Is Acne Made Worse By Diet?

I have never had great skin, as a baby I was covered in eczema which persisted until early puberty when the pimples started to develop.  As if pimples and teenager hood weren’t enough of a drama my eczema also came back to make my youthful formative years an itchy, bumpy and embarrassing mess.

The hardest part about having acne at that time of my life was the judgement that I felt from other people whether directly or indirectly, that either I or my body was doing something wrong.  The first judgement was to do with my hormones,  that I’d got too much ‘boy’ hormone (testosterone) and that was causing the pimples.  I felt this all to be highly embarrassing as being sporty (as in strong and with lots of endurance), un coordinated and a bit of an adventurer I already felt less girly than I felt society demanded so this outer validation that I was really a female imposter (even though I clearly wasn’t) was mortifying embarrassing.   I now appreciate that girls and boys both need testosterone and that it was more likely that my body was reacting to natural changes that we all have rather than me making shed loads more than a girl reasonably should but that’s not how teenage me read it.  Anyway, that’s not what I want to talk about today,  what I want to discuss now is the second equally cringeworthy judgement that I felt about my skin  and that’s to do with food.

The saying ‘you are what you eat’ has always been a bone of contention to me as I have always had such trouble with eating thanks to multiple annoying food intolerances of the ‘not-pleasant-but-not-life-threatening’ variety.  I should have known I was in for a troubled life when my weaning process involved me coming out in a rash every time I ate something.

The fact that as a teenager, my skin started to resemble the pizza that I was quite fond of eating was again mortifying. From time to time people would throw pearls of wisdom at me such as ‘eat less sugar’ or ‘what about you try eating more vegetables’ which is, of course all very sensible and sound health advice but not at all easy to stomach as a sporty and normal weight but stressed-out teen. Sure I favoured cheese on toast and chocolate cake for dinner whenever possible but I also ate a lot of fruit and home-cooked meals and drank only tea and water. To be frank I felt that I was copping more drama on the skin front than my C+ diet deserved.  Intellectually I knew I could do better but I didn’t feel I was quite the abject failure that my skin was making me out to be, I felt like I’d been cheated.  I did go through periods of time when I tried hard with my diet, eating as much fresh fruit and tolerable veggies as I could and cutting out the chocolate – at that time (the late 80’s and early 90’s chocolate was widely ‘known’ to cause acne in certain circles. This was a shame as chocolate was my drug of choice and still is) but nothing seemed to help much or for long so I would always give up.

The trauma of those teenage years  caused by the unruliness of my skin and its inability to respond quickly and positively to any increase in fruit and veg intake or sugar decrease led me to form an internal bias against the ‘you are what you eat’ hypothesis.  My thoughts were further validated when, like most other people, I grew up and my skin woes died down a lot.  Sure I still have some issues but nothing like I used to and no, I haven’t changed my diet much.  My views became set,  that while eating a good diet was ever a bad thing, a great diet can’t ‘cure’ bad skin, that acne is much more complicated than that.

But have I too readily disregarded the food / acne link because of my own failures?

Probably…..

So this morning while catching up on my journal reading I found this recently published article: Acne Vulgaris: The metabolic syndrome of the pilosebaceous follicle .  and I have to admit that it made sense.

Wanting to see if the above article was a one-off or if others had linked diet to acne in this particular way I went googling and found the authors earlier paper (2013) published in Experimental Dermatology here: Potential role of FoxO1 and mTORC1 in the pathogenesis of Western diet-induced acne.

There is also a book: Bioactive Dietary Factors and Plant Extracts in Dermatology. 

and another article by author Bodo Melnik here. 

So first a pilosebaceous follicle is the term used to describe a hair follicle and sebaceous gland unit.  We have these all over the body including the face and on the face our follicles are somewhat atrophied whereas our sebum production has not.  This manifests as hairless but potentially greasy skin, especially in what we call the T-Section.  Acne Vulgaris is an inflammatory skin disease and according to this study increased mTORC1 activity has been detected in acne affected skin.

