Acne Diet

Definition

The acne diet—or, more accurately, the acne-free diet—is a way of eating that claims to improve or eliminate acne. There is, in fact, no official acne diet.

Possible causes of acne

SOURCE: National Institute of Arthritis and Musculoskeletal and Skin Diseases. “Acne: What Causes It?” National Institutes of Health, U.S. Department of Health and Human Services. https://www.niams.nih.gov/health-topics/acne#tab-causes (accessed April 4, 2018).

Doctors, nutritionists, and acne sufferers have experimented with various dietary modifications, some of which are claimed to be effective. The internet and bookstores are full of resources claiming to know how to cure acne with diet. The medical community has engaged in debate about the impact of diet on acne, and for years, many doctors claimed that acne was not affected by diet. A growing body of evidence, however, supports the idea that certain foods affect the skin and that nutrient deficiencies affect skin health and appearance.

Origins

Most cultures had folk remedies to help clear the skin, and until the 1960s most Americans believed that diets high in sugar caused acne. In the later part of the twentieth century, serious scientific research attempted to confirm or disprove these folk tales and myths. This early research failed to find a connection between food and acne. One of the first studies on food and acne focused on chocolate, based on the belief that chocolate contributed to acne. The study found that chocolate did not increase acne breakouts. Most other studies have since confirmed this finding, though recent research is again implicating chocolate. Based on these early findings, dermatologists insisted that diet made no difference to acne.




Teenage boy with acne.





Teenage boy with acne.
(Suzanne Tucker/Shutterstock.com)

Adding to the hypothesis that ethnic groups that maintain traditional diets do not get acne, a 2016 paper studied adolescent boys of the Dogon tribe in Mali and found a connection between their new acne outbreaks and their recently modernized diet; it suggested that acne should be considered one of the “diseases of civilization” that is promoted by the inflammatory properties of modern diets. The same result was seen in another 2016 study of adolescents in Nigeria.

In the 2000s and 2010s, several studies have found a relationship between high-glycemic index foods and acne. Widespread internet reports of skin miraculously clearing after dietary changes expanded the conversation on the topic; individuals have discovered diets that they believe actually do help them and have been sharing their findings online.

Description

Acne is caused when glands in the skin called sebaceous glands begin to form a sticky oil called sebum. These glands are stimulated by hormones that become active at puberty, which is why acne occurs most often in adolescence, when these hormones are produced in abundance. The oils formed by the sebaceous glands hold dead skin cells, preventing them from being sloughed off. As these cells die, they create the perfect environment for bacteria to grow. When these bacteria, called acne vulgaris, become too plentiful, they will attempt to erupt from the skin, causing a pimple. Sometimes, when the bacteria grow, the body sends white blood cells to fight the infection. This natural reaction can cause large, painful cysts to form in the deeper layers of skin.

Some dietary changes have been proposed to help prevent acne breakouts. The advice can be contradictory, and much of it has little scientific evidence to back it up:

Other vitamins and minerals proposed to improve acne include vitamins A, D, E, and B; selenium; zinc; omega-3 fatty acids; iodine; and chromium. Vitamin D is of particular interest now; in 2016 Korean researchers found that patients who took vitamin D supplements experienced significant improvement in their acne. Omega 3 fatty acids, found in fish, also seem to work to reduce acne. A 2014 study, also from Korea, found that patients who took fish oil supplements saw a significant reduction in inflammatory lesions.

Carbohydrates

Research in the 2010s found an association between a food's glycemic index and the likelihood it would lead to acne breakouts. The glycemic index is a measure of the effect that food has on blood sugar. The glycemic index ranks foods based on a scale of 0–100. Foods with higher glycemic index ratings break down quickly and cause a sharp spike in blood sugar. When blood sugar rises quickly, the body produces a surge of insulin to lower the amount of glucose (sugar) in the blood. Insulin is a hormone that helps the body take glucose out of the bloodstream and put it into cells, where it can be used for energy or stored in fat. Foods with lower glycemic index ratings break down more slowly and cause a more gradual rise in blood sugar, meaning that less insulin will be needed to restore blood sugar to normal levels.

