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Preventing acne with diet

Preventing AcneAcne is the most common skin condition in the U.S. About 85% of people in the Western world experience acne during their teenage years, but it can occur at any age. Acne is more than just pimples and it can leave permanent scars. In many people, acne can seriously affect quality of life, causing low self-esteem, withdrawal from social situations, anxiety, and depression.1

There are four major components of acne2:

  1. Excessive production of oil by the skin
  2. Skin cells dividing excessively or “hyperproliferation”
  3. Bacteria
  4. Inflammation

A pimple or lesion forms when a pore in the skin begins to clog with old, dead skin cells. Usually these cells are simply shed from the surface of the skin, but if too much oil is being produced, the dead cells can stick together and become trapped inside the pore. Bacteria also play a role, they can grow and multiply inside the pore, resulting in an inflammatory response.1

Scientific studies have demonstrated that the diet is very important, because what we eat can affect the hormones that contribute to the oil production, hyperproliferation, and inflammation that cause acne. The two acne-promoting dietary factors that have been most extensively studied are dairy products and high glycemic load foods. These factors influence hormonal and inflammatory factors increasing acne prevalence and severity.3,4 Hormonal influences that raise insulin and insulin-like growth factor 1 (IGF-1) levels are key.5 Elevated IGF-1 levels lead to changes in gene expression that cause inflammation, hormonal changes, increased oil production, and development of acne lesions. Of important concern is that the same hormonal milieu of high IGF-1 and high insulin, also promotes breast and prostate cancer, so it is important to maintain a diet that is hormonally favorable all through life.

In addition to dairy and high glycemic foods, excessive oil production by the skin can be exacerbated by oil intake. Vegetable oils drives omega-6 intake up, which have pro-inflammatory effects, and high omega-6 intake is associated with the development of acne.4,6-8 The effects of oil intake on acne is exacerbated by the consumption of high glycemic carbohydrates, such as commercial baked goods. Higher intake of omega-3 fatty acids is associated with reduced likelihood of acne, as omega-3s counteract the pro-inflammatory processes that drive acne. Just because overeating nuts and oil (especially peanuts and peanut butter) can contribute to sebum production and acne, does not mean nuts and seeds need to be eliminated from the diet to help acne. It is the combination of the glycemic load of the diet and other hormonal promoters acting together to produce acne. So excessive intake of fat may increase sebum production, but this tendency is permitted and exacerbated by the glycemic effect of the diet. When your diet has more beans, greens, seeds, onions and mushrooms, and is free of high glycemic carbohydrates, it can tolerate more fat, without any acne-promoting effects on sebum production, because the antioxidant and phytochemical exposure is higher, and the glycemic load of the diet is lower. So up to two ounces of raw nuts and seeds can generally be eaten by those on an oil-free Nutritarian diet without creating acne. But once you start eating refined and high glycemic carbohydrates, your body will be more sensitive to the fat in your diet, maybe even from nuts.

The two most important hormonal factors that drive acne are IGF-1 and insulin. In addition to avoiding oils, to prevent or resolve acne, avoid dairy products and high-glycemic load foods, especially sweeteners and commercial baked goods and make sure to get an adequate supply of micronutrients. Remember, high glycemic carbohydrates can raise both insulin and IGF-1.

1. Avoid dairy

Protein intake is the major factor that determines circulating IGF-1 levels, especially protein from dairy products. A three-year prospective study of 9-15 year old girls found a 20% increase in acne prevalence in girls that had 2 or more servings of milk per day compared to less than 1 per week. This association held true for total, whole, low fat, and skim milk.9 The same researchers found a similar association in boys who drank skim milk (milk highest in protein).10 Furthermore, in the Nurses' Health Study, dairy products eaten during high school were associated with acne during women's teenage years.11