This mTORC1 thingo is a protein complex that plays an important role in controlling protein synthesis. It does this by managing energy and oxidation requirements.  Among other things, this complex is activated by insulin and it is because of this that the complex is being linked to ‘metabolic syndrome’ – a collection of conditions which include obesity, insulin resistance, high blood triglycerides, low levels of HDL cholesterol and high blood pressure.

It looks like honing in on this mTORC1 pathway has enabled scientists to link what we eat with what happens to our skin at a cellular level which is quite exciting and is in keeping with our deeper knowledge of how our bodies interact with the fuel we give it – how not all calories are created equally for example…

Human trials have been carried out looking at how different diets have impacted the skin of acne sufferers including a placebo-controlled randomised study by Smith RN, Mann NJ, Braue A et al ‘The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters associated with acne vulgaris’ but while we might see an impact positive or negative in a change of diet, it isn’t until we can map exactly where this impact is being felt that we can truly know what it was that made a difference.  It looks like this work is starting to clarify that.

So Metabolic Syndrome is not something that all acne sufferers would necessarily be diagnosed with.  I wasn’t and have never been obese, had high blood pressure or particularly high cholesterol but that doesn’t mean to say that my diet wasn’t stressing out my system.

I have long since believed that our skin is the first to scream when something inside isn’t right and this looks like being another example of how that plays out.  Further, while this particular research doesn’t particularly look like it has all of the answers as to why some people get acne and some don’t the evidence pointing to specific dietary triggers seems to be to be compelling as much as I didn’t ever want it to be!

Changing your diet is very, very difficult and if you already have a low self-esteem from acne, the thought that your skin is punishing you for having that extra block of chocolate or milkshake is cruel, especially when you no doubt have friends who eat whatever they like and never get a pimple.   I’d say that like most other things that we are finding out about our body, while metabolic syndrome or the components to that, however mild, may be a powerful trigger to developing acne, something has to pull that trigger and that may be enzyme deficiencies, stress, poor barrier functioning, lifestyle choices, your environment and/ or any medication you are taking.

Talking of medication.

As I’m not a dermatologist I don’t want to go into the details of oral treatments for acne but those that we do use topically and cosmetically such as Benzyl Peroxide and Retinol do seem to affect this mTORC1 pathway too which plays into the hypothesis of cause and effect – control the cause and get a better effect.  The fact that we can correct this dysfunction, at least to some degree through topical (or, if severe medical) treatment rather than just relying on diet is a relief and may give sufferers enough of a boost in confidence to see them through a change in diet.

And back to diet – what should be avoided?

The evidence put forward in the papers above shows that a high glycemic load and milk consumption are the greatest aggravators for acne.  High glycemic foods include refined carbs such as white bread and rice; sugar, white potatoes,  bananas, grapes, cherries, watermelon and corn flakes.   Interestingly enough the studies also found Acne to be a disease of ‘Westernised’ countries and it becomes an issues as countries move from their traditional diets too – this is being felt in China right now.

So it turns out that I should have listened to those people who were telling me to change my diet back in the late 80’s and early 90’s only back then we didn’t know exactly how diet affected the skin and as such my change to incorporate more fruit (for vitamins and fibre) and milk (for calcium) was doing the opposite to what I was trying to achieve which is probably why I eventually gave up.

The bottom line for me is that while it is becoming more and more clear scientifically how our food impacts our skin, it is not so clear or simple to implement that as a cure-all.  When we say ‘we are what we eat’ we mean far more than just the sum of the foods nutritional data,  food is emotional, cultural, spiritual even and as such, no matter what we know about what we SHOULD be eating, I feel those of us who do suffer from acne will probably always need a little extra help in the form of a tablet or skin care regimen, especially when we are feeling and looking (to us) at our worst.

How cool that we are finally honing in on this stuff even if it did come around 30 years too late for me!