Dietary Cure for Hidradenitis Suppurativa

What is the role of dairy- and yeast-exclusion diets on arresting and reversing an inflammatory autoimmune disease?

A landmark study suggested that exposure to dietary yeast, like baker’s yeast, brewer’s yeast, and nutritional yeast, may worsen the course of Crohn’s disease, an autoimmune inflammatory bowel disease. The reason the researchers even thought to do the study was because Crohn’s patients tend to have elevated levels of antibodies to yeast, but Crohn’s is not the only autoimmune disease with increased yeast antibodies. The same has been found in lupus patients, found in rheumatoid arthritis, found in another joint disease called ankylosing spondylitis, found in autoimmune liver disease, and also found in autoimmune thyroid disease. So, might avoiding yeast help those conditions, too? They haven’t been put to the test, but hidradenitis suppurativa has. What is that? I discuss this in my video Dietary Cure for Hidradenitis Suppurativa.

Hidradenitis suppurativa can be a gruesome disease. It starts out with just pimples, typically along parts of the body where there are folds, such as the armpits, groins, buttocks, and under the breast. Then, painful nodules form that turn into abscesses and drain a thick, foul-smelling pus. And then? It gets even worse, forming active tunnels of pus inside your body.

And, it is not that rare. It has an estimated prevalence of about 1 to 4 percent, which is like 1 in 50. Clothes typically cover it up so it remains hidden, but you can often smell the pus oozing out of people. There are all sorts of surgical options and chemotherapy, but why did researchers even think to try diet for the condition? I mean, since Crohn’s is a disease of intestinal inflammation, you can see how a food you react to could make matters worse, but why a disease of armpit inflammation? Because there seems to be a link between hidradenitis suppurativa and Crohn’s disease. Having one may make you five times more likely to have the other, so there may be an “immunopathogenic link” between the two—they may share similar abnormal immune responses. Given that, if cutting yeast out of Crohn’s patients’ diets helps them, then maybe cutting it out of the diets of people with hidradenitis suppurativa might help them. A dozen patients with hidradenitis suppurativa were put on a diet that eliminated foods with yeast, like bread and beer, and they all got better, 12 out of 12. There was an “immediate stabilization of their clinical symptoms, and the skin lesions regressed,” that is, reversed, and went away within a year on the diet. Okay, but how do we know it was the yeast? By cutting out a food like pizza, you also may be cutting out a lot of dairy, and that also appears to help. Indeed, a dairy-free diet led to improvement in about five out of six patients.

See, those tunnels of pus are caused by the rupturing of the same kind of sebaceous glands that can cause regular acne. In hidradenitis suppurativa, however, they explode, and “[d]airy products contain 3 components that drive the process that blocks the duct [clogging your pores] and contributes to its leakage, rupture, and ultimate explosion.” First, there’s casein, which elevates IGF-1. (I have about a dozen videos on IGF-1.) Second, the whey and lactose, and third, the hormones in the milk itself—six hormones produced by the cow, her placenta, and mammary glands that end up in the milk. So, why not try cutting out dairy to see if things improve?

There is a whole series of nasty drugs you can use to try to beat back the inflammation, but as soon as you stop taking them, the disease can come roaring back. Even after extensive surgery, the disease comes back in 25 to 50 percent of cases, so we are desperate to research new treatment options. But, patients aren’t waiting. They’re getting together in online communities, sharing their trial and error though social media, and people have reported successes cutting out dairy and refined carbohydrates, like white flour and sugar. So, a dermatologist in New Hampshire decided to give dairy-free a try, and 83 percent of the hidradenitis suppurativa patients he tried it on started to get better. What’s more, he didn’t even try cutting the sugar and flour out of their diets. Now, he didn’t conduct a clinical trial or anything. He just figured why not give dairy-free a go? It’s not easy to conduct randomized, clinical, dietary interventions, but that doesn’t stop individual patients from giving things a try. I mean, you can understand why there have to be institutional review boards and the like when trying out new, risky drugs and surgeries, but if it’s just a matter of trying a switch from cow’s milk to soy milk, for example, why do they have to wait? “As patients search for an effective path to clearance [of this horrible disease], they need support and guidance to follow the most healthful diet available, free of dairy and highly processed sugar and flour. Nothing could be more natural.”

