Does Diet or Food influence Acne? Of Course
Can you do without your acne medicine or acne drug treatment?

Subscribe to a FREE Supplement Research Update newsletter. What your dermatologist may not know about the role of acne and food. Twice a month we email you a brief abstract of several new studies on various supplements and natural medicine topics and their practical interpretation by Ray Sahelian, M.D. We will mention new research updates regarding acne food and diet.


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Acne vulgaris information
Acne vulgaris, or common acne, is a skin disorder of the pilosebaceous unit that generally develops in adolescence and improves in adulthood. Adolescent males, in particular, can be severely affected by acne, which, if left untreated, can cause scarring. Acne can sometimes last well into one's thirties and forties. In addition to facial acne, many people can have body or back acne.

Acne Diet - Acne Food - There is no doubt that diet and acne are related
Is there an acne diet or food that can reduce this problem? I suffered with facial acne as a teenager and even had adult acne. I tried many acne treatments, took acne medicine, mostly in the form of antibiotics, and tried various acne products, including a home remedy for acne by my grandmother. However they didn't help much and some of the acne treatments and medications made me feel sick. After years of trial and error with different foods and diets, I believe I have gained some insight regarding dietary influences on acne that I wish to share with you. I strongly believe food influences acne severity. If you suffer from acne, I truly hope the knowledge I have gained is helpful to you, and prevents or reduces the possibility of cystic acne or acne scars. I prefer to approach acne treatment from the food and diet perspective as opposed to drugs and herbs.

Natural Acne remedy - Natural Acne treatment
Acne is difficult to treat or cure. I do not claim to have a definitive acne solution, or a magic acne medication or acne cure, but over the past three decades of trying to find a dietary solution to my acne problem, I have come to realize that diet does play an important role, even though the medical profession denies that food has anything to do with acne. Basically, acne is an inflammatory process, and the types of food we eat can certainly influence inflammation.
   Here are some suggestions to prevent, treat, or control acne:

Avoid friction or contact with acne pimples. Leave them alone, do not play with or pop pimples. Avoid any kind of friction on your skin areas that are prone to acne. Rubbing of the skin or friction with clothing can lead to pimples. At night, try to sleep on your back rather than on your side since the friction of your cheek or side of face against the pillow can clog pores and aggravate acne.

Avoid androgenic hormones such as DHEA, testosterone, and androstenedione. Acne is definitely aggravated by androgens and certain hormones. Pregnenolone may also cause acne.

Reduce stress of any type if you can. Stress can make acne worse by releasing certain hormones.

Acne and facial hair - if you are a male with moderate or severe facial acne, you may consider growing a beard. I did and it helped reduce the severity of my acne since shaving was making it worse.

Acne face wash - I don't think washing your face more than required is going to help get rid of acne.

Acne Diet - Foods that cause Acne
Reduce your intake of sugar (including excessive amounts of fruit juices), sweets, processed flour, baked goods, and trans or hydrogenated fats. Examples include donuts, cookies, pastry, ice cream, pies, etc. Use Stevia, the no calorie natural sweetener rather than sugar. Regularly eating breads, cakes, chips and other staples of Western culture is likely to promote acne. Sodas are a significant source of sugar. Switch to water, herbal teas, and vegetable juices. You can sweeten herbal teas with stevia.
   Foods that produce a high glycemic load -- such as sugared drinks, white bread and white potatoes -- cause a quick rise in blood sugar. More complex carbohydrates with fiber, such as unrefined cereals or beans, lead to a more gradual change and are considered to have a low glycemic index. Dr. Robyn N. Smith, from the RMIT University in Melbourne, Australia, evaluated acne symptoms in 43 male patients, between 15 and 25 years, who were randomly assigned to a low glycemic load diet or a normal diet. The intervention diet consisted of 25 percent energy from protein and 45 percent from low-glycemic-index carbohydrates. After 3 months, the low-glycemic diet was associated with a significant reduction in acne compared with the normal diet. American Journal of Clinical Nutrition, July 2007.
   Comments: One reason for the success of this low glycemic acne diet is that it limited the rise in high insulin levels. Chronically high levels of insulin may lead to blockages in skin pores and extra oil building up under the skin.

Reduce intake of nuts, including brazil nuts, walnuts, almonds, pistachios, and filberts. Peanuts and peanut butter may provoke acne in some individuals. If you eat nuts, limit your intake to small amounts and preferably eat raw nuts.

