Can diet cause acne?

What is acne?

Acne vulgaris (acne) is an inflammatory skin condition that occurs when the pores at hair follicles become blocked. The blockage is caused by excess sebum (oil) and sticky dead skin cells that clump together due to an over production of the skin protein, keratin. This blockage causes a spot and it is when this blemish becomes infected by normally harmless skin bacteria, that an inflammatory process occurs and acne develops.

What causes acne?

Sadly, there’s not one thing or one trigger that makes you prone to a breakout. Acne is caused by a number of different factors that influence the production of oil and skin cells and as a result lead to the blocked pores and the inflammation that follows. Examples of these include:

• Your hormones – especially those referred to as androgens, such as testosterone and dihydrotestosterone (DHT) – these bind to receptors in the skin and stimulate the oil glands to produce more oil. Both males and females have androgen hormones and it’s the ratio of these relative to other hormones that influences acne breakouts, most notably at key life stages such as puberty and peri-menopause.
• A medical condition – an example being polycystic ovarian syndrome (PCOS), which involves an excess of androgenic hormones.
• Your genes – it is possible to inherit a predisposition to acne, this may be a hormonal condition or the tendency to react more acutely to a bacterial infection. Your genes may also influence the amount of keratin you produce and how active your oil glands are.
• Certain prescribed medications – these include steroids, the mood stabiliser lithium, some anti-epileptic medication and the progestogen-only contraceptive pill.
• Pollution – environmental factors such as living in an area with poor air quality may aggravate already irritated skin.
• Other potential triggers include stress, lack of sleep, smoking, age, your skincare routine and the products you use.

Can certain foods lead to acne?

Although diet is commonly blamed for skin blemishes and acne, the British Dermatology Association say there is not enough research to prove a direct link between diet and acne. However, anecdotal reports and observational studies suggest that, for some people, certain foods may aggravate their condition.

The most common include:

Sugar

Foods that increase blood sugar levels, often referred to as high glycaemic index (GI) foods, like refined sugar and white carbs appear, for some people, to act as a trigger. This is because these foods spike insulin, the hormone that manages blood sugar, and as a result triggers another hormone called insulin-like growth factor (IGF1), this increases the effects of androgen hormones on the size and activity of oil glands.

Dairy

Some studies suggest consuming milk may trigger acne, but to date this hasn’t been studied in depth and it may not be relevant for all acne sufferers. Furthermore, dairy foods other than milk, such as cheese and yogurt, may not have such an acne-promoting effect. One reason for this may be the lower GI of cheese and yogurt, coupled with the lower whey content of cheese. Whey is a protein found in the liquid part of dairy and appears to be partly responsible for dairy’s effect on insulin levels.

Fats

Western diets tend to be disproportionately skewed towards higher levels of saturated fats, trans fats and omega-6 fatty acids, while levels of omega-3 fats found in oily fish, nuts and seeds are typically low. Saturated fats found in red meat, and trans fats in some processed and fast foods, aggravate acne by stimulating the factors that lead to clogged pores, such as oil production.

Whilst studies suggest omega-3 fats help reduce the production of IGF1 and as a result lower oil and keratin production at the hair follicle, they also have a valuable anti-inflammatory effect which may help alleviate symptoms.

Other possible food triggers

Like dairy, meat is rich in the amino acid leucine, this appears to play a role in the stimulation of oil glands in the skin. High-meat diets as well as the use of whey protein powder, a popular supplement among gym-goers, have been reported to aggravate acne symptoms.

Despite being famed for its health benefits, dark chocolate may be a potential trigger, at least for some people. Studies report that young males, who eat dark chocolate regularly, may exacerbate their acne symptoms. This is because dark chocolate is thought to promote bacterial colonisation of the skin surface.

The high levels of sugar, refined carbs and unhealthy fats in some ultra-processed foods (UPFs) may also be detrimental. This is because UPFs may disrupt the gut microbiome, spike insulin and promote inflammation, all of which may aggravate skin conditions, like acne.

Is your diet causing skin problems?

Despite limitations in studies there is some evidence that for certain people, diet may play a role in the severity and frequency of their breakouts. That said, it is important that you do not make significant changes to your diet without first consulting your GP, dietician or other healthcare provider such as a dermatologist or endocrinologist.

One practical step you can take is to keep a food and symptom diary. This may help you identify trigger foods specific to you, and it will provide useful information to help guide your healthcare practitioner. However, if you are thinking of adopting an elimination diet, the evidence is inconclusive and such a diet should only be attempted under medical supervision.

So, what foods do cause acne?

There is currently not enough evidence to support a specific diet for the management of acne. However, studies using a Mediterranean-style diet, that reduces ultra-processed foods, dairy (especially milk) and meat while encouraging the intake of omega-3 fatty acids combined with low GI foods, looks promising.

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Kerry Torrens BSc. (Hons) PgCert MBANT is a BANT Registered Nutritionist® with a post graduate diploma in Personalised Nutrition & Nutritional Therapy. She is a member of the British Association for Nutrition and Lifestyle Medicine (BANT) and a member of the Guild of Food Writers. Over the last 15 years she has been a contributing author to a number of nutritional and cookery publications including Good Food.

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