The complexion connection: how foods cause acne?

man's face with acne Most people think of acne as “hormonal”—a normal part of adolescence that often lingers long into adulthood.  However, while it is true that acne is hormonal, it is not normal and it is not inevitable. We know this because people who eat a “Paleolithic” whole foods diet do not get acne.

 

Cultures as different from each other as you can imagine—from Inuit Eskimos to rural Brazilians to the island people of Kitava off the coast of Papua New Guinea—all ate their own local versions of a “Paleo” style whole foods diet, and all had an acne incidence of ZERO, unless and until they started eating a modern “Western” diet.  In the United States, approximately 85% of teenagers develop acne, and as many as 50% of adults continue to wrestle with it.  So, what is it about the Standard American Diet (SAD) that could be causing acne?
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HOW TO MAKE A PIMPLE IN 3 EASY STEPS

STEP 1:  Set the stage for inflammation in your body

The types of fats and carbohydrates we eat play a major role in regulating the healthy balance between inflammation and healing.  In people with acne, systems are tilted too far in the direction of inflammation.

STEP 2:   Block your pores with skin cells

The foods we eat affect the hormones that regulate skin cell behavior.  In people with acne, skin cells are out of control—they build up around pores, stick together, and clog pore openings, trapping otherwise harmless bacteria inside.

STEP 3:  Crank up sebum production

Sebum is the oily/waxy substance that healthy pores make to soften and waterproof the skin.  However, people with acne have too much of a good thing.  Excess sebum causes the skin to become too oily.  Sebum can also get trapped inside clogged pores, where it becomes food for the bacteria imprisoned underneath the skin.

PIMPLE INGREDIENTS:

High glycemic index carbohydrates

High glycemic index and refined carbohydrates, such as sugar, flour, refined cereal products, white potatoes, and fruit juice, are prime suspects in the development of many common “diseases of civilization”, including acne. These “fast carbs” are rapidly digested and absorbed into the bloodstream, causing insulin levels to surge. High insulin levels increase risk of acne because they:

  • Promote inflammation. For more information about how fast carbs and high insulin levels can cause inflammation, read my Carbohydrates page.
  • Cause overgrowth and accumulation of skin cells. Insulin is a growth hormone, so one of its most important jobs is to stimulate cell growth and reproduction.
  • Raise androgen levels. Androgens are the so-called “male hormones”, such as DHEA (dehydroepiandosterone) and testosterone. Androgens are naturally present in males and females (but normally at much lower levels in women than in men). Androgens stimulate sebum production, so if you eat too many fast carbs, your androgen levels may run too high, which can put your oil glands into overdrive.

Dairy products

Milk and most milk products contain two main types of proteins:  casein and whey. The proteins in dairy products, which are designed to grow a baby cow, have the power to shift growth hormones into overdrive:

  • Whey proteins trigger insulin spikes just as powerfully as pure sugar does,
  • Whey proteins contain a growth factor called betacellulin. This growth factor binds to a special receptor on human skin cells called the Epidermal Growth Factor Receptor (EGFR) like a key in a lock. When betacellulin binds to EGFR, it can trigger the skin follicle to make too much sebum.
  • Casein proteins raise IGF-1 levels by about 30%. IGF-1 stands for “Insulin-like Growth Factor.” IGF-1 is a growth hormone similar to insulin that stimulates excess sebum, skin cell, and androgen production.

Low-fat and non-fat dairy products, such as fat-free yogurt and skim milk actually contain a higher concentration of dairy proteins than high-fat dairy products, and therefore are even better at triggering breakouts in susceptible people.

Omega-6 fatty acids

When there is too much omega-6 in the diet, and not enough omega-3, the scales tip too far in the direction of inflammation. Seed oils, such as canola, soybean, and corn oil, are high in omega-6’s, whereas certain fish oils are higher in omega-3’s, which promote healing. For more information, click here.

