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?
SodaStream (Soda-Club) USA


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.


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.


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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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.

Please note that after 30 days, Dr. Ede may not personally respond to comments, however comments shall remain open to encourage community discussion.
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  • ambermcginty

    I ate a cookie while reading this post and felt really bad about it. Hopefully my face will forgive me! 🙂 I tend to eat sugar more frequently for a few days or even weeks at a time, and then I steer clear of it for days or weeks at a time. I definitely have clearer skin in the “off season”. Thanks for the great information!

    • I have the same problem – a love of cookies.

  • Des

    What happens when someone adheres to a so called uncivilized diet and still experiences pimples every so often? I live off meat, liver, fish, cod liver oil, fruit, coconut and ghee but am still experiencing a few cysts a month which make me very upset. For the past two days, I’ve eaten no fruit to see if the inflammation would subside and it seems like it’s working. I had half a red pepper last night though, im hoping that wont set me back. so I guess my experiment will be this: how much fruit can I get away with and have clear skin?

    Am I alone with this? Fruit is the only culprit (okay, maybe sweet as well as white potatoes too) I can think of. Perhaps a very low carb diet with minimum fruit will help. I’ll experiment and write back.

    Ps. Since eating more dried and fresh fruit and the occasional white potato, my skin has been in agony. This I know for sure. So acne sufferers out there, try cutting back on fruit and potatoes and see what happens. start to re-introduce your favourite fruits and starches and see what happens.

    Good luck!

    • Rachel Lynn Salazar

      Keep the whole fruit (just cut juices and purés) because when whole, they still have a low gycemic index. Cut out the meat! Or at least eat only grain fed, hormone free meat and eggs.

  • Good Doer

    Based on my adjacent personal experience with acne for the past three years, I’ve come to conclude that following few recommendations will definitely eliminate your acne issues.

    Do never think of consuming: Caffeine, Nuts, High-sugar-contents, Any kind of oils, all dairy products, Margarine, Butter.

    Some of the mainstream foods and drinks that you should not consume: Chocolates, Pizza, Soda drinks, Chips, Pasta, French Fries, and it’s recommended to keep juices in a reasonable amount, unless it’s a natural juice.

    However, your acne will not only disappear by boycotting these substances. You want a healthy face and skin? Then you _must_ eat and drink healthy.

    Green salad, oranges, bananas, apples, strawberries, watermelons are recommended, then all fruits follow (except almonds and coconuts.) Drink water as much as you can. Exercise regularly, twice or thrice a week. All of these steps will have a huge positive impact on your acne, face and skin.

    I, by far, haven’t witnessed anyone else more allergic to acne than myself. So this food system might be a little strict but it’s an assured cure. Always keep in mind, it’s your decision whether to have acne or not. If you acne appears on your skin, think of all what you’ve consumed and it’s certain that you’ll find a mistake within your food. It’s only your strong will that will prevent acne. Before losing your resistance and deciding to eat a product that will cause you acne, remember that you’ll wake up tomorrow morning with the consequences!

    • Sam

      What about eatting healthy fats? Do u eat any kinds of fat?

  • Maija

    Dr. Ede, I really appreciate your site so I’ll share this story with you. In my early thirties I was diagnosed with rosacea. I spent 15 years with very painful red skin. My dermatologists tried out a plethora of therapies and suggested that I avoid exercise etc. A few years ago, one dermatologist wanted me to go on a low dose of daily antibiotics. I asked, “Why?” and she told me that it had an anti-inflammatory effect. I decided to find an alternative to this because I did not want to destroy my intestinal flora and I couldn’t afford the medicine ($500/month). I tried a variety of supplements such as turmeric, pineapple, oil of primrose…then I found OMEGA 3 fish oil. My skin healed, hot flashes ceased, my mood improved and the aches and pains felt after exercising, I never stopped exercising BTW, disappeared. Additionally, over the past two months, I have been eating a low carb, as paleo as possible diet, and although the first week felt horrible with headaches and fatigue, my skin and stomach are now happier than ever. I find that I do not need as much Omega 3 as I did before the low carb diet, in order to keep my skin calm. I always recommend exercise and Omega 3 oils to distressed friends but few of them believe that these steps to feeling better could be so simple:)

  • Canadian

    Typical american insular article. People have acne all over the world – even in Asia– just just in the USA. It’s more than diet stupid, it’s several different genetic abnormalities that lead to hyperkeritinization and androgen sensitivity (90% of people with acne have androgen levels within the normal range, with only increased sensitivity) regardless of environmental factors. Acne is not a disease of western gluttony (or should I say american gluttony) it is an age old disease of genetics predating history. The ancient egyptians had acne, they used sulphur and honey on blemishes, did ya’ know that? This isn’t a new or lifestyle induced condition, acne is a part of the human genome.

