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What does the scientific literature say about the causes of acne?
Politically correct nutrition says: "Foods high in cholesterol and saturated fat clogs the skins pores and causes acne".
What do peer reviewed scientific papers say?
In a review of the literature looking at the causes of acne Dr. Hope Ferdowsian of The George Washington University Medical Centre found that no study had ever found an association between acne and saturated fat.(1) A handout provided by the American Academy of Family Physicians confirmed this by stating that acne is not caused by greasy foods.(2) Indeed a study conducted by Professor Clement Adebamowo at theHarvard School of Public Health revealed that a diet high saturated fat was associated with a 12% decrease in acne risk.(3)
However Professor Adebamowo did find a very positive link between skimmed milk and acne. This data corroborates the results of an earlier study in which he again found a positive association between the intake of skimmed milk and acne. The connection between full fat milk and acne was much less pronounced if there at all.(4)
A common theme with acne sufferers is they have low values of high-density lipoprotein cholesterol (HDL-C), the good cholesterol.(5)(6) After an analysis of 27 trials Professor Ronald Mensink found the best way to raise HDL-C was to eat saturated fat.(7) This was supported by another review from University of Connecticut Associate Professor Jeff Volek who again revealed that saturated fat increased (good) HDL-C.(8)
So, apart from the possibility of skimmed milk, what else might cause acne, which in westernized societies isa nearly universal skin disease afflicting 79% to 95% of theadolescent population.(9)
Professor Loren Cordain examined the prevalence of acne in 2 non-westernized populations:the Kitavan Islanders of Papua New Guinea and the Achéhunter-gatherers of Paraguay. He inspected 1315 of these Islanders and hunter-gatherers and did not find one case of acne. Professor Cordain observed that both the Aché and Kitavan diets were composed of minimallyprocessed plant and animal foods and were virtually devoid oftypical Western carbohydrates that yield high glycemic loads that may elevate insulin levels.(9)
This observation, that carbohydrates with a high glycemic load may be connected to the prevalence of acne has been confirmed in other studies.
Dr. Robyn Smith of the RMIT University, Melbourne, Australia investigated the effect of two diets on thirty-one male acne patients aged 15-25.(10) One diet was a low glycemic load diet, comprised of 25% energy from protein and 45% from low glycemic index carbohydrates and 30% from fat. In contrast, the other diet emphasized carbohydrate-dense foods with a higher glycemic index. After twelve weeks those on the low glycemic index diet had fewer acne lesions. This correlated with the low glycemic index diet producing a higher amount of saturated fat compared to mono-unsaturated fat in the oil on their skin, than did the subjects eating the high-glycemic diet. Again saturated fat is shown to be beneficial in alleviating acne. Dr. Smith carried out more trials(11)(12) on diets and acne which also confirmed that low glycemic index diets significantly decreased facial acne lesions and alleviated the severity of acne symptoms.
So what are low glycemic index diets? Meat, poultry, fish, lard, tallow, cheese and eggs have a glycemic index of zero because these foods contain little or no carbohydrate and it would be exceedingly difficult for people to consume a portion of the foods containing 50 g or even 25 g of available carbohydrate. Even in large amounts, these foods when eaten alone are not likely to induce a significant rise in blood glucose.(13)
What are high glycemic index (GI) foods? Sugar has a glycemic index of 65. I think we can all agree sugar is not a healthy item to eat. However even sugar is not classed as a high glycemic index food. High GI foods are classed as 70 or greater.(14) Let's examine the glycemic index of a list of common foods.(15)
Wholemeal bread 74
White bread 71
Bran flakes 74
Weetabix 75
Special K 84
Cornflakes 93
White rice 83
Brown rice 87
Boiled potatoes 89
Baked potatoes (without fat) 111
Beetroot 64
Pumpkin 75
Full fat milk 11
Skimmed milk 48
Taking the low GI value for full fat milk as compared to the higher skimmed milk GI value may explain why skimmed milk had a marked tendency to cause higher acne lesions.
To summarize the glycemic index; foods of animal origin such as meat, fish, fat and eggs have a zero glycemic index, some vegetables have a medium to high value and bread & cereals have a high figure.
Acne sufferers may sometimes be prescribed isotretinoin (known in the United States as Accutane and Roaccutane worldwide). Extreme caution should be observed by pregnant women before taking isotretinoin. Dr. Antonio Malvasi who specializes in materal-fetal medicine found isotretinoin(16) can cause severe malformations on an embryo or fetus such as serious craniofacial, cardiovascular and central nervous system malformations. Dr. Malvasi concluded the risk of malformations is 3-5%, but it increased to almost 30% in women exposed to isotretinoin during the first trimester of pregnancy.
In an overview of acne and its treatment(17) Dr. Diane Thiboutot echoed this warning for pregnant women and noted that isotretinoin treatment is also implicated in lowering the immune system, severe blisters and increased heart disease risk. A Brazilian study completed by Dr. Miguel Ângelo De Marchi(18) also found isotretinoin may contribute to an elevated risk of heart disease.
