Acne Information
and Treatment

Diet & Acne

Since the advent of modern acne treatments, the notion that diet affects acne has widely come to be thought of as a myth. However, there is no evidence from which one can reasonably infer that diet does not affect acne. Instead, the simple fact is that there has been insufficient investigation into diet's role in acne

There is some evidence that diet affects acne, as well as theories of how and why it does so. Recently, interest in studying diet and acne has increased, and hopefully a better understanding of diet's role in acne will manifest in the near future.

Below is a summary of current knowledge and theories about diet and acne. When reviewing this information, keep in mind that dietary influences on acne are inherently difficult to study, and the results of any study and accompanying theories are readily subject to critique. Also, this information is not dietary advice and should not be construed as advice. Consult your doctor or a dietician before making significant modifications to your diet, or before undertaking a vitamin or mineral supplement regimen.

Dietary Habits and Acne

There is evidence that some populations unexposed to western diets are not afflicted with acne.[1] Therefore, recent research on diet and acne has focused the characteristics of the modern western diet.

Glycemic Load:

Glycemic load is a measure of a food's tendency to raise blood sugar. Insulin regulates blood sugar, and high glycemic load diets increase insulin levels. Refined sugars and grains, prevalent in western diets, carry high glycemic loads and therefore elevate insulin levels. Consuming a high glycemic load diet over time can lead to insulin resistance, which causes the body to produce more insulin.[2]

Insulin affects concentrations of free insulin like growth factor I (IGF-1) and insulin like growth factor protein 3 (IGFBP-3).[2,3] Relative levels of IGF-1 and IGFBP-3 affect hyperkeratinization, which is a factor in acne formation. IGF-1 increases hyperkeratinization and sebaceous gland growth, while IGFBP-3 blocks IGF-1 and thereby inhibits hyperkeratinization and sebaceous gland growth.[3,4] High glycemic load diets increase IGF-1 levels, while low glycemic load diets increase IGFBP-3 levels. Lower levels of IGF-1 are associated with increased intake of omega-3 fatty acids, tomatoes, vegetables, and dietary fiber.[3]

Thus, the theory is that chronic consumption of a high glycemic load diet increases insulin resistence, which in turn increases insulin and IGF-1 and ultimately the intensity of acne-causing factors. Conversely, there is evidence that switching to a low glycemic load diet can increase insulin sensitivity and therefore reverse this process over time.[5] In a twelve week study, participants switching to a low glycemic load diet experienced increased insulin sensitivity and a decrease in acne severity.[5]

Ratio of Omega-3 to Omega-6 Polyunsaturated Fatty Acids:

The ratio of omega-6 and omega-3 polyunsaturated fatty acids may play a role in acne inflammation.[2] Omega-6 fatty acids are the predominant unsaturated fatty acids in western diets, being prevalent in vegetable oils and processed foods made with those oils.[6] Omega-3 fatty acids are best known for their presence in fish.

Consuming larger concentrations of omega-6 relative to omega-3 fatty acids causes the omega-6 fatty acids to displace omega-3 fatty acids in human cells.[2] Because omega-3 suppresses inflammation-inducing molecules, an imbalance of omega-6 and omega-3 fatty acids causes an increase in the production of these inflammatory molecules.[2,6] It is theorized that, by balancing the ratio of omega-6 and omega-3 fatty acids via increased intake of omega-3, the inflammatory process of acne may be inhibited.[2]

Dairy/Milk Consumption:

There is some evidence of a correlation between milk consumption and acne, and that evidence indicates skim milk is more acnegenic than whole milk.[7] However, it is unknown whether milk's effect on acne might be due to an insulin effect caused by IGF-1 (see glycemic load above) or whether it has some relation to the hormone content of milk.[3]

Vitamin and Mineral Deficiencies and Acne

Vitamin A, Vitamin E, & Zinc:

The role of Vitamin A, Vitamin E, and Zinc in acne appear to be interrelated. There is evidence that acne sufferors have lower Vitamin A levels than others.[8] However, supplementation with Vitamin A appears to aid acne only in large doses [8,9]. In large doses, Vitamin A can be toxic. With the availability of isotretinoin (common brand name "Accutane"), which is a vitamin A derivative and administered under close medical supervision, direct supplementation with vitamin A is unnecessary and arguably unnecessarily dangerous.

