Preventing acne with diet

Healthy skin. Flickr: LukaIsntLuka

Acne is the most common skin condition in the U.S.  About 85% of people in the Western world experience acne during their teenage years, but it can occur at any age.  Acne is more than just pimples - it can leave permanent scars, and in many people, acne (even if it is not severe) can seriously affect quality of life, causing low self-esteem, withdrawal from social situations, anxiety, and depression.1

What causes acne? 

There are four major components of acne:  excessive production of oil by the skin, skin cells dividing excessively (hyperproliferation), bacteria, and inflammation.2 A pimple or lesion forms when a pore in the skin begins to clog with old, dead skin cells.  Usually these cells are simply shed from the surface of the skin, but if too much oil is being produced, the dead cells can stick together and become trapped inside the pore.  Bacteria also play a role – they can grow and multiply inside the pore, resulting in an inflammatory response.1 

Does what we eat really affect acne?

For years doctors have proclaimed that diet has nothing to do with acne.  That reflects the nutritional ignorance of physicians and their inexperience in treating disease with superior diet.  Scientific studies have demonstrated that the diet is very important, because what we eat can affect the hormones that contribute to the oil production, hyperproliferation, and inflammation that cause acne. The acne-promoting dietary factors that have been most extensively studied are dairy products and high glycemic load foods – these factors influence hormonal (increase IGF-1 levels) and inflammatory factors increasing acne prevalence and severity.3,4

IGF-1: an important hormone that influences acne

Hormonal influences that affect insulin-like growth factor 1 (IGF-1) levels are key.5  Elevated IGF-1 levels lead to changes in gene expression that cause inflammation, hormonal changes, increased oil production, and development of acne lesions.  Protein intake is the major factor that determines circulating IGF-1 levels, especially protein from dairy products. Read more in Dr. Fuhrman’s Healthy Times Newsletter on IGF-1.

Dairy products

A three-year prospective study of 9-15 year old girls found a 20% increase in acne prevalence in girls that had 2 or more servings of milk per day compared to less than 1 per week. This association held true for total, whole, low fat, and skim milk.6  The same researchers found a similar association in boys who drank skim milk (milk highest in protein).7  Furthermore, in the Nurses’ Health Study, dairy products eaten during high school were associated with acne during women’s teenage years.8

High glycemic load foods

Glycemic load (GL) is a measure of the effect of a certain food on blood glucose levels.  High-GL foods like refined carbohydrates produce dangerous spikes in blood glucose, leading to excessive insulin levels in the blood (hyperinsulinemia), which contribute to diabetes, heart disease, and several cancers.9,10  Hyperinsulinemia not only promotes inflammation but also raises IGF-1 levels, further contributing to acne.  A low glycemic load diet has been shown to improve acne symptoms, and decrease IGF-1 and skin oil production in several studies.11-13

Protective micronutrients

Blood levels of zinc, carotenoids, and Vitamin E are known to be lower in acne patients compared to those without acne, suggesting that maintaining micronutrient adequacy may help to prevent acne.14,15 Carotenoids are abundant in green and orange vegetables, and vitamin E is abundant in nuts and seeds.  Although pumpkin seeds and hemp seeds are rich in zinc, zinc absorption efficiency may be low on a plant-based diet, so a multivitamin and mineral supplement is recommended to assure optimal levels of zinc, iodine, Vitamin D and B12.

 

References:

1. American Academy of Dermatology: Acne. http://www.aad.org/skin-conditions/dermatology-a-to-z/acne. Accessed June 29, 2011.

2. Costa A, Lage D, Moises TA: Acne and diet: truth or myth? An Bras Dermatol 2010;85:346-353.

3. Ferdowsian HR, Levin S: Does diet really affect acne? Skin Therapy Lett 2010;15:1-2, 5.

4. Melnik BC, Schmitz G: Role of insulin, insulin-like growth factor-1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris. Exp Dermatol 2009;18:833-841.

5. Danby FW: Diet and acne. Clin Dermatol 2008;26:93-96.

6. Adebamowo CA, Spiegelman D, Berkey CS, et al: Milk consumption and acne in adolescent girls. Dermatol Online J 2006;12:1.

7. Adebamowo CA, Spiegelman D, Berkey CS, et al: Milk consumption and acne in teenaged boys. J Am Acad Dermatol 2008;58:787-793.

8. Adebamowo CA, Spiegelman D, Danby FW, et al: High school dietary dairy intake and teenage acne. J Am Acad Dermatol 2005;52:207-214.

9. Barclay AW, Petocz P, McMillan-Price J, et al: Glycemic index, glycemic load, and chronic disease risk--a meta-analysis of observational studies. Am J Clin Nutr 2008;87:627-637.

10. Gnagnarella P, Gandini S, La Vecchia C, et al: Glycemic index, glycemic load, and cancer risk: a meta-analysis. Am J Clin Nutr 2008;87:1793-1801.

11. Smith R, Mann N, Makelainen H, et al: A pilot study to determine the short-term effects of a low glycemic load diet on hormonal markers of acne: a nonrandomized, parallel, controlled feeding trial. Mol Nutr Food Res 2008;52:718-726.

