The story behind food and acne is not completely straightforward. Read more...
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Why are there mixed answers on acne and diet?
The story behind food and acne is not completely straightforward. The reality is that there is an almost 100% likelihood that at some point in our lives we will have a clogged pore somewhere on our body. At any one point in time, the prevalence of acne is thought to impact just over 9% of the population. True acne is the interplay of hormonal triggers to increase oil and sebum in our pores and a bacteria called Cutibacterium acnes that triggers inflammation. There is a potential role for external factors such as products we use to physically clog the pores or physical elements such as chin strips directly blocking the pores at the surface. For food to play a role in the development of acne, it likely needs to either impact our hormones, impact the bio flora on our skin to allow acne-related bacteria to overgrow, and/or inflame our skin directly in the manner that Cutibacterium can.
Are there any studies on diet and acne?
There are numerous reviews on the topic of acne and diet. This is clearly an important topic and one that we are routinely asked about in the exam room. In general, patients are increasingly attempting to understand what factors with regard to their health are in their control and not in their control. This sincere effort is even more pronounced when dealing with breakouts as so many people try to make sense of the seemingly erratic nature of breakouts. It is hard not to wonder if the food we ate, the pillow we slept on, the frequent touching of our face, the products we used, and so on are responsible for the massive pimple that greets us in the mirror in the morning!
So, which foods are considered linked to acne?
With all that being said, let’s review the literature first on foods that may be considered acne-promoting. These include foods with a high glycemic index, high glycemic load, dairy products, fatty foods, and chocolate.
What are high glycemic index and high glycemic load and why does this affect acne?
High Glycemic Index (GI) foods are ones that trigger a rapid increase in your blood sugar levels when consumed. There is actually a rating system from 0 to 100 assigned to foods with 100 being pure glucose. The Glycemic Load (GL) is thought to be a more accurate representation of the impact of glucose on our body by considering the amount of carbohydrates in the food. There is evidence that a low GI and low GL diet reduces the tendency towards acne. There is a reduced free active testosterone in the bloodstream and reduced IGF(insulin-like growth factor)-1 binding protein which is known to have endocrine effects. The glycemic index and glycemic load can also affect the composition of sebum in our pores. Foods in the high GI and high GL categories should be no surprise: candy, sugary breakfast cereals, etc. However, some food items may not be as obvious. Fruits for example tend to have a high glycemic index but a low glycemic load. This website is a reference for glycemic index and glycemic loads for a variety of foods.
What is the story with dairy and acne?
Now, let’s talk dairy. The connection between dairy and acne has been postulated based on the effect of dairy’s ability to stimulate the liver to produce IGF-1 and insulin secretion from the pancreas. There are several studies that have demonstrated the impact of IGF-1 on promoting acne. Some studies have suggested milk contains cow-derived bioactives that survive processing and may transfer when consumed. One study suggested a role for whey protein in milk as a possible trigger. One study found an association with whole, low-fat, and skim milk but not with yogurt or cheese. And, another study determined that skim milk had a higher association with acne compared to low-fat milk and whole milk. The theory behind the higher association of acne with skim milk compared to whole milk is that a protein that can bind to IGF-1 and make it less active is still present in whole milk but may have been removed during the skimming process for removing fat from milk. This would render the IGF-1 in the milk more active.
How do fatty foods affect acne? Do fatty foods literally add oil to our skin?
Fatty foods and acne has been a long-suspected link. It has been demonstrated in studies that acne improves with omega-3 fatty acids, docosapentaenoic acid, and γ-linolenic acid in our diet by suppressing the production of inflammatory cytokines. The most important myth to dispel is that it is not that the greasiness or oiliness of food directly “comes out of our pores”. Fatty foods likely trigger inflammation that can in turn predispose one to acne.
How does chocolate cause acne?
Lastly, chocolate. A study evaluating dark chocolate consumption demonstrated increased acne counts over 4 weeks. It has been postulated that chocolate triggers the release of cytokines, IL 1β and TNF 𝛂, that lead to inflammation with Cutibacterium acnes.
So what does all of this mean for choosing a diet that is less triggering for acne?
There is this concept of the anti-inflammatory diet that appears to take each of these factors into consideration. The anti-inflammatory diet is one that favors:
Fruits and vegetables. Remember that fruits may have a high glycemic index but tend to have a lower glycemic load.
Omega-3 fatty acids containing foods