Does anyone really believe there’s no relationship between diet and acne?
Apparently, most dermatologists believe just that. As of 2008, the American Academy of Dermatology was still saying right there on its Web site that a connection between diet and acne is a “myth.” And dermatology textbooks say that, too.
Chocolate? No problem. French fries? Go ahead. Drink all the sodas you want. Eat all those greasy chips. Indulge in the great American fast food diet if you want to. It might not do your waistline or your heart any good, but your dietary indiscretions won’t show up on your skin. . . .
Do you really believe that?
Neither does dermatologist Valori Treloar, MD, coauthor of The Clear Skin Diet. Dr. Treloar, who is in private practice in Newton, Massachusetts, says that it’s time for dermatologists to change their thinking. The number of scientific studies supporting the connection between diet and acne is growing. The connection is clearly and unmistakably there, she says.
So what about those studies done decades ago showing that there is no connection between diet and acne? Dermatology texts cite two early studies as the basis for this dogma, says Dr. Treloar; and those two studies, by today’s standards, don’t hold up as well.
One of these studies, done in 1971, had just 27 subjects and lasted only a couple of weeks, says Dr. Treloar. In that study researchers asked the participants with acne to name what they thought was their problem food. Each participant was then given that specific food daily. After a week, researchers examined the participants’ skin to see if their acne had worsened. They couldn’t detect any significant difference in their condition. One problem with this study, aside from the size and duration, was that researchers didn’t ask about what else the people in the study were eating, says Dr. Treloar.
The Chocolate Study, done in 1969, is the second study often cited as supporting the idea that there is no connection between diet and acne. That study is similarly flawed, says Dr. Treloar. In the study, which lasted several weeks, the 65 participants ate either a chocolate bar or a “control bar,” which was a non-chocolate bar of similar size. The problem here, according to Dr. Treloar, is that the control bar contained 28 percent hydrogenated vegetable fat, which actually contributes to acne. (More about that substance later.) Once again, researchers could not detect differences in the acne condition of people eating the offending substance—in this case chocolate.
The Chocolate Study research results might have shown that there was no difference in the skin of people eating the chocolate bar or the greasy control bar, but it sure didn’t prove that there is no connection between diet and acne. Once again, researchers in this study failed to ask about what else the participants were eating. For all the researchers knew, the study participants could have been having M&M’s for breakfast.
Since those early studies, there have been a number of studies that do show that diet can make a significant difference in whether a person gets acne and in how the condition progresses, says Dr. Treloar. And dermatologists, if they look at the studies, now have a whole arsenal of dietary and lifestyle interventions for acne that they can offer to their patients along with antibiotics and other helpful medications.
Population studies have certainly indicated the likelihood that diet plays a role in the development of acne.
“In different cultures, as the diet westernizes—starts to look more and more like the American diet—acne becomes more of a problem for kids,” says Dr. Treloar.
The Inuit people of Alaska and Canada, for example, were once known for their beautiful skin, says Dr. Treloar. As their traditional diet became more westernized, Inuit adolescents started developing skin problems. The same thing happened on the Japanese island of Okinawa, she says. Before World War II, the people of Okinawa tended to have clear skin. As American fast food made its appearance in the 1950s, Okinawan teens started developing acne. The same story has been repeated in several other cultures as they switched from their traditional diets, she says, so clearly, their acne is not genetic.
As candy bars, sodas, and fast foods appear, so do skin problems. It’s as simple as that.
While definitive studies have not yet been done on exactly which foods to eat and which to avoid to discourage acne, there are a number of studies that offer good suggestions for possible dietary strategies, says Dr. Treloar. And she reports that in her own holistic dermatology practice, she has seen dietary changes make a significant difference in the skin conditions of many of her patients. We are all individuals, however, with our own biochemistry, so not every dietary intervention works for every individual, cautions Dr. Treloar. (Let’s note that the standard prescription medications given for acne don’t work the same for every individual either.)
Before looking at specific nutritional strategies that you can try, it’s helpful to understand what happens to the skin during an outbreak of acne.
Stepped-up hormone production during adolescence leads to steppedup oil (sebum) production, especially on the face. Increased sebum can plug pores and cause inflammation. Actually, hormones—specifically insulin resistance—can also play a role in adult acne. Once the pores become plugged, they manifest as redness, whiteheads, and blackheads. Plugged pores can also become infected with bacterial overgrowth. That’s where pimples and pustules come in.
