1. Do Keep a Food Diary to See Which Foods May Affect Your Symptoms
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. “You don’t want to just restrict nutritional intake without consulting a physician,” says Paek. “There might be risks to doing that, and it’s a very individual situation, so I think it’s good to show that to a healthcare provider. You can discuss the potential role for certain foods, talk about any data or evidence in the literature to suggest a connection, and then go from there.”
Your doctor might recommend an elimination diet, in which you completely cut one food or food group from your diet at a time so you can see how each affects you, says Paek. Be patient because these diets don’t work instantly. It can take weeks or even months to see improvement.
2. Don’t Forget About Fiber
Fiber is important for everyone, and people with HS are certainly no exception. “It’s not particularly specific to HS, but fiber can increase your feeling of fullness or satiety,” says Paek. “[This] can help reduce your intake of unhealthy foods, which then may actually lead to weight loss.” Also, high-fiber foods tend to help reduce blood sugar and improve healthy gut function, which can help keep inflammation at bay. According to the Dietary Guidelines for Americans, 2020–2025, issued by the U.S. Department of Agriculture and U.S. Department of Health and Human Services, adults need 22 to 34 grams of fiber per day, depending on age and sex.
3. 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, says Paek. Some HS patients notice an improvement in their symptoms within weeks of eliminating dairy.
A review of research cautions that dairy products may worsen insulin resistance, inflammation, and potentially HS symptoms.
4. Don’t Eat Too Many Added Sugars or Refined Carbs
In one study, HS patients listed the foods that most commonly exacerbated symptoms. Sweets were first on the list, followed by bread, pasta, and rice. 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, says Paek.
The Dietary Guidelines for Americans recommend consuming less than 10 percent of your calories from added sugars and less than 3 ounces of refined grains per day. Bonus: Reducing intake of these foods has been linked to many health benefits beyond HS.
5. Do Consider Eliminating Foods That Contain Brewer’s Yeast
Brewer’s yeast (Saccharomyces cerevisiae) is a common ingredient in baked goods and fermented foods, such as cheese, soy sauce, and alcohol. 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.
6. Don’t Skip Foods Rich in 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, says Paek.
7. Do Consider Reducing Your Intake of 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.
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, says Paek. You can substitute with other nutritious veggies that aren’t in the nightshade family.
8. Don’t Take Supplements Without First Talking to Your Doctor
Supplements may help some people with HS, but, just as with food changes, it’s important to talk to your doctor before taking any. Some people with mild to moderate HS benefit from a zinc supplement, which can boost immune system activity, says Paek. 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.
Then there’s 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.
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.
9. Do Ask Your Doctor or Dietitian if a Specific Diet May Help
The Mediterranean diet, rich in olive oil, fish, fruits, vegetables, and whole grains, could be a good choice. “I think that is probably one of the first diets I would recommend to patients if they were to consider a complete dietary change versus specific food elimination,” says Paek. 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.
Another diet to ask about is the paleo diet, which is often recommended for other immune disorders, such as Crohn’s disease. As noted above, there’s some overlap between HS and Crohn’s: People with HS have a higher risk of Crohn’s than those without HS, suggests one review.
“Something that is beneficial for this other immune-mediated condition, Crohn’s, may also be beneficial for HS, so I do have patients who have both conditions and have tried this specific diet,” says Paek. “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.”
You could also ask about a keto diet, which is low in carbs and high in fat. While there’s no specific research linking it to HS, it could be beneficial if it helps you reduce excess weight. Another possibility is the autoimmune protocol diet, which is similar to paleo and designed for autoimmune conditions and inflammation reduction.
“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,” says Paek. “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.”
The bottom line? “The focus should be on common things: Reduce consumption of high-sugar foods, focus on healthier eating choices, consider eliminating certain specific foods, and supplement if there is a known deficiency, such as vitamin D,” says Paek.
It’s also important to remember that dietary changes may not necessarily help everyone. “That’s why the recommendations are not universal,” says Paek. “They’re just recommendations, not guidelines for care.” Think of dietary modification as just one part of your overall HS management strategy and healthy lifestyle.
The Takeaway
Adjusting your diet can be a valuable part of your HS treatment plan to help reduce inflammation and ease symptoms.
There is no one-size-fits-all diet, but experimenting with anti-inflammatory foods, such as those in the Mediterranean diet, and keeping a food diary can help identify what works for you.
Some simple changes, such as reducing processed foods and sugary beverages, might help provide relief for your symptoms.
