noun_Search_345985 Created with Sketch.
0 cart-active Created with Sketch. noun_Search_345985 Created with Sketch.

Q&A: Hidradenitis Suppurativa and The Paleo Diet

By Loren Cordain, Ph.D., Professor Emeritus, Founder of The Paleo Diet
October 1, 2013
Q&A: Hidradenitis Suppurativa and The Paleo Diet image

Hi Dr. Cordain,

I'm not sure if you remember me- I was one of the women who interviewed you last August at the Ancestral Health Symposium in LA.

The reason I'm writing you today is 1) to thank you and 2) to ask you some questions. When we spoke, I asked you about Hidradenitis Suppurativa (HS). You told me that you suspected it had an autoimmune connection, but didn't have any more information to add. I suffered from HS for over 20 years, Stage II, so I was very motivated to get rid of it for good. Once you mentioned "autoimmunity," I went on an autoimmune Paleo protocol and my HS disappeared. With experimentation, I found my trigger- potatoes. I never would have known, or even tried the AlP, had you not mentioned autoimmunity. For that, I thank you from the bottom of my heart. 3) I had a guest post on about the issue (I've now been in clinical remission off medication for almost a YEAR) and am currently writing a book about it. My background is in Journalism, though, not science or any medical field, so I am quoting the hell out of your book, Robb Wolf's book, and others.

1. I can't find any documentation of HS being autoimmune in nature, except for what you told me in the hallway of the AHS building. Doctors currently treat it with antibiotics or don't treat it at all. You did say when we spoke that you were going to look into it. Do you know of any medical literature that suggests that HS is autoimmune in nature?

2. When I experimented on myself by removing nightshades and went into remission, and then flared up when I reintroduced potatoes, did I not prove the autoimmune nature of HS in myself? I have been talking to other people who have been also putting their HS into remission by removing nightshades and it seems to be working across the board. Some have diagnosed wheat as their trigger, but the overwhelming majority of us have found nightshades to be the offender. I did do my elimination and reintroduction quite scientifically, but I'm not a scientist, so do my results "count" or are they just anecdotal?

3. You say that the white blood cells in our guts have become sensitized to proteins from bacteria or food or both. For people who have become sensitized to the bacteria, what options are available to them? Obviously antibiotics don't work in this case, so would taking probiotics and something like Allimed (a garlic extract which has been shown to have antibacterial effects in the body) help? Since I didn't have this particular problem, I would like to present options in my new book and help those who do. Obviously I am putting the dietary changes at the forefront of the treatment, but if those fail, then I would like to have another line of treatment, unless the dietary changes plus probiotics are enough if kept up in the long run (long enough to allow the gut to fully heal)?

That's it! Thank you so much for your time and consideration. And thank you again for giving me the tools to change my life. I've had a few emails from people who say they want to kill themselves and I am driven to help them end their symptoms.


Tara Grant

Tara Grant has transformed from 235 pounds to 159 pounds since going Primal in 2009. Tara suffered a litany of serious health problems related to the Standard American Diet and repeated failures of western medicine to cure her. Empowered by the reclaiming of her health, Tara has made it her mission to inform and inspire others about Primal living. Her motto, “Empower. Enlighten. Evolve”, has been put into play in numerous ways! Her book, The Hidden Plague – A Comprehensive Guide to Surviving Hidradenitis Supprativa – details her struggle with this debilitating skin condition, and how sufferers can take matters into the own hands and heal naturally.

Tara is a veteran presenter of numerous PrimalCons, where she holds court detailing her Primal transformation from health to wellness. Tara is also a contributing writer for the Primal Blueprint Expert Certification program and is working with Carrie Sisson on her upcoming Primal Woman book. A dynamic speaker, Tara presents the Primal Transformation Seminar in numerous cities, and counsels individuals as a certified CHEK Holistic Life Coach. Tara holds a degree in Journalism from Carleton University in Ottawa, Canada and blogs regularly at She currently lives in Phoenix, Arizona with her husband Derek and their twin boys, Taylor and Gibson.

Dr. Cordain's Response:

Hi Tara,

Let me dive into your questions. Specific white blood cells called dendritic cells process protein fragments (antigens) of gut bacteria and/or food antigens in a manner that may promote inflammation and autoimmunity in genetically susceptible people. When the gut becomes leaky, it allows these antigens to interact with dendritic cells and other immune system cells to set the stage for autoimmune diseases. Hence, dietary and environmental factors which promote a leaky gut need to be removed.

1. Nightshade plants contain a variety of compounds which promote a leaky gut, but also can be sources of immunological adjuvants (compounds used in vaccines to rev up the immune response).

2. Alpha tomatine in tomatoes has been demonstrated to be a powerful adjuvant.

3. Probiotics and Prebiotics represent good supplements for most people to promote and healthy gut flora and to reduce intestinal permeability. I know of one physician who healed his alopecia completely only after adopting Paleo and then adding probiotics. However, I also know of a few cases where probiotics may agitate the gut and make things worse.

4. Garlic has been used in traditional medicine for thousands of years to cure a variety of health problems. I haven't examined the literature on the topic of autoimmunity and garlic, but garlic is a concentrated source of saponins which in most cases disrupt membrane function and can lead to a leaky gut.

In my most recent book, The Paleo Answer, I list all of the known dietary factors which promote a leaky gut.

Below are the references which led me to believe HS is a gut mediated autoimmune disease that has the potential to be improved or put into remission by contemporary Paleo diets - gluten free, dairy free, grain free, legume free, and nightshade free. In your case nightshades were the major triggering factor, and we believe it is because certain glycoalkaloids in tomatoes and potatoes may act to increase intestinal permeability and also contain certain immunological adjuvants (alpha tomatine in tomatoes) that up-regulate the immune response in genetically susceptible HLA haplotypes.

Good luck with your book!


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.

Even More Articles For You

Is Chocolate Paleo?
Can chocolate be a part of The Paleo Diet? Studies show dark chocolate can have therapeutic affects, but can you over indulge in this treat?
By Kyle Cordain
Chronic Fatigue and The Paleo Diet
Nutritional deficiencies can contribute to chronic fatigue syndrome and can impact the healing processes. Learn how a nutrient-dense Paleo Diet can help.
By Stephanie Vuolo
Excessive Production of Ear Wax Cured on The Paleo Diet
For most of my adult life I have suffered with excess ear wax that would reduce the quality of my hearing, to the point of becoming almost completely deaf.
By The Paleo Diet® Team
Paleo Leadership
Trevor Connor
Trevor Connor

Dr. Loren Cordain’s final graduate student, Trevor Connor, M.S., brings more than a decade of nutrition and physiology expertise to spearhead the new Paleo Diet team.

Mark J Smith
Dr. Mark J. Smith

One of the original members of the Paleo movement, Mark J. Smith, Ph.D., has spent nearly 30 years advocating for the benefits of Paleo nutrition.

Nell Stephenson
Nell Stephenson

Ironman athlete, mom, author, and nutrition blogger Nell Stephenson has been an influential member of the Paleo movement for over a decade.

Loren Cordain
Dr. Loren Cordain

As a professor at Colorado State University, Dr. Loren Cordain developed The Paleo Diet® through decades of research and collaboration with fellow scientists around the world.