With the beginning of school teenagers everywhere may be worried about additional acne breakouts.
Turns out those in the West may struggle with acne more, but studies published in medical journals this summer show dietary modifications may offer substantial help.
Termed acne vulgaris, this is the most common form. Dermatologists John H. Stokes and Donald M. Pillsbury hypothesized over 80 years ago that microbes in the gut were connected to acne breakouts.
“They hypothesized that emotional states (e.g. depression and anxiety) could alter normal intestinal microbiota, increase intestinal permeability, and contribute to systemic inflammation. They were also among the first to propose the use of probiotic Lactobacillus acidophilus cultures. In recent years, aspects of this gut-brain-skin theory have been further validated via modern scientific investigations.” Today’s specialized medicine allows for incredible knowledge of the skin and gut, albeit separately. “It is evident that gut microbes and oral probiotics could be linked to the skin, and particularly acne severity, by their ability to influence systemic inflammation, oxidative stress, glycaemic control, tissue lipid content, and even mood. This intricate relationship between gut microbiota and the skin may also be influenced by diet, a current area of intense scrutiny by those who study acne.”
Not a lot of studies, at least recently, on probiotics and acne, but research may be warranted as some of the latest studies support the diet connection in those consuming lots of sugar and dairy. Probiotics are traditionally known as preventing accumulation of harmful disease-causing bacteria or fungus in our gut, which would combat some of the damage done with a high sugar diet.
It’s time we start thinking of the body as a whole.
Dr. BC Melnik has published four articles in the last year supporting the removal of dairy products and high sugar from the diet.
In the May 2013 article in “Experimental Dermatology”, Dr. Melnik explains how “the Western Diet,” or WD, increased insulin needs. He shows how this affects the extraordinary pathways that regulate the body’s metabolic process, which can ultimately increase sebaceous gland size. This does not just affect acne. This reaction, maintains the article, is of critical importance in the development of many diseases driven by the WD.
In fact, maintains Dr. Melnik in his April article in the German “Hautarzt”, acne is associated with increased body mass and insulin. Here again his findings support how a high glycemic load (i.e., high amounts of sugar) and milk proteins play an important role in acne pathogenesis. This article too encourages consumption of vegetables and fish.
Last year Dr. Melnik quoted two randomized controlled studies promoting the therapeutic effects of the removal of dairy products and high amounts of sugar from the diet. “Epidemiological evidence confirms that milk consumption has an acne-promoting or acne-aggravating effect.” Acne, the article states, should be viewed as a Western civilization disease, such as obesity, type 2 diabetes and cancer, all driven from the Western diet. “Early dietary counselling of teenage acne patients is thus a great opportunity for dermatology, which will not only help to improve acne but may reduce the long-term adverse effects of Western diet on more serious …diseases of civilization."
In “Dermatoendocrinology,” of Jan. 2012, Dr. Melnik highlights how high calorie, high fat and meat intake, high sugar and dairy intake signal endocrine systems. Meat and milk proteins are high in leucine, an essential amino acid. In high amounts, however, leucine activates the cells in the sebaceous glands and is directly converted to fatty acids. Other consequences include increased hormone secretion. Increasing fruit and vegetable intake is the “only possible” way to downregulate these signalling pathways. “The dermatologist bears a tremendous responsibility for his young acne patients who should be advised to modify their dietary habits in order to reduce activating stimuli …, not only to improve acne but to prevent the harmful and expensive march to other … chronic diseases later in life.”
Teenagers of all generations have struggled with acne. The generation born in 1920 suffered. They didn’t have as much sugar in their diets, but they had extensive amounts of salt. Every generation thereafter has suffered.
A relatively significant report published in "Pediatrics" in May,
“Consideration of a role for diet in contributing to acne arose in the 1930s, and chocolate, sugar, and iodine were among the dietary factors implicated. As a result of a series of studies in the late 1960s that failed to identify a dietary connection, the concept fell out of fashion.”
Mentioning some studies quoted here, the most significant they touched upon was a study involving glycemic load.
“Based on the currently available data, it is difficult to point with certainty to any dietary manipulation that should be recommended to pediatric patients suffering from acne; however, consideration may be given in individual cases to institution of a low glycemic diet. Patient and parent education to dispel acne myths is an important treatment consideration.”
Given all the studies supporting a low glycemic diet, especially in the last year, many might disagree that it should be considered more than on an individual basis. One randomized controlled Korean study last year showed those who lowered their glycemic load, or amount of sugar delivered to the body at one meal, “demonstrated significant clinical improvement in the number of both non-inflammatory and inflammatory acne lesions.”
In Malaysia last year, 44 acne patients were matched against 44 controls and recorded their food intake for three days. "Cases had a significantly higher dietary glycemic load (175 ± 35) compared to controls (122 ± 28) (p < 0.001). The frequency of milk (p < 0.01) and ice-cream (p < 0.01) consumptions was significantly higher in cases compared to controls. … No significant difference was found in other nutrient intakes, Body Mass Index, and body fat percentage between case and control groups (p > 0.05). Glycemic load diet and frequencies of milk and ice cream intake were positively associated with acne vulgaris."
High glycemic diets may have connections with the insulin response necessary to keep up with the sugar digested. Another study released this summer in India’s Dermatology Journal, revealed that the insulin response needed for milk consumption and high sugar diets can activate the sebaceous glands, aggravating the acne response.
