Part I: Hidradenitis Suppurativa and The Paleo Diet

Hidradenitis Suppurativa | The Paleo Diet

Dear Professor Cordain,

I read very useful information on your website regarding the importance of nutrition for health, therefore I have a few questions and hope you will find time to provide the answers.

My fiance have been struggling with Hidradenitis Suppurativa (HS) for about 12 years. Doctors and antibiotics did not provide much help. The only thing that helped him about 10 years ago was his trip to Malaysia that resulted in total change of food (no bread, no meat – except fish, no diary, but a lot of turmeric).

Unfortunately, the illness returned about two years ago and has been getting worse. As a psychologist, and Ph.D. candidate in psychology, I know how stress can be related to this disease.

But, I also read on Internet (Primagirl Blog, more precisely), that The Paleo Diet can heal this disease, because it is always certain types of food that triggers it. I also found your name and information on your book there, therefore I decided to contact you.

I would really appreciate if you could help me with your advice. If you know what kind of food can trigger this disease, or if you can recommend something, I would strongly appreciate.

Thank you in advance.



Dr. Cordain’s Response:

Hi Alma,

Abundant scientific evidence exists in Hidradenitis Suppurativa (HS) patients showing that pro-inflammatory cytokines (local hormones) are elevated in the blood are almost certainly involved in the skin lesions presenting in HS patients. Two major categories of circulating white blood cells (macrophages and dendritic cells) likely have become activated (sensitized) in the gut to specific gut proteins (either bacteria or food or both) and these gut borne cells then initiate an immune response which affects cells lining either the hair follicle or apocrine sweat glands in other parts of the body, particularly the groin and armpit areas. Hence, it seems likely that HS, although it presents clinically as a single disease, is actually at least two diseases, one in the hair follicle and one in the apocrine sweat glands, both likely to be autoimmune in nature. Women are more likely to have the form of HS involving the cells lining the hair follicle. To date, it has not been conclusively demonstrated that HS is autoimmune in nature. Nevertheless, work from our group as far back as 2002 and from Alessio Fasano’s group at the University of Maryland suggest that a key triggering event in most autoimmune diseases is a leaky gut.

My suggestion for all autoimmune patients is to restrict foods which are known to increase intestinal permeability. These food restrictions form the basis for the contemporary Paleo Diet, however for autoimmune patients a few more restrictions should be included.

General food restrictions for all Paleo Dieters include:

1. All cereal grains (wheat, rye, barley, oats, rice, corn, sorghum and millet). Wheat is probably the grain which should be avoided strictly because of its combination of antinutrients (wheat germ agglutinin, gliadin, thaumatin like proteins, and phytic acid) which have varying degrees of toxicity in humans.

2. All dairy products. The rationale for this food group restriction can be found in my new book, The Paleo Answer, in a single chapter I have written with hundreds of scientific references to support these conclusions.

3. All beans, legumes (including, green beans, soy, peas and peanuts). Again, I have extensively documented the rationale for these restrictions in The Paleo Answer.

4. All processed foods containing refined sugars, grains, vegetable oils and salt. The rationale for these restrictions can be found in all of my popular books and in my scientific writings which are available across the website.

An Elimination Diet

For Autoimmune patients including those with HS, I suggest restricting the following foods for a 30 day period to determine if symptoms improve. This strategy is called an “elimination diet” in which foods are removed from the diet and then added back in to determine if they are problematic.

1. All nightshades (potatotes, tomatoes, eggplants, tomatillos, tobacco and all capsaicin containing peppers [cayenne, serrano, jalapeno, paprika, habanera and all foods made with these- salsa, hot sauce, tomato pastes & sauces etc.]. The nightshade family of plants contain a variety of compounds which increase intestinal permeability. In potatoes, it is the glycoalkaloids (alpha solanine and alpha chaconine); in tomatoes it is alpha tomatine; in spicy peppers it is capsaicin. The scientific references showing how nightshade compounds increase intestinal permeability can be found in my new book, The Paleo Answer. In HS patients, smoking tobacco (a nightshade plant) has been shown to aggravate the disease symptoms in HS patients.

2. Alcohol (ethanol) found in beer wine and all alcoholic beverages increases intestinal permeability.

3. Aluminum hydroxide (alum) in antacids increases intestinal permeability.

4. Alfalfa sprouts contain high concentrations of compounds called saponins which increase intestinal permeability.

5. Psuedo grains (quinoa, amaranth) contain saponins which increase intestinal permeability in a dose dependent manner – meaning the more you consume the leakier the gut becomes. Chia seeds also likely increase intestinal permeability.