Isotretinoin is also associated with many other ailments. Research carried out at the Silesian Medical University in Katowice(19) by Dr. Beata Bergler-Czop observed that isotretinoin had adverse effects such as cheilitis, dry skin, erythema, itching, scaling, bruising, skin atopy, conjunctivitis, dry eyes, and eyelid inflammation.
In conclusion saturated fat consumption may lower acne risk, skimmed milk and low values of high-density lipoprotein cholesterol could contribute to acne risk. Carbohydrate foods with a high glycemic index may significantly contribute to higher rates of acne and severe acne lesions. Medical treatments for acne are not without risk especially for pregnant women.
For more articles on nutrition, diet and health go to: http://healthydietsandscience.blogspot.com/
References:
(1) Ferdowsian HR, MD, MPH; Levin S, MS, RDDoes Diet Really Affect Acne? Skin Therapy Lett. 2010 Mar;15(3):1-2, 5
(2) Informationfrom Your Family Doctor: AcneAm Fam Physician. 2004 May 1;69(9):2135-2136
(3) Adebamowo, Clement A. et al. High school dietary dairy intake and teenage acne J Am Acad Dermatol. 2005 Feb;52(2):207-14.
(4) Adebamowo CA, Spiegelman D, Berkey CS, Danby FW, Rockett HH, Colditz GA, Willett WC, Holmes MD. Milk consumption and acne in teenaged boys. J Am Acad Dermatol. 2008 May;58(5):787-93.
(5) Abulnaja KO. Changes in the hormone and lipid profile of obese adolescent Saudi females with acne vulgaris. Braz J Med Biol Res. 2009 Jun;42(6):501-5.
(6) Arora MK, Seth S, Dayal S. The relationship of lipid profile and menstrual cycle with acne vulgaris. Clin Biochem. 2010 Dec;43(18):1415-20.
(7) Mensink RP, Katan MB; Effect of dietary fatty acids on serum lipids and lipoproteins. A meta- analysis of 27 trials Arteriosclerosis and Thrombosis, Vol 12, 911-919
(8) Jeff S Volek and Cassandra E ForsytheThe case for not restricting saturated fat on a low carbohydrate diet Nutrition & Metabolism 2005, 2:21
(9) Cordain L, Lindeberg S, Hurtado M, et al. Acne Vulgaris: A Disease of Western Civilization. Arch Dermatol 2002; 138: 1584-1590
(10) Smith RN, Braue A, Varigos GA, Mann NJ. The effect of a low glycemic load diet on acne vulgaris and the fatty acid composition of skin surface triglycerides. J Dermatol Sci. 2008 Apr;50(1):41-52.
(11) Smith R, Mann N, Braue A, Varigos G Low glycemic load, high protein diet lesseds facial acne severity Asia Pac J Clin Nutr. 2005;14 Suppl:S97
(12) Smith RN, Mann NJ, Braue A, Mäkeläinen H, Varigos GA. A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Am J Clin Nutr. 2007 Jul;86(1):107-15.
(13) Kaye Foster-Powell, Susanna HA Holt and Janette C Brand-Miller. International table of glycemic index and glycemic load values: 2002 American Journal of Clinical Nutrition, Vol. 76, No. 1, 5-56, 2002
(14) Fiona S. Atkinson, RD, Kaye Foster-Powell, RD and Jennie C. Brand-Miller, PHD International Tables of Glycemic Index and Glycemic Load Values: 2008 Diabetes Care December 2008 vol. 31 no. 12 2281-2283
(15) Values taken from the glycemic index website http://www.glycemicindex.com accessed 22 Feb 2011
(16) Malvasi A, Tinelli A, Buia A, De Luca GF. Possible long-term teratogenic effect of isotretinoin in pregnancy. Eur Rev Med Pharmacol Sci. 2009 Sep-Oct;13(5):393-6.
(17) Thiboutot DM. Overview of acne and its treatment. Cutis. 2008 Jan;81(1 Suppl):3-7.
(18) De Marchi MA, Maranhão RC, Brandizzi LI, Souza DR. Effects of isotretinoin on the metabolism of triglyceride-rich lipoproteins and on the lipid profile in patients with acne. Arch Dermatol Res. 2006 Mar;297(9):403-8
(19) Bergler-Czop B, Brzezińska-Wcisło L. Assessment of Moisture, Melanin Content, Intensity of Erythema, Transepidermal Water Loss, pH, and Sebum Production in the Skin of Patients Treated with Oral Isotretinoin: A Preliminary Report. Actas Dermosifiliogr. 2011 Feb 4
About the Author
David is a qualified diet & nutrition advisor and an independent nutrition researcher. His interest in diet and nutrition started with his own creeping weight gain and health problems. After researching many thousands of scientific studies David changed his dietary habits, lost over 50lb in weight and now enjoys vibrant health. Details of the research can be found at http://healthydietsandscience.blogspot.com/