A question that I get asked a lot by patients who have come to see me in the clinic for acne treatment is whether food may be contributing to their breakouts. This is hardly surprising as I can remember being told very clearly when I was a teenager that my spots were caused by eating chocolate. These days, speculation about what we should be eating to lose weight, be healthier and live longer is as hot a topic as ever. With this in mind, I thought it might be useful to put the record straight and share with you what the research shows about diet and acne.
In guidelines published by the American Academy of Dermatology (AAD) in 2016 (1), the role of diet in adult and adolescent acne was investigated. To my count, 13 studies were identified by authors after searching the medical literature on the subject. Many of these studies were small in size so it is difficult to draw firm conclusions from them. All is not lost, however, because if multiple small studies show similar effects, it may be possible to identify trends that can be investigated in future to determine if there is a true association.
1. Glycaemic index
Glycaemic index is a number. It gives you an idea about how fast your body converts the carbohydrates in a particular food into glucose (sugar). Some foods can make your blood sugar rise very fast. This is because refined sugars and bread, for example, are easier for your body to change into glucose than more slowly digested carbohydrates like vegetables and whole grains. The smaller the number, the lower the glycaemic index and the less impact the food has on your blood sugar.
23 Australian males aged 15-25 were observed over a 12 week period and 32 Koreans aged 20-27 were observed for a 10 week period (2,3). In both studies, subjects who were asked to follow a low glycaemic index diet showed a significant improvement in the severity of their acne at the end of the trial period compared to those who didn't. Although these 2 studies are the most rigorous to date regarding the effects of glycaemic index on acne, a small number of other studies also supported this association.
Several studies were identified suggesting that dairy products may aggravate acne. 47355 adult women were asked to recall their high-school diet and whether they had been diagnosed with acne by a physician. In this particular study, acne was associated with higher quantities of milk intake, particularly skim milk (4). Because this study relied on memory, there were concerns about it's accuracy. Further studies performed in a prospective manner have also suggested a link between milk consumption and acne, with the association most marked for skim milk, but the data is still pretty limited.
Some small preliminary studies were found examining the role of antioxidants, probiotics and fish oil on acne, but the AAD comment that the existing evidence is not strong enough to support any recommendations regarding these dietary factors at this time.
The role of diet in acne remains an area of intense interest and there are still many unanswered questions. We know that acne has a strong genetic component, but it has also been proposed that the rise of adult acne in recent times may be linked to the modern Western diet as well as lifestyle factors, such as stress. Thankfully, further research is underway which will hopefully help us to answer these questions.
For now, the American Academy of Dermatology concludes:
- Current data is not strong enough to support specific dietary changes in the management of acne.
- Emerging data suggests that high glycaemic index diets may be associated with acne.
- Limited evidence suggests that some dairy, particularly skim milk, may influence acne.
It is therefore important that you discuss these issues very carefully with a doctor knowledgeable about acne before eliminating entire groups of food from your diet as this may lead to nutritional deficiencies that can impact your broader health and wellbeing. A healthy, balanced diet remains the best recommendation at this time.
If you are struggling with acne and would like non-judgmental advice and effective treatment, please contact my team to book an appointment as I would love to help.
1. Zeingein AL, Pathy AL, Schlosser BJ et al. Guidelines for the management of acne vulgaris. J Am Acad Dermatol 2016. 74(5):945-73.e33.
2. Smith RN, Mann NJ, Braue A et al. The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters associated with acne vulgaris: a randomized, investigator-masked, controlled trial. J Am Acad Dermatol. 2007;57:247-256.
3. Kwon HH, Yoon JY, Hong JS, Jung JY et al. 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.
4. Adebamowo CA, Spiegelman D, Danby FW et al. High school dietary dairy intake and teenage acne. J Am Acad Dermatol. 2005;52:207-214.