Yahoo Lifestyle Could the clear skin diet spell the end of adult acne?
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Loren Cordain might have been the only person in the auditorium without a medical degree that night in 2004.
He wasn't even a skin specialist. But for over an hour at the Society for Investigative Dermatology's meeting, he shocked the luminaries in the room by upending the current thinking about a growing problem: adult acne.
Cordain, a professor at Colorado State University in the US, tells me later that his skin obsession started with an article about Canadian Inuit in a dusty 1971 issue of Nutrition Today. One observation caught his attention: the Inuit only started getting acne when they began eating processed foods. But why? He'd clung to that question, letting it take over his research. Diet, he decided, irrefutably affects acne.
He knew it wouldn't be an easy sell. The idea of a diet-acne connection had been anathema since the '60s, when a few dermatologists (two of whom were on stage with him that evening) found that chocolate, long considered an acne culprit, didn't worsen breakouts. Study subjects who ate placebo bars developed the same number of zits as those who munched on chocolate bars. The case was considered settled and the study canonised (which explains why all five of the dermatologists I've seen as a grown-up have insisted that diet has absolutely nothing to do with my adult acne).
While Cordain stood at that lectern, he cited research he'd done on remote populations and explained how a high-glycaemic diet could result in a crop of pimples. He debunked the chocolate study by pointing out its flawed methodology: the placebo bar packed the same glycaemic load as the chocolate one, and because they contained the same amount of sugar, the bars were almost nutritionally identical. After Cordain returned to his seat, one of the authors of the chocolate paper leaned over and shook Cordain's hand. "Thank you for correcting our mistake," he said quietly.
And the fact more women see a dermatologist for adult acne than any other reason makes this one of the hottest topics in the beauty world.
The diet-acne link explained
Every day, examination rooms ring with one consistent query from patients: "Does what I eat affect my acne?" It's a question that forces dermatologists to take sides. Some still consider the debate settled with the chocolate study. The rest either believe in the research that shows food can affect the skin or deem the evidence too weak. Attitudes have evolved over the past 10 years, and now there's enough research on diet and acne to demand it be taken seriously.
I was one of those patients. Since early high school, my face and back have been home to deep cystic acne ranging from moderate to severe. For more than 10 years, I asked various dermatologists if food could be the culprit behind my crazy-making skin problems. "It's a myth," they all told me. But when my rounds of antibiotics and isotretinoin (Accutane), a prescription drug that delivers high doses of a vitamin A derivative, weren't working, I started looking for answers. Dietary changes were touted as a magical cure on acne message boards online, and it seemed like common sense: everyone knows that after a week of too few vegetables and too much wine, we don't look our best. And when we indulge in greasy food, a little always seems to somehow shimmy its way through our pores.
Your new route to radiance
But it wasn't until I was writing a story for Prevention that I heard there was science to back up the claims. A researcher specialising in gut bacteria suggested I ditch my acne antibiotic and change my diet. "Drop all refined carbs and eat a tonne of plants," he told me. People with diverse gut microflora also tend to sport healthy skin, he said. Days after I began following his suggestion, my skin was radiant. I had an even complexion, fading red spots, and a magical, vegetable-fuelled glow.
Could I have stumbled upon an acne treatment as simple as kale and complex carbs?
The group of scientists and researchers who think so is growing fast. Five years ago, when US dermatologist Whitney Bowe began lecturing on the ties between diet and acne for the American Academy of Dermatology, doctors were confused. "They'd say, 'But wait, my textbooks said there was no link,'" she says. Recently, audiences have grown dramatically and, instead of questioning her, they ask for handouts for their own practices.
Most dermatologists' go-to options for acne are still drugs: antibiotics, topical retinoids and Accutane. But these can be costly and come with side effects like excessive dryness and nosebleeds, and the benefits often don't last. Add in the fact that it's difficult to predict which drug will work best, and a natural cure sounds pretty appealing.
Why a clean diet = clean skin
We know what a pimple is - a tiny blocked hair follicle attached to an oil gland--but nobody knows exactly what causes pimples or how to prevent them. What science does know for sure is that adult acne is often a hormonal process. In excess, hormones known as androgens trigger growth in oil-producing cells, leading to acne. Most adult women with breakouts, though, don't have a hormonal imbalance - their androgen receptors are just more sensitive than average. Psychological stress can also play a role, because the hormone cortisol also bumps up the body's oil production.