Dr. Treloar summarizes this picture as the four stages of acne:
1. Oiliness
2. Plugged pores
3. Redness
4. Bugs (bacteria)
What all this translates into, of course, is misery in the mirror. Almost everyone gets an occasional pimple. But for millions of teenagers and young adults, acne is a skin disease that mars their physical appearance at a time of life when looking good is of supreme importance. To say that acne messes with your head is putting it mildly. Let’s just say that the impact on self-esteem can last a lifetime.
Acne is an inflammatory disease, says Dr. Treloar, and keeping the body’s insulin levels on an even keel helps keep inflammation under control. Insulin is the hormone the body uses to metabolize glucose, a simple sugar that serves as our main fuel source. And glucose comes both from sugar and from carbohydrates.
In people with the most common form of diabetes, the body’s cells resist insulin’s efforts to deliver necessary glucose into them, which leads to a number of health problems. You don’t have to have diabetes in order to have problems with insulin resistance, however.
“I think that insulin resistance is a major player in acne,” says Dr. Treloar. “You can change your insulin resistance by how you eat.”
What exactly does insulin have to do with acne? One theory is that insulin increases the amount of inflammation in the body and affects the liver, which leads to elevated levels of hormones and hormone activity. And hormones, particularly the male sex hormone testosterone, play a role in the development of acne by contributing to stepped-up sebum production. (Women produce some testosterone as well, just not as much as men do.) Finally, insulin directly stimulates the production of sebum, the oily substance at the heart of acne problems.
While a direct mechanism has not yet been established, there certainly seem to be lots of good acne-related reasons to keep the body’s insulin production on an even keel.
The kind of diet that keeps insulin levels from fluctuating wildly is the same kind of diet that would be ideal for someone with diabetes, prediabetes, or a weight problem. (Truth be told, experts interviewed for many of the conditions in this book recommended the same kind of diet for a wide variety of health problems.) That is, says Dr. Treloar, eat lots of fruits and vegetables, good-quality protein, and complex carbohydrates that provide plenty of fiber and nutrients.
To keep your insulin levels even, it helps to eat small meals or snacks every 2 to 3 hours. “Have three meals and two snacks a day, focusing on nutrient-dense foods,” Dr. Treloar recommends.
Also strive to completely eliminate the following:
Foods that provide calories with few nutrients. That means things like french fries, sodas, white bread and pasta, and candies.
Foods containing high fructose corn syrup, a sweetener found in sodas and many processed foods. Avoiding high fructose corn syrup can be a challenge, as it’s in so many foods, including salad dressings, ketchup, jam, and many baked goods. You’ll need to be a careful label reader for this one. Watch out for some of those “health” drinks as well. You may find high fructose corn syrup in things such as green tea beverages.
Foods containing hydrogenated or partially hydrogenated vegetable oils.
A couple of Australian studies done in the past few years have shown that this kind of diet does help with acne. In 2007, Melbourne researchers fed what’s known as a low-glycemic load diet to one group of young men with acne. The other group of young men with acne ate a typical diet rich in refined carbohydrates—things like bread, pasta, and foods containing sugar.
Researchers found that the skin condition improved in those eating the low-glycemic load diet. Eating enough fiber to have a daily bowel movement and eliminate constipation also helps, says Dr. Treloar. (To learn more about avoiding constipation, see the Constipation chapter)
If switching to an anti-inflammatory diet seems like a daunting prospect, make small changes one at a time and pay attention to how your skin reacts, suggests Dr. Treloar. Meanwhile, there is one dietary strategy to try that involves eliminating just one kind of food. Try removing milk and all other dairy products from your diet for just 3 months and watch what happens, she says.
Why?
Three studies that came out of the Harvard School of Public Health showed a direct connection between acne and dairy products. Milk, explains Dr. Treloar, contains a rich array of hormone precursors and growth factors. It also triggers a high insulin response.
While eliminating dairy doesn’t work for everyone, Dr. Treloar has seen acne clear up in some of her patients who took this route. “Some come in and say, ‘I cut out milk and I don’t need to take your medicines anymore,’” she says.
A number of individual nutrients can also be helpful in dealing with acne. To begin with, says Dr. Treloar, it’s a good idea to take a multivitamin as insurance that you’re getting all of the nutrients that may be missing from your daily diet.