Reduce intake of milk products, including ice cream and cheese. There is a high amount of hormones produced in the milk of cows, particularly in the milk of pregnant cows, which makes up the bulk of marketed milk and dairy products. Milk from pregnant cows contains progesterone, 5-alpha reduced steroids, and other steroid hormones. These hormones, when consumed, can break down into dihydrotestestosterone (DHT), the final molecule that turns on oil-making cells. Studies show there is an association between milk consumption and acne, and it didn't matter whether the milk was whole, low fat, or skim. For those who eliminate or significantly reduce milk products from their diet, calcium supplements could be helpful. Consider soy milk as a partial alternative. Buy unsweetened soy milk and sweeten it with stevia. Milk also contains high levels of iodine which may be an additional reason to avoid excessive dairy consumption.

Reduce or avoid vitamin E supplements. I have come across some patients who have noticed acne pimples after taking vitamin E. I am not certain of this connection, but until more is known you may wish to stop taking high dose supplements of this vitamin. There have also been rare case reports of aggravated acne following very large intake of B vitamins.

Increase intake of foods that may improve acne such as fish (halibut, salmon, tuna, sardines). These contain important omega 3 oils such as EPA and DHA. They will make a difference in the health of your skin. Eating more fish is one of the most important dietary steps you can take to improve your skin. If you dine at Japanese restaurants, order the Ikura which is the salmon egg sushi. Salmon eggs, or fish eggs, I believe, improve the health of skin since they provide many long chained fatty acids which are anti-inflammatory. Acne is an inflammatory process and the idea is to eat foods that reduce inflammation. .

Increase your vegetable intake - Eat as many vegetables as you wish, preferably organic. Eat a wide variety, not just the few that most American eat. The combination of fish and vegetables is likely to be the healthiest meal for those with acne.

Consider taking fish oil capsules if your intake of fish is fewer than twice a week.

Increase your intake of water. Drink a glass or two of cold water first thing in the morning to eliminate the bowels. Drink 4 to 8 glasses of water per day, more in hot weather.

Foods that I consider to have no major influence on acne, or to be relatively neutral, include meats, turkey, and chicken. I am not sure about coconut oil, whether it helps or makes acne worse.

Acne Lifestyle
Relax, meditate, do yoga, take long walks, attempt to change your response to perceived stressful experiences. Acne prevention is easier than the best acne treatment. 
How to get rid o f acne.
Does Chocolate influence Acne?
I'm not sure. I don't think cocoa itself is a cause, but most likely the sugar and milk added to chocolate may influence acne. If you do wish to eat chocolate, try small amounts of the low sugar, dark, 70% cocoa variety.

Physiological Cause of Acne
At least four factors are important in the development of acne: plugging of the hair follicle with abnormally cohesive desquamated cells, sebaceous gland hyperactivity, proliferation of bacteria (especially Propionibacterium acnes) within sebum, and inflammation.

The Inflammatory process of Acne
Earliest changes in the hair follicle occur when the follicular canal becomes blocked with abnormally keratinized desquamating cells. This plug starts above the opening of the sebaceous gland into the follicular canal and causes gradual expansion of cells and sebum within the canal. The plug becomes visible at the skin surface as a white papule ("whitehead," or closed comedo). If the opening of the follicular canal dilates, this plug protrudes from the canal and turns a dark color ("blackhead," or open comedo). Bacteria, most importantly P. acnes, are present in increased numbers in persons who have acne. Much of the inflammation that eventually occurs in acne arises from the action of enzymes produced by the bacteria. These enzymes hydrolyze sebum into free fatty acids, which stimulate the inflammatory process. Chemotactic factors are released by this reaction, attracting neutrophils (a type of white blood cell). As the follicular wall becomes inflamed, an red papule appears at the skin surface. With increased sebum production, obstruction and bacterial colonization, the follicular unit ruptures, spilling its contents into the dermis. The inflow of neutrophils causes the formation of pustules. Continuation of severe inflammation leads to formation of nodules and subsequent acne cysts.

Acne Medicine
There is no known cure for acne with medicine, but acne can be controlled. Most acne medicines take several weeks to work. The best results happen after taking acne medicine for three months. Sometimes, acne may seem to get worse in the first few weeks of treatment, because hidden bumps rise to the skin surface. Your acne may get better if you keep using the acne medicine. When you start using a new acne medicine, you may have mild redness and swelling of your skin.

Acne Medicine - Isotretinoin if nothing else works
Low doses of isotretinoin (brand name, Roaccutane or Accutane) are effective for treating moderate acne. The efficacy of isotretinoin at (regular doses) in the treatment of acne is well established but has several mild and serious side effects. However, using low doses of isotretinoin such as 20 milligrams daily for six months can offer benefits with fewer medicine side effects. The most common side effects are mild inflammation of the lip and mild dryness of the skin. Some users notice low mood, and depression can occur with high doses of Accutane.

