“Don’t eat chocolate. It will give you acne and everybody knows girls don’t like acne.” I’ve heard numerous versions of this speech, but none ever deterred me from devouring all sorts of chocolate products in my youth. When puberty struck I was quite devastated with the results this behavior brought me. Actually, in retrospect, I suffered from some of the mildest acne any child going through puberty could have. I overreacted of course like any self-aware, image obsessed teen does when normal changes of puberty bring unwelcome results. The most unfortunate part is that the whole time I thought it was the chocolate! It turns out that chocolate had nothing to do with my little acne crisis (or so the most recent studies suggest), but some of the other things I ate likely did.
Acne Vulgaris is a skin condition that affects anywhere between 40 to 50 million Americans. It is the most common skin condition. About 40% of adolescents in their mid teens have acne severe enough that requires treatment by a dermatologist. It is particularly common amongst this population due to all of the hormonal changes of puberty. However, the condition can affect any age group (including people over 50 years old).(1) It is generally accepted that the development of the disease is multifactorial; anything from genetics, to stressors, to diet can affect it in some way. The real question is how much do these effects within our control (such as diet and stress) actually affect its development?
Several studies within the last 10 years have linked a high sugar diet with the severity of acne. A 2008 paper published in the Journal of Dermatological Science showed an inverse relationship between high levels of SHBG and acne severity. SHBG (or steroid hormone binding globulin) is increased by LOW insulin levels and decreased by HIGH insulin levels. Hence, consuming foods with a low glycemic index that don’t cause insulin spikes may actually help control your acne. A similar study was carried out a year before by the same authors which observed 43 adolescent males with acne over a period of 12 weeks. One half of the participants were placed on a low-glycemic index diet (experimental group) while the other half continued to eat their regular diet (control group). Several blinded dermatologists (no, not BLIND dermatologists… that would prevent them from doing their work properly; but dermatologists who did not know whether they were examining participants from the experimental group or the control group) examined the them every 4 weeks and the results showed a decrease in the number of acne associated lesions in participants consuming the low-glycemic index diet as compared to the ones who continued on the regular diet.(2,3) While this was a small study with limited uses, it will hopefully open the doors for further, larger studies of the sort in the future.
Another interesting study about how diet may play a key role in the development of acne was published in Archives of Dermatology in 2002. This study focused on comparing the incidence of acne in the United States with that of indigenous populations in Paraguay and New Guinea. Shockingly enough the researchers examined 1200 patients in New Guinea and 110 patients in Paraguay (including 300 patients from the high risk group between ages 15-25) and did not find a single participant with any sort of lesion suggesting acne. This 0% prevalence of acne in the selected populations got the researchers to further investigate the possible causes. What they found was that both populations consumed a good amount of fish, but most importantly, consumed a HIGH amount of carbohydrates (much like their acne afflicted counterparts in the United States)! There was however a significant difference in the sort of carbohydrate they consumed. While the United States population consumes most of its sugar from refined, high glycemic sorts (such as white bread, white pasta, and soft drinks) the carbohydrates being consumed by our indigenous counterparts was primarily fibrous, low glycemic index types (such as the kind found in fruits, tubers, and vegetables). (4)
It is important to also mention here that other studies of the sort have been carried out with larger, non-indigenous portions of Paraguay. In these populations the incidence was still significantly lower than in the United States, but there was acne. Their diets were also more “western” in comparison to the indigenous group. This may suggest that Paraguayans in general may have some protective genetic qualities against acne, and presumably what made the indigenous population essentially immune was the combination of genetics and diet. (5)
Like most things in medicine this is not exactly a black and white issue, however. If consuming a high glycemic index diet guaranteed acne, then every diabetic patient would be expected to have acne. While there is an association between acne and diabetes (for reasons not necessarily associated to high sugar levels), the fact that all patients do not have it simply solidifies the belief that the development of acne is multifactorial. Family history is a common finding in patients with acne, for example. Since we cannot yet fully appreciate the importance of diet in the management of acne it may be best to simply use it as an adjuvant to all of the effective treatments we already have for the condition. So next time you have a choice… skip the soft drink with lunch and grab the chocolate for dessert.
FOR MORE INFORMATION ON THE GLYCEMIC INDEX AND ITS RELATIONSHIP WITH FOOD; REVISIT OUR PREVIOUS POST HERE. You will find a convenient list of LOW glycemic index foods. . .
1. American Academy of Dermatology Statistics
2. The effect of a low glycemic load diet on acne vulgaris and the fatty acid composition of skin surface triglycerides.Smith RN, Braue A, Varigos GA, Mann NJ. J Dermatol Sci. 2008 Apr; 50(1):41-52.
3. The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters associated with acne vulgaris: a randomized, investigator-masked, controlled trial.Smith RN, Mann NJ, Braue A, Mäkeläinen H, Varigos GAJ. Am Acad Dermatol. 2007 Aug; 57(2):247-56.
4. Acne vulgaris: a disease of Western civilization.Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, Brand-Miller J. Arch Dermatol. 2002 Dec; 138(12):1584-90.
5. The prevalence of facial acne in Peruvian adolescents and its relation to their ethnicity. Freyre EA, Rebaza RM, Sami DA, Lozada CP. J Adolesc Health. 1998 Jun;22(6):480-4.