A recent study published in the Dermatology journal Cutis concluded that most of the information found online regarding diet and acne was misleading or unfounded. This ranges from claims such as “salty and oily food cause acne” to lists provided by so-called experts of superfoods and supplements that supposedly fight acne, including coconut and olive oil, avocados, oranges, lemons and kiwis. Problems can occur when this advice is taken seriously and sufferers delay seeking advice and meaningful treatment from their GP or Dermatology Consultant for a condition that is known to cause psychological distress, physical scarring and, sadly, social prejudice.
The most comprehensive guidance on diet and acne to date comes from the 2016 American Academy of Dermatology (AAD) guidelines on the management of acne by Zaenglein and colleagues which concluded at the time that:
1. There is insufficient data to be able to recommend specific dietary changes in the management of acne.
2. There is emerging data that high glycaemic index (GI) diets may be associated with acne.
3. There is limited evidence that some dairy, particularly skim milk, may influence acne
On their website , the AAD now advises that a low GI diet may reduce the number of spots in acne patients & highlights data from around the world that support the concept that a high GI diet and dairy are correlated with acne severity. They state that consumption of milk (of all types this time) may be linked to increased breakouts, but that no studies have found the same for products made from milk e.g. cheese & yoghurt. So why is the guidance evolving?
Evidence from several recent studies suggests that transitioning to a low GI diet may lead to fewer spots after 12 weeks.High GI diets are believed to stimulate acne pathways by increasing insulin-like growth factor-1 (IGF-1) which increases keratinocytes (skin cells) and sebocytes (sebaceous gland cells) and triggers androgen hormone production.Although not studied as extensively or rigorously as GI, consuming milk and dairy products does appear to have a potential to exacerbate acne. This is also thought to be due to increased insulin and IGF-1 levels as well as the fact they contain bovine IGF-1 and dihydrotestosterone (DHT) precursors.A recent meta-analysis (one of the highest quality forms of research) found a correlation between dairy (whole milk, low fat milk and skim milk) and acne occurrence, but no significant association between yoghurt/ cheese consumption and acne development.
The available research does not demonstrate that diet causes acne, rather that it may influence or aggravate existing acne. This goes some way to explain why altering diet alone is rarely sufficient to control acne on its own, but can work in conjunction with medical treatment.
So for now, pending an update in the guidance, Dermatologists recommend that you pay attention to your breakouts and ask yourself these questions:
1. Does any food or drink seem to trigger a breakout or worsen your existing acne?
2. If something seems to trigger a breakout, what happens when you don’t have that food or drink for a day, a week, or a month?
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