    I can bet my bottom dollar the author is not a dermatologist or licensed M.D. I’m right aren’t. Just a typical quack making things up as they go.

    • Dear Canadian

      I welcome comments from all viewpoints but would appreciate it if you could please be more polite when disagreeing with me and others on this site so that the tone of the conversation can be civil and respectful. I would be happy to continue the dialogue with you and allow your posts on the site if you can be respectful going forward. I am a licensed and practicing M.D., for whatever that’s worth (not that one has to be an M.D. to have valid things to say about food, science, and medicine; in fact M.D.’s learn little about nutrition in medical school) and I base the information on this site on scientific articles which are cited at the end of each post.

      I agree with you that diet is not everything–genetic susceptibilty and other factors come into play, as evidenced by the observation that not everybody who eats a diet containing sugar, flour, and dairy products gets acne.

      Unfortunately, ancient Egyptians were not hunter-gatherers and ate an agriculturally-based diet as opposed to a “Paleo” style diet based on meats, fruits, and vegetables and excluding dairy and grains.

      The following is the complete abstract from a recent paper (Touzeau et al J Archaeol Sci 2014: 46;114-124) about ancient Egyptian diets, which concludes that their diet was grain and dairy based:

      “Carbon, nitrogen and sulfur stable isotope compositions were measured in hard and soft tissues from Egyptian mummies of humans and animals in order to track the diet of ancient Egyptians from 5500 to 1500 years B.P. The carbon isotope ratios of bone apatite (δ13Cbo = −14.3 ± 0.9‰) and hair protein (δ13Ch = −19.9‰) are compatible with a diet based almost exclusively on C3-derived food (proportion of C4 < 10%). Less negative carbon isotope ratios of enamel (δ13Cen = −11.6 ± 0.7‰) relative to bones from the same mummies could be the result of differences in the chemical microenvironment in which mineralization occurred, as well as of differences in diet between children and adults, in particular through the consumption of milk or millet gruel during infancy and childhood. High values of nitrogen isotope ratios for hair protein (δ15Nh = 9.1‰–15.5‰) are ascribed to aridity rather than fish consumption because the δ34S values of human hair are lower than those measured in Nile perch scales. Except for Coptic mummies, the constancy of δ13Cbo and δ13Cen over a duration of ∼3000 years is striking considering the various political, technological, and cultural changes that impacted the Egyptian civilization during this time interval."

      While the full article is not available through my database, you can read a synopsis of it here:

      In contrast, hunter-gatherer cultures seemed not to have acne. The following is directly taken from the Cordain 2005 article cited in this post:

      "…acne has been reported to be absent in nonwesternized populations such as the Inuit (ie, Eskimo), Okinawa islanders, Ache hunter-gatherers, and Kitavan islanders. Although familial studies have demonstrated that hereditary factors are important in determining susceptibility to acne, the complete absence of this disease in nonwesternized populations points strongly to underlying environmental factors, including diet."

      Thank you for your consideration.

  • Russ 88

    Hi Dr. Ede,
    You said “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
    That sounds like a LOT! Do you know how much IGF-1 levels are raised by proteins in fish, eggs, or cheese, for the sake of comparison?

  • Alex26

    I just started paleo and I’ve been breaking out, when I never used to do that before. I’ve also cut sugar out of my diet. Very frustrating. Especially since I have been losing some weight.

    • It could be the influx of fat.. I know when I started the Bulletproof diet and started eating far more saturated fats (coconut oil, avocado, ghee) I started breaking out like crazy, especially on my forehead. Sometime I even had the really deep painful bumps that would take weeks to disappear. Personally, I notice a correlation between saturated fats and acne in myself..

  • You explained everything perfectly, thank you!

  • FutureFox

    Natural fruits are a problem when eaten out of moderation. Learned that the hard way eating too many mangoes at a time. I have to stick with oligosaccharide type vegetables (i.e broccoli green beans, etc). Day in. Day out. It really is the only way to keep acne away from the gates so to speak.

  • Hi Skinny Yoked

    Thank you for your kind comment–sounds like you are a fellow soldier for the cause! Keep up the great work spreading the word!