6. Oral contraceptives

7. NSAIDS (Nonsteroidal anti-inflammatory drugs) like aspirin and ibuprofen.

8. Egg whites contain a substance called lysozyme which increases intestinal permeability.

9. A foaming agent called Quillaja found in many brands of root beer increases intestinal permeability and potently stimulates the immune system.

10. In addition to peanuts, which are not a not at all, but a legume, tree nuts (almonds, walnuts, pecans, brazil nuts, etc.) are one of the most common allergenic foods. To date, tree nuts have been poorly studied for antinutrient content, and it is unclear if they increase intestinal permeability or adversely affect the immune system. This would be one of the last foods I suggest restricting.


Zinc supplementation (90 mg/day for 3 months) has been shown to reduce inflammation in HS patients. Supplements which improve intestinal integrity and which may reduce intestinal permeability include:

1. Probiotics

2. Prebiotics

3. Viamin D3

4. Fish oil (EPA and DHA)

5. Zinc

6. Medium chain triglycerides (Coconut Oil)

There are no guarantees that these food restrictions will improve symptoms or cure autoimmune diseases.

Nevertheless, I know of hundreds of anecdotal cases worldwide which demonstrate contemporary Paleo diets to be therapeutic in autoimmune patients. Together with my graduate students we are currently writing up a large case study involving nearly 100 autoimmune patients who have reported varying degrees of success in managing their conditions following The Paleo Diet.


Loren Cordain, Ph.D., Professor Emeritus


1. Rambhatla PV, Lim HW, Hamzavi I. A systematic review of treatments for hidradenitis suppurativa. Arch
Dermatol. 2012 Apr;148(4):439-46 Epub 2011 Dec 19.

2. Nazary M, van der Zee HH, Prens EP, Folkerts G, Boer J. Pathogenesis and pharmacotherapy of
Hidradenitis suppurativa. Eur J Pharmacal. 2011 Dec 15;672(1-3):1-8. Epub 2011 Sep 14.

3.Dreno B, Khammari A, Brocard A, Moyse D, Blouin E, Guillet G, Leonard F, Knol AC. Hidradenitis
suppurativa: the role of deficient cutaneous innate immunity. Arch Dermatol. 2012 Feb;148(2):182-6.
Epub 2011 Oct 17.

4.Brocard A, Dreno B. Innate immunity: a crucial target for zinc in the treatment of inflammatory dermatosis. J Eur Acad Dermatol Venereal. 2011 Oct;25(10):1146-52. doi: 10.1111/j.1468-
3083.2010.03934.x. Epub 2011 Jan 24.

5. van der Zee HH, de Ruiter L, van den Broecke DG, Dik WA, Laman JD, Prens EP. Elevated levels of tumour necrosis factor (TN F)-a, interleukin (IL)-1[3 and IL-10 in hidradenitis suppurativa skin: a rationale for targeting TN F-a and IL-1[3. Br J Dermatol. 2011 Jun;164(6):1292-8. doi: 10.1111/j.1365-
2133.2011.10254.x. Epub 2011 May 17.

6. van der Zee HH, van der Woude CJ, Florencia EF, Prens EP. Hidradenitis suppurativa and inflammatory bowel disease: are they associated? Results of a pilot study. Br J Dermatol. 2010 Jan;162{1):195-7. Epub
2009 Aug 14.

7. van der Zee HH, Laman JD, de Ruiter L, Dik WA, Prens EP. Adalimumab (antitumour necrosis factor-a) treatment of hidradenitis suppurativa ameliorates skin inflammation: an in situ and ex vivo study. Br J
Dermatol. 2012 Feb;166(2):298-305.

8. Giamarellos-Bourboulis EJ, Antonopoulou A, Petropoulou C, Mouktaroudi M, Spyridaki E, Baziaka F,
Pelekanou A, Giamarellou H, Stavrianeas NG. Altered innate and adaptive immune responses in patients with hidradenitis suppurativa. Br J Dermatol. 2007 Jan;156(1):51-6.

9. Hunger RE, Surovy AM, Hassan AS, Braathen LR, Yawalkar N. Toll-like receptor 2 is highly expressed in lesions of acne inversa and colocalizes with C-type lectin receptor. Br J Dermatol. 2008 Apr;158(4) :691-7. Epub 2008 Jan 30.