Understanding the birth of a pimple gets even more dicey once you factor in diet. But the idea that food may be connected to acne isn't new: back in the 1800s, doctors prescribed dietary changes for acne patients. By the mid-1900s, small studies linked acne to excessive carbs, milk, sugar and fat.
One 1959 article nicknamed acne "skin diabetes" because of its positive response to a diabetes drug. The 1969 chocolate study settled the diet-acne debate in medical textbooks, but then, in 2002, Cordain published his research on 1200 islanders in Papua New Guinea and 115 hunter-gatherers in Paraguay. "There was not a single case of acne," he says. He attributes the populations' clear skin to their clean diets. He became so convinced that he started the Paleo diet movement--and people paid attention. "In 2002, the diet-acne notion was a complete joke in the dermatology community,"
he explains. "This paper reopened the case."
The inflammation connection
One way it's thought diet could affect acne is through inflammation. The new theory formed by some scientists is that acne is a disease of Western civilisation (like obesity, type 2 diabetes and some cancers), which is triggered by overstimulation of a certain cell-growth system. The mechanism: a high sugar load increases blood levels of the hormone insulin, which triggers androgens, growth hormones and cell-signalling pathways, resulting in low-grade inflammation, more oil secretion, clogged pores and acne flares.
Some of the most-studied acne aggravators are refined sugars and processed grains, so a low-glycaemic diet tends to improve skin. A study published in the American Journal of Clinical Nutrition in 2007 found that when 43 Australian boys followed a low-glycaemic diet for 12 weeks, they had significantly fewer lesions and a healthier insulin sensitivity than those with a high-glycaemic load. A 2012 Korean study produced similar results: the skin of men on a low-glycaemic diet had less inflammation and their oil glands shrank.
In my personal, unscientific study of one, sticking to a diet free of pasta and doughnuts really did seem to shrink pimples and prevent breakouts. I'm not alone: according to a survey of more than 1500 mostly female followers of the low-GI South Beach Diet who had acne, 87 percent reported better skin. And 91% of those being treated for acne decreased the amount of their usual treatment.
Balancing out the science
It's not just pastries that can cause problems -- research suggests that milk can also alter insulin production. Skim seems especially bad: one Harvard study examined 47,000 dietary questionnaires and found that acne was associated with milk intake, especially skim milk. But because there haven't been any randomised controlled trials, the evidence isn't as strong.
And yet the case for using diet to heal acne isn't settled. Because of a dearth of large randomised trials, there's no proof that diet has a significant impact, according to Susan Bershad, an associate clinical professor of dermatology. In a 2003 paper 'The Unwelcome Return of the Acne Diet', she likened the re-emerging belief in a diet-acne link to Samuel Johnson's 18th-century view of remarriage: it's a "triumph of hope over experience". Bershad often prescribes hormone therapy to female acne patients via birth control pills or spironolactone, a medication that blocks the effects of androgens. "It's much easier to alter a person's hormonal levels with hormonal therapy than with diet," she says. "Most diets fail and most patients give up on them."
The new believers tell a more hopeful story. "I have people travelling two to three hours to see me--they're very motivated about their diet," says Bowe. She asks patients to keep a three-day food log and puts them on a low-glycaemic, milk-free, vegetable-rich diet. She's seen a dramatic increase in adult female acne patients and believes it's due to stress and high-glycaemic food. "I'm not saying that diet alone is going to do what Accutane, an antibiotic, or a topical retinoid is going to do," she says. "When you look at the studies, they're small changes, but they're not meant to be a substitute for tried-and-true acne therapy."
That neither-black-nor-white message came as a relief to me. My case isn't mild, my body is sensitive, and my willpower in the face of cheese pizza is changeable. So, after months of trying to stick to a diet, only to wake up post-slippage with massive breakouts (and guilt of the same proportion), I decided to give a dermatologist one last try. My new doctor put me on spironolactone; it's only been a month, but not since my perfect-diet experiment has a treatment worked so fast or so effectively.
Now that my medication is doing the heavy lifting of hormone balancing, I put less pressure on myself to eat my way to perfect skin. The truth is that having acne is not my fault, no matter what I eat. But maybe if I pair a tasty salmon salad with a nice pharmaceutical, I can get closer to the clear adult skin I've been chasing for so long.
