Does food really cause acne?

By Lynda Soberanes

Have you seen the amount of products from different brands, colors, and mix of ingredients promising to help with acne? You may even have a collection of creams and serums at home. This amount of face care products for acne is proportional to the amount of people suffering from this condition. About 8 out of 10 people had, have or will have acne at any point in their life. It is common to see teenagers and young adults with acne, but actually a fair amount of adults can have acne as well. Acne is often seen as an inflammatory condition of the skin, but it also has side effects that go beyond what we can see: anxiety, depression, low self-stem. Acne can have a huge impact on productivity and quality of life. So it is not a small or a strictly cosmetic problem.

In many cases, the root cause is internal due to androgen hormones, bacterial overgrowth, medications and/or genetics. Lifestyle including exercise, the use of face masks and nutrition may also have an effect. In terms of nutrition, foods can provide us with nutrients and components needed to create hormones, for gene expression and other complex metabolic reactions. For a long time, it was thought that food had no relation with acne, but we have new research showing some possible connections. So far we know that foods may not cause or cure acne on their own, or at least not for everyone. But nutrition may for certain be an aid for acne while helping with general health as well. There are recent studies exploring the link with sugar, chocolate, milk, omega 3, zinc and other antioxidants, water, probiotics, alcohol, protein, whey… and while the evidence on many of those topics is still inconsistent, there are many interesting findings.

But just as with the rest of information around acne, many of the things we hear/read on foods and diets is based on thoughts and experiences, not science. I have seen really desperate clients unsure on what to eat or avoid, and others with many food restrictions, as recommended in magazines, blogs or from well-intended friends or family. The problem is that many times all the extreme changes do not lead to an improvement on the acne. On top of that, people may end up with a bad relationship with food, nutrient deficiencies and of course more frustration, disappointment and stress. And in case you didn’t know, stress may also be one trigger for acne breakouts, so better not to over-stress with info that is not based on real facts.

Lets speak about science based information.

At this point we know that triggers can be individual. I have seen clients experiencing more acne breakouts from eating chocolate or peanuts, while others experience the same after using collagen or a specific protein powder; others may be sensitive to alcohol. Some people may see no difference after drinking milk, while some others get more acne lesions.

Sugar & Glycemic Index
Perhaps the strongest evidence we have now is on glycemic index/glycemic load, which is related to the management of blood sugar: consumption of lower glycemic index foods can help to keep blood sugar under control. When blood sugar is under control, the hormones insulin and insulin-like growth factor 1 (IGF-1) are also regulated. A higher than normal production of those hormones may lead to an increase in androgen hormone production, oil production  and inflammation of the skin, so it makes sense that we want to have them under control. Some people interpret the low glycemic index diet as avoiding all sources of sugar. In reality, it may be more relevant to focus on how much, how often and how to combine the foods containing  carbohydrates. It is good idea to choose carbohydrate-rich foods that are less processed and contains some fiber, such as fruits, vegetables and whole grains. Combining those food with a source of protein or healthy fats can also help.
Following this idea, we cannot only say that foods like pasta are “bad”. Pasta is metabolized differently if we eat a big plate of it, compared to eating a smaller serving with salmon and asparagus. You can change the salmon and asparagus for any protein and vegetable that you may like. The same principle can be used for any other food containing sugar or carbohydrates.

Chocolate, Dairy and Specific Nutrients
There is some research suggesting chocolate could be linked with acne, but at this point it is unknown if the trigger is the fat, the milk or the sugar. One study found that even dark chocolate was linked to an increase in the number of breakouts when consumed daily. However, the relationship is still not well understood and there are more questions than answers. For example, the number of participants included in the study was really small and they all already had acne, so it is unknown if the chocolate could cause acne or only increase it. It is also unknown what happens if people eat chocolate occasionally rather than daily, and we don’t know if this would happen with women, as the study included only men. We also don’t have much information about the diet or lifestyle, so it is difficult to make recommendations based on the results.
Milk is in a similar situation, with researchers not being sure if the problem is the protein, the carbs or maybe the hormones. Some people that are sensitive to milk may still have a reaction with organic milk, so at this point the recommendation on avoiding milk based on individual reactions. Of interest, no relation has been found with yogurt, perhaps because of the probiotic content, but it is hard to tell for sure right now.
Some nutrients like zinc and omega 3 have promising results, but nothing conclusive at this point. The good news is that we can all benefit from a diet including those nutrients, and we can find zinc in a variety of foods such as leafy green vegetables, beans, nuts, animal products and whole grains. Food sources of omega 3 are mentioned below.

So what to do?

The next lines will give you some suggestions, you may decide to start with one and build on that or tackle all of them at once. Don’t forget that the goal is health (both physical and mental) so think what will be sustainable and achievable.

  •  Hydrate.
While there is relation found between water consumption and acne, water is needed for the health of all cells in the body, including the skin cells. Water is also important for digestive health, and there are some suggestions of it being related to skin health.

  • Keep an eye on the things you consume.
Some people find journaling to be useful. I find less stressful to take pictures of your meals instead of writing down absolutely everything you eat, but you can do whatever feels the best for you. Put attention on potential  triggers like alcohol, self-prescribed supplements such as collagen, whey protein, branch-chain amino acids (BCAA) or other protein powders. 

  • Be mindful about sugar...
...but not to the point of it being stressful. You don’t have to avoid it totally, especially the natural sugar that comes attached to fiber, vitamins, minerals and antioxidants, which could also be good for skin health.

  • And for inflammation:
Inflammation seems to be a problem for many patients with acne, so it could be good to eat less processed foods (as much as possible!). Prefer more whole foods that don’t have many chemicals AND have antioxidants and other anti-inflammatory compounds, such as omega 3 that can be found in salmon and fatty fish, flax, walnuts and chia seeds.

  • You don’t have to go through all this alone!
Search for health care providers as needed, ideally including a dermatologist. To speak more about food and diets, make sure to speak with a registered dietitian. 

  • Find a way to manage your stress
There are many options like exercise, yoga meditation, praying, coloring, arts, walk in nature, reading… find what you like the most.

Bottom line: nutrition has the potential to support your acne treatments and overall health. Having a right guide (vs. just avoiding everything recommended online) can also help with stress management, food enjoyment, nutrient adequacy and quality of life.   Changes are not immediate, if you have a new treatment or started with lifestyle modifications, it can take up to 12 weeks to see results. Don’t give up or modify things again before that time, unless recommended by your healthcare providers.