Debunking The REAL Diet Acne Myth

By Seppo | Diet

21

Diet doesn’t cause acne. How often you’ve heard that? For several decades now dermatologists have scoffed at suggestions that diet causes acne and insisted that it’s just a myth. While they believed to be riding the high horse of science, in reality they’ve been cruising with lowly donkey of dogmatism. And now the real myth comes back to bite them on the backside.

Did you know that before the 1960s, dietary advice was part and parcel of acne therapy. Patients were asked to avoid sugary foods. Because studies as early as 1931 suggested that acne patients suffer from blood sugar problems.

Then $(*@ hit the fan.

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The diet doesn’t cause acne myth is born

1969 and 1971 saw publishing of two deeply flawed studies that to this day cause misery and suffering to acne patients.

In 1969 Fullerton et al, conducted their now infamous chocolate acne study. They gave 65 people either a daily candy bar with chocolate or a candy bar without chocolate (control). 4 weeks later they measured the difference in rates of acne, and found none. From this they concluded that chocolate doesn’t cause acne.

This study is flawed on some many levels that I doubt even a 7th grade science teacher would accept it. Both of the candy bars were equally high in sugar, fat and calories. The control bar also had plenty of trans-fats, known to increase acne-causing inflammation. All we can say from this study is that one candy bar didn’t cause more acne than the other one.

In 1971 Anderson gave 27 university students, with self-reported dietary acne triggers, either chocolate, milk, roasted peanuts or cola for 1 week. He found no change in acne between the groups. Now, if the 1969 Fullerton et al study was bad, this one is beyond terrible. 1 week is nowhere nearly long enough (most diet-acne studies run for 12 weeks). He didn’t in anyway take into account the other foods the students ate. In scientific terms this study is completely useless.

These two studies are the grand total of scientific evidence that dermatologists have when they say diet doesn’t cause acne. As this 2010 review concludes.

The studies by Fulton et al and Anderson, although suffering from major design flaws, were sufficient to dissociate diet from acne in the minds of most dermatologists. Textbooks were revised to reflect this new academic consensus, and dermatologists took the stance that any mumblings about the association between diet and acne were unscientific and one of the many myths surrounding this ubiquitous disease.

Bowe WP, Joshi SS, Shalita AR.
Diet and acne.
J Am Acad Dermatol. 2010 Jul;63(1):124-41. Epub 2010 Mar 24.

Let me be very clear about that. The notion that diet doesn’t cause acne is not, and has never been, based on science. The fact that dermatologists still repeat it shows how badly out of date they are.

Let’s see just how badly out of date they are.

Studies that link diet to acne

In 2002 Dr. Lorein Cordain did his famous Kitavan study. He studied two groups of native people living in Kitavan Islands in Papua New Guinea and Ache hunter-gatherers in Paraguay. He found zero incidence of acne among these native populations and concluded that acne is a disease of Western civilization.

Another review mentions studies showing increased prevalence of acne when Canadian Inuits and Okinawans in Japan were introduced to Western foods.

Milk and acne

In 2005 Adebamowo et al, tested the idea that milk causes acne. More than 47’000 nurses (data from Nurses Health Study 2) were asked about their high-school dietary intake and whether they had acne. The study found that those how drank the most milk had 22% higher risk of getting acne than those who drank the least milk. The risk was even higher (44%) for those who drank skim-milk.

This study has an obvious problem. Do you remember what you ate last week? Last month? Last year? Dietary recall is obviously less than perfect.

In 2008 the same authors followed up with better studies, a 2006 study with girls and a 2008 study with boys. In both cases they asked the participants to note down what they ate and followed them for 3 years. In both studies high milk intake increased risk of acne by about 20%.

Even a Nestle-sponsored review found several ways milk and dairy products aggravate acne. The paper suggested that if Nestle wants to keep selling boatloads of milk, it better develop dairy products that don’t cause so much acne.

Finally, an Italian study from 2012 also showed milk consumption increases the risk of acne.

These studies don’t conclusively prove that milk causes acne, but they certainly suggest that drinking milk increases the risk of getting acne.

