Don't eat chocolate. That was the advice dispensed - unsolicited of course - to pimply teens in my time. Dermatologists disagreed. The chocolate acne connection was debunked by studies - albeit weak and flawed ones -- and the thinking back then was that diet doesn't affect acne in any significant way.
A recent article in the New York Times reminded me how much has changed in the last decade. Anahad O'Connor interviewed Dr. Daniel J. Aires, a researcher and dermatologist at the University of Kansas Hospital in Kansas City, who recommends a low glycemic diet for acne, and points to research that shows that foods that cause spikes in insulin, such as those with added sugars and refined carbs, exacerbate the skin affliction. "I've had a lot of patients who get their acne under control just by changing their diet," says Dr. Aires.
In skin disorders, much like in other fields of medicine, further research shows that what we eat, unsurprisingly, affects our wellbeing. We're not back to chocolate prohibition for acne sufferers; today's lists of bad-for-your-skin is a little more involved.
Acne's main food suspects
Carbs:
A curious finding of a study led by Loren Cordain sparked the suspicion that something in the Western Diet promotes acne. The study examined 1315 15-25 year olds from Papua New Guinea and Paraguay, all from non-Westernized societies, who ate traditional diets. They found zero cases of acne. To put this in perspective: 80-90 percent of American teens have some degree of acne. The researchers hypothesized that the glycemic load - a measure of carbohydrate foods' effect on blood glucose and insulin levels -- see previous post for a short explanation of the concept - causes a cascade of endocrine changes that make acne worse.
This notion was given support by several studies. In a 2007 randomized controlled study, 23 Australian 15-25 year olds showed significant improvement of acne symptoms under a low- glycemic load diet. Another randomized controlled study of 32 20-27-year-old Korean volunteers found pretty much the same. These are small studies, but there are several other -- less rigorous ones -- that point in the same direction.
Milk:
Studies that relied on people's recall of their diet in their teens, and the severity of their acne, suggested that milk affects acne. Looking further into milk type studies showed that only skim milk showed a statistical correlation with acne.
Foods to avoid if you have acne
Given the new information gleaned from the latest research it seems that diet does play a role in acne. It probably doesn't cause it, but it can aggravate or improve it, at least to a certain degree.
In guidelines published by the American Academy of Dermatology in 2016, the group of 17 experts concluded that, regarding diet, "emerging data suggest that high glycemic index diets may be associated with acne" and that "limited evidence suggests that some dairy, particularly skim milk, may influence acne," but "given the current data, no specific dietary changes are recommended in the management of acne."
They did not find that the evidence was strong enough to warrant a recommendation.
Guidelines aside, since high glycemic load foods are generally to be minimized anyway - they are typically highly processed foods, foods with white flour, added sugar, and low fiber - I can see no reason to why people with acne shouldn't give it a try.
Eating more fruits, non-starchy veggies and whole grains is good for you anyway, and it so happens that this eating pattern has low glycemic load. Minimizing added sugar helps curb weight gain and chronic diseases such as diabetes and atherosclerosis.
This kind of eating plan will also add color and glow to your skin.
No reason not to give it a shot.
Dr. Ayala
This is a crosspost of my blog, Healthy Food & Healthy Living.