Nutritionist guide to diet and acne
If you type into google ‘acne and diet’, the overwhelming number of articles, blog posts and websites that pop up is enough to make anyone confused. Here you will find a full evidence based breakdown exploring the link between dietary components and acne as well as nutrition to support and heal the skin. Remember its very important if you are removing foods from your diet to replace them to ensure you don’t stumble into any deficiencies.
PART 1: DIETARY TRIGGERS FOR ACNE
Acne is an inflammatory skin disease, associated with over production of sebum, altered skin follicles, clogged pores and increased P. acnes bacteria which in turn triggers an inflammatory response. Acne shows genetic trends with a definite hereditary component however the severity and response to treatment can be heavily impacted by environmental factors such as your nutrition!
The nutritional link to acne has been debated and thrown back and forward but we finally have a good body of evidence to confidently say that the main food classes that can trigger acne severity are dairy products (notably skimmed milk) and high glycemic carbohydrates ie highly refined and processed that cause your blood sugars to rocket.
DAIRY
A 2019 meta analysis (basically a summary of multiple studies) published in the clinical nutrition journal observed a positive relationship between dairy, total milk, whole milk, low-fat and skimmed milk with acne occurrence. Whilst there is a pattern of trend, there are so many variables that could affect the end result. For example people who drink more milk may eat less fibre, oily fish and be consuming more added sugars. So comparing the highest to lowest consumers of dairy and tracking the occurrence of acne is much more complicated that you first think.
It has been suggested dairy can be a trigger for some individuals with acne, exasperating the condition but not necessarily the root cause of it. The main mechanism by which dairy can trigger acne is via the IGF-1 pathway. IGF-1 is an anabolic hormone mainly synthesized in the liver and is essential for normal growth in children and for the maintenance of anabolic processes in adults. It rises during puberty due to increased growth hormone secretion and shows a positive correlation with acne development.
Dairy consumption results in a significant increase in insulin and IGF-1 levels.
Acne is proposed to be an IGF-1-mediated disease.
Especially milk and whey protein-based products contribute to increased IGF-1 (think of protein shakes here!).
Increased IGF-1 pumps up the production of sebum, the oily substance produced by our skin, which can provoke acne development.
Now, before you go cold turkey on dairy, it’s not all created equally! That same 2019 study referenced above found no significant association between yoghurt/cheese and acne development. Fermented dairy seems to be a safer option for those suffering from acne and it also supports heart and bone health, gut flora and digestion. Rather than cutting out all the dairy, reduce your intake of milk and dairy with added sugars and focus more on appropriate portions of kefir, bio live natural yoghurt and harder cheeses such as cheddar & parmesan.
Removing dairy from your diet removes ALOT of good stuff. Calcium, iodine, B vitamins, zinc, magnesium, vitamin D and phosphorous to name a few. It’s incredibly important, especially for growing adolescents to make sure they incorporate either fortified milk alternatives ie soy and consume calcium rich foods such as green leafy vegetables, beans and fortified foods in order to minimise deficiency risk.
HIGH GLYCEMIC CARBOHYDRATES
Diets which are mainly based around high glycemic carbs ie cakes, sweets and white bread lead to hyperinsulinemia (high insulin levels) which stimulates the secretion of androgen hormones (testosterone and androstenedione). Androgen hormones increase the production of sebum which can provoke and worsen acne. It has been shown that these androgens increase levels of IGF-1 in blood and this causes a further increase in androgens, therefore a vicious circle begins for increased oil production. High glycemic foods also lead to:
Proliferation of skin cells in hair follicle which can mix with sebum and cause spots.
Hyperkeratinization resulting in hard clogged pores.
Switching from refined carbohydrates will not only benefit your skin, but improve your overall nutrient intake through increased fibre, vitamins and minerals from wholegrain alternatives.
PART 2: FOODS TO EAT FOR ACNE
So now that we have covered dietary components which can provoke acne development, lets look at food choices to help reduce inflammation and decrease the risk of acne symptoms.
OMEGA-3 FATTY ACIDS
Omega-3 are best found in oily fish like salmon, sardines and mackerel. You can also get omega-3 from grass fed meat products but in drastically smaller amounts than fish, so don’t rely on this as your main source. Fish can be expensive and in order to reach the 2-3 portions of oily fish a week recommend by the British Nutrition Foundation, turning to a high quality fish oil supplement can be a more economical way of getting in your daily intake. Nuts, seeds and plant oils also contain omega 3 in the form of ALA however this is less readily available so if you are vegetarian or vegan, a good algae based supplement is worth investing in. A high intake of omega-3 can reduce pro inflammatory signals which can impact acne development due to a resulting anti inflammatory effect. They have also shown an ability to lower IGF-1 levels, hence their beneficial effect in treatment of acne.
ANTIOXIDANTS
Antioxidants found in wholefoods, fresh vegetables and fruits can help reduce oxidative stress and the inflammatory component of acne. It has been suggested that oxidative stress may be a cause of origin in acne and individuals with acne have lower levels in their blood, notably fat soluble vitamins A and E. Loading up your intake of things like dark green vegetables, avocados, berries and brightly coloured foods is key. It’s worth noting these fat soluble vitamins NEED fat to aid their absorption, so make sure you drizzle a little olive oil over your salad and roast your vegetables in it too.
ZINC
Zinc can be found in things like meat and shellfish. Legumes also contain high amounts of zinc however they also contain phytates which can reduce its absorption. Heating, soaking or fermenting can help improve its bioavailability and if you are vegetarian tofu is a great source of too. Its role in acne comes from its action against the bacteria that is involved in its development (Propionibacterium acnes). It also displays mild anti inflammatory action too. Patients with acne are often deficient in zinc however high dose supplementation can cause nausea, vomiting and diarrhoea so its worth trying to get as much as you can from your diet.
I hope you found this clear and interesting to read. If you are struggling with skin health and acne, it is something I am able to guide and help you with in my clinic. Please feel free to pop me a message for any questions or queries.