Sugar and refined carbohydrates

Several studies have looked at the effect of sugar and other high glycemic index (GI) carbohydrates on acne.

I’m not going to bore you by going over all the studies individually. If you are interested, you can find the studies here, here, here, here, and here. And don’t forget about the Korean diet study I wrote about earlier. Pretty much each of these studies took a group of acne patients and either asked them to eat a low glycemic load (LGL) or high glycemic load (HGL) diets. The LGL diets have more protein and focus on whole grains, fruits and other healthy carbohydrates. HGL diets are more normal Western diets that contain more white bread and pasta and other refined (white) carbohydrates.

Here’s a summary of the results:

  • Acne reduced by 20 – 50% (as measured by total pimple count) in the LGL diet group, which was much better than the HGL group.
  • Hormones linked to acne improved in the LGL diet group and worsened in the HGL diet group.
  • Sebum production decreased in the LGL diet group. Sebum composition also shifted towards saturated fatty acids, which is good because they are more resistant to acne-causing inflammatory damage.

With the exception of one, all the studies showed that low glycemic load diets improve acne. In the one negative study both groups had similar total carbohydrate intake, I also wonder how well the teenagers actually stuck to the diet.

Regardless, the majority of the studies show that sugar and refined carbohydrates aggravate acne.

Other bits and pieces

Malaysian study from 2012 compared diets of acne patients to those with healthy skin. They found that acne patients ate more refined carbohydrates, milk and ice cream. And an Italian study from 2012 found that adhering to Mediterranean diet protects against acne.

Diet acne summary

A 2009 review included a handy table that summarizes current diet-acne evidence.

Dietary intake Established causation?
High-glycemic load diet Yes
Dairy (skimmed, chocolate, or total milk) Yes
Chocolate Inconclusive
Salt No
Iodine No
Saturated fat Inconclusive

Source: Diet and acne: a review of the evidence, table 2 summary of associations between acne and selected foods and dietary patterns

Putting it all together

If I’m being completely honest the evidence for diet causing acne is not rock solid, scientifically speaking. There are still open questions that need answering. But when we are evaluating new claims we should look at 3 things:

  • Is this claim plausible, meaning does it agree with what we already know in medicine? Yes, it’s very plausible diet causes acne. It doesn’t violate anything we already know about acne formation.
  • Is there a mechanism for it? Yes, there are many ways diet can cause acne. For example diet affects the levels of hormones that we know are linked to acne.
  • Does it agree with observations? Yes, several studies now show a link between diet and acne. Not to mention that acne patients have decades and decades kept saying diet aggravates acne.

There’s no question about it anymore. The vast majority of scientific evidence says that diet indeed aggravates acne. The only things going against this are two dingy studies from 4 decades ago.

Diet may not be the be-all-end-all cause and cure for acne, but the view that diet doesn’t affect acne is hopelessly outdated.

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About the Author

Seppo Puusa, a.k.a. AcneEinstein shares rational advice about natural and alternative acne treatments. Read more about me and my acne struggles at the page.

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(21) comments

Thanks for your article on acne and it’s link with diet. There is certainly a link, which most doctors won’t talk about. I’ve also found that acne can be aggravated by other things even though a person has a good diet. Have you found the same in your experience?

Reply
    Seppo October 3, 2012

    I think this info needs to get out more widely. Google searches on diet and acne still bring up a lot of those ‘myths’ articles that are at least 10 years behind on research.

    I agree that diet isn’t be-all-end-all thing for acne. I would count it into top 3 or 5 factors behind acne. But I think things like stress, genetics, gut issues, food allergies and sensitivities and topical irritants can be more important. Of course gut issues and food sensitivities are linked to diet, but if I talk about healthy eating in general. That’s why I’m not a big fan of overtly restrictive diets. In most cases balanced, low-sugar diet is enough to make a big difference.

    Reply
Humprey January 21, 2014

Hi again sir Seppo!

How are you doing?

I just have a general acne-diet inquiry. Since different people may have different response to the same acne-inducing food, trial-and-error approach may be necessary (as you also suggest as I recall). My question is, how long do you think would be the response of breakouts after the acne-inducing-food-for-you?