But what about the yeast? How do we know it was the yeast? In the study we discussed earlier, 8 of the 12 patients had just gone through surgery, so maybe that’s why they got so much better. It’s similar to when I hear that someone with cancer had gone through the conventional route of chemotherapy, surgery, and radiation before going to some questionable clinic and then attributes their cure to the wheatgrass colonics or whatever else they got. How do they know it wasn’t the chemo/surgery/radiation that saved them? Well, in this study, why do we suspect it was the yeast? Because not only did every single one of the patients get better, “all the patients demonstrated an immediate recurrence of skin lesions following accidental or voluntary consumption of beer or other foods” like bread. So, not only did the elimination of yeast result in “rapid stabilization” and “a slow, but complete, regression of the skin lesions within a year,” but, in every single case, within 24 to 48 hours of taking a little brewer’s yeast or other “yeast-containing foods,” BAM!—the symptoms were back. So, that’s why the researchers concluded a “simple exclusion diet could promote the resolution of the skin lesions involved in this disabling and [perhaps not so] rare disease.”

What was the response in the medical community to this remarkable, landmark study? “Why was there no mention of informed consent and ethics committee approval…?” Letter after letter to the editor of the journal complained that the researchers had violated the Declaration of Helsinki, which is like the Nuremburg Code or Geneva Convention to protect against involuntary human experimentation, and asked where was the institutional review board approval for this yeast-exclusion study? In response, the researchers simply replied that they had just told them to avoid a few foods. They had given them the choice: We can put you on drugs that can have side effects, such as liver problems, or you can try out this diet. “The patients preferred the diet.” Let’s not forget, I would add, that they were all cured!

Anyway, bottom line, by avoiding foods, like pizza, which contains both dairy and yeast, sufferers may be able to prevent the ravages of the disease.


This is the fourth and final installment of a video series on the role baker’s, brewer’s, and nutritional yeast may play in certain autoimmune diseases. If you missed any of the others, see:

For more on dairy hormones, see:

Check out our IGF-1 topic page if you’re unfamiliar with this cancer-promoting growth hormone, which I highlight in my video Animal Protein Compared to Cigarette Smoking.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

Is Candida Syndrome Real?

Does the presence of Candida in stool correlate with “Candida-hypersensitivity” symptoms, such as headaches and tiredness? And what happens when people are placed on a high-sugar diet?

Despite its extensive use in the brewing and baking industries, only about 5 percent of healthy people—1 in 20—have anti-yeast antibodies in their bloodstream, whereas that percentage is more like 60 or 70 percent in people with Crohn’s disease. Most people with Crohn’s have antibodies that react to regular baker’s, brewer’s, or nutritional yeast, which are all just different forms of a yeast known as Saccharomyces cerevisiae.

But baker’s/brewer’s/nutritional yeast has never been directly implicated in Crohn’s. Maybe the antibodies are a direct reaction to it, or maybe they are a reaction to another yeast altogether and just mistakenly cross-react with regular yeast. Indeed, it was discovered that antibodies against Candida, a totally different kind of yeast (the yeast that causes thrush and vaginal yeast infections), can cross-react with Saccharomyces. Is it possible that baker’s/brewer’s/nutritional yeast was just an innocent bystander all along? I investigate this in my video Is Candida Syndrome Real?.

For nearly 30 years, we’ve known that antibodies to Saccharomyces are linked to Crohn’s disease, but instead of bread, beer, and nutritional yeast leading to Crohn’s disease, perhaps Candida is causing the Crohn’s disease and the antibodies. Or maybe Candida is the innocent bystander, and exposure to food and beverage yeast is the real culprit. You don’t know until you put it to the test: Remove yeast from the diet of Crohn’s patients, and see if they get better. If they do, then yeast was indeed the culprit. If they don’t? Then maybe Candida is the real cause.

