Does Fasting Help HS? The Role of Diet in Managing Hidradenitis Suppurativa

According to a 2019 study, participants who underwent Ramadan fasting experienced a significant decrease in their HS severity scores. This research, among other emerging evidence, highlights a growing interest in how dietary interventions like fasting help HS by influencing underlying inflammatory pathways.

Quick Summary

Studies show intermittent fasting may reduce hidradenitis suppurativa severity by improving insulin sensitivity and lowering inflammation. Individual results vary, and dietary changes are not a cure but a potential complementary strategy.

Key Points

• Fasting's Impact on Inflammation: Fasting can reduce systemic inflammation and improve insulin sensitivity, which are key factors in HS disease activity.

• Ramadan Fasting Study: A small-scale 2019 study showed that HS patients experienced reduced disease severity scores after observing Ramadan fasting.

• Weight Loss Not Required: The symptom improvement in the Ramadan fasting study was not correlated with weight loss, indicating other metabolic changes are at play.

• Trigger Food Identification: While fasting, it's critical to avoid known dietary triggers like dairy, sugar, and brewer's yeast to prevent flares during eating windows.

• Medical Supervision is Essential: Dietary changes, including fasting, should be discussed with a healthcare provider, especially if you are on medication.

• Not a Standalone Cure: Fasting is considered a complementary approach and should not replace conventional medical treatment for HS.

• Consider Other Diets: For those unable or unwilling to fast, other anti-inflammatory diets like the Mediterranean or elimination diets have also shown benefits for HS management.

The Connection Between Diet, Inflammation, and HS

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition, and inflammation is at the heart of its painful symptoms. For many years, treatment focused solely on medication and surgery. However, increasing evidence suggests that dietary choices and overall lifestyle can significantly impact disease severity. The food we eat can either exacerbate or mitigate the inflammatory response in our bodies. In individuals with HS, certain dietary patterns may trigger immune dysregulation, leading to follicular blockages and painful flares.

How Diet Influences HS

Foods with a high glycemic index (GI), such as refined carbohydrates and sugars, can cause rapid spikes in blood sugar and insulin. For those with HS, this can be problematic, as insulin resistance is more prevalent among patients with the condition and can worsen symptoms. Moreover, certain trigger foods have been identified by many patients through personal trial and error, as well as in some research. Dairy products, for instance, contain hormones and proteins that can contribute to follicular inflammation. Brewer's yeast, found in baked goods and fermented drinks, has also been shown to worsen symptoms in some individuals. By contrast, a diet rich in anti-inflammatory foods like fruits, vegetables, and omega-3 fatty acids can help reduce overall inflammation.

The Anti-Inflammatory Effects of Fasting

Fasting, particularly intermittent fasting, has gained traction for its potential health benefits, including reducing inflammation and improving insulin sensitivity. During periods of fasting, the body can shift its focus from digestion to cellular repair processes, known as autophagy. This natural process involves clearing out damaged cells and is believed to have a positive impact on the body's inflammatory state. By reducing the frequency and duration of eating, fasting may help stabilize blood sugar and insulin levels, addressing a key factor linked to HS flares.

What the Research Says: Fasting and HS

Intermittent Fasting and HS Severity

One of the most cited studies on fasting for HS involved participants observing Ramadan, a form of intermittent, time-restricted eating. A 2019 study published in Nutrients found that 60 HS patients experienced a significant decrease in their disease severity score (IHS4) after a month of Ramadan fasting. Interestingly, this improvement was not directly associated with weight loss, suggesting that other metabolic or hormonal factors related to the fasting pattern may be responsible. While the results are promising, it is important to note that these were small-scale studies and the benefits observed sometimes subsided after the fasting period ended. This highlights the need for a consistent, sustainable approach to dietary management.

Comparison of HS Dietary Approaches

Dietary management of HS is not a one-size-fits-all solution. Various approaches exist, each with a different focus. The table below compares fasting with other popular dietary strategies for managing HS symptoms.

Dietary Approach	Primary Mechanism	Evidence for HS	Key Considerations
Intermittent Fasting	Reduces inflammation, improves insulin sensitivity, cellular repair.	Promising pilot study results (Ramadan fasting) showed reduced severity scores.	Individual responses vary; benefits may subside after fasting ends; requires medical supervision, especially for longer fasts.
Mediterranean Diet	Anti-inflammatory properties from high fiber, omega-3s, and antioxidants.	Associated with lower HS severity and offers overall health benefits.	A sustainable, well-researched, and relatively easy dietary shift for most people.
Elimination Diets	Identifies and removes specific food triggers, such as dairy, yeast, or nightshades.	High success rate for identifying personal triggers; 70% of patients saw improvement on a yeast-elimination diet.	Can be restrictive and requires careful reintroduction to pinpoint triggers; often needs guidance from a doctor or dietitian.
Ketogenic Diet	Lowers insulin levels by restricting carbohydrates; may improve gut microbiota and inflammation.	Pilot studies in overweight women showed reduced HS severity and metabolic improvements.	Highly restrictive and not suitable for everyone; requires medical supervision to prevent nutritional deficiencies.

