You are what you eat.
– Source unknown
A timely and most welcome review of the scientific literature concerning the role of diet in HS has been published in the International Journal of Dermatology (Silfvast-Kaiser et al., 2019). Unfortunately, the review is not open access, meaning you must have a subscription to the journal, or be affiliated with some educational/research facility with access to the journal to access the review paper. It is disappointing that this has happened as the review contains lots of useful and important information that HS patients should be made aware of, information that they could apply to their lives today. I will summarise the key points from this review paper in what follows.
Dr. Annika Silfvast-Kaiser and colleagues from Dallas, Texas have reviewed the scientific and lay literature for possible connections between diet and HS. There is some scientific evidence to back-up claims that maintaining the following dietary regimes can help with HS:
- Eliminating wheat and brewer’s yeast
- Maintaining a low glycemic load
- Avoiding dairy products
Brewer’s yeast is used in beer, wine, and cheese production and is also found in many bakery products, pizza dough, soy sauce, and cakes. The link between HS and wheat and brewer’s yeast stems from a single scientific report (Cannistra et al., 2013). This study involved just 12 patients (a small number for scientific studies), and all patients showed alimentary intolerance of brewer’s yeast. The 12 HS patients went on a wheat- and brewer’s yeast-free diet for 12 months following surgery to remove HS lesions and were followed over time. Skin lesions regressed and all 12 patients reported an increased quality of life. As soon as the patients consumed products containing wheat or brewer’s yeast, their HS recurred. Notably, there were not any control groups in this study.
Glycemic load is a measure that factors in the quality and quantity of carbohydrates in a portion of food and how quickly they can raise blood glucose levels. A low glycemic load diet has also been reported to help with HS (Margesson and Danby, 2014).
Dairy-free diets have also been examined as possible influences on HS (Danby 2015). In this study, most (83%) of the 47 HS patients who stuck to a dairy-free diet showed various degrees of improvement in their HS. No patient experienced worsening of the disease compared to the control population not on a dairy-free diet.
In addition to the aforementioned elimination diets, there are claims that some dietary supplements can help with HS, as follows:
- Vitamin D
Turmeric is a spice widely used in Asian cuisine that has well-established anti-inflammatory properties. Despite there being much anecdotal evidence of its beneficial effects in HS, there are no scientific studies investigating turmeric in HS.
Vitamin D deficiency has been reported in HS patients (Kelly et al., 2014; Guillet et al., 2015) and therefore dietary supplementation with vitamin D has been considered as an option to help HS. Guillet et al. (2014) found a correlation between vitamin D deficiency and HS severity (as measured using the Hurley staging system) in a study of 22 HS patients. After supplementation with vitamin D, many of these (63%) HS patients reported a decrease in disease activity after 6 months.
The role of zinc in HS has been explored in a few studies. Poveda et al. (2018) analysed serum zinc levels in 122 moderate to severe HS patients compared to 122 controls and found that low zinc levels were more prevalent in HS patients than in the controls. Zinc gluconate supplementation has been used in a single study involving 22 HS patients, of whom 14 showed partial remission and the remaining 8 patients had complete remission over a 2-year period (Brocard et al., 2007). Another small study involving 12 HS patients showed that zinc gluconate supplementation helped reduce the levels of some biological markers associated with disease activity (Dréno et al., 2012).
Levigon is a dietary supplement containing magnesium, folic acid, and the sugar myo-inositol. In a study by Donnarumma et al. (2018) involving 20 HS patients, those receiving Levigon supplementation showed increased efficacy of concomitant HS therapies, along with an improved metabolic profile when compared to those not receiving supplementation.
It is apparent from this review paper by Silfvast-Kaiser et al. (2019) that research to date has only skimmed the surface of possible links between HS and diet. Some interesting connections have emerged that require further exploration.
Have you found that certain foods trigger your HS?
Does avoidance of certain foods help your HS?
Brocard, A., Knol, A.C., Khammari, A. and Dréno, B. (2007) ‘Hidradenitis
suppurativa and zinc: a new therapeutic approach. A pilot study, Dermatol., 214, 325–327[online], available at: doi: 10.1159/000100883, [accessed 05 May 2019].
Cannistra, C., Finocchi, V., Trivisonno, A. and Tambasco, D. (2013) ‘New perspectives in the treatment of hidradenitis suppurativa: surgery and brewer’s yeast–exclusion diet’, Surgery, 154, 1126–1130, [online], available at: doi: 10.1016/j.surg.2013.04.018 [accessed 05 May 2019].
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Donnarumma, M., Marasca, C., Palma, M., Vastarella, M., Annunziata, M.C. and Fabbrocini, G. (2018) ‘An oral supplementation based on myo-inositol, folic acid and liposomal magnesium may act synergistically with antibiotic therapy and can improve metabolic profile in patients affected by Hidradenitis Suppurativa: our experience,’ G Ital Dermatol Venereol., [online], available at: doi: 10.23736/S0392-0488.18.06012-1, [accessed 05 May 2019].
Dréno, B., Khammari, A., Brocard, A., Moyse, D., Blouin, E., Guillet, G., Léonard, F. and Knol, A.C. (2012) ‘Hidradenitis suppurativa: the role of deficient cutaneous innate immunity’, Arch Dermatol., 148, 182–186, [online], available at: doi: 10.1001/archdermatol.2011.315, [accessed 05 May 2019].
Guillet, A., Brocard, A., Bach Ngohou, K., Graveline, N., Leloup, A.G., Ali, D., Nguyen, J.M., Loirat, M.J., Chevalier, C., Khammari, A. and Dréno, B. (2015) ‘Verneuil’s disease,
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Kelly, G., Sweeney, C.M., Fitzgerald, R., O’Keane, M.P., Kilbane, M., Lally, A., Tobin, A.M., McKenna, M.J. and Kirby, B. (2014) ‘Vitamin D status in hidradenitis suppurativa’, Br J Dermatol., 170, 1379–1380, [online], available at: doi:10.1111/bjd.12900, [accessed 05 May 2019].
Margesson, L.J. and Danby, F.W. (2014) ‘Hidradenitis suppurativa’, Best Pract
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Poveda, I., Vilarrasa, E., Martorell, A., García-Martínez, F.J., Segura, J.M., Hispán, P., Sánchez-Payá, J., Álvarez, P.J., González, I. and Pascual, J.C. (2018) ‘Serum zinc levels in hidradenitis suppurativa: a case-control study’, Am J Clin Dermatol., 19, 771–777, [online], available at doi: 10.1007/s40257-018-0374-5, [accessed 05 May 2019].
Silfvast-Kaiser, A., Youssef, R. and Paek, S.Y. (2019) ‘Diet in hidradenitis suppurativa: a review of published and lay literature’, Int J Dermatol., [online], available at: doi:10.1111/ijd.14465, [accessed 05 May 2019].