Written by Mojgan Hosseinipour
Edited by Paul M. Graham
Historically, certain foods were thought to contribute to acne and dietary restriction was a part of acne treatment. In the 1960’s, this relationship between diet and acne was considered to be a myth. However, in the past 40 years, there has been scientific studies and new evidence supporting the role of diet in acne.
Earlier research studies examined the relationship between milk consumption and acne. Between 2005-2008, researchers at the University of Maryland conducted several studies that demonstrated a statistically significant increase in acne associated with frequent consumption of milk, particularly skim milk. Skim milk correlates with higher levels of the hormones such as insulin and insulin growth factor-1 (IGF-1), which stimulates synthesis of androgens. Androgens are male sex hormones, such as testosterone, that increases sebum production. In women, androgens are converted into female sex hormones called estrogens. However, increased levels of testosterone contribute to acne. The oil (sebaceous gland) is a small gland in the skin which secretes a lubricating oily matter called sebum into the hair follicles to lubricate the skin and hair. It is controlled primarily by hormonal stimulation. As we mentioned in our Acne Basics: Part I article, the breakdown of sebum causes inflammation. Propionibacterium acnes is a bacterium that lives in the oil glands and breaks down the sebum that is produced. This cycle of elevated hormonal influence on sebum production, sebum breakdown, and inflammation exacerbates acne.
One of the most fascinating research studies about acne was conducted in 2002 by Dr. Cordain. Their research studied the incidence of acne among two non-Westernized societies, the Kitavan Islanders of Papua New Guinea and the Aché hunter-gatherers of Paraguay. Among these societies, no cases of acne were reported. Western diets consist of processed foods such as cereals, cookies and bread, whereas the hunters-and-gatherers from these countries consumed mainly whole foods. Additional studies showed an increase in acne prevalence after migration of rural populations into cities. His findings suggested that diet plays an important role in acne.
More recent research studies indicate a positive correlation between a high glycemic diet and exacerbation of acne. Glycemic index is the measure of carbohydrates impact on blood sugar; how slowly or quickly those foods cause an increase in blood sugar. High glycemic foods include refined sugars, white bread and Russet potatoes. These foods cause a rapid increase in blood sugar leading to increased insulin levels in the body, followed by a subsequent rapid decrease in blood sugar. Low glycemic foods keep blood sugar levels steady. Low glycemic foods include legumes, fruits and non-starchy vegetables. Australian researchers demonstrated improvement of acne with a low glycemic diet. Their study, in addition to other published data, demonstrated that the hormone, IGF-1, was increased in patients with acne, and IGF-1 amplifies androgen levels. The results demonstrated increased insulin sensitivity and decreased androgen production on low glycemic diets compared to high glycemic diets.
Another interesting finding is the role of healthy fats and acne prevalence. A study published in 2012 showed that acne was negatively associated (lower incidence) with frequent consumption of fish. The Kitavan and Aché societies consume a diet rich in omega-3 fatty acids such as wild fish. Omega-3 fatty acids are important in regulation of inflammation. Dr. Whitney Bowe published an article commenting on decrease levels of IGF-1 with consumption of omega-3 fatty acids.
After reviewing the medical literature, it is convincing that diet contributes to acne. Consuming whole foods and avoiding processed foods, even processed meats found at the deli, can improve acne. (Everything in moderation of course.) Not only does a low glycemic diet improve acne, it improves cardiovascular health and mood, leaving you feeling better from the inside and out.
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- Bowe WP, Joshi SS, Shalita AR. Diet and Acne. Journal of American Academy of Dermatology. 2010;63(1):124-41
- Smith RN, Braue A, Varigos GA, Mann NJ. The effect of a low glycemic load diet on acne vulgaris and the fatty acid composition of skin surface triglycerides. Journal of Dermatological Science. 2008;50(1):41-52.
- Burris J, Rietkerk W, Woolf K. Acne: The Role of Medical Nutritional Therapy. Journal of the Academy of Nutrition and Dietetics. 2013;113(3):416-30.
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