chicken and fish - seem to improve HS symptoms, likely due to high concentrations of micronutrients such as zinc and B12, Peart notes. And there’s one anti-inflammatory eating style in particular, that focuses on all of them.

Known as a healthy diet for your heart, the Mediterranean diet focuses on whole, minimally processed foods, especially those that are plant-based. “This helps grow a wide range of gut bacteria, which supports overall health and immunity,” she continues. “You want to be sure you’re eating fiber- and nutrient-rich foods.” That includes:Beans, healthy fats, like olive oil, fruits and vegetables, lean proteins, like fish and chicken and whole grains.

A 2019 study showed that following a Mediterranean diet can improve disease severity in people with hidradenitis suppurativa. The Mediterranean diet is based on the foods eaten in countries like Greece, Spain, Italy and other countries of the Mediterranean Sea. Researchers in the 1960’s started examining the diets of people in the Mediterranean as they were found to have a lower risk of many different diet related heath problems like cardiovascular disease. 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.

Fiber-Rich Foods

Foods that are high in fiber help balance blood sugar and hormone levels. Fiber also helps you feel full faster. This may help you keep a moderate weight for your body size. 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.

Read also: Weight Loss Strategies for HS

Omega-3 Fatty Acids

Research shows that omega-3 fatty acid foods may help to lower inflammation in your body. Reducing overall inflammation may help prevent or soothe symptoms of hidradenitis suppurativa, such as inflamed sores.

Further research is needed to confirm the benefits of omega-3 fatty acids for hidradenitis suppurativa, but these healthy fats are also good for your heart, blood vessels, and brain. Try adding them to your diet by eating: salmon, sardines, walnuts, flaxseed and flaxseed oil, avocados, pumpkin seeds and chia seeds.

Supplements

Some research has shown that taking certain vitamin and mineral supplements may benefit people with hidradenitis suppurativa. For example, research has demonstrated that people with hidradenitis suppurativa are more likely to have low blood levels of zinc and vitamin D. Supplementing with these nutrients may help lower symptoms.

If you’re interested in supplements that may improve hidradenitis suppurativa and correct possible deficiencies, consider speaking with a healthcare professional about your options.

Zinc: Zinc utilization displayed suppressive qualities rather than curative in some evidence. Overall, deficiency correlated to higher reactive oxygen species (ROS) and MMPs. Data also found zinc as a potential marker of disease severity. Zinc supplements have immune system modulation effects, reducing acute flares and achieving disease-free survival rates.
Vitamin D: Vitamin D supplements are a recommended method of diet alteration since substantial information indicated HS severity to vitamin D deficiency. One study resulted in patients with HS embodying higher levels of vitamin D deficiency compared to the control groups. The relationship between vitamin D and skin immunology relies on the production of antimicrobial peptides, emerging skin inflammation after an excess of microbial buildup.
Vitamin B12: The production of elevated plasma homocysteine levels is directly related to the severity of HS symptoms. Pro-inflammatory effects of cytokines are largely related to homocysteine. Homocysteine is known to increase ROS generation via NADPH oxidase stimulation. However, vitamin B12 adjusts homocysteine levels, alluding towards beneficial effects of supplementation, reducing proinflammatory effects.

Other Diets to Consider

Diets for hidradenitis suppurativa have become popular. They include the autoimmune protocol and the Whole30 diets. However, further research is still needed to determine their exact effectiveness. Some adults with hidradenitis suppurativa report good results on these diets. This may be because these diets restrict foods such as dairy and refined carbohydrates that are clinically shown to trigger symptoms. Still, some diets can be overly restrictive, and there’s currently no scientific evidence that any one diet works for hidradenitis suppurativa.

Paleo Diet: 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. Many people believe that leaky gut (intestinal permeability) causes toxins and food particles to be absorbed into the blood stream through tiny gaps in the lining of the intestine. 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. It’s recommended to get some Tupperware so you can batch cook and plan meals to make following the AIP diet a bit easier. Eating out can be an issue for people following this diet, and even certain types of seasonings and cooking oil are excluded. But these sacrifices are worth it for some.

Additional Lifestyle Considerations

Other lifestyle adjustments that could help manage hidradenitis suppurativa:

Smoking: Tobacco use is associated with hidradenitis suppurativa, so quit smoking to reduce the likelihood of HS flare-ups. (Ask your healthcare provider for advice and resources.)
Obesity: Having overweight or obesity increases insulin resistance and can lead to hormonal changes, which may contribute to HS symptoms.
Diabetes: One study found that 10.6% of people who have diabetes also have hidradenitis suppurativa. Stabilizing your blood sugar may help your HS.

Practical Tips for Implementing Dietary Changes

Do Keep a Food Diary: By writing down what you eat and noting the severity of your symptoms, you can glean important clues about which foods may cause flares or make them worse. Not everyone has the same trigger foods, so it’s helpful to develop a personalized log and show it to your doctor at your next visit.
Don’t Forget About Fiber: Fiber is important for everyone, and people with HS are certainly no exception. Fiber can increase your feeling of fullness or satiety.
Do Ask Your Doctor About Eliminating Dairy: Dairy foods 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.
Don’t Eat Too Many Added Sugars or 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.
Do Consider Eliminating Foods That Contain Brewer’s Yeast: 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.
Don’t Skip Foods Rich in Omega-3 Fatty Acids: 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.
Do Consider Reducing Your Intake of Nightshades: 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.
Don’t Take Supplements Without First Talking to Your Doctor: 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.

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