Further, vitamin A is affected by vitamin E and zinc. Low levels of vitamin A are often accompanied by low levels of vitamin E.[11] Vitamin E affects the absorption of Vitamin A, and therefore Vitamin E supplementation can restore levels of Vitamin A when a deficiency exists.[10]

An interrelated deficiency of vitamin A and zinc may also effect acne.[12] Studies have shown zinc supplementation to reduce the severity of acne, particularly inflammatory acne over several months.[13,14,15] In one study, participants taking zinc and vitamin A supplements did not have better results than those taking zinc supplements alone.[15]

Pantothenic Acid:

It has been theorized that a deficiency of pantothenic acid may facilitate androgen-induced sebum production, and therefore, acne.[16] In a nine week study of Chinese patients given pantothenic acid orally and topically, there was significant improvement in acne symptoms over nine weeks. It was speculated that severe acne could be brought into near remission over six months or longer, with a small maintenance dose being required thereafter.[16]

Selenium:

In one study, selenium and vitamin E supplementation was found to reduce inflammatory acne over a six-to-twelve week period.[17]

Vitamin B6:

There is evidence that a vitamin B6 deficiency in rats increases sensitivity to testosterone.[18] With androgen-induced sebum production being a factor in acne for humans, it is possible that resolving a vitamin B6 deficiency could moderate excess sebum production. While there is limited evidence of Vitamin B6 supplementation's affect on acne, there is evidence that Vitamin B6 supplementation may be helpful for women with premenstrual acne.[19]

References:

1. Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, Brand-Miller J. Acne Vulgaris: a disease of Western civilization. Arch Dermatol. 2002;138(12):1584-90.
2. Cordain L. Implications for the Role of Diet in Acne. Semin Cutan Med Surg. 2005;24(2):84-91
3. Treloar V, Logan AC, Danby FW, Cordain L, Mann NJ. Comment on acne and glycemic index. J Am Acad Dermatol. 2008;58(1):175-77
4. Thiboutot DM, Strauss JS. Diet and Acne Revisited. Arch Dermatol. 2002;138(12):1591-92
5. Smith RN, Mann NJ, Braue A, Mäkelmäinen H, Verigos GA. 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. J Am Acad Dermatol. 2007;57(2):247-56.
6. Simopoulus AP. Omega-3 Fatty Acids in Inflammation and Autoimmune Diseases. J Am Coll Nutr. 2002;12(6):495-505.
7. Adebamowo CA, Spiegelman D, Danby FW, Frazier AL, Willet WC, Holmes MD. High school dietary intake and teenage acne. J Am Acad Dermatol. 2005;52:207-14
8. Labadarios D, Cilliers J, Visser L, Van Stuijvenberg ME, Shephard GS, Wium D, Walker R. Vitamin A in acne vulgaris. Clin Exp Dermatol. 1987;12(6):432-36
9. Kligman AM, Mills OH Jr, Leyden JJ, Gross PR, Allen HB, Rudolph RI. Oral Vitamin A in Acne Vulgaris. Int J Dermatol. 1981;20(4):278-85.
10. Ayre S Jr, Mihan R. Acne Vulgaris: Therapy Directed at Pathophysiologic Defects. Cutis. 1981;28(1):41-42.
11. El-Akawi Z, Abdel-Latif n, Abdul-Razzak K. Does the plasma level of vitamins A and E affect acne condition? Clin Exp Dermatol. 2006;31(3)430-34.
12. Michäelsson G, Vahlquist A, Lennart J. Serum zinc and retinol-binding protein in acne. Br J Dermatol. 1977;96(3):283-86.
13. Pohit J, Saha KC, Pal B. Effect of Zinc Administration In Acne Vulgaris. Indian J Pharmac. 1988;20:152-58.
14. Dreno B, Amblard P, Agache P, Sirot S, Litoux P. Low Doses of Zinc Gluconate for Inflammatory Acne. Acta Derm Venereol. 1989;69(6):541-43.
15. Michäelsson G, Lennart J, Vahlquist A. Effect of Oral Zinc and Vitamin A in Acne. Arch Dermatol. 1977;113(1):31-36.
16. Leung LH. Pantothenic acid deficiency as the pathogenesis of acne vulgaris. Med Hypotheses. 1995;44(6):490-92.
17. Michäelsson G, Edqvist LE. Erythrocyte glutathione peroxidase activity in acne vulgaris and the effect of selenium and vitamin E treatment. Acta Derm Venereol. 1984;64(1):9-14.
18. Symes EK, Bender DA, Bowden, JF. Increased target tissue uptake of, and sensitivity to, testosterone in the vitamin B6 deficient rat. J Steroid Biochem. 1984;20(5):1089-93.
19. Snider B, Deiteman D. Pyridoxine Therapy for Pemenstrual Acne Flare. Arch Dermatol. 1974;110(1);130-31