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Home > Selected Expert Articles > Acne > Does Food Aggravate Acne? Journal Scan.
Does Food Aggravate Acne?
Part 2: Journal Scan.
The role of food in the aggravation of acne has been a controversial topic since a long time. Although there have been several case reports, surprisingly, very few systematic studies have been done on this topic.
Fulton et al (JAMA,1969) in a short-duration study of 65 patients, showed that there was no association between the consumption of chocolate bars and acne, sebum production and composition, and comedogenicity. Interestingly, the chocolate bars used in their study had very low milk component, in contrast to a typical chocolate bar of that period. The perceived association with commercial chocolate products may, therefore, be a result of the presence of milk in them. The above study has also been refuted by Bruce and Laila Mackie (Australian Journal of Dermatology,1974) for not making adequate allowances for the dietary properties of chocolate. They hypothesized that fats with higher melting points may reduce sebum flow, and thus cause the plugs to become comedones, the primary lesions of acne.
In another study, patients were fed large amounts of food that they believed exacerbated their acne, but no noticeable effect was found after one week.(Anderson PC, American Family Physician, 1971).
In contrast, as early as in 1949, Robinson had reported in South Medical Journal that 1925 patients who kept food diaries had noted that milk was the most common food associated with their acne flares.
The incidence of acne in young black populations (eating a traditional diet) in both Zambia and Kenya is much less than that of young blacks in the U.S. Observational studies indicate that a low fat, high fiber and low refined carbohydrate diet may be beneficial for acne (Frank, 1971; Kaufman, 1983; Ringsdorf et al, 1976).
A study by nutritionists at RMT University in Melbourne found significant improvement in the acne lesions of 25 adolescent boys when they were put on low glycemic index(GI) carbohydrate food like wholegrain bread, pasta and legumes along with lean meat and seafood. High glycemic index carbohydrates stimulate increased insulin release into the blood stream.
Recent research has indicated that this hyperinsulinaemia, through a hormonal cascade action, promotes unregulated tissue growth and enhanced androgen production. Note that the two main pathological events that take place in acne(hair follicular epithelial growth and androgen mediated sebum secretion) can be induced by hyperinsulinaemia!
To determine whether milk or other dairy products is associated with acne outbreaks, Adebamowo from Harvard University and his team analyzed survey responses from 47,335 women involved in the National Nurses Health Study( Journal of American Academy of Dermatology, 2005).They found a positive association with acne for intake of total milk and skim milk.
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The same team led by Adebamowo, in a prospective study of US girls aged 9 to 15 years in 1996, found that greater consumption of milk was associated with higher prevalence of acne. They did not find an association with dairy fat contents and acne. They hypothesize that the association may be caused by the hormones and other bioactive molecules in milk, especially when most of the milk available in the market comes from pregnant cows. The link between increased dairy consumption and teenage acne may also be explained by the high iodine content in milk. Farmers give their cows iodine-fortified feed to prevent infection. They also use antiseptic iodine solutions on their cows' udders and milking equipment. Another important study by Loren Cordain et al in the Archives of Dermatology (2002) found no evidence of acne among 1,200 Kitavan Islanders aged 10 or older, including 300 between the 'acne’ ages of 15 and 25. They ate primarily fruit, fish, tubers and coconut but almost no cereals or refined sugars. The researchers also saw no acne among 115 Ache hunter-gatherers, including 15 aged 15 to 25. Their diet consisted mostly of the root vegetable sweet manioc, peanuts, maize and rice, as well as some wild game. About 8% of their diet was made up of Western foods such as pasta, sugar and bread. The report also cites previous studies where it was found that acne is rare or nonexistent in people living in non-industrialized(non-fast food) cultures but tends to appear when they transit to a Western way of life. These findings are quite contrary to the belief held by many dermatologists that there is no link between diet and acne! Parker Magin et al (Family Practice, Jan 2005) 'A systematic review of the evidence for 'myths and misconceptions' in acne management: diet, face-washing and sunlight.' states that based on the present state of evidences clinicians cannot be didactic in their recommendations regarding the influence of diet in patients with acne, meaning, they can neither deny nor support the acne-diet relationship as a whole. As a physician with a quarter of century's clinical experience behind me, 18 years of it as a dermatologist, I would affirm that I am personally convinced of a definite relationship, both positive and negative, between acne and food. Acne has a complex etiology, involving abnormal thickening and plugging of hair follicles, altered hormonal function, bacterial growth, and immune hypersensitivity. Individual variations due to genetic susceptibility, environmental factors and stress also affect the course of the disease. Hence any decisions regarding food restrictions in management of acne should be highly individualized and reviewed with care by the patient as well as the treating dermatologist . Next : Part 3: Which Food to be Avoided in Acne?
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