This became relevant when I’ve thought about the trial-and-error approach. For if, say, the response to the specific acne-inducing food is in actuality months delayed, then we might think that what we are eating now are acne-inducing while it is in actuality what we ate months ago, or vice verse, namely, what we are eating now are acne-countering while in actuality is is what we ate months ago and what we are eating are silently building for a grand breakout later.

Perhaps the example is far-fetched but therein lies the point.

The summary question then would be: how long should we try the questioned food during the trial-and-error approach? Weeks or months?

Thanks again! Keep up the good work!^^,

Reply
    Seppo January 22, 2014

    Good question, Humprey! I’m sad to say there’s no simple answer to this and ‘it depends’ – doesn’t it always :)

    In some cases you might see quite quick results. For example, when I eat something that irritates my gut I usually see it on my skin a day or two later. Consequently, when I stop those foods it takes only a day or two for new pimples to stop forming and about a week for everything to fade away.

    It might take somewhat longer to see the results with milk and dairy. You probably need to wait at least a week or two to see results there.

    And finally we have the long-term effects. Say you are insulin resistant and as a consequence break out after eating carbohydrates. Cutting out carbs, or reducing them, can produce fairly quick results – probably in a few weeks, but reversing insulin resistance itself takes several months. And during those months your skin will still be sensitive to carbs.

    For if, say, the response to the specific acne-inducing food is in actuality months delayed, then we might think that what we are eating now are acne-inducing while it is in actuality what we ate months ago, or vice verse, namely, what we are eating now are acne-countering while in actuality is is what we ate months ago and what we are eating are silently building for a grand breakout later.

    I don’t think it’s like that. More often than not, acne is due to the foods you ate fairly recently, say in the past week or two. Long-term effects are possible, say if you’ve eaten a lot of junk food and sugars. In such a case you may be insulin resistant and have a lot of chronic inflammation going on in your body, both of which can throw off your hormones. Or perhaps you’ve unknowingly eaten foods that damage the gut. All of those can make you more likely to get acne.

    So in summary, it can take anywhere from a few days to a few months to see results. If your acne is more hormonal in nature, then you might be looking at the longer end of the range.

    Reply
Michael Clews February 6, 2014

I notice on the Elaine Mummery Acne Clinic web site, there is a varied list for the causes of acne that the specialist investigates.In particular I noted the reference to:

1) The type of spots
2) Mineral imbalance e.g. high levels of tin and lead being mentioned

The scientific approach needs to be open minded but I’m not aware of any scientific journals saying that types of spots matter or that tin levels affect acne. This fact being established by hair analysis.
Are you aware of any studies, double binding etc?

Reply
    Seppo February 7, 2014

    I have no idea what she’s doing and thus can’t comment on that specifically. But you are right, there’s no scientific reason to believe ‘type of spots’ you have tells any meaningful information. By now I have read most of the scientific papers dealing with acne (excluding those that compare different prescription treatments) and none of them have ever mentioned that the type or location of spots would have any significance.

    The only meaningful difference I know of is separating mild acne patients from those with moderate to severe acne. There is evidence to show people with moderate to severe acne have lower antioxidant levels and more oxidative stress, and as such might benefit from antioxidant supplementation.

    I tried searching PubMed on anything published regarding lead and tin in relation to acne. Lead didn’t bring up anything relevant. Ironically, searching for tin, returned several papers dealing with anorexia and eating disorders.. kinda suggestive of what often happens when you follow bad acne advice.

    Reply
Michael Clews February 6, 2014

Here’s another mineral imbalance article on the Love vitamin web site. I know the zinc/acne link is well established but what about copper, all of this being based on hair analysis tests? My gut instinct is that there is the potential for vitamin companies to make a killing here based on unverified evidence

http://www.thelovevitamin.com/2594/read-this-copper-toxicity-a-zinc-deficiency-could-be-causing-your-acne/

Reply
    Seppo February 7, 2014

    Hair mineral analysis is one of those altie diagnostic tools that seems scientific but in reality is anything but, much like their blood tests to diagnose food sensitivities.