Practical Guidelines for Considering Fasting

Before starting any new dietary regimen, especially fasting, it is crucial to consult a healthcare provider or a dietitian who understands HS. They can help you develop a safe and effective plan tailored to your specific needs and medical history.

How to Approach Fasting Safely

• Start with time-restricted eating: The 16:8 method (fasting for 16 hours, eating within an 8-hour window) is a common starting point and can be more manageable.
• Time it right: Try to align your eating window with natural circadian rhythms.
• Listen to your body: It can take several weeks for your body to adjust to fasting. Pay attention to any adverse effects and adjust your schedule as needed.
• Avoid extremes: Prolonged, unsupervised fasts are not recommended and may be dangerous, potentially causing nutritional deficiencies.

Combining Fasting with an Anti-Inflammatory Diet

During your eating windows, focusing on nutrient-dense, anti-inflammatory foods can maximize the benefits. Conversely, reintroducing trigger foods can negate any positive effects of the fasting period. Focus on the following:

• Foods to eat: Plenty of fresh fruits and vegetables, whole grains, omega-3 rich fish (like salmon), legumes, and healthy fats (such as avocado and olive oil).
• Foods to consider avoiding: Dairy products, high-sugar foods (including refined carbs), processed meats, and brewer's yeast.
• Hydration is key: Drink plenty of water and calorie-free beverages during your fasting period to stay hydrated and manage hunger.

The Importance of a Food Diary

Keeping a food diary is one of the most effective tools for identifying personal triggers and monitoring your response to dietary changes. By tracking what you eat and drink, along with your symptoms, you can uncover patterns that are unique to your condition. Share this information with your doctor to help refine your HS management strategy.

Conclusion: Is Fasting Right for Your HS?

For some people with HS, fasting can be a useful tool to help manage symptoms by targeting underlying inflammation and metabolic factors. Studies, including those on Ramadan fasting, have demonstrated a reduction in HS severity scores, but these results are not universal and benefits can wane. Fasting is not a cure and should be viewed as one component of a holistic treatment plan, alongside medical therapy, weight management, and other lifestyle modifications. The most successful approach involves consulting a healthcare professional, patiently observing your body's response, and maintaining a healthy, anti-inflammatory eating pattern, whether incorporating fasting or not. For a more detailed look at the study on Ramadan fasting and its effects on HS, consult this scientific publication: The Safety and Impact of a Model of Intermittent, Time-Restricted, Ramadan Fasting in Patients with Hidradenitis Suppurativa.

Frequently Asked Questions

Frequently Asked Questions

Can I do intermittent fasting to treat my HS?

Intermittent fasting is not a cure for HS, but it can be a supportive strategy. Some studies suggest it may help reduce inflammation and improve insulin sensitivity, potentially leading to fewer or less severe flare-ups for some individuals. It's best to discuss this with your doctor before starting.

What kind of fasting is best for HS?

There is no universally recommended type of fasting for HS. Many people start with time-restricted eating, such as the 16:8 method, as it is generally more sustainable. Extreme or prolonged fasts should be avoided without strict medical supervision.

Will fasting help me lose weight and improve my HS?

While weight loss is generally beneficial for HS management, some studies on fasting and HS found symptom improvement regardless of weight changes. However, losing excess weight can reduce friction in skin folds and lower inflammation, which can both help with HS symptoms.

What foods should I avoid when practicing intermittent fasting for HS?

When eating, you should continue to avoid common HS triggers like dairy products, high-sugar foods, high-glycemic carbohydrates, and brewer's yeast, as these can increase inflammation and negate the potential benefits of fasting.

Is there evidence that fasting works for everyone with HS?

No. The response to fasting varies significantly from person to person. While some patients report major improvements, others experience little to no change. Keeping a food and symptom diary can help you determine your individual response.

Can fasting replace my prescribed HS medication?

No. Fasting and dietary changes are considered complementary approaches, not replacements for prescribed medical treatment. It is crucial to continue your medication as directed by your doctor and to consult with them before making any changes to your treatment plan.

What is the role of diet beyond fasting in HS management?

Diet plays a significant role in managing HS by influencing inflammation. Beyond fasting, adopting an anti-inflammatory eating pattern, such as the Mediterranean diet, avoiding trigger foods, and maintaining a healthy weight are all important strategies.

Is it safe to start fasting for HS on my own?

It is not recommended to start fasting for HS without medical supervision, especially if you have other health conditions or are on medication. A healthcare provider can help you assess the risks and create a safe plan.