10. Schlapbach C, Hanni T, Yawalkar N, Hunger RE. Expression ofthe IL-23/Th17 pathway in lesions of hidradenitis suppurativa. JAm Acad Dermatol. 2011 Oct;65(4):790-8.

About Loren Cordain, PhD, Professor Emeritus

Loren Cordain, PhD, Professor EmeritusDr. Loren Cordain is Professor Emeritus of the Department of Health and Exercise Science at Colorado State University in Fort Collins, Colorado. His research emphasis over the past 20 years has focused upon the evolutionary and anthropological basis for diet, health and well being in modern humans. Dr. Cordain’s scientific publications have examined the nutritional characteristics of worldwide hunter-gatherer diets as well as the nutrient composition of wild plant and animal foods consumed by foraging humans. He is the world’s leading expert on Paleolithic diets and has lectured extensively on the Paleolithic nutrition worldwide. Dr. Cordain is the author of six popular bestselling books including The Real Paleo Diet Cookbook, The Paleo Diet, The Paleo Answer, and The Paleo Diet Cookbook, summarizing his research findings.

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“27” Comments

  1. I have suffered from HS for the last 62 years without ever obtaining any sort of satisfaction from the medical world.
    In July of 2008 I have put myself into complete and total remission following a honey treatment of my own conception.
    Since then I have tried to convince many people to follow it with very little success. I suppose that honey sounds too insignificant a remedy to be capable of doing what I claim that it does but it really works fine.
    I fact only about eight people have consented to follow my advise and are today in remission and very happy to be.
    I find it a little disappointing that so few people will not try it. But if they are happy to suffer, what can I say?

    • hello jean my name is diana and i have concluded that i may have hs. i would like to know if you could please share the honey treatment with me. I am in alot of pain and do not have medical health insurance. thank you in advance

  2. I have been dealing with mild break out’s for as long as I can remember, but this last year has been horrible, and specifically this last week where I didn’t leave bed for two days…

    I usually eat somewhat healthy during the week, but on the weekend I typically over indulge on cigars, jack Daniels, coke and coke-zero, as well as greed and red peppers.

    Just now starting elimination diet process and try to identify my trigger!

  3. My name is Mary and i am a Hispanic women age 51 I have had a breast reduction,abdominalplasty ,a vaginal reduction,and several cyst removed from both under arms and I now have a row of cysts across my stomach that are currently inflamed. I am a type 2 diabetic smoker I have seen a dermatologist other doctors that have put me on several different types of antibiotics. i am type 2 diabetic and a smoker.What can i do to help myself?

  4. Hi I’ve literally just been diagnosed with HS yesterday after seeing a dermatologist and having a minor operation to cut out a lump underneath my breast.
    I have found everyone’s comments really interesting to read.
    It’s good to know I’m not alone with this. I would like to know if I do try paleo diet. What would I have to eat to live on exactly?
    Thank you Amanda

    • Read the book “The hidden Plague”. I was heart broken when I was diagnosed and then I stumbled on this book. It is my bible now when it comes to HS!

      • Me too! i have gone from stage 3 to stage 1 in 4 months. Turns out I am allergic(blood allergy tested) to eggs, milk, wheat, corn. The dermatologist denied any link between diet and HS. Gave me antibiotics, which didn’t help. I found out they contained corn maize as a filler! I do have a flare-up now, as it is my menses, and I tried reintroducing nuts. It is very difficult, as all I can eat is meat, veg(minus nightshades) and fruit. I still have coffee, I am yet to replace my sugar with honey, and I have the occasional 85% dark chocolate, as it doesn’t contain milk. It us very restrictive, but I was fainting almost daily and I was so inflamed and ill, I couldn’t work. I lost my job, but now I have hope!

  5. After nearly a decade of the dreaded HS, I started with a new doctor who used a steroid injection to collapse the tunnel that bacteria were hunkered down in. This worked for me.

  6. I have found it to be strictly nightshades. Many other blogs point to this too. However, because the pathways have formed, they still tend to get acne-ish (not nearly as bad as when it was actually HS) when I have inflammatory foods like Dairy.

    I have found that I can have beens and quinoa with no problems. Other than Rice, beens, and quinoa, I try to eat Paleo because Paleo has brought me from being almost diabetic to almost perfect blood test results, even with moderate drinking. I do try to have high quality, non processed versions of these when I do though.

    Once again, Nightshades will likely be your best bet, in my experience, and that of other people I have met who have removed nightshades.