    I found a few papers from early 2000 that tested commercially available hair mineral analysis laboratories. In these studies they took samples from one or two healthy participants and sent them to several different laboratories. In some cases they even sent several samples from the same subject to each laboratory.

    The results weren’t very flattering. There was no consistency between the results from different labs, and the results weren’t just little different – often they were orders of magnitude different. And this is when the labs are testing for the same mineral from the same person!

    Here’s the abstract from one of the papers:

    Laboratory differences in highest and lowest reported mineral concentrations for the split sample exceeded 10-fold for 12 minerals, and statistically significant (P< .05) extreme values were reported for 14 of the 31 minerals that were analyzed by 3 or more laboratories. Variations also were found in laboratory sample preparation methods and calibration standards. Laboratory designations of normal reference ranges varied greatly, resulting in conflicting classifications (high, normal, or low) of nearly all analyzed minerals. Laboratories also provided conflicting dietary and nutritional supplement recommendations based on their results.

    Assessment of commercial laboratories performing hair mineral analysis.

    And here’s from the other paper showing what happened when different labs tested the same hair sample several times

    Only one lab classified all elements of the first and the second analysis of the identical hair sample in the same category (below, within, or above normal range). The others grouped 4 to 7 elements different.

    Assessment of hair mineral analysis commercially offered in Germany.

    In other words, the data these labs produce is just noise. Their analysis is not reliable and you can’t use it to conclude anything.

    To be honest, a paper published in 2013 showed better results. They took samples from one person and sent it to analysis to 3 different labs, 2 in South Korea and 1 in the US. They also took blood sample to see how the results from the hair sample correlate with blood analysis.

    In this study most labs returned comparable results, i.e. there was no statistically significant differences in the values for most of the minerals. There were differences in their analysis of the results. Some labs recommended supplementation because of low levels while others said the same minerals are within normal range.

    1 of the 3 labs showed different results when they analyzed the same hair sample twice, while the other two returned consistent results.

    The results also agreed reasonably well with blood analysis.

    Reliability on Intra-Laboratory and Inter-Laboratory Data of Hair Mineral Analysis Comparing with Blood Analysis

    It’s hard to say why this paper from 2013 produced different results. Perhaps the analysis techniques have improved in the past 10 years, or perhaps they just used better quality labs.

    The bottom line is that there’s very little reason to believe hair analysis produces reliable data. Most likely it’s just one more way altie doctors and vitamin companies get people to buy more useless supplements – as you pointed out.

    Reply
Michael Clews February 7, 2014

Seppo,

Thanks again for replying and giving such a detailed answer. Keep up the good work with the web site and I will always recommend it to anyone looking for advice on acne

MichaelC

Reply
    Seppo February 8, 2014

    Happy to help! Hope I can make a small dent to the mountain on nonsense online..

    Reply
jenn July 18, 2014

What have you learned about caffiene and acne? I have a suspicion it is part of my issue but I’m not sure.

Reply
    Seppo Puusa July 18, 2014

    Here’s a post I did on coffee and acne. In short, caffeine causes temporary insulin resistance. It’s not clear whether this is enough to cause acne though.

    Reply
Susan July 21, 2014

I went to a doctor for IPL and one of the things she told me was to get on a low glycemic diet. She said she had a lot of diabetics in her practice and put them on a low glycemic index diet. She and her staff could not believe what a difference it made in their skin. Their acne and rosacea both cleared up. She now recommends it for all of her patients.

Reply
    Seppo Puusa July 27, 2014

    *SIGH* I wonder when the rest of the doctors really wake up and realize what has been obvious for non-doctors for a long time, lol.

