Hidradenitis Suppurativa and Supplements

Is following a diet like the one described in the AIP protocol enough? Not necessarily. In this article, we will look at supplements that some people consider as part of their approach to feeling better while living with Hidradenitis Suppurativa.

Some supplements may help support the integrity and health of the gut and may also play a role in maintaining the intestinal barrier.

Anyone living with Hidradenitis Suppurativa may want to discuss the following supplements with a qualified healthcare professional as one possible part of a broader symptom management plan. HS is a chronic autoinflammatory condition with no definitive cure. I am not a doctor, and I am sharing personal experience and general information, not medical advice.

Before Taking Supplements

Before taking any supplement, speak with your doctor or another qualified healthcare professional. They can recommend appropriate tests, assess whether supplementation is necessary, and advise you on suitable doses.

Always follow the recommendations on supplement labels and never exceed the stated dose unless a qualified healthcare professional has specifically advised you to do so.

Omega-3 Fatty Acids

Omega-3 fatty acids, including those naturally found in fish, are involved in pathways that can help regulate inflammation in the body.

By contrast, some omega-6 fatty acids can contribute to proinflammatory pathways. However, both omega-3 and omega-6 fats are essential, and the overall balance of the diet matters.

Omega-6 fats are found in many everyday foods, particularly grains, seeds, and products made from them. Sources include:

meat, since conventionally raised animals may be fed grain, while grass-fed meat can have a different fatty acid profile
vegetable oils
grains and seeds

A diet very high in omega-6 and low in omega-3 may be associated with an unfavorable inflammatory balance and could affect inflammatory conditions. Research on specific health outcomes is complex, so this ratio should not be treated as a diagnosis or a stand-alone treatment target.

Reducing heavily processed foods and industrial seed oils may help lower omega-6 intake, depending on your overall diet.

Because animals in conventional farming systems are often fed grain-based diets, some meat may contain proportionally more omega-6 and less omega-3 than grass-fed alternatives.

Unlike most meat, oily fish is a useful source of omega-3, and one supplement people sometimes consider is cod liver oil, which contains omega-3 fatty acids as well as vitamins A and D3. These vitamins can accumulate or interact with medications, so professional guidance is important.

EPA and DHA: Key Forms of Omega-3

Omega-3 supplements commonly provide the long-chain omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

The human body can convert short-chain omega-3 fats such as ALA (alpha-linolenic acid), which is present in higher concentrations in certain oils and nuts and in smaller amounts in legumes, grains, vegetables, and especially leafy greens such as spinach. However, this conversion is limited, and only a relatively small proportion of ALA is converted into EPA and DHA.

Estimates suggest that the ratio of omega-6 to omega-3 fats in ancestral diets may have been around 1:1 to 2:1. Published estimates for some modern Western diets range from 20:1 to 200:1, although the ratio varies considerably according to food choices.

Probiotics and Prebiotics

Probiotics: Why Take Them?

A quality probiotic may support gut health for some people, but it should not be expected to cure the gut or eliminate HS symptoms. Evidence is still developing, and individual responses vary.

Yogurt, kefir, kimchi, some aged cheeses, raw sauerkraut, kombucha, and naturally fermented pickles can all contain probiotic microorganisms. Some people report that fermented foods or yeast worsen their symptoms, but yeast sensitivity is not universal among people with acne inversa.

So how can you get probiotics if those foods do not suit you? One option to discuss with a professional is a probiotic supplement containing Lactobacillus strains, which does not contain yeast.

If you are currently taking antibiotics, ask your doctor or pharmacist how to time probiotics. They are often taken at a different time of day from the antibiotic.

If yeast is not a concern for you, another option may be a supplement containing Saccharomyces boulardii. This beneficial yeast has been studied for helping prevent some forms of antibiotic-associated diarrhea, although its suitability depends on your health and medications. It should not be used without medical advice by people who are severely ill or immunocompromised.

What Are Prebiotics?

You may also have heard of prebiotics and wondered how they differ from probiotics. Probiotics are live microorganisms, while prebiotics are substances that feed beneficial gut microbes.

Prebiotics are found mainly in foods such as

chicory
bananas
kiwifruit
onions
garlic

Smaller amounts can be found in many other fruits and vegetables.

Prebiotic supplements are available, but research into their use for specific conditions is still developing. For now, it may be preferable to get prebiotics from a varied range of whole foods when tolerated.

Vitamin A

Vitamin A is a fat-soluble vitamin. Preformed vitamin A, also known as retinol, is found in animal-derived foods, while plant foods provide carotenoids that the body can convert into vitamin A. Vegetarians and vegans should therefore pay attention to getting enough vitamin A through a balanced diet and professional guidance when needed.

As discussed, nutritional deficiencies can sometimes be associated with digestive or absorption problems, including conditions involving increased intestinal permeability. However, a nutrient deficiency should be confirmed and its underlying cause assessed by a healthcare professional.

Vitamin A helps maintain mucous membranes, including the lining of the digestive tract. A deficiency can compromise the integrity of these tissues.

Vitamin A and Its Effects on the Skin

Vitamin A is involved in skin cell turnover and the normal process of exfoliation. Retinoids can influence sebum and keratin production, and pores may be less likely to become blocked when these substances do not build up excessively. Isotretinoin, also known by the former brand name Accutane, is a prescription retinoid derived from vitamin A and must be used under close medical supervision.