2. Avoid high-glycemic load foods

Glycemic load (GL) is a measure of the effect of a certain food on blood glucose levels. High-GL foods like refined carbohydrates produce dangerous spikes in blood glucose, leading to excessive insulin levels in the blood (hyperinsulinemia), which contribute to diabetes, heart disease, and several cancers.12,13 Hyperinsulinemia not only promotes inflammation but also raises IGF-1 levels, further contributing to acne. A low glycemic load diet has been shown to improve acne symptoms, and decrease IGF-1 and skin oil production in several studies.14-17

3. Include protective micronutrients

Blood levels of zinc, carotenoids, and vitamin E are known to be lower in acne patients compared to those without acne, suggesting that maintaining micronutrient adequacy may help to prevent acne.14,18 Carotenoids are abundant in green and orange vegetables, and vitamin E is abundant in nuts and seeds. Although pumpkin seeds and hemp seeds are rich in zinc, zinc absorption efficiency may be low on a plant-based diet, so a multivitamin and mineral supplement is recommended to assure optimal levels of zinc, iodine, vitamin D and B12.

Hundreds of people with severe acne, of all ages have resolved their acne, and gained a healthy colorful glow to their skin with a Nutritarian diet. Not only does the richness in antioxidants protect against acne, but it gives skin a healthy color and more youthful appearance as one ages.


References:

1. American Academy of Dermatology: Acne.
2. Costa A, Lage D, Moises TA. Acne and diet: truth or myth? An Bras Dermatol 2010, 85:346-353.
3. Melnik BC, Schmitz G. Role of insulin, insulin-like growth factor-1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris. Exp Dermatol 2009, 18:833-841.
4. Ferdowsian HR, Levin S. Does diet really affect acne? Skin Therapy Lett 2010, 15:1-2, 5.
5. Danby FW. Diet and acne. Clin Dermatol 2008, 26:93-96.
6. Pappas A. The relationship of diet and acne: A review. Dermatoendocrinol 2009, 1:262-267.
7. Logan AC. Dietary fat, fiber, and acne vulgaris. J Am Acad Dermatol 2007, 57:1092-1093.
8. Picardo M, Ottaviani M, Camera E, Mastrofrancesco A. Sebaceous gland lipids. Dermatoendocrinol 2009, 1:68-71.
9. Adebamowo CA, Spiegelman D, Berkey CS, et al. Milk consumption and acne in adolescent girls. Dermatol Online J 2006, 12:1.
10. Adebamowo CA, Spiegelman D, Berkey CS, et al. Milk consumption and acne in teenaged boys. J Am Acad Dermatol 2008, 58:787-793.
11. Adebamowo CA, Spiegelman D, Danby FW, et al. High school dietary dairy intake and teenage acne. J Am Acad Dermatol 2005, 52:207-214.
12. Barclay AW, Petocz P, McMillan-Price J, et al. Glycemic index, glycemic load, and chronic disease risk--a meta-analysis of observational studies. Am J Clin Nutr 2008, 87:627-637.
13. Gnagnarella P, Gandini S, La Vecchia C, Maisonneuve P. Glycemic index, glycemic load, and cancer risk: a meta-analysis. Am J Clin Nutr 2008, 87:1793-1801.
14. El-Akawi Z, Abdel-Latif N, Abdul-Razzak K. Does the plasma level of vitamins A and E affect acne condition? Clin Exp Dermatol 2006, 31:430-434.
15. Smith R, Mann N, Makelainen H, et al. A pilot study to determine the short-term effects of a low glycemic load diet on hormonal markers of acne: a nonrandomized, parallel, controlled feeding trial. Mol Nutr Food Res 2008, 52:718-726.
16. Smith RN, Braue A, Varigos GA, Mann NJ. The effect of a low glycemic load diet on acne vulgaris and the fatty acid composition of skin surface triglycerides. J Dermatol Sci 2008, 50:41-52.
17. Smith RN, Mann NJ, Braue A, et al. A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Am J Clin Nutr 2007, 86:107-115.
18. Amer M, Bahgat MR, Tosson Z, et al. Serum zinc in acne vulgaris. Int J Dermatol 1982, 21:481-484.

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