At some point in our lives, we have all had problems with pimples, some of us developing acne, most likely in our teenage years. As there is a strong link between hormones – particularly testosterone – and acne, the hormone rush of puberty causes skin problems in many teenagers, boys more so than girls.
However, many adults suffer from acne, too, and while teenagers may grow out of it as hormone levels normalise, adults have a much tougher battle on their hands – it can be a lot more persistent then and less likely to just go away – and need to look at their diet and lifestyle choices.
What causes acne?
Acne is characterised as inflammation of the sebaceous (oil-producing) glands and hair follicles of the skin, which is marked by the formation of pimples or pustules, especially on the face, frequently on the chest and back. An increase in oil secretions may build up beneath a blocked pore, allowing bacteria and yeast to accumulate and cause inflammation. Severity varies from whiteheads or blackheads, to reddened, hard, painful pustules.
Acne is a normal response to abnormal levels testosterone, a hormone usually thought of as ‘male’, but while men make (and need) more of it, women produce testosterone as well. Women may experience mild to moderate acne due to hormonal changes associated with pregnancy, menstrual cycles, menopause, or starting/stopping birth control pills. Many women are prescribed the contraceptive pill just to deal with acne.
Contributing factors to adult acne include hormone imbalances, stress, overproduction of sebum – the oil made in the skin – accumulation of dead skin cells and build-up of bacteria in the cells.
Can diet contribute to acne?
It most certainly can. In the past, the general advice was to avoid saturated fats – not anymore (there’s a surprise!). Dietary advice for those who suffer from acne has shifted quite considerably, and the number one advice now is: balance blood sugar.
As I have written many times before (here and here and here), a diet high in sugar and refined carbohydrates raises insulin levels, and insulin is the most inflammatory hormone in the body. Moreover, it stimulates the production of a growth hormone called IGF-1, and IGF-1 promotes the secretion of testosterone, which in turn stimulates the production of even more IGF-1. A vicious cycle!
Another source of IGF-1 is dairy. Milk contains a lot of IGF-1, because it is designed to turn a small calf into a fully-grown cow within just six months. It is mainly due to IGF-1 that dairy is thought to contribute to acne. However, dairy is one of the two (alongside yeast) most common foods that show up in food intolerance tests, in fact it tops the list by far if dairy from cow, goat and sheep is looked at together. Food intolerances contribute to inflammation.
To control inflammation, it is important to include enough essential fatty acids – particularly omega-3 – into the diet. ‘Essential’ means that the body cannot make them, we have to eat them. The modern diet is high in omega-6 fatty acids, but often short of omega-3, found in oily fish, seaweed, walnuts, pumpkin seeds, milled linseeds and chia seeds. While omega-6 fats can turn into anti- or pro-inflammatory compounds called prostaglandins, omega-3 can only turn into an anti-inflammatory one. Which way the omega-6 conversion goes is to some extent affected by sugar and insulin. Note that omega-3 from plants has a much longer way to go to be converted into the form of omega-3 we need, and conversion isn’t very efficient, which is why – if at all possible – you should include some animal sources. This is usually fish, but organic grass-fed beef and venison also contains omega-3, more than factory-farmed meet – which hopefully you are not eating anyway for all sorts of reasons.
Free radicals are chemicals that are a normal byproduct of metabolism, but are increased by stress and environmental factors such pollution and smoking. These chemicals promote inflammation and can be neutralised by antioxidant nutrients, such as vitamin A, C, E, zinc and selenium as well as plant nutrients, such as flavonoids, commonly found in blue and dark red foods such as berries, beetroot, red cabbage and red wine. Chocolate, too, is a source of flavonoids and although it has been suspected to actually contribute to acne, this suspicion is yet to be confirmed. If it does, this is most likely due to the sugar and milk contained in many brands of chocolate, rather than cacao. Brazil nuts provide selenium.
Apart from being an antioxidant, zinc has been found to affect Propionibacterium acnes, a bacterium that is implicated in acne. Nuts, seeds and nut butters as well as seafood, pulses and whole grains are good sources of zinc.
So, in a (very small) nutshell: eliminate sugar, dairy, and factory-farmed meats and eat real food. Including very dark, low-sugar chocolate.
Kucharska A et al (2016) Significance of diet in treated and untreated acne vulgaris. Advances in Dermatology and Allergology 2016 Apr;33(2):81-6. doi: 10.5114/ada.2016.59146. Epub 2016 May 16.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884775/ (free full text)