The what & why:
Acne is an inflammatory condition of the sebaceous follicles of the skin
Triggered by range of factors, individual cases may be caused by;
Overdevelopment of hair follicles – high keratin production
Changes in the bacterial composition on the skin – higher concentration of p. acnes
Excess production of sebum – increased oil production
Increased inflammation – pro-inflammatory production
Hormone imbalances – elevated androgens
Metabolic disturbances – poor blood sugar control
Underlying health conditions – PCOS & Cushing’s disease
The physical symptoms and psychological repercussions associated with acne include pain and discomfort, obsessive-compulsiveness, shame, embarrassment, body image concerns, self-consciousness, social assertiveness, and poor self-esteem.
The link between diet & acne:
More recent studies are strengthening the connection between diet and acne, with a particular focus on a Western-style diet. This is due to the highly pro-inflammatory nature of the typical Western-style diet with poor ratios of omega-3 and omega-6 fatty acids, High GI and Low GI foods, excessive use of additives and preservatives, highly processed foods and a poor intake of fibre.
Key foods and nutrients to be aware of:
MILK
Proteins found in milk can trigger the release of a liver hormone called insulin-like growth factor-1 (IGF-1). This hormone has been the main instigator connecting dairy to acne severity. IGF-1 has a role in initiating excess follicular keratin and sebum production in the skin.
Higher levels of blood IGF-1 are thought to relate to the increased occurrence and severity of acne. In a 2018 systematic review, dairy intake (skim or full-fat milk and yogurt) was correlated with increased acne between the age groups of 7-30 and skim milk found to be more aggravating to acne due to a higher protein content. Because of this higher protein hypothesis, it is also important to consider products such as whey protein powder and its effects on acne production.
Milk also contains androgens and growth factors both of which increase just as IGF-1. The combination of these hormones leads to increased oil gland size, oil production, and inflammatory molecules at the site of the skin. And to add insult to injury, the excess oil produced on the skin surface is then metabolised by the bacteria, crowding out good bacteria and allowing species that are contributing to inflammation to thrive.
HIGH GI/LOW GI
High GI diets are those which include excess intake of simple sugars that are rapidly absorbed, resulting in increased insulin and glucose (sugar) levels in the blood. A diet predominated with high GI foods will also impact IGF-1 production. Because a high GI diet alters the metabolism of blood sugar, it promotes the release of IGF-1 from the liver, to then go on to have the effects previously mentioned.
Low GI diets have shown to enhance the binding of IGF-1 making it less available to be active in the body, therefore reducing those acne promoting effects. Some small-scale studies have displayed beneficial outcomes in acne severity with a low GI diet. This study applied a low GI diet on its subjects for 2 weeks and recorded a steady decrease in IGF-1 concentrations and activity, showing that a nutritional approach to acne treatment is beneficial. The increased consumption of low GI foods has also been shown to reduce inflammation, improve insulin sensitivity, decrease BMI score and, most importantly, decreased acne. Fibre from a low GI diet can also promote the release of a protein called sex hormone-binding globulin (SHBG). Due to elevated androgens being a driver of acne, SHBG can bind to these androgens, reducing their activity and role in the development of acne lesions.
Some recent studies have suggested the following nutrients for managing the severity and duration of acne:
ZINC
Zinc can be used topically and internally. It has the potential to inhibit the bacterial proliferation of p. acnes bacteria on the surface of the skin as well as contribute to modulating androgens from within the body. This results in better management of oil and sebum production from sebaceous glands.
OMEGA 3
Omega 3 is helpful in reducing inflammation in the body. As acne is an inflammatory condition of the sebaceous follicles in the skin, it is only natural to include natural anti-inflammatories as therapeutics. Omega 3 is also important for general skin health and wellbeing by maintaining cell structure and reducing water loss.
VITAMIN A
Studies have shown that those who are suffering with acne have a lowered Vitamin A status. In regards to the skin, Vitamin A is used in collagen synthesis, immune modulation, skin cell production and managing inflammation.
Identifying the cause of your acne is key to determine treatment. Many internal pathways can be managed to decrease the expression of acne, identify underlying issues and support dietary changes to prevent its reoccurrence.
Assaedi, L. M. E., Al-Taisan, S. A., & Alharbi, A. G. (2018). The Relationship of Diet and Acne. The Egyptian Journal of Hospital Medicine, 70(3), 473–477. https://doi.org/10.12816/0043490
Burris, J., Shikany, J. M., Rietkerk, W., & Woolf, K. (2018). A Low Glycemic Index and Glycemic Load Diet Decreases Insulin-like Growth Factor-1 among Adults with Moderate and Severe Acne: A Short-Duration, 2-Week Randomized Controlled Trial. Journal of the Academy of Nutrition and Dietetics, 118(10), 1874–1885. https://doi.org/10.1016/j.jand.2018.02.009
Cervantes, J., Eber, A. E., Perper, M., Nascimento, V. M., Nouri, K., & Keri, J. E. (2018). The role of zinc in the treatment of acne: A review of the literature. Dermatologic Therapy, 31(1), e12576. https://doi.org/10.1111/dth.12576
Dai, R., Hua, W., Chen, W., Xiong, L., & Li, L. (2018). The effect of milk consumption on acne: A meta-analysis of observational studies. Journal of the European Academy of Dermatology and Venereology, 32(12), 2244–2253. https://doi.org/10.1111/jdv.15204
Juhl, C. R., Bergholdt, H. K. M., Miller, I. M., Jemec, G. B. E., Kanters, J. K., & Ellervik, C. (2018). Dairy Intake and Acne Vulgaris: A Systematic Review and Meta-Analysis of 78,529 Children, Adolescents, and Young Adults. Nutrients. https://doi.org/10.3390/nu10081049
Kim, H., Moon, S. Y., Sohn, M. Y., & Lee, W. J. (2017). Insulin-Like Growth Factor-1 Increases the Expression of Inflammatory Biomarkers and Sebum Production in Cultured Sebocytes. Annals of Dermatology, 29(1), 20. https://doi.org/10.5021/ad.2017.29.1.20