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Ep 33: Anti-Acne Diet – Best and Worst Foods for Acne
Hi guys, welcome to my podcast Dermatologist Talks: Science of Beauty. I’m Dr. Teo Wan Lin of TWL Specialist Skin and Laser Centre . In this week’s Dermatology Flash Briefing, we’re going in depth into our diet interactions with the pathways of acne formation. For example, we often wonder if it’s really true that junk food causes acne. In the previous episode, we have spoken about the influence of diary, in particular. In this episode we’re going to delve into the best anti-acne diet, acne metabolomics and how it affects inflammation and the process of comedogenesis.
Food that promotes acne
Three major food classes have been established in scientific literature to promote acne. Firstly, the hyperglycaemic carbohydrates. The second category will be the milk and dairy products. The third category are saturated fats, including trans fats and diets that are deficient in anti-inflammatory omega-3 polyunsaturated fatty acids. You can find these in fatty fish and nuts. It’s important for us to understand the various terms to describe the role of diet in the pathogenesis of acne.
IGF-1
Insulin growth factor 1, or IGF-1 is the the main mediator that links dairy consumption with acne. IGF-1 is highest at puberty and thereafter decreases continuously. It is not just your hormones – androgens testosterone, the male hormone that links to acne formation. It’s actually the serum levels of IGF-1 that correlates with the manifestation of acne.
Supporting this theory in acne pathogenesis is the medical syndrome, Laron syndrome. Laron syndrome is a genetic defect in IGF-1, due to growth hormone receptor mutations. Interestingly, these patients never develop acne or many diseases related to the Western civilisation. However, when we administer high doses of IGF-1 to these growth hormone receptor deficient patients, we find that it’s possible to induce acne and a state of hyper-androgenism.
Western diet and acne
We want to focus on the increasing interest in the Western diet and how it directly impacts acne metabolomics. There is high acne prevalence of over 90% in adolescence and persistence into second and third decades of life. We also find that 60% to 70% of these individuals may be affected by both environmental and genetic factors. These factors interact to cause predisposition to acne. Populations that keep to Paleolithic diets – with low glycemic load without milk or dairy consumption – for example, the Papa New Guinea Islanders, are acne free. We have also observed an increase in acne prevalence in the Chinese after transitioning from traditional diets to Western nutrition. All these bear evidence pointing to an anti-acne diet.
The influence of nutrients in the development of acne
These accumulating evidence points towards the influence of nutrients and nutrition in the development of acne. One should focus on nutrients that increase IGF-1 signaling, as the most critical features are what we call epidemic acne. In a study of New York young adults, acne severity links to – increased intake of sugar, high glycemic load, increase milk consumption as well as saturated fat and trans fat intake. It’s very relevant for us to see how these nutrients interact with one’s personal genetics, nutrigenomic impact in this influence on these food classes.
Low glycemic load diets
High intake of refined carbohydrates, plays a definite role in acne formation. In a study, there was a correlation with a low glycemic load diet and a decrease in sebaceous gland size in facial acne skin over 10 weeks. We can describe this as a metabolomic reaction, in which we also see evidence in meta metabolomic studies. Scientific literature backs up the fact that milk increases and stimulate IGF-1 and we consider it an acnegenic food. Saturated fat and trans fat are our focus today.
We should highlight that industrially-produced trans fats, which are major components of fast food and show to worsen acne in studies. Hydrogenated fats, partially hydrogenated fats have replaced natural solid fats, most notably in fast food, snacks, fried foods and baked goods. All of these associate with diet-induced acne.
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Acne & inflammation
Another perspective is that the Western diet promotes the inflammasome activation – and we know clearly that acne is related to inflammation. There are clearly genetic factors but because of the epidemic prevalence of acne. One can pay more attention to the influence of environmental factors. In this case we will zoom into the influence of diet on the overall evolution of acne, especially in populations that are acne-free.
It has been said that sebum is the oil of the acne flame, so p. acnes, the bacteria known to cause acne, is known to thrive when you have increased oil production. Additionally, the free fatty acids promote the process of white head and black head formation, also known as comedogenesis. Research shows that the chemical mediator IL17, contributes to keratinocyte overgrowth, which is involved in the comedogenesis process that occur in acne patients.
On top of that, oleic acid, a free fatty acid, when applied on the inner surface of the ear of rabbits in an animal study, induced comedones. In addition, there are a lot of evidence that Western diet increases the local bioavailability of free palmitic oleic acid. This drives whitehead and blackhead formation. These cytokines interleukins which directly play a role in inflammation in acne and in comedone information are also evidence of this entire inflammation process.
Dietary interventions
With regards to dietary interventions, it is important to note that androgen abuse, the use of male hormone steroids, for example in bodybuilding, is also a synergistic factor to your diet in terms of the effects of acne – acnegenic effects. Together with the Western diet driven nutrient signalling pathways with the chemical mediators, overall increases an individual’s chances of developing acne which is also influenced by genetic factors.
In conclusion, we need to understand that there is increasing evidence of epidemic acne vulgaris. It is driven by the same processes observed in the systemic diseases of Western civilisation’s. This is in conjunction with diseases such as obesity, diabetes, and cancer. Interestingly they all have one thing in common which is the underlying MTORC1 drive.
Key takeaway points
If you suffer from acne, you should control your total caloric intake and look instead to incorporate more foods for an anti-acne diet. It may be helpful to restrict your sugar and refine carbohydrate intake. The same goes for milk and protein supplements and definitely, avoid junk food which are high in saturated fats and trans fats. All these increase sebum activity – which has a direct impact on acne. In closing, is there such a thing as an anti-acne diet? It seems that Palaeolithic-like nutrition with increased intake of vegetables and fruits with low glycemic index and fish consumption, that’s enriched in anti inflammatory omega-3 fatty acids, can be part of an ideal anti-acne diet that will reduce the severity of your acne and be helpful especially when you are undergoing treatment as well.
That’s it for this week’s Dermatology Flash Briefing. You can follow me on my instagram @drteowanlin for more podcast updates.