    Reply
Johnny September 9, 2014

you know what all these years i’ve always thought diet had something to do with my acne. but i as i get older, i realize that not all of the diet talk is true. for years i tried to avoid wheat, gluten and sugary foods, but i still got acne. i tried to quite coffee and sugar and i still got acne. it seems that no matter what i drink or eat, i would still get acne.

even if i don’t eat anything “bad” i would still get acne. i blamed my acne on so many foods…fruits, vegetables, sugar, coffee, bread and wheat products…chocolate, milk…every thing that isn’t naturally made. guess what? i still got acne.

if i changed my diet into a good one, i’d still get acne, but in tiny forms…like whiteheads and pustules. if i ate something else, i’d get big cysts.

at 24 years old, i sort of gave up on this idea that diet plays a role on my acne. although, i gotta say, i have quite drinking coffee and other beverages besides plain water, not because of my acne, but because of overall health issue like bad breath, dehydration, diabetes…etc.

anyways, at this point, i give up on this diet affects acne. i think it doesn’t necessarily so.

no matter what you eat, if you’re going to break, you’re going to break out. my parents don’t get acne and they eat what i eat. so i don’t see the point.

anyways, what i do now is i take raw garlic, two cloves in the morning, crushed in plain water, and i just drink it down. i eat normal foods and i just drink plain water and avoid sodas and coffee.

my acne will go away eventually. i don’t know when. but i hope soon.

all i know is i’m no longer going to be obssessed with what i eat as i think that makes acne worse. i’ll just be happy. and accept my acne as part of growing up.

Reply
    Seppo Puusa September 9, 2014

    Good points. I don’t mean to say diet affects acne for everyone. I know there are people who get acne no matter how healthy they eat. But it’s equally wrong for dermatologists to keep saying it’s a myth that diet affects acne. Because there is plenty of evidence to show dairy products and high GI foods aggravate acne for some people.

    Reply
      Johnny September 9, 2014

      yes, that’s true. diet plays a role in acne, but it’s just sugar really. we tend to consume so much sugar these days, especially the regular table sugar and hfcs. that’s why i avoid flavored drinks and coffee in general…i just drink water.

      i eat fairly healthy now…i eat every thing.

      if you haven’t tried raw garlic, try it. i do it in the morning, just two cloves of fresh garlic, crushed. this will help you regulate your sugar levels in the body, thus decreasing inflammation. the only thing though is you must take it with an empty stomach because it works better this way.

      Reply
        Seppo Puusa September 15, 2014

        No, it’s not ‘just sugar’. Sugar and dairy play a part in hormonal-type acne, but they are not the only foods that affect acne. In my case, any foods that cause constipation also lead to acne. So foods like onions, cocoa, strawberries and grapes are out of the question if I want to keep clear skin.

        Reply
groentje November 18, 2014

I am going to mail these studies to a dermatologist on whose website was written that diet does not have an influence on acne. Why don’t doctors read scientific research after their graduation ? Shouldn’t that be obligatory ? I always astonished how little the average doctor or med student really knows about disease. All the new research is completely lost at them because it takes so long for new knowledge to be integrated.

Reply
    Seppo Puusa November 24, 2014

    You hit the nail in the head. It’s unfortunate that doctors don’t have enough time to keep up to date with research and various medical organizations don’t do a better job at informing them of low risk, low cost options (even if they aren’t fully proven yet).

    Reply
Ash January 25, 2015

Hi Seppo,

I remember checking your website about 1.5years ago, and one of your articles about the gut acne axis got me to try a diet based cure.
So after allot of research I diecided the GAPS diet would be the best one and saw a qualified GAPS consultant… So after nearly 2 years of cutting out everything artificial (sugar, dairy, wheat, preservatives, nuts and even fruit) I can report it has worked..

I suffered with acne for over 10years, and now my skin is really good and starting to heal. It took about 12months to start seeing good results though I did see small improvements after 3 months. I still get 1 or 2 little bumps a month though I feel as my gut continues to heal it will be 100%.

The downside…. I basically lived like a hermit for the entire period.. I made every single meal I ate, it was very expensive. Was it worth it? Yes..

My diet contains only 3 food groups – Meat, Vegetables (LOTS of veggies) and Fish.

That’s it, no rice, no fruits (I have the lcassional fruit as a treat if I crave something sweet)

Life is good and I want to thank you for leading me the cause of my acne. I say “my acne” as diet was cause for me, specifically sugar. Hope this helps other ppl

Reply
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