Vitamin A derivatives are used in the treatment of several skin conditions because of their effects on cell turnover and keratinization.

This is because vitamin A helps regulate keratin production. However, the relationship between blood retinol levels, keratin production, and skin disease is complex and should not be self-diagnosed.

Keratin can contribute to blocked hair follicles, which may be associated with bumps, spots, ingrown hairs, and dry or scaly skin. Getting enough vitamin A supports normal skin health, but taking more than you need does not guarantee clearer skin or HS remission. HS has no definitive cure, and vitamin A supplements are not a substitute for care from a dermatologist.

How to Get Vitamin A

Before considering supplements, I encourage you to try to get vitamin A from food sources. Fruit and vegetables provide beta-carotene, which the body can convert into retinol, although the efficiency of this conversion varies between individuals.

Vitamin A tablets can be dangerous if used incorrectly. Retinol is stored in the body, and an overdose can be harmful. This is especially important during pregnancy, when excessive preformed vitamin A can harm the developing baby.

If an underlying digestive condition is affecting nutrient absorption, treating that condition with professional support may help you absorb nutrients more effectively from food.

Fermented cod liver oil, which is also rich in vitamin D, is one source of vitamin A, while other food sources include liver, eggs, and butter. Because cod liver oil and liver can provide high amounts of preformed vitamin A, check your total intake with a healthcare professional.

Other Products Containing Vitamin A

You could also discuss a topical vitamin A product with a dermatologist to support skin cell turnover, although retinoids may cause dryness, peeling, irritation, or greater sensitivity to sunlight. Other products, such as salicylic acid, can also support exfoliation, but they may not be appropriate on open or irritated HS lesions.

Vitamin C

Vitamin C, or ascorbic acid, is an antioxidant that supports the normal function of the immune system. It also contributes to collagen formation and wound healing and participates in pathways involving cytokines. Vitamin C helps protect cells from oxidative stress and supports skin repair, but supplementation has not been shown to cure HS.

I have personally had a good experience with this supplement. The company is based in Italy and is known for its quality. Click here for the Amazon link.

VITAMIN D3

Cholecalciferol, or vitamin D3, acts more like a hormone precursor. Vitamin D receptors are found in many tissues, and vitamin D is involved in numerous processes throughout the body. Despite its importance, vitamin D deficiency is common and can have several causes.

Sunlight as an Important Source

Many of us spend limited time outdoors with enough skin exposed to sunlight. Our bodies can produce vitamin D3 when the skin is exposed to UVB light, but the amount varies widely according to skin pigmentation, season, latitude, age, clothing, and sunscreen use. There is no single exposure time or dose that is safe and effective for everyone, and it is not accurate to assume that 20 minutes of sun exposure always produces 20,000 IU of vitamin D. Sun exposure should always be balanced against the risk of skin damage.

Vitamin D and Food Sources

There are relatively few natural food sources of vitamin D3. Some foods are fortified with either D3 or ergocalciferol, also known as vitamin D2. Both forms can raise vitamin D levels, although D3 may be more effective at maintaining them in some circumstances. The claim that vitamin D2 causes cancer is not supported by current evidence. In a future article, I will look more closely at vitamin D and its possible relevance to immune and inflammatory health.

Zinc

Some people living with HS report benefits from zinc supplements or zinc-based creams used around affected areas. Evidence remains limited, and topical products should not be applied to open wounds without professional advice.

The First Scientific Study

Dr. Loren Cordain has discussed research into zinc supplementation at 90 mg per day for HS. A 2007 pilot study in France evaluated zinc gluconate in people with mild to moderate HS. All 22 participants showed some clinical response, and eight participants experienced complete remission. This was a small, uncontrolled study, so the findings are preliminary and do not establish zinc as a cure. The dose studied was high and may cause adverse effects, including copper deficiency, so it should not be taken without medical supervision.

Another Scientific Study

Another French study published in 2012 explored how zinc gluconate might affect innate immune markers in HS. It did not establish that HS is autoimmune. HS is currently understood as a chronic autoinflammatory condition.

The researchers reported that skin from HS-affected areas showed significantly reduced expression of several innate immunity markers.

After three months of zinc gluconate treatment, the researchers observed a significant increase in some innate immunity markers. This suggests a possible biological mechanism, but it does not show that autoimmune responses were reduced or that zinc will benefit everyone with HS.

The participants in this research received zinc gluconate.

Magnesium

Magnesium is essential to human health.

It is the fourth most abundant mineral in the body and contributes to more than three hundred biochemical reactions.

As well as supporting bones, muscle and nerve function, and the immune system, magnesium helps regulate blood glucose and blood pressure. It is not a replacement for medical treatment for diabetes or hypertension.

It can also affect bowel movements. Some forms of magnesium have a laxative effect and may help with constipation, although excessive intake can cause diarrhea and other problems.

Where Can You Find Magnesium?

Leafy green vegetables are an excellent source of magnesium, but many of us do not eat enough of them to meet our recommended daily intake.

Some compounds sometimes called antinutrients, found in grains, legumes, and nuts, can reduce mineral absorption in certain circumstances. However, these foods can also be valuable sources of magnesium and other nutrients, so they should not be excluded automatically.

A magnesium supplement may help some people stay regular and reduce constipation, but constipation has many possible causes and is not proof of increased intestinal permeability. Ask a healthcare professional whether supplementation is appropriate, especially if you have kidney disease or take medication.