  7. I can tell you for sure that going on AIP Paleo indeed worked for me and clearing my HS. Now I only break out if I go off the AIP diet. After a while I can handle a few cheats but overall I have to keep on it 99%. And loosing weight will just happen with AIP. I found the same blog as the OP did. Primalgirl. Her blog is the one that gave me all the answers and my Ah Ha moment. I found that it is the nightshade and more specifically peppers that hurt me the most.

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  9. I suffer from HS and use a diet similar to this, I try to just eat meat and eat a lot of raw foods, I also stay away from dairy and foods containing a lot of corn, wheat and grains. This diet mixed with a daily topical and oral regimen using things such as tea tree oil and turmeric has dramatically reduced my number of outbreaks a year to just a couple. For anyone reading this who suffers from HS and is looking for more help I strongly believe the key to fighting the condition is knowing your outbreak triggers and education.
    Hope this helps!

    • Hi! I suffer from HS. After years of suffering, I finally learned about the food connection. I first eliminated gluten from my diet, that wasn’t enough. Then all grains, then nightshades… and sugar too. I can also attest to ibuprofen being a trigger.
      Being a chef- all these food restrictions were hard at first, but now my skin is better than ever and I’m eating healthy foods.

  10. No legumes. No dairy, no night shades, no quinoa, no dairy?….how the heck are you supposed to do this? Is there a country who’s cuisine looks anything like this? Even in the paleo cookbook potatoes, tomatoes, and quinoa are present everywhere!

    • Hi Alma,

      Most Paleo cookbooks that I’m familiar with won’t have white potatoes or quinoa in recipes, but nightshades are indeed prevalent. Some great cookbook options for HS concerns would be Sarah Ballantyne’s The Paleo Approach Cookbook, The Autoimmune Paleo Cookbook, by Mickey Trescott and The Wahls Protocol, by Terry Wahls, MD. It is absolutely not easy, but living with HS is certainly not easy either. I am in the process of adjusting to the more limiting autoimmune protocols myself and completely understand your frustration. I do definitely believe it is the right direction for me.

      • Hi there,
        I have been suffering from HS for the past 27 years. It is particularly bad at the moment. I have also got infected cellulitis at the moment which seems to be linked. I am out of work for the past 4 weeks and no sign of me returning yet. I hadn’t heard of the Paleo Diet, but I have ordered the Sarah Ballantyne cookbook just now. Just wondering, is this a lifetime change or just a temporary thing. It looks tough. But I’ll try anything….

  11. Rachel, I have seen quite a dramatic improvement in my HS symptoms by following the Paleo diet. I began to notice several changes after 3 months of rather strict adherence to the Paleo diet. I am now about 1 1/2 years into eating Paleo and I plan to continue for life. I can’t recommend strongly enough how confident I am that you will see BIG change if you commit to at least 3-4 months following this plan. It won’t happen immediately, so please be patient and give it a chance. Once your symptoms improve, I’m guessing you will also be happy to continue!

    I’m now planning to follow the autoimmune protocol, and feel very hopeful that these additional measures will help me to get my HS into remission completely!!

    Dr. Cordain, as well as Sarah Ballantyne, and Tara Grant all have a wealth of information relating to HS & the miracle of Paleo eating.

    Good Luck, I know you’ve got A LOT to look forward to!!

  12. Has anyone ever had any relief with their HS after using the paleo diet??? I am definetly going to give it a shot, just wondering if anyone has had success with this and their HS. Thanks.

    • Yes, it worked and is working for me, give it a go, and it helped more than the HS, i have a mild form of it but i caught it early, i have a few breakouts if i eat sugar by mistake, some one i know went down the antibiotic route but can’t keep it under control and she is covered in it, mine on the other hand is well under control, Paleo done it for me, i would,t go back to anything elce, good luck with it, try for 30 days what have you got to loose, it started to work for me straight away two weeks made a hugh difference..

    • im going to try this also ive searched n searched for a cure for this horrible illness and was told yesterday by my gp i suffer from HS after googling and finding out what this was im unhappy there is no cure but so pleased there is help out there for us to heal ourselves i will be here for advice as this has freaked me out so much as i haven’t got a clue what n cant eat any help would be appreciated thanks trish

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  17. I have been told I am pre-diabetic after my yearly physical and I have peripheral neuropathy, which I think could be diabetic related. I stopped eating most sugar and it improved.I started the YMCA Diabetes Prevention class and they said watch out for fat and exercise more. I have lost 9 lbs. I started taking Alpha Lipoic Acid 300. and someone recommended Paleo. I am worried about getting diabetes, lose weight and stop the neuropathy in my feet. Thank you, Connie

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