NMU 85 – Dietary Factors Shown to Affect Acne

Nutrition / Natural Medicine Update No. 85 (March 27, 2018)

with Dr. James Meschino

Topic: Dietary Factors Shown to Affect Acne

Source: Various Journals of Dermatology (see references below)

Our topic today is “The Emerging Evidence that Diet Plays a Key Role in the Frequency and Severity of Acne”.  We know that genetic, as well as hormonal changes during puberty, play a role in acne development. However, more and more evidence, published in journals of Dermatology, point to a significant effect of diet on the frequency and severity of acne breakouts. Researchers point to the fact that some societies, who have very healthy dietary patterns, do not have any incidence of acne at all. As well, recent dietary challenge studies with acne patients have shown that certain foods can flare-up acne conditions while other foods can help to suppress the development of acne. So, here are the key dietary and supplementation findings on this subject have been published in various dermatology journals in recent years.

Let’s start with dietary factors shown to aggravate acne:

1. Refined sugars – refined sugars are known to raise insulin levels, and high insulin, in turn, stimulates the overproduction of sebum in sebaceous glands. The excess sebum then blocks pores and creates the site for acne infections to take hold. High insulin also drives up the secretion of testosterone, which is the male hormone that also increases sebum production – blocking pores and increasing frequency and severity of acne infection by skin bacteria. High insulin also increases the release of IGF-1, which further increases testosterone secretion and cortisol – the stress hormone that makes acne worse. High sugar diet also stimulates the mTOR pathway, which causes the sebaceous glands to divide faster and produce even more sebum, and blocking pores.

Several studies have been undertaken with acne patients to examine the effect of refined sugars on acne incidence and severity. An association between high-glycemic-index foods (sugary foods and beverages) and longer acne duration was reported, whereas two randomized controlled trials associated low-glycemic foods with reduced acne risk.  Examples of low-glycemic foods include things like beans and beans (instead of other starchy foods) and non-sweet vegetables (broccoli, cauliflower, kale etc.), low-carbohydrate/high fiber cereals, and non-sugar containing beverages. It has been reported that people living in the Kitavan Islands (off the coast of Papua New Guinea and the Aché hunter-gathers of Paraguay do not suffer from acne and this is associated with their low-glycemic diet, consisting mainly of fresh fruits, vegetables, and lean proteins.

2. Dairy Products – dairy products are high in the amino acid L-Leucine. Like high insulin, leucine also directly stimulates the mTOR pathway causing sebaceous glands to divide faster and produce more sebum. As one researcher noted, in the North American diet mTOR-activating system from dairy ingestion is frequently combined with hyperglycemic, sugary carbohydrates or pure sugar (milk plus sugary cornflakes, milk chocolate or ice cream etc.), a combination which ramps-up mTOR activation. Researchers suggest this is a key factor in the high incidence of acne in many developed countries.

3. Chocolate –  As chocolate contains milk and sugar (milk chocolate) it is not surprising to see the association between chocolate and increased acne breakouts in a large number of individual case reports. The cocoa itself may not be implicated. We think it’s the milk chocolate and sugar that is at the root of the acne problem in these cases.

4. Omega-3 fats from fish – evidence suggests that more fish and seafood consumption is associated with reduced acne flare-ups in adolescence who eat these foods in place of red meat and pork

Here is a direct quote from Dr. B Melnik – the Department of Dermatology, Environmental Medicine and Health Theory (University of Osnabrück; Osnabrück, Germany) in his review paper in the journal Dermatoendocrinology in 2012):

“Epidemic acne of Westernized societies should be considered as a visible model disease of exaggerated mTOR signaling promoted by the Western diet. Dermatologists should not needlessly waste time with controversial discussions concerning isolated food components in the pathogenesis of acne but should realize the emerging whole network of exaggerated mTOR signaling mediated by Western diet. The most important task of preventive dermatology will be the reduction of mTOR. All three major stimulatory pathways of mTOR1 activation have to be attenuated. Dietary intervention in acne should thus (1) decrease total energy, glucose and fat intake, (2) diminish insulin/IGF-1 signaling predominantly mediated by high dairy protein consumption, and (3) should limit the total leucine uptake predominantly provided by increased animal protein intake including meat and dairy proteins. This comprehensive dietary strategy can only be achieved by higher consumption of vegetables and fruit and reduction of animal-derived food”.

Ok finally, what about vitamins and minerals? There may also be some merit in taking multivitamin and mineral, enriched with antioxidants, as some studies have shown that zinc, selenium and vitamin E supplementation may be helpful in preventing acne flare-ups, as well as correcting the commonly seen marginal deficiency in vitamin A. Most people only get 50% of required vitamin A each day, according to the National Health and Nutrition Examination Surveys. Each of these nutrients, as well as many B-vitamins, play an important role in skin health and appearance.

So, I hope you found this to be of interest, as acne is a common skin problem in our modern society.

I have included the key references in the text below

Published Acne Studies

1. Pappas A. The Relationship of Diet and Acne. Dematoendocrinology Sept-Oct;1(5):262-267 (2009) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2836431/

2. Burris J, Rietkerk W, Woolf K. Acne: the role of medical nutrition therapy. J Acad Nutr Def Mar; 113(3):416-30 (2013) https://www.ncbi.nlm.nih.gov/pubmed/23438493

3. Kuhcarska A et al. Significance of diet in treated and untreated acne vulgaris. Advances in Dermatology . April;33(2):81-86 (2016) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884775/

4.. Melnik B. Dietary Intervention in Acne. Dermatoendocirnology. Jan1; 4(1): 20-32 (2012) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408989/

Eat Smart, Live Well, Look Great,

Dr. Meschino