Our bodies need to get both omega-3 and omega-6 fatty acids, says Dr. Treloar. But if we get these in the wrong ratio—too many 6s and not enough 3s—it creates an inflammatory condition in the body. And inflammation, as we know, contributes to acne. Things such as chicken, eggs, and milk all have more omega-6s than omega-3s. To bring the ratio more into balance, she recommends fish oil, which is rich in omega-3 fatty acids.
Dr. Treloar suggests taking 1 to 3 grams of fish oil daily. “If you still have a lot of redness and swelling, you might benefit from even more,” she says. You can take 4 to 10 grams daily, if you can tolerate it, she says. “If you’re allergic to fish, you can’t take fish oil. If you’re not, try it, pay attention, and see what’s going on with your body.”
Studies have shown that inflammation and oxidation tend to go together, says Dr. Treloar. Oxidation is the formation of free radicals, highly reactive molecules that damage the body’s cells. If you have an inflammatory disease such as acne, you’ll likely benefit from the protection that antioxidants like selenium, vitamin A, and vitamin E can offer, says Dr. Treloar. And, in fact, studies do show that getting enough selenium can help decrease acne. She suggests aiming for 200 micrograms of this essential mineral. You can get this amount from simply eating three Brazil nuts a day, she says.
Brazil nuts are high in calories, so it’s best to stick with the recommended “dosage.” Likewise, don’t take supplements in excess of 200 micrograms, as high doses can be toxic, warns Dr. Treloar.
The Clear Skin Diet: How to Defeat Acne and Enjoy Healthy Skin by Alan C. Logan, ND, and Valori Treloar, MD
Vitamin A metabolism is complex and varies greatly from individual to individual, says Dr. Treloar. If you have a genetic makeup that causes vitamin A to break down faster, you need more of this vitamin, which can be extremely helpful in keeping acne under control. However, high doses of vitamin A can be toxic, and if you take more than 5,000 IU over a long period of time, it can lead to the bone disease osteoporosis, cautions Dr. Treloar.
It’s safe to take 5,000 IU daily, she says. Your dermatologist may recommend higher amounts for a time as an anti-acne therapy, she says, but this is not something that you should do on your own. As an alternative, a dermatologist might prescribe isotretinoin (Accutane), a medication related to vitamin A.
Studies have shown that topical applications of a vitamin B3 (niacinamide) product are just as effective as clindamycin, a topical prescription antibiotic cream often prescribed for acne, says Dr. Treloar. The niacinamide product—2 to 4 percent vitamin content—is available over the counter.
One small study showed that vitamin B6 can be helpful for women with PMS-related acne. If you want to see whether this nutrient might be helpful for you, start with 50 milligrams daily for a couple of months, says Dr. Treloar. You can ramp the dose up to 150 milligrams on your own, she says, but don’t go past that amount without medical supervision.
Vitamin E offers antioxidant protection helpful for people with acne. Dr. Treloar recommends taking 100 to 200 IU daily in the form of mixed tocopherols.
A number of studies have shown that zinc can be helpful for people with acne, says Dr. Treloar. She suggests taking 15 to 30 milligrams daily of zinc sulfate.
If you have acne, you should be under the care of a dermatologist. Consider taking a multivitamin to ensure that you’re getting all of the essential nutrients that your body needs.
Omega-3 fatty acids |
1 to 10 grams of fish oil* |
Selenium |
200 micrograms |
Vitamin A† |
5,000 IU |
Vitamin B3 |
Topical over-the-counter product containing 2 to 4 percent niacinamide |
Vitamin B6‡ |
For PMS-related acne only: 50 to 150 milligrams |
Vitamin E* |
100 to 200 IU of mixed tocopherols |
Zinc |
15 to 30 milligrams of zinc sulfate |
*Start with 1 to 3 grams of fish oil daily. If you still have a lot of redness, try increasing the dose, if you can tolerate it. Fish oil has a blood-thinning effect. So does vitamin E. If you’re taking any kind of blood-thinning drug, talk to your doctor before taking these supplements.
† Do not take a higher dose of vitamin A on your own. Your dermatologist may suggest more as an acne therapy. Make sure you ask how long you should take the higher dose.
‡ Start with the lower dose. Do not exceed 150 milligrams without medical supervision.