Dr. Jennifer Hsiao summarizes her " Diet in HS" lecture on Thursday, November 7, 2024, at the 5th Annual Elevate-Derm West Conference at the Westin Kierland Resort in Scottsdale, Arizona.

In this video

Dr. Hsiao offers practical ways to meet the "I just want something natural" patient where they are. For those patients, she notes there is data behind zinc — she'll recommend zinc gluconate 100 mg a day, paired with a little copper so they don't become copper deficient — as a way to "get on the same page" and open the door to other options. When patients ask what to eat, she points to the Mediterranean diet, which she says has more supporting data than any other specific diet: leafy greens, chicken, fish, and staying away from highly processed, high-sugar foods. She prefers this over telling someone they "definitively cannot eat X, Y, Z," since strict restrictions are hard to sustain and leave patients feeling like they failed.

On brewer's yeast, she traces the "noise" back to a small study where patients on a brewer's yeast–free diet after surgery kept symptoms at bay but flared when the food item was reintroduced. Because it's found in beer, wine, and baked goods, she frames it as: some literature suggests limiting it may help, but more data is needed. On GLP-1s, the data is very early — a first larger case series of about 30 patients on semaglutide with both HS and obesity showed decreased weight, decreased hemoglobin A1C, and improved HS quality of life, though patients were also on biologics and metformin, making the specific GLP-1 benefit hard to tease out. She's excited for randomized controlled trials to clarify the outcome.

  • For the "natural" patient, recommend zinc gluconate 100 mg daily with a little copper supplementation to avoid copper deficiency — there's data behind it and it builds rapport.
  • The Mediterranean diet has the most supporting data of any specific diet in HS; favor it over rigid "you can never eat this" restrictions that patients can't sustain.
  • Brewer's yeast — found in beer, wine, and baked goods — may be worth limiting based on a small study, but more data is needed; describe it that way to curious patients.
  • GLP-1 data in HS is very early: one ~30-patient semaglutide case series showed lower weight, lower A1C, and better HS quality of life, with no worsening, but confounders make the specific benefit hard to isolate.
  • Randomized controlled trials are still needed to tie GLP-1 intervention directly to HS outcomes.