Foods with a high glycemic index rating include:

Foods with moderate glycemic index ratings include:

Low glycemic index foods include:

Foods that are high in fiber tend to have lower glycemic index numbers because fiber takes longer to digest. Studies have shown that the presence of fats, such as olive oil or butter, can also slow digestion and keep blood sugar from rising too quickly. It can be difficult to determine the GI of meals, which is influenced by ripeness, cooking method, and other factors

Some experts recommend eliminating most carbohydrates from the diet. Practitioners of low-carb high-fat (LCHF) diets report that people who adopt a low-carb or ketogenic diet often see improved skin quality. Research from 2015 suggests a relationship between insulin resistance and acne. Some experts believe that insulin resistance is the result of a lifetime overconsumption of refined carbohydrates, and low-carb diets are one approach to combating this problem. Acne is common in people who are overweight and obese, who are also often insulin resistant.

Function

Eliminating certain foods from the diet and increasing the amount of specific vitamins and minerals, if lacking from the diet, may help reduce the amount of sebum produced and prevent acne breakouts. The interaction between diet and acne, however, is not a simple cause-and-effect relationship—if an oily food is eaten, the oil does not travel to the skin or cause it to be oily.

Benefits

Habits such as limiting sodium and processed foods and increasing intake of whole grains, vegetables, and fiber are in line with federal dietary recommendations and support overall health. Eliminating entire food groups could potentially lead to vitamin or mineral deficiencies. People interested in the acne diet should consult with a physician or registered dietitian before starting the diet.

Precautions

An acne diet, like all acne treatments, can take time to work. Some people who adopt a low-glycemic-index diet report improvement after 10 to 12 weeks. If the diet is, in fact, responsible for the improvement, relapsing and eating sugars or starchy foods could result in acne coming back.

Some acne diets suggest zinc or vitamin A supplementation. People should always consult with their physicians before taking any supplements or other drugs. Zinc supplements can cause stomach upset, and authors of acne diet plans recommend no more than 30 mg of zinc per day to avoid this.

Dietary supplements could potentially interact with medications prescribed for acne. Some acne medications contain retinol, a form of vitamin A. Taking a vitamin A supplement with these prescriptions can cause a dangerous buildup of vitamin A in the body.

Women who are pregnant or those who may become pregnant should not take vitamin A supplements or any medications containing vitamin A, as excessive amounts of vitamin A may cause birth defects. Women should never take the acne medication Accutane during pregnancy because it does cause birth defects; women who take this medication should be very careful not to become pregnant.

Risks

There are few risks associated with an acne diet. Most relate to taking dietary supplements. Zinc may prevent the body from absorbing enough copper. To avoid this, consumers should avoid taking high doses.

Vitamin A is a fat-soluble vitamin. That means that excess vitamin A is stored in the body rather than eliminated in the urine. Many acne prescriptions contain concentrated forms of vitamin A, but too much vitamin A can be toxic. Consult a doctor before taking vitamin A supplements.

Research and general acceptance

No consensus has been reached on whether or not diet plays a role in causing or preventing acne. Many dermatologists do not believe that diet has a significant effect on acne. Early studies about diet and acne focused on specific foods believed to trigger acne breakouts. Most of these studies found no evidence that individual foods cause acne. The most recent research is, however, finding links between diet and acne, especially between acne and high glycemic-index foods.

The theory with the strongest support is that foods high on the glycemic index contribute to acne, making existing acne worse. Studies have shown that half of acne patients tested had abnormal glucose levels, and in another study, 80% of premenstrual women with acne had abnormal glucose metabolism. This data, and others that show a high-carbohydrate diet increases the levels of testosterone in the blood, have led to the recommendation of limiting consumption of refined carbohydrates as a means of treating acne.

A US study in 2016 found the same relationship between milk and high glycemic foods and teenage acne, as did a 2017 paper from Norway. Another 2016 study found a link between acne and low-fat milk, but not full-fat milk. A 2017 study found a link between high carbohydrate consumption and acne in adults in New York City.

KEY TERMS
Acne vulgaris—
An inflammatory disease of the skin characterized by pimples and cysts that may cause scarring in severe cases.
Dermatologist—
A doctor who specializes in the treatment of the skin.
Glycemic index—
A scale for rating how quickly foods are converted to glucose or sugar by the body, indicating a food's impact on insulin levels as it is digested.
Hormone—
Substances in the body that regulate a process such as metabolism or growth.
Insulin—
A hormone that regulates the conversion of food into glucose or sugar so the body can use it for energy.
Insulin resistance—
A state in which the body does not respond well to insulin, resulting in the pancreas producing higher levels of insulin to regulate the level of glucose (sugar) in the body.
Low-carbohydrate, high-fat (LCHF)—
LA diet with high levels of fat (around 80% of calories) and very low carbohydrates (less than 5% of calories), with the rest of calories from protein.
Metabolism—
The process by which food is converted into energy.
Sebaceous glands—
Small glands in the skin, usually part of hair follicles, that produce sebum.
Sebum—
The fatty substance secreted by sebaceous glands. It helps moisturize and protect skin and hair.