12. Smith RN, Braue A, Varigos GA, et al: The effect of a low glycemic load diet on acne vulgaris and the fatty acid composition of skin surface triglycerides. J Dermatol Sci 2008;50:41-52.

13. Smith RN, Mann NJ, Braue A, et al: A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Am J Clin Nutr 2007;86:107-115.

14. El-Akawi Z, Abdel-Latif N, Abdul-Razzak K: Does the plasma level of vitamins A and E affect acne condition? Clin Exp Dermatol 2006;31:430-434.

15. Amer M, Bahgat MR, Tosson Z, et al: Serum zinc in acne vulgaris. Int J Dermatol 1982;21:481-484.


 

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Comments (11) Read through and enter the discussion with the form at the end
Charity - July 12, 2011 12:26 PM

Finally! I am going to have to send this article to several of my friends and family who have questioned my sanity every time I mention how my face breaks out when I eat poorly. I hardly ever had acne when I was a teenager, but in my twenties I started having problems with it. By the time I was 29 and had two kids, my face was so red with rosacea and acne that I had people stopping me everywhere I went to offer their advice on what I could do to clear my skin up. I was prescribed a topical treatment that helped a little, but it wasn't until after I started ETL that my face cleared up completely! Now whenever I start to slide back into the standard American diet, I will wake up with a blaring red spot on my face reminding me to get back on track! So thank you for the post! It is great to finally know what is going on from a doctor's point of view.

Abigail - July 12, 2011 2:57 PM

I've been eating a nutritarian diet for 3+ years and, while my acne is vastly improved, it's still not completely gone away and I've been getting a new flare-up in the last 2 weeks. (FYI: I was just at the health getaway - all my stats were great and my antioxidant score is 92,000.) I eat absolutely no dairy ever. For someone who is nutritarian and still getting acne, what would you suggest? Thanks.

StephenMarkTurner - July 12, 2011 8:32 PM

Even in my mid fifties I am prone to spots. I certainly do think that my skin quality, especially on my cheeks and forehead, does correlate to my diet quality.

Cheers, Steve

Bonnie Leary - July 13, 2011 8:16 AM

I have to say this article is completely spot on! I have been acne prone for 20 years. I have been battling acne on and off for that long. I recently stopped eating dairy cold turkey due to my son's dairy allergy (I am nursing him). My skin has never been so clear and I am not on any acne medicine either (first time for this as well)! I have also followed the Dr. Fuhrman diet on and off since 2005. WHen I was very strict with his diet my skin was clear as can be. When I slide off of it and eat cheese my skin gets oily and cystic acne returns quickly. Now that I am off dairy for the past three months (the longest stretch of my life) my skin has changed. It feels totally different. I realize that sugar and refined carbs also have a lot to do with it as well. I am working on getting that addiction under control as well. Thanks!!

Deana Ferreri, Ph.D. - July 13, 2011 10:30 AM

Abigail,

Overeating and stress (from lack of sleep or other factors) can also cause acne flares.

However individual advice that would entail supplement recommendations and questions about your personal health issues are addressed best in the member center at DrFuhrman.com. (https://www.drfuhrman.com/members/default_member.aspx)

Jo - July 13, 2011 2:11 PM

As a teen I never had trouble with acne however I am now 49 and it has taken me 4 years to figure out that fruit is the culprit of my adult acne. I have Celiacs, Hashimotos & Pernicious Anemia and have been doing well on the ETL diet for the last few months but I am seriously missing my fruit smoothie of a morning and am disappointed that something as wholesome as fruit has to be eliminated from my already restricted diet. I will be forwarding this article on to my children who are in the early 20's and also have acne, Celiacs and Hashimotos.

Eliminate Your Acne - July 14, 2011 3:45 AM

I agree that diet can play a role in the development of acne. However, I don't think that changing one's diet can completely eliminate instances of acne for all people.

Skin cells clogging hair follicles and the proliferation of the P. acnes bacteria is something that diet alone is not going to be able to completely control.

Dustin Rudolph - July 19, 2011 7:10 PM

This is a great article Deana! I had heard from Dr. McDougall about dairy products leading to acne issues but you explained why this happens in easy to understand language. I wasn't familiar with high glycemic foods being a direct cause of acne.

Also my understanding is that the use of oils (olive, vegetable, canola, or any oil) is detrimental to those suffering from acne. I remember very clearly from my teenage years that my skin was very oily and I had more breakouts when I was eating fatty foods fried in oil.

Judit Sastre - July 27, 2011 11:29 AM

I just started this diet 6 days ago. I have had the headaches, nusea, irritability as well as all the negative feedback from family and friends who believe this is a fad like all the other diets I have been on. My concern is that you claim that this diet heals acne - yet- here I am a 48 year old women who has broken out all along my jaw bone. Is this 1 more of the ditox symptoms or am I doing something wrong?

Deana Ferreri, Ph.D. - July 27, 2011 2:34 PM

Judit,
Yes this is probably a detox symptom.

Norman Smith - August 20, 2011 8:21 PM

Acne is a result of vitamin D deficiency. It is required to produce cathericin, a peptide antibiotic. Cathericin controls the growth of staph on the skin. Take your vitamins!


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