Before I get to the study, let me first bust some Candida myths. Candida is a normal constituent of our gut flora. Get some Candida in your bloodstream, though, and it can cause a life-threatening infection. But it is normal to have some Candida in your mouth or colon—what’s important is location! location! location! It’s similar to how having stool bacteria in our colon is normal, but stool bacteria in our blood or a wound would be bad. Because of the ability of Candida to cause problems in the wrong location or in people who are immunocompromised, a Candida-syndrome theory arose, linking the presence of Candida to all sorts of health problems. This led to “mycophobia”—or fungalphobia—“spreading due to the false interpretation” that the finding of Candida in your mouth or stool is evidence of some kind of infection, rather than just being totally normal. (If you think the authors of that paper were being a little overdramatic with their phobia talk, just google “Candida” and you’ll see.)

Not only is it normal to have Candida in your gut, you apparently can’t get rid of it even if you wanted to. Give people powerful antifungal drugs, and you can drop levels down, but they pop right back up again as soon as you stop the antifungals. What about the concept that sugar feeds yeast, so you should go on a low sugar diet? It doesn’t make much sense because sugars should get absorbed high up in the small intestine and never even make it down into the colon unless you’re lactose intolerant. Indeed, there appears to be no correlation between Candida counts and sugar consumption. You can put people on a high-sugar diet by adding an additional 14 spoonfuls of sugar to their diets and still not see an effect. Of course, there are lots of science-based reasons to cut sugar from your diet, but Candida does not appear to be one of them.

There does not appear to be good “evidence for the existence of the so-called “Candida-syndrome” at all. But those are fighting words! “Few illnesses have sparked as much hostility between the medical community and a segment of the lay public as the chronic candidiasis syndrome.” The medical community has dismissed purported sufferers as emotionally disturbed and they’ve also been dubbed just plain crazy. Of course, you can’t just come out and call people crazy. “Psychiatric diagnoses need to be presented gently…” Some patients, for example, prefer to believe their mental illness is caused by the Candida, in which case doctors may just pat them on the head so they’ll take their pills. “However, patients self-diagnosed as having the yeast connection will only infrequently relinquish their illness”—some even to the extent they attempt to use their yeast as a drunk driving defense: I wasn’t drinking, your Honor. My yeast was just self-brewing beer in my gut!

The whole concept of Candida syndrome is officially derided by the American Academy of Allergy and Immunology as “speculative and unproven,” without any proof that it exists. The presumption that “the ubiquitous C. albicans [Candida] has some toxic effect on the human immune system…[is] without a trace of clinical evidence or scientific proof.” If you want proof, argued a response to the study, what about the millions of unnecessary tonsillectomy surgeries and all the radical mastectomies? At least putting people on low-sugar diets doesn’t disfigure them. Though some anti-Candida therapies can be “potentially dangerous,” antifungal drugs might breed resistance and can have side effects. Nystatin isn’t so bad, but ketoconazole can damage your liver. And, indeed, there are reports of people being treated for what may be a fake diagnosis and ending up in quite dire straits because of it. So, it’s important to know if the syndrome actually exists. Researchers decided to put it to the test in a super simple study: Give subjects stool-tubes to take samples, and ask them questions about their symptoms—headaches, stomachaches, tiredness, and all the other typical Candida syndrome symptoms. The result? The researchers found no relationship to whether or not the subjects had Candida growing in their guts. No hints of Candida syndrome could be found.


This was a bit of a tangent from the topic of my video Does Nutritional Yeast Trigger Crohn’s Disease?. I return to that topic in my video Is Nutritional Yeast Healthy for Everyone? and then offer hope for sufferers of another inflammatory condition in Dietary Cure for Hidradenitis Suppurativa.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

How Much Arsenic in Rice Is Too Much?

What are some strategies to reduce arsenic exposure from rice?

Those who are exposed to the most arsenic in rice are those who are exposed to the most rice, like people who are eating plant-based, gluten-free, or dairy-free. So, at-risk populations are not just infants and pregnant women, but also those who may tend to eat more rice. What “a terrible irony for the health conscious” who are trying to avoid dairy and eat lots of whole foods and brown rice—so much so they may not only suffer some theoretical increased lifetime cancer risk, but they may actually suffer arsenic poisoning. For example, a 39-year-old woman had celiac disease, so she had to avoid wheat, barley, and rye, but she turned to so much rice that she ended up with sky-high arsenic levels and some typical symptoms, including “diarrhea, headache, insomnia, loss of appetite, abnormal taste, and impaired short-term memory and concentration.” As I discuss in my video How Much Arsenic in Rice Is Too Much, we, as doctors, should keep an eye out for signs of arsenic exposure in those who eat lots of rice day in and day out.

