Written by David Rakel MD, FAAFP

The Acne Diet

The number of published research papers on nutrition and acne has been greater in the last 10 years than the previous 50. This systematic review summarizes the findings.

In general, what is good for the heart is also good for the skin, except for chocolate. The flavonoids in dark chocolate improve the endothelial lining and lower blood pressure for heart health, but chocolate may worsen acne. To see if it was the sugar or the chocolate, one study supplemented groups with chocolate or jelly beans. Despite similar amounts of sugar, the chocolate group had more acne lesions. Chocolate also remained a trigger for acne when dark chocolate was studied without added milk or sugar.

Diet influences hormones that are known to worsen acne. Eating a high glycemic diet triggers excess insulin, which causes weight gain and inflammation. The sugar load in fruit juices, soda, processed foods, and products made from white flour have a similar effect. Dairy is rich in estrogens, androgens, IGF-1, and bovine growth hormone. Both whole and skim milk contain acne-causing hormones, and, lastly, saturated fat from non-dairy sources also poses an inflammatory risk.

A Summary of the Acne Diet

Foods to Avoid in Descending Effect

• Dairy products.
• Foods with a high glycemic index and load. These are mainly sugar void of fiber and include candy, breads and other baked goods made from white flour, rice, fruit juices, soda, and processed foods.
• Saturated fat from excess red meat and fried foods.
• Chocolate.
• Although not a food, mental stress is also a known trigger of acne. This is made worse if we eat the above foods when under stress (stress eating).

Foods to Eat to Avoid Acne

• Whole vegetables and fruit.
• Essential fatty acids found in cold water fish and oily plants like flax seed, nuts, and avocados.
• Less acne has been associated with eating the Mediterranean diet, which includes the above foods with high fiber, whole grains, and olive oil.

Abstract
BACKGROUND
Dietary habits may play a non-negligible role in the development, duration, and severity of acne, as shown in past critical review articles on such association.

METHODS
The aim of this systematic review is to supplement data available on scientific literature spanning the last 10 years by inserting the keywords “acne” or “acne vulgaris” and “diet”, “nutrition”, “food”, “chocolate”, “dairy”, “whey protein”, “fatty acid”, or “drink” in the timeframe “January 2009-April 2020” within the PubMed database.

RESULTS
Fifty-three reviewed articles met eligibility criteria. They included 11 interventional clinical trials (seven randomized controlled trials and four uncontrolled open label studies) and 42 observational studies (17 case-control and 22 cross-sectional studies, and three descriptive studies).

CONCLUSIONS
This review reinforces the notion of a rapidly growing exponential trend of interest in this subject by the scientific community. Acne-promoting factors include high GI/GL food, dairy products, fat food, and chocolate, whereas acne-protective factors include fatty acids, fruit, and vegetable intake. The role played by specific dietary components pertaining to different foods, as done for milk (full-fat/whole, reduced-fat, low-fat/skim milk), dairy products (milk cream, ice cream, yogurt, cheese, etc.), or chocolate (cocoa, dark/milk chocolate), remains an unsolved issue and objective of future research.

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