Acne and Antibiotics
Acne patients who have been taking antibiotics for at least six weeks are twice as likely to develop an upper respiratory tract infection as those who aren't on acne antibiotic treatment.

Acne and Diet Research
Carbohydrate foods with a low glycemic index (GI) can improve acne in teenagers. Nutritionists at RMIT University in Melbourne, Australia enlisted 50 boys with moderate to severe acne and randomly assigned half a typical adolescent boy's diet high in processed foods and refined grain products. The other half were put on a diet high in low-GI foods like wholegrain bread, pasta and legumes, along with lean meat and seafood. The acne of the boys on the higher protein-low GI diet improved dramatically, by more than half. This finding is contrary to the belief held by many dermatologists that there is no link between diet and acne.

Acne Research Update
The link between increased dairy consumption and teenage acne may be partly explained by the high iodine content in milk. Farmers give their cows iodine-fortified feed to prevent infection, and they use sanitizing iodine solutions on their cows' udders and milking equipment. Previous research has suggested that teens who consume lots of milk and other dairy products have an increased risk of acne, but the reason why is unknown. In a recent study investigators hypothesized that the association may be due to hormones and bioactive molecules in milk. That may be true, but iodine may also play a role. Studies have shown that milk produced in the United States, Britain, Denmark, Norway and Italy have high levels of iodine. Source: American Academy of Dermatology, December 2005.

Antimicrobial effects of Thai medicinal plants against acne-inducing bacteria.
J Ethnopharmacol. 2005 Oct 3;101(1-3):330-3.
Propionibacterium acnes and Staphylococcus epidermidis have been recognized as pus-forming bacteria triggering an inflammation in acne. The present study was conducted to evaluate antimicrobial activities of Thai medicinal plants against these etiologic agents of acne vulgaris. Crude extracts were tested for antimicrobial activities by disc diffusion and broth dilution methods. The results from the disc diffusion method showed that 13 medicinal plants could inhibit the growth of Propionibacterium acnes. Among those, Senna alata, Eupatorium odoratum, Garcinia mangostana, and Barleria lupulina had strong inhibitory effects. Antimicrobial activity from fractions of column chromatography revealed one of the active compounds in Garcinia mangostana - mangosteen - could be mangostin, a xanthone derivative. Taken together, our data indicated that Garcinia mangostana had a strong inhibitory effect on Propionibacterium acnes and Staphylococcus epidermidis. Therefore, this plant would be an interesting topic for further study and possibly for an alternative treatment for acne.

Acne and its management beyond the age of 35 years.
Am J Clin Dermatol. 2004;5(6):459-462.
Although acne is not usually considered to be a disorder that affects the elderly, the disorder occurs sufficiently often in mature individuals to be noteworthy. The variety known as 'persisting acne' is, as its name suggests, ordinary acne that continues into adult life. 'Chin acne' is a curious type that occurs premenstrually in mature women, while 'sporadic acne' describes the sudden development of significant acne in later life for no apparent reason. When acne develops in an individual outside the usual susceptible age group precipitating causes such as exposure to comedogenic substances or drugs must be excluded. Similarly, endocrine causes such as androgen-secreting tumors and the administration of anabolic steroids need to be considered. All inflammatory processes are decreased in the elderly and this may be one reason for the persistence and intransigence of acne lesions in older age groups. The principles of treatment of acne in the elderly do not differ from those in other age groups, although the emphasis during counseling needs to focus on explanation and reassurance rather than prognosis. Topical retinoids and benzoyl peroxide easily irritate elderly skin, so azelaic acid and even sulfur preparations are preferable.

A systematic review of the evidence for 'myths and misconceptions' in acne management: diet, face-washing and sunlight.
Fam Pract. 2005 Jan 11;
Lay perceptions that diet, hygiene and sunlight exposure are strongly associated with acne causation and exacerbation are common but at variance with the consensus of current dermatological opinion. The objective of this study was to carry out a review of the literature to assess the evidence for diet, face-washing and sunlight exposure in acne management.  RESULTS: Given the prevalence of lay perceptions, and the confidence of dermatological opinion in rebutting these perceptions as myths and misconceptions, surprisingly little evidence exists for the efficacy or lack of efficacy of dietary factors, face-washing and sunlight exposure in the management of acne. Much of the available evidence has methodological limitations. CONCLUSIONS: Based on the present state of evidence, clinicians cannot be didactic in their recommendations regarding diet, hygiene and face-washing, and sunlight to patients with acne. Advice should be individualized, and both clinician and patient cognizant of its limitations.