BREAKING THE BREAKOUT CYCLE

Researchers have found it can take about 3 months on a new diet to see significant improvement in acne, so it is important to be patient. Diets that may be helpful in reducing or eliminating acne include:

A Paleolithic diet. We know that people who ate a Paleo diet did not have acne at all, probably because a Paleo style diet contains no refined carbohydrates, no dairy products, and no seed oils. If you still have acne on this diet, you may need to try a low-carb version, such as the LCHF diet below.

The LCHF diet.  This diet lowers insulin levels more than any other diet because it is both extremely low in carbohydrate and in dairy proteins.

A low glycemic index diet. A few small clinical studies have suggested that people who eat a low glycemic index diet have less acne than people who eat a standard diet. This diet stabilizes insulin levels but may not reduce them enough in some people to see dramatic results.

A low carbohydrate diet. This diet lowers insulin levels much more than a low glycemic index diet does, so if you are very carbohydrate-sensitive, you may have better results with a low-carb diet than a low glycemic index diet.

A dairy elimination diet.  Some people with acne may be sensitive only to dairy products and may not need to alter their carbohydrate intake to get rid of their acne.

Some people believe that chocolate can trigger their acne breakouts. Plain milk chocolate has not been properly studied yet, but it would make sense that this food, which contains both milk proteins and sugar, might contribute to unsightly blemishes. Other prime suspects include sugar-sweetened cereals with skim mik, fat-free sugary yogurts, and baked goods or deep-fried foods made with flour and vegetable oils.

The bottom line is this:  if you lean more towards an “uncivilized” diet, with fewer refined carbohydrates and dairy products, your skin just might thank you by clearing up and looking healthy again. That’s reason to smile!

What about you?  

If you have made changes to your diet that have improved your acne, please consider sharing your story with other readers in the comments section below.

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REFERENCES

Berra B and Rizzo AM. Gycemic index, glycemic load:  new evidence for a link with acne.  Journal of the American College of Nutrition 2009; 28 (4), 450S–454S.

Block SG et al.  Exacerbation of facial acne vulgaris after consuming pure chocolate.  Am Acad Dermatol 2011; 65(4): 114-5.

Cordain L et al.  Acne vulgaris:  a disease of Western Civilization.  Arch Dermatol 2002; 138(12): 1584-1590.

Cordain L.  Implications for the Role of Diet in Acne.  Semin Cutan Med Surg 2005; 24:84-91.

Fulton JE Jr et al.  Effect of chocolate on acne vulgaris.  JAMA 1969; 210 (11): 2071-2074.

Goh W et al.  Chocolate and acne: how valid was the original study? Clinics in Dermatology 2011; 29: 459–460

Jung JY et al.  The influences of dietary patterns on acne vulgaris in Koreans.  Eur J Dermatol 2010; 20: 768-772.

Kwon HH.  Clinical and histological effect of a low glycaemic load diet in treatment of acne vulgaris in Korean patients:  a randomized, controlled trial.  Acta Derm Venereol 2012; 92: 241-246.

Lindeberg S et al. Low serum insulin in traditional Pacific Islanders–the Kitava Study. Metabolism. 1999;48:1216–9.

Melnik BC.  Dietary intervention in acne:  attenuation of increased mTORC1 signaling promoted by Western diet.  Dermato-Endocrinology 2012; 4 (1): 20-32.

Paoli A et al.  Nutrition and acne: therapeutic potential of Ketogenic diets.  Skin pharmacol physiol 2012; 25(3): 111-117.

Smith RN et al.  A low-glycemic-load diet improves symptoms in acne vulgaris patients:  a randomized controlled trial.  Am J Clin Nutr 2007; 86:107–15.

Taylor M et al. Pathways to inflammation: acne pathophysiology.  Eur J Dermatol 2011; 21(3): 323-33.

Veith WB and Silverberg NB.  The association of acne vulgaris with diet.  Cutis 2011; 88(2): 84-91.

Yang JH et al.  A comparative study of cutaneous manifestations of hyperandrogenism in obese and non-obese Taiwanese women.  Arch Gynecol Obstet 2010; 282(3):327-33.

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