Still, not everyone agrees with the elimination of dairy proteins. According to a March 2013 article in the “Journal of the Academy of Nutrition and Dietetics,” there is not enough evidence and not enough controlled studies. Authors also advocate addressing individual needs, stating “The evidence is more convincing for high glycemic load diets, compared with other dietary factors.”
Other studies support the need for additional vitamins, also supporting the need for additional vegetables in the diet of these individuals. In one study 94 patients were matched against 56 similar controls. The acne patients all had lower Vitamins A, E and Zinc. When broken into two groups, those with the highest severity of acne had significantly lower Vitamin E and Zinc levels. Vitamin A levels were similar in both groups. The study did not go on to determine what a change of diet or supplementation did to help acne patients.
Vitamin A, however, is frequently used in treatment of acne. One study involving females ages 20 plus showed results of Vitamin A treatment having significant correlation between body mass index, high glycemic load diet, tobacco and age of acne onset. In other words, those who have low body mass, low glycemic load diets, don’t smoke and did not break out prior to puberty will have the most success.
Another study showed 30 patients with the same therapy had increased levels of mucus and mucus levels. While this may sound counterproductive, mucus is designed to help clear bacteria.
This same therapy has been studied and found to have positive and negative affects on the body’s mood, shows an e-published highlight of a new review to be published in September in the International Journal of Dermatology. Vitamin A, such as Vitamin D, E and K are so-called fat-soluble vitamins, which means they are easily dissolved in the cells protecting the nervous system and can pass through this protective layer to have an affect on brain function.
Fish oil may also show some promise for acne sufferers. The theory of treating with fish oil supplementation is very similar to the reasoning fish oil is indicated for other inflammatory conditions, such as arthritis or heart disease. Acne is less prevalent in societies that have higher fish consumption. The fatty acids in fish suppress the inflammation process, “thus reduce acne severity.”
The Mediterranean diet provides foods high in good fats, such as olive oil. This diet was shown to have a protective factor against acne. Familial hypercholesterolaemia, diabetes and hypertension were also shown to be strong risk factors for acne, but, even though these people may be more susceptible, diet can be protective. Done in Italy, this was yet another randomized controlled study supporting high glycemic food and dairy products implications in “ the pathogenesis and progression of acne vulgaris in Western countries. In this context, diets that mimic the nutritional characteristics of diets found in hunter-gatherers and other non-western populations may have therapeutic value in treating acne vulgaris.” This would be a decrease in grains and dairy products, and an increase in vegetables and lean meats.
And while this study concludes that “environmental and dietetic factors in acne should be further explored,” it also concludes “Family history, body mass index and diet may influence the risk of moderate to severe acne.” Moderate to severe acne and family history of a first-degree relative was the highest association found here, and “no association with smoking emerged.” Keep in mind first-degree relatives tend to eat the same diet. Consuming more than three portions of dairy products, in particular skim milk over whole milk, increased risk, while increase in fish consumption decreased risk. “No association emerged between menstrual variables and acne risk.”
In a Chinese study last year, 1,399 people were found to have acne out of 17,345 Chinese people included in the study. The group with the highest percentage of acne were 19 year olds (46.8 percent) with evidence higher in males. Interestingly, smoking and drinking here were associated with higher levels of acne, but diet was not found to be a component, keeping in mind that fish consumption is generally higher in China, as milk consumption is generally lower. “These results suggest that the prevalence of acne in the Chinese population is lower than that in Caucasian populations.”
Here is a summary of large study published December last year in the Journal of the European Academy of Dermatology and Venereology:
“There is increasing evidence supporting acne and diet relationship. … A cross-sectional study was conducted on 2300 participants aged 13-18 years. The participants were asked to complete a questionnaire form consisting information about acne and a questionnaire form consisting information about dietary habits (The Adolescent Food Habits Checklist). In addition an objective evaluation of acne was determined. … The participants without acne had healthier dietary habits than participants with acne (P<0.05). Frequent fat intake (OR=1.39, 95% CI: 1.06-1.82), frequent sugar intake (OR=1.30, 95% CI: 1.05-1.60), frequent eating sausages, burgers (OR=1.24, 95% CI: 1.03-1.48), frequent eating pastries, cakes (OR=1.20, 95% CI: 1.01-1.43) were associated with increased risk for acne. … Acne was related with dietary habits. Fat, sugar and fast food consumption is found to be positively correlated with acne prevalence.”
Last, but not least, one review actually examined another aspect of diet: specifically carbohydrates examined the physiological and biochemical effects of ketogenic diet, actually showing that this highly specific diet usually prescribed for seizure relief, can help with treatment of acne. As a side note, however, this diet does mimic the effects one has when starving, so a doctor needs to be consulted since it could affect kidney function among other things.
Finally, for those who don’t want to change their diet, dried barberry is showing promise as a safe and well-tolerated choice for treatment in teenagers. In a randomized study, 600 mg of oral aqueous dried barberry taken daily for four weeks showed promise in relieving the total acne severity score. Barberry has anti-inflammatory, antibacterial and antilipogenic properties, all of which may contribute to its success in acne treatment.
Given all these factors, limiting sugar intake should send kids to school with less breakouts.