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The Role of Diet in Acne by David South, M.D., F.A.A.D., F.A.C.P. in private practice in Freedom
With acne affecting 40-50 million people in the USA, there is always interest in anything simple, such as diet, which might improve this common disorder. The belief that diet affects acne is widely held, with one survey showing 32% of patients feeling diet caused acne and 44% felt diet aggravated their acne. This despite all prior scientific studies failing to show any evidence for these assumptions. Renewed interest in this debate developed when it was noted that there is essentially no acne in extremely underdeveloped countries with no processed foods, where the people are hunter-gatherers, and milk is not a staple. Further, there are anecdotes that when such people move to an industrialized country, they then are at the same risk as everyone else for acne. A current theory on how an” American style” diet could adversely affect acne is as follows: All foods have a certain potential to affect insulin and blood sugar (glucose) levels, unrelated to their caloric content. As an example, the body handles 100 calories of broccoli differently than 100 calories of double fudge ice cream. This is expressed scientifically as a glycemic (sugar) load and index, which have now been established for all foods. Totally unprocessed foods have a low load/index and highly processed foods and milk (the favorites of teenagers) have a high load/index. Foods with a high load/index are known to increase both insulin and an important hormone (IGF-1) known to be involved with the first steps of acne pimple formation. Clinically this is substantiated by studies in women showing those with acne having higher levels of IGF-1 than those without. Further, women with polycystic ovarian disease (in which acne is a major feature) have high IGF-1 levels. When treatment improves their insulin metabolism and IGF-1 levels normalize, their acne also improves. High glycemic load foods also have some adverse effects on other male-like (androgenic) hormones known to be involved with the cause of acne. Milk stands out as a food that not only increases IGF-1 levels, but contains variable amounts of a variety of hormones known to be involved with acne. A recent study showed an adverse effect of skim milk (again processing seems to be important) on acne in adolescent males. All prior observations of populations and scientific studies are limited by the inability to completely control for the very important factors of genetics, environment, and actual (as opposed to reported) diet history. Whereas it is intriguing to think one could control acne by diet alone, there is no present data to confirm or refute this idea definitively, and more research and nutritional studies are needed. From a practical standpoint, even if it is shown that a diet of unprocessed foods definitively prevents acne, it is highly unlikely that busy Americans will devote the time it takes to shop for, clean, chop, cook or otherwise prepare these foods, (not to mention their taste on the palates of the average teen) and make this a viable treatment option.
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