23/02/2024

Care Health

Prioritize Healthy life

Food and acne: is there a connection?

Food and acne: is there a connection?

I have noticed a lot of opinions being shared online about how foods can affect your skin, with the most common one being how removing certain foods from your diet can help with acne.  

From my searches on social platforms stemming from requests I get about food and skin, acne is the most popular topic. And for good reason- it is estimated that nearly 100% of the population is affected by acne at some point in their life (usually around puberty). And for many people, the problem isn’t just limited to the awkward teenage years-  it continues into the adult years. In adulthood, it’s more likely to stick around if you’re a woman, and while it tends to decrease over time, it still affects a quarter of women over the age of 40.

While not normally dangerous in any way, acne can be uncomfortable, itchy, and even painful. The presence of acne can be anxiety inducing for even the most self-confident of us. 

Acne can leave permanent scars in about 20% of teenagers, leaving a permanent ‘badge-of-honour’ to commemorate the time of driving tests and cringey school dances. This emotional and physical scarring has been linked to higher rates of anxiety and depression in adulthood. 

This problem is caused by a relatively simple phenomenon – our skin produces oil, pores in our skin get blocked, inflammation results, and pop! A pimple shows up.

A number of foods have come under scrutiny for their potential link to acne, driven largely by higher rates of acne in the Western world, and the belief that foods in a typical ‘Western’ diet may contribute to inflammation which then leads to acne.

In particular, chocolate, dairy and high glycemic index diets have been studied most extensively, with fruits and vegetables, meat, nuts, pasta, green tea, semolina, rice, carbonated drinks and many others having been looked at across a variety of study types, sizes and qualities

Like many medical conditions, the causes of acne are complex, and not fully understood, with new insights being generated continuously. A combination of genetic, hormonal, and environmental (e.g., behaviours, exposures, potentially diet… but more on that later) factors contribute to the development of acne (here) and (here).  

Conditions such as insulin resistance and elevated blood glucose have been linked to acne

Believe it or not, some of the supplements you may be taking can cause acne. Vitamins B12, biotin, whey protein, iodine, and even collagen can lead to breakouts in some people. 

That being said, there is little high-quality evidence to support any one food being directly responsible for our skin’s appearance and health. In fact, research around food and acne seems to be very mixed.

Although influencers love to target specific foods as the cause for acne, this is an oversimplification. What works for one group or individual, may have the opposite effect on another. For example, person A may eat yogurt made from cow’s milk for breakfast most days and would report their skin is clear and healthy. Person B may say that when they cut out cow’s milk yogurt, and have soy yogurt instead, their skin is clear.

Unfortunately, the unregulated side of the multi-billion-dollar wellness industry doesn’t have to answer to ethics boards or provide sound evidence, which makes it an easy avenue for influencers and other modern day snake oil salespeople to market. The intersection between ‘nutrition products’ and ‘skincare’ – two areas rich in unregulated ‘miracle’ products, is sure to have lots of interesting material.

Here are some common food and acne claims:

You have acne because your gut isn’t ‘detoxifying’ properly.

Just one more thing for the gut to take the fall for, when really, acne isn’t ‘toxins’ leaving your body, nor is it a measure of gut health. 

This influencer is trying to tell us that acne can occur when the liver ‘gets heated’ and ‘sluggish.’ (FYI, this is a complete fallacy).

She claims that in this case, it needs a specific supplement that she just happens to be selling. Quelle Suprise!

food and acne
diet and acne
WUT.

There’s just no research or physiology to support this, which is why when you see someone recommending raw carrot salad or some other ‘gut-health diet’ for acne, you know they’re just hypothesizing. And by ‘hypothesizing,’ I mean, ‘reaching.’ 

(Read my post on the carrot salad trend here)

There’s also this odd idea that carrots contain vitamin A, which, if applied topically in the form of retinol, can help your skin. Eating foods that contain vitamin A is healthy, but it has nothing to do with clearing up your acne. 

Refined carbs, sugar, and vegetable oils cause inflammation, which then causes acne. 

The inflammation part of this may have a kernel of truth, although we actually haven’t proven this 

There are some studies that link high glycemic carb intake with higher levels of acne. The thinking behind this is that overeating refined carbs and sugar causes frequent blood glucose spikes/elevated blood glucose, which may cause inflammation, leading to acne. 

If you believe that ultra-processed carbs flare your acne, by all means, try eating less of them (which is a great idea for everyone and not a groundbreaking recommendation at all).

Read my explanation of glycemic index here .

The whole ‘vegetable oils cause inflammation’ is so overdone, I can’t believe I even have to debunk it again, but here we are.

There is no evidence that vegetable oils – or omega-6 fats – cause inflammation. If anything, they may be anti-inflammatory. 

The nuance that often gets missed is that a lot of ultra-processed foods tend to contain vegetable oils. When we eat a lot of ultra-processed foods and skimp on fibre and antioxidants, this may cause inflammation in our body. 

