Intermittent fasting (IF) has attracted significant interest in the HS community, with many patients reporting reduced flare frequency after adopting time-restricted eating or alternate-day fasting protocols. While large clinical trials are lacking, the biological mechanisms are plausible and the available evidence is encouraging. This article reviews what we know.
Why Intermittent Fasting Might Help HS
Several mechanisms may explain why intermittent fasting could benefit HS patients. First, IF consistently produces weight loss in overweight individuals, and obesity is a significant risk factor for HS severity. A 10% reduction in body weight has been associated with meaningful improvements in HS disease activity scores in multiple studies. Second, IF reduces insulin resistance and lowers circulating IGF-1 levels, both of which are implicated in HS pathogenesis. Third, fasting periods activate autophagy, a cellular cleanup process that reduces inflammatory signaling and may dampen the NLRP3 inflammasome activity central to HS inflammation.
What the Research Shows
A 2019 case series published in JAMA Dermatology described four HS patients who adopted Ramadan fasting (a form of intermittent fasting) and experienced significant improvement in their HS during the fasting period, with worsening after the fast ended. A 2022 patient survey of 87 HS patients who had tried intermittent fasting found that 54% reported a reduction in flare frequency, with the greatest benefit reported by patients who were also overweight or had metabolic syndrome.
These are small, observational studies and should be interpreted cautiously. However, the consistency of patient-reported benefit and the plausible mechanisms make IF a reasonable dietary strategy to discuss with your healthcare team, particularly if you are overweight or have insulin resistance.
Common Intermittent Fasting Protocols
The most studied and most practical IF protocol for most people is 16:8 time-restricted eating: eating within an 8-hour window each day (for example, 12 noon to 8 PM) and fasting for the remaining 16 hours. This is generally well-tolerated, does not require calorie counting, and can be maintained long-term. The 5:2 protocol (eating normally five days a week and restricting to 500-600 calories on two non-consecutive days) is another option with good evidence for weight loss and metabolic benefits.
Important Considerations for HS Patients
Intermittent fasting is not appropriate for everyone. It should be avoided during pregnancy, by people with a history of eating disorders, by those who are underweight, and by people with certain medical conditions including type 1 diabetes. If you are on medications that need to be taken with food, discuss IF with your prescribing physician before starting. Some HS patients find that skipping meals increases stress, which can itself be a flare trigger, so monitor how your body responds.
As with all dietary interventions for HS, intermittent fasting should be viewed as a complementary strategy alongside medical treatment, not a replacement for it. Discuss any significant dietary changes with your dermatologist and consider working with a registered dietitian who can help you implement IF safely and effectively.