Shereen Reine S. Rodriguez-Gimarino, MD, FPDS
Because food is at the heart of Filipino culture, dietary restriction comes up as a frequent question during consults with the doctor. Much of our cuisine is flavorful, comforting, and tend to be on the greasy side. No wonder that after a trip to the doctor, we’d be told to cut down on certain foods to improve our health. We come to realize the role food plays in diseases, oftentimes leading to assumptions.
“I have pimples because I’ve been eating a lot of [insert food item] lately,” is a statement us dermatologists have heard too often. You may have been advised some time ago that they have nothing to do with each other. This is because in truth, the role of diet as a trigger for acne took decades to establish. Even with new research coming out regularly, the verdict for certain foods is still not absolute. In the midst of the abundance of anecdotes out there, evidence-based research updates are continuous, so here we are, setting the record straight with the evidence to date:
Food that promote acne:
1) Sugary foods (High glycemic index / glycemic load foods)
Glycemic index is a numeric score that indicates how rapidly a certain food is digested and elevates your blood sugar. The more refined and processed the carbohydrate is, the faster it metabolizes into glucose (high glycemic index). On the other hand, glycemic load is a ranking system that takes into account both the glycemic index of a food and the portion that you consume.
Several studies support that diets high in glycemic index / glycemic load exacerbate existing acne, and can prolong its duration. Therefore, be wary of products that are refined and those that have “added sugar” on the label. Consume foods rich in fiber, fat and protein because these release glucose more slowly, so they have a lower glycemic index.
2) Dairy
Consumption of cow’s milk – whole, low-fat and skim, has consistently been linked to acne exacerbation and break-outs in several studies, including an advisory from the American Academy of Dermatology. Interestingly, dairy products such as yogurt and cheese were not observed to influence acne.
3) Whey protein supplements
Commonly drank as protein shakes for body building and fitness, whey is the main protein component (80%) of milk. Dermatologists often encounter severe acne in protein shake drinkers. Supported by studies, severe acne in these patients persists even with appropriate medication, and respond only when whey protein is discontinued.
Food that protect from acne:
1) Low glycemic index / glycemic load foods
Just as how high glycemic index / glycemic load foods aggravate acne, low glycemic index / load foods reduce the inflammation, count and severity of acne consistently across multiple studies to date.
2) Omega-3 fatty acids and linoleic acid
These fatty acids, often associated with a Mediterranean diet and fish, have also been consistently observed to reduce inflammatory acne.
3) Vegetarian / vegan diet
Eating a fruit and vegetable-rich diet has been shown in recent studies to be acne protective.
Food that have been studied and deemed to not affect acne:
1) Salt
No association between salty food intake and acne was observed in studies.
2) Yogurt, cheese and other dairy products
As mentioned earlier, these milk products have no effect on acne in contrast to milk itself.
Food that have been studied but found to have insufficient evidence to either improve or aggravate acne:
1) Chocolate
This is food item is a popular question during an acne consult. Different studies varied in the brands and purity of chocolate (vs. its milk and sugar content) used, as well as the population involved, and have produced inconclusive results. Therefore, to date, chocolate is not yet proven to influence acne. Also be aware, however, that chocolates can easily become a high glycemic index food with dairy.
2) Probiotics
Probiotics have attracted attention for its gut health benefits over the recent years, and its effect on acne is not exempt from that. While initial studies are promising, further research and evaluation are needed to conclusively say it is beneficial for acne.
While there is some evidence supporting the relationship of acne and diet, this cannot replace proper evaluation of the cause of your acne and its corresponding management done in the setting of a Dermatology consult. Use the above information as a guide for your everyday food choices, rather than a treatment for your acne. Note that the evidence does not demonstrate that a certain type of food causes acne, rather they may influence existing acne positively or negatively.
Every year more and more evidences are unearthed about this topic, so stay tuned.
References:
- Dall’Oglio F, Nasca MR, Fiorentini F, Micali G. Diet and acne: review of the evidence from 2009 to 2020. International Journal of Dermatology 2021;60(6):672-685. doi: 10.1111/ijd.15390.
- Baldwin H, Tan J. Effects of Diet on Acne and Its Response to Treatment. American Journal of Clinical Dermatology 2021;22:55–65. https://doi.org/10.1007/s40257-020-00542-y
- Barbieri JS. Diet and Acne –Challenges of Translating Nutritional Epidemiologic Research Into Clinical Practice. JAMA Dermatol. 2020;156(8):841-843. doi:10.1001/jamadermatol.2020.1601
- Matsui M. Update on Diet and Acne. Cutis 2019;104(1):11-13.
- Spencer EH, Ferdowsian HR, Barnard ND. Diet and acne: a review of the evidence. International Journal of Dermatology 2009;48:339-347.
- What are high and low glycemic index foods? https://www.medicalnewstoday.com/articles/high-glycemic-index-foods#factors-affecting-gi