Does this mean we should be blaming vegetable oils for acne? Probably not.

Drinking water will give you clear skin and heal your acne.

Hydration may improve skin turgor, but in no way does it ‘clear up’ your skin or affect your acne. 

Pasteurized cow’s milk ‘increases sebum production’ and causes acne.

The link between dairy and acne has been extensively studied over the last 20 or so years. Dairy intake became of interest in acne causes on a survey from 2005 where high schoolers who responded that they had acne, were found to have consumed more milk than those without acne. 

The American Academy of Dermatology states that several studies appear to link cow’s milk to acne in some people, but the mechanism that causes this isn’t known. Cheese and yogurt do not seem to have the same effect.

A more recent study of nearly 25,000 adults in France who tracked their dietary intake and acne levels over time also drew identified an association with increased milk consumption and the presence of acne.

A meta-analysis of 14 studies (a statistical pooling of data collected from a systematic review) identified any dairy (milk, yogurt, and cheese) was linked to a small increase in acne in children and young adults (up to age 30). Another meta-analysis of 13 studies also showed a small increase of milk intake with acne.  

In some research, skim milk in particular appears to be more comedogenic (aka acne-producing) than full-fat dairy. Regardless, we don’t know the mechanism by which this happens with any type of milk.

As always (or as USUAL), there are some issues:

Check out the last line of the study: “However, results should be interpreted with caution due to heterogeneity and bias across studies.” In non-scientist speak, that translates to ‘garbage in -> garbage out’. Basically, the studies they lumped together had some underlying differences, making it hard to trust. 

Importantly, on many topics, a study is less likely to be published (and therefore included in the meta-analysis) if it doesn’t have a ‘positive finding’. This is called publication bias, and a definite concern here. It gets a lot less headlines when your study says ‘no link between dairy and acne’ than one that says the opposite.

If you think dairy makes you break out, try eliminating it and see what happens (don’t change anything else about your diet/lifestyle/cleansing routine at that time!). But by no stretch of the imagination do I recommend that everyone cut milk out of their diet because some random TikTok person said it ‘messes up our skin.’ That’s ridiculous. 

Some influencers recommend raw milk to clear up acne. This is irresponsible and dangerous. Even if your raw milk comes from a farm that’s supposedly ‘clean,’ it’s can still be contaminated. 

There is no evidence or mechanism for drinking raw milk to get rid of acne. Just don’t.

Do food intolerances or allergies cause acne?

There is no evidence that suggests a link between food allergies or intolerances, and acne.

How about acne supplements like Flo?

Flo is actually a PMS supplement that claims to clear up and prevent hormonal acne. 

food and acne
Funny ads. Not a lot of good research.

The active ingredients in Flo are lemon balm, chasteberry, and vitamin B6, none of which have been conclusively proven to be effective in dealing specifically with acne. While this supplement appears to be safe, it’s important to know that companies make a ton of claims around natural products – including that they balance hormones *ahem* Flo *ahem* – and if they’re vague enough for the FDA, none of these claims have to be proven.

So please, do research before you spend your money. 

The food and acne connection.

I think it’s safe to say that for some people, diet does contribute to acne. Acne triggers are very individual, varying from person to person, and they are often multifactorial.

The bottom line is this: we still don’t have any perfect evidence to be able to make blanket statements like: “Avoid X food for acne”.  Besides the controversial position that food causes breakouts, acne has a lot of other causes – genetics, cosmetics, environment, hygiene, stress, and even medications and supplements.

Specific links are not yet fully understood, and more data is needed before we begin vilifying certain foods for causing acne, especially when acne is often multifactorial.

As with a lot of health conditions, the best evidence we have around food and skin points to the combination of diet and other lifestyle and genetic considerations (some of which can’t be changed). It many cases it seems as though acne is not the result of one single food – it’s your diet as a whole, plus other factors.

Is there an anti-acne diet?

As always, I recommend a diet that’s as full of whole and minimally processed foods as possible. Ultra-processed foods are fine in moderation, but try to avoid basing your entire diet on them if possible. 

A diet high in fruits and vegetables, olive oil, whole grains, legumes, and low in red meat AKA the Mediterranean diet – is likely your best anti-inflammatory option.

Does the anti-inflammatory diet exist? Here’s my take.

Preliminary research suggests that omega-3 fats from foods like olive oil, avocados, fish, and nuts can help with skin health and inflammation.

Eating a high-fibre diet, fewer refined carbs and sugars, and a combination of carbs, protein, and fat at each meal can help stabilize blood sugars. 

Studies on the effect of pre and probiotics on skin are lacking. 

Lastly, avoid any foods that you believe are triggers for your acne. If you aren’t sure, eliminate these foods one at a time from your diet for at least 2 weeks to see if there are any changes in your skin.

When you’re on social media, look for information from credentialed professionals who provide high quality evidence to back up their claims.