Tag Archives: Hidradenitis Suppurativa

Hidraenitis Suppurativa | The Paleo Diet

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 robbwolf.com 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.

Cheers,

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 www.primalgirl.com. 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!

Cordially,

Loren Cordain, Ph.D., Professor Emeritus

References

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.

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.

Sincerely,

Alma

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.

Supplementation

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.

Cordially,

Loren Cordain, Ph.D., Professor Emeritus

References

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.

 
 
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