Chocolate's role in causing acne has been revisited in recent years. A study published in 2016 found that adolescent boys who ate chocolate daily for four weeks had significantly worse acne at the end of the period, though the authors hesitated to conclude that the dietary change caused the acne. A Polish study from 2016 linked milk and chocolate to acne, and concluded that evidence for an association between diet and acne is compelling.

See also Dietary supplements ; Fiber ; Glycemic index diets ; Vitamins ; Zinc .

QUESTIONS TO ASK YOUR DOCTOR

Resources

BOOKS

Grigore, Adina. Skin Cleanse: The Simple, All-Natural Program for Clear, Calm, Happy Skin. New York: Harper, 2015.

Logan, Alan C., and Valori Treloar. The Clear Skin Diet. Nashville: Cumberland House, 2007.

Nelson, Nina, and Randa Nelson. The Clear Skin Diet: The Six-Week Program for Beautiful Skin. New York: Hachette, 2018.

PERIODICALS

Bae, Yoon Soo, Nikki D. Hill, Yuval Bibi, et al. “Innovative Uses for Zinc in Dermatology.” Dermatologic Clinics 28, no. 3 (2010): 587–97.

Bowe, Whitney P., Smita S. Joshi, and Alan R. Shalita. “Diet and Acne.” Journal of the American Academy of Dermatology 63, no. 1 (2010): 124–41.

Burris, Jennifer, William Rietkerk, Kathleen Woolf, et al. “Acne: The Role of Medical Nutrition Therapy.” Journal of the Academy of Nutrition and Dietetics 113, no. 3 (March 2013): 416–30.

Campbell, Christine E., and Beverly I. Strassmann. “The Blemishes of Modern Society? Acne Prevalence in the Dogon of Mali.” Evolution, Medicine, and Public Health 2016, no. 1 (October 2, 2016): 325–37.

Caperton, C., S. Block, M. Viera, et al. “Double-Blind, Placebo-Controlled Study Assessing the Effects of Chocolate Consumption in Subjects with a History Of Acne Vulgaris.” Journal of Clinical and Aesthetic Dermatology 7, no. 5 (May 2014): 19–23.

Cordain, Loren, Staffan Lindeberg, Magdalena Hurtado, et al. “Acne Vulgaris: A Disease of Western Civilization.” Archives of Dermatology 138, no. 12 (2002): 1584–90.

Haak, Emma. “The Diet that Helps with Adult Acne.” Huffington Post (January 11, 2017). https://www.huffingtonpost.com/entry/foods-that-clear-up-acne_us_586e80f0e4b043ad97e2245f?utm_hp_ref=acne (accessed May 3, 2018).

Smith, Robyn N., Neil J Mann, Anna Braue, et al. “A Low-Glycemic-Load Diet Improves Symptoms in Acne Vulgaris Patients: A Randomized Controlled Trial.” The American Journal of Clinical Nutrition 86, no. 1 (July 2007): 107–15.

Sujata, Mehta-Ambalal. “Clinical, Biochemical, and Hormonal Associations in Female Patients with Acne.” Journal of Clinical and Aesthetic Dermatology 10, no. 10 (October 2017): 18–24.

Veith, W.B., and N.B. Silverberg. “The Association of Acne Vulgaris with Diet.” Cutis 88, no. 2 (August 2011): 84–91.

WEBSITES

Butler, Natalie. “Anti-Acne Diet” Healthline. https://www.healthline.com/health/anti-acne-diet (accessed May 5, 2018).

Kern, Dan. “Diet and Acne” Acne.org . https://www.acne.org/diet.html (accessed May 5, 2018).

Spritzler, Franziska. “Can Keto or Low-Carb Diets Cure Acne?” Diet Doctor. https://www.dietdoctor.com/low-carb/benefits/acne (accessed May 5, 2018).

ORGANIZATIONS

American Academy of Dermatology, 9500 W. Bryn Mawr Ave., Ste. 500, Rosemont, IL, 60018-5216, (888) 462-3376, www.aad.org .

Deborah L. Nurmi, MS
Revised by Amy Hackney Blackwell, PhD

  This information is not a tool for self-diagnosis or a substitute for professional care.