The maker of the acne medication Accutane ignored a company doctor's recommendation that people who take the controversial acne drug be monitored for signs of depression and that a warning to that effect be added to the drug's U.S. label.

Over-the-counter (OTC) benzoyl peroxide skin cream clears up acne as well as prescription antibiotics -- and at a fraction of the cost. UK investigators found that roughly 60 percent of people with mild to moderate acne said they noticed an improvement after using OTC benzoyl peroxide cream for 18 weeks. This is the same rate of acne improvement reported by people who tried antibiotic pills, antibiotic creams, and acne creams that combined an antibiotic with benzoyl peroxide, the researchers note in The Lancet medical journal. Moreover, the benzoyl peroxide used in the current study was one-twelfth the price of one of the oral antibiotics. Importantly, benzoyl peroxide also sidesteps the growing problem of bacterial resistance to antibiotics in acne patients, which can occur when people take oral antibiotics.

The newspaper cited allegations in a Florida-based federal court case against the drug company, Hoffman-La Roche, charging that the Swiss pharmaceutical giant didn't include the warning because it could affect sales or prompt lawsuits. Roche's acne drug Accutane and its generic versions will face tighter prescription controls to prevent harm to unborn children. The measures include a new joint database shared by all manufacturers of the drug to monitor patients, doctors and pharmacies, the Food and Drug Administration (FDA) said. Accutane, or isotretinoin, is already restricted to prevent use by pregnant women because it can cause fetuses to die or develop birth defects. But FDA officials are concerned about women who get pregnant while taking the drug. Under the new monitoring program, manufacturers must keep track of doctors who prescribe the drug, pharmacies that distribute it and patients who take it.

Anger and acne: implications for quality of life, patient satisfaction and clinical care.
University of North Carolina-Chapel Hill, Biology, Chapel Hill, NC
Br J Dermatol. 2004 Jul;151(1):183-9.
Acne is a common skin disorder with a significant psychological and social impact for some people. Little is known about how personality and emotional traits affect acne and its impact on quality of life and treatment. Trait anger (TA), which is related to heart disease and other morbidities, may also affect acne and patients' adjustment to it. Objectives To evaluate the relationship between TA and acne severity, skin-related quality of life, satisfaction with treatment, and adherence to treatment. Participants and methods A sample of 479 individuals with acne completed a survey instrument to assess acne severity, skin care practices, skin-related quality of life, satisfaction with treatment, adherence, TA and demographic variables. Respondents who reported high TA were compared with individuals with low TA on outcome variables.  High TA was unrelated to acne severity or frequency of face washing. Anger was significantly related to both global quality of life and skin-related quality of life as well as to satisfaction with treatment  and adherence to treatment advice. Conclusions: Anger is associated with the quality of patients' lives and with their satisfaction with treatment. Care of acne patients should include attention to anger and other chronic emotional states, quality of life, as well as to clinical severity. Simple guidelines are suggested for how clinicians might approach this important aspect of care.

Treating acne with a laser does not appear to work.

Topical antibacterial therapy for acne vulgaris.
Drugs. 2004;64(21):2389-97.
Topical antibiotics and benzoyl peroxide, are the two main topical antibacterial treatments indicated for mild-to-moderate acne vulgaris. Topical antibiotics act both as antibacterial agents suppressing Propionibacterium acnes in the sebaceous follicle and as anti-inflammatory agents. Benzoyl peroxide is a powerful antimicrobial agent that rapidly destroys both bacterial organisms and yeasts. Topical clindamycin and erythromycin have been proven to be effective against inflammatory acne vulgaris in concentrations of 1-4% with or without the addition of zinc. However, none of the antibacterials tested for acne was more effective than benzoyl peroxide, which also has the advantage of not being associated with antimicrobial resistance.T opical antibacterial therapy for acne should be discontinued once improvement is observed. If no improvement is observed within 6-8 weeks, the agent should be discontinued and a therapeutic switch considered.

N95 acne.
Int J Dermatol. 2004 Jul;43(7):522-3.
Two women, aged 27 and 45 years, presented to the Dermatology Outpatient Clinic with acne vulgaris. Both had nodular acne in a similar distribution over the cheeks, chin, and perioral areas (Fig. 1). Each had a history of acne vulgaris as a teenager. Both were healthcare assistants working in the Singapore General Hospital throughout the severe acute respiratory syndrome (SARS) crisis, had worn N95 masks continuously for about 3 months whilst on the wards, and had suffered an outbreak of acne of the skin occluded by the mask. They were treated with topical retinoid and systemic antimicrobials, and both responded well.

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