Research into the relationship between diet and acne over the years has been controversial. Early research reported an association between acne and foods like chocolate, sugar and fat. However, there was little understanding about the pathogenesis of acne, and in the 1960s the diet connection was dismissed due to a lack of convincing evidence.
In recent years, dermatologists and dietitians have revisited the role of nutrition therapy based on relatively new evidence that shows the influence of diet on hormones and immune responses involved in the pathogenesis of acne.
Recent research suggests that the Western diet plays a role. In several studies, countries with relatively low consumption of processed foods, dairy and fat and high consumption of fruits, vegetables and fish were found to have a lower incidence of acne.
It is also important to keep in mind that there are other factors that may influence acne prevalence including genetic makeup, age and ethnicity.
Acne pathogenesis is related to several key factors, including:
- Excessive sebum production influenced by hormones (Androgens) and insulin-like growth factor-1 (IGF-1)
- Hyper-proliferation of follicular cells and bacteria. Follicular occlusion (hair follicles become blocked with scales and rupture)
- Inflammation in response to bacteria
- Insulin, sex hormone binding protein (SHBP) and sterol regulatory element binding protein-1 (SREBP-1)
These factors are also associated with diet and help us to understand a possible link between diet and acne.
Diet and Acne – The Causes
Dietary factors that may influence the severity of acne include:
GI/GL and Acne
The Glycaemic Index (GI) system measures the effect of carbohydrates on blood glucose levels. Glycaemic Load (GL) is the quantity and effect of the carbohydrate on blood glucose or sugar. Researchers speculate whether a high GL diet might increase acne by triggering a hormone response. A high GL diet increases insulin levels which stimulates an endocrine response favouring proliferation of skin cells and sebum production.
Note: It is important to not restrict all foods containing carbohydrates as they provide essential nutrients. Eat sufficient wholegrains and legumes because these carbohydrates have a lower GL.
Dairy, in particular skim and whole milk, had been linked to increased acne severity in a similar way to high GL foods. However, not all dairy contains carbohydrates and in recent studies fermented dairy foods are associated with reduced severity of acne lesions, possibly because of the anti-inflammatory effects of Lactoferrin and its ability to suppress microbial growth.
Note: Dairy is an important source of calcium and I would not recommend restricting foods that have a positive benefit for bone strength and growth, especially during adolescence. Instead, some people may benefit from choosing low fat cheese, yoghurt and calcium fortified dairy alternatives.
In 2012, several studies explored the relationship between Omega 3 fatty acids and acne. Omega 3 fatty acids have been shown to have anti-inflammatory properties that may be beneficial for acne sufferers however there are limited studies to date.
Fruit, vegetables, herbs and green tea contain antioxidants. Antioxidants are important for a healthy immune system enabling the body to resist disease and fight infection.
A balanced diet is essential for good health, this is especially important during times of rapid growth. I do not recommend restricting foods unnecessarily, however as suggested above, some individuals will reduce acne severity by making positive changes to their diet. If you/your patients decide to trial a period of time without consuming milk it is important to choose a calcium rich alternative. The relationship between diet and acne has strong evidence, but it is important to ensure that decisions are made according to nutritional needs.
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- Burris J1, Rietkerk W, Woolf K. 2013. Acne: the role of medical nutrition therapy. J Acad Nutr Diet.; Mar.2013, 113(3):416-30. doi: 10.1016/j.jand.2012.11.016.
- Burris J, Rietkerk W, Woolf K. 2014. Relationships of self-reported dietary factors and perceived acne severity in a cohort of New York young adults. J Acad Nutr Diet. 2014 Mar;114(3):384-92. doi: 10.1016/j.jand.2013.11.010. Epub 2014 Jan 9.
- Whitney P. Bowe, Smita S. Joshi, MD, Alan R. Shalita, MD. 2009. Diet and acne. DOI: http://dx.doi.org/10.1016/j.jaad.2009.07.043