As you can see at 1:08 in my video, in its 2012 arsenic-in-rice exposé, Consumer Reports recommended adults eat no more than an average of two servings of rice a week or three servings a week of rice cereal or rice pasta. In its later analysis, however, it looked like “rice cereal and rice pasta can have much more inorganic arsenic—a carcinogen—than [its] 2012 data showed,” so Consumer Reports dropped its recommendation down to from three weekly servings to a maximum of only two, and that’s only if you’re not getting arsenic from other rice sources. As you can see from 1:29 in my video, Consumer Reports came up with a point system so people could add up all their rice products for the week to make sure they’re staying under seven points a week on average. So, if your only source of rice is just rice, for example, then it recommends no more than one or two servings for the whole week. I recommend 21 servings of whole grains a week in my Daily Dozen, though, so what to do? Get to know sorghum, quinoa, buckwheat, millet, oatmeal, barley, or any of the other dozen or so common non-rice whole grains out there. They tend to have negligible levels of toxic arsenic.

Rice accumulates ten times more arsenic than other grains, which helps explain why the arsenic levels in urine samples of those who eat rice tend to consistently be higher than those who do not eat rice, as you can see at 2:18 in my video. The FDA recently tested a few dozen quinoa samples, and most had arsenic levels below the level of detection, or just trace amounts, including the red quinoas that are my family’s favorite, which I was happy about. There were, however, still a few that were up around half that of rice. But, overall, quinoa averaged ten times less toxic arsenic than rice. So, instead of two servings a week, following the Consumer Reports recommendation, you could have 20. You can see the chart detailing the quinoa samples and their arsenic levels at 2:20 in my video.

So, diversifying the diet is the number-one strategy to reduce exposure of arsenic in rice. We can also consider alternatives to rice, especially for infants, and minimize our exposure by cooking rice like pasta with plenty of extra water. We found that a 10:1 water-to-rice ratio seemed best, though the data suggest the rinsing doesn’t seem to do much. We can also avoid processed foods sweetened with brown rice syrup. Is there anything else we can do at the dining room table while waiting for federal agencies to establish some regulatory limits?

What if you eat a lot of fiber-containing foods with your rice? Might that help bind some of the arsenic? Apparently not. In one study, the presence of fat did seem to have an effect, but in the wrong direction: Fat increased estimates of arsenic absorption, likely due to the extra bile we release when we eat fatty foods.

We know that the tannic acid in coffee and especially in tea can reduce iron absorption, which is why I recommend not drinking tea with meals, but might it also decrease arsenic absorption? Yes, by perhaps 40 percent or more, so the researchers suggested tannic acid might help, but they used mega doses—17 cups of tea worth or that found in 34 cups of coffee—so it isn’t really practical.

What do the experts suggest? Well, arsenic levels are lower in rice from certain regions, like California and parts of India, so why not blend that with some of the higher arsenic rice to even things out for everybody?

What?!

Another wonky, thinking-outside-the-rice-box idea involves an algae discovered in the hot springs of Yellowstone National Park with an enzyme that can volatize arsenic into a gas. Aha! Researchers genetically engineered that gene into a rice plant and were able to get a little arsenic gas off of it, but the rice industry is hesitant. “Posed with a choice between [genetically engineered] rice and rice with arsenic in it, consumers may decide they just aren’t going to eat any rice” at all.


This is the corresponding article to the 11th in a 13-video series on arsenic in the food supply. If you missed any of the first ten videos, watch them here:

You may also be interested in Benefits of Turmeric for Arsenic Exposure.

Only two major questions remain: Should we moderate our intake of white rice or should we minimize it? And, are there unique benefits to brown rice that would justify keeping it in our diet despite the arsenic content? I cover these issues in the final two videos: Is White Rice a Yellow-Light or Red-Light Food? and Do the Pros of Brown Rice Outweigh the Cons of Arsenic?.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations: