You have control of your food, it’s interaction with your genetics, how it impacts your biology, and your acne.
Growing Up with Acne
There was a time when I blamed all the difficulties of my life on acne. I do feel it impacted the course of my life. It certainly did not help that my breakouts started in about the 3rd grade. Having learned about nutrition and my nutrition related genetics, I now have more insight into what acne causing foods I was eating and the other forces at play which resulted in the severe cystic bumps, blemishes, and white heads that plagued my life and resulted in many social struggles.
Growing up with acne was isolating and often made me feel there was something wrong with me. I’d wash my face religiously, but everyone seemed to think that I was not. The whole experience definitely left me feeling depressed, hopeless, and rejected. The psychological harm of living with acne is well documented in research.
In retrospect, struggling with acne made me a more empathic and sensitive person. I’m even a bit thankful in this regard. Having acne is one of many reasons I felt a drive to learn more about root causes of health and disease and how nutrition can help.
I’ll share with you the things I think make the biggest difference in the state of my skin health. And I use the current tense, because to this day, as a 42 year old woman at the time of this writing, I still can’t get away eating certain foods without seeing something manifest on my face. While my skin is clear and healthy now, if I have too much ice cream or drink sugary beverages, there will be a breakout that reminds me not to go down that road again.
I think of it as “the blessing and the curse of the healer”. I know because I’ve experienced it. And learning scientific reasons for ‘why me’ has been so interesting and exciting.
An Environment with Acne Causing Foods
When I was young, my mom and dad were both working full time. They were stressed middle class people, like most of us. My mom cooked (and cleaned up) a lot of dinners for our family of five with basically no help from anyone. We also ate out regularly as it helped alleviate some of the stress which my dad was happy to be able to do by paying for dinner. Sometimes it was fast food and sometimes one of the many large buffets popular in Florida, where I grew up.
In our house, there was always soda, ice cream, cheesecake, and ultra processed foods and snack foods. I have some compassion with how easily people fall in with processed foods. Life is busy, isn’t all that sweet much of the time, and ready to eat processed foods provide easy comfort, sweetness, and joy. But all at a price and to leave you feeling like crap.
In this day and age we have easier access to sweets and ultra processed foods than probably anyone, ever. We are also under considerable stress, and have evolved under stress that has taught us on a genetic level to go for the sweets and fats to survive (think famished cave people and early civilizations). So there is alot going on under the surface making our food choices at risk if there’s no conscious, intentional effort to make a different choice.
So I’m a kid, and am drinking Pepsi and eating Frito’s for a snack and sometimes even cheesecake for breakfast. To this day, regular sodas will make me break out. If ice cream or candy have any sort of frequency to them, I break out. Every once in a while I can get away with it. I usually have a break out early October, when my husband and son have birthday’s a week apart and there is cake around. And again at my birthday for the same reason. At the time of this writing I’m pregnant, and give into cravings for sweets more, which shows up on my face. Why?
Sugar: High Intake Sets a Stage for Acne
Foods with a high glycemic index, or foods that cause your blood sugar to spike quickly, can play a role in acne. Without having diabetes, some people with acne have higher levels of insulin, which brings sugar into the cells. Larger glycemic loads, or larger portions of sugary or carbohydrate rich foods, cause a larger rise in IGF-1, a hormone that also happens to stimulate cell proliferation and sebum production (making skin oily and pores easily clogged).
This sets the stage for acne to develop. So for some people, a big sugary beverage can set all of this off and increase their chances of developing acne. Glycemic index and glycemic load (the portion of carbohydrate food) levels have been shown in multiple studies to be significantly higher in patients with acne than in control participants.
Dairy Linked to Acne Risk
Dairy is also frequently found to be a culprit in the development of acne. While I am no longer vegan, I have to admit that when I was, my skin cleared rapidly. To put this in context, at that time I basically went from eating a fast food standard American diet (SAD) to hanging out with some vegans, getting inspired, and making a dramatic diet change.
A meta-analysis, where the results of many studies are pooled together for a larger effect size, found a positive, dose dependent relationship between dairy, total milk, whole milk, low-fat and skim milk consumption and acne occurrence. The same analysis found no significant association between yogurt or cheese and acne development.
Interestingly, research has found links between lactose intolerance and acne. It may be possible to avoid some of the acne associated with consuming dairy products by choosing lactose free dairy products. Lactose free dairy products have simply had lactase enzymes added to the milk to break down the milk sugars.
For those who don’t make adequate lactose, symptoms of whole lactose sugars that did not get digested adequately would be GI upset like gas, bloating, and diarrhea. Yogurt has little to no lactose, as the bacterial fermentation that makes yogurt yogurt breaks down lactose in the process. So it would make sense that the meta-analysis did not find a relationship between yogurt and acne if lactose is the culprit.
High Fat Foods and Fat Types Impact Acne
Research links the consumption of high fat foods to acne, but let’s make more nuanced distinctions about fats and how they affect acne.
Omega 6 and 3 Fats and the Phospholipid Bilayer of Cell Membranes
Fats we consume become part of our cell membranes, and when the body is creating or resolving an inflammatory process, it cleaves off fats from our cell membranes to create molecules involved in the signaling that regulates these inflammatory responses.
We have all heard that you are what you eat. Your cell membranes are made of a phospholipid bilayer composed of fats. And what you eat makes is reflected in what fats this phospholipid bilayer is made of. If we consume more pro-inflammatory fats, you may see that inflammation that lingers in the body. To reduce inflammation when needed, it may be helpful to consume enough anti-inflammatory fats, like EPA, DHA, and ALA.
A standard American diet, or SAD diet, has been estimated to have a high ratio of omega 6 to omega 3 fats. Omega 6 fats perpetuate inflammation while the omega 3 fats help calm and resolve inflammation. Eating more fatty fish, walnuts, flax, and chia seeds along with reducing the intake of higher omega 6 oils like corn and soy oil can help improve your ratio. Additionally, choosing grass fed and pasture raised animal products will help you get less omega 6 and more omega 3.
Studies have found that supplementing with anti-inflammatory fats will help change the types of fatty acids found in the skin. To see if you may benefit from taking an omega 3 supplement, consider testing your red blood cell fatty acid composition to see where you stand.
Fried Foods and Oxidative Stress
Furthermore, when we consume fried foods, we are eating oxidized fat. This in and of itself creates inflammation. If you aren’t eating adequate antioxidants from foods like fruits and vegetables, it may never really resolve the inflammatory process.
So, we want to improve the balance of omega 6 and 3 fats with our diet, avoid fried foods, and possibly supplement with some omega 3s. Avoiding hydrogenated oils can also have a positive impact on skin health, along with reducing risk of diabetes and heart disease. Hydrogenated oils can form with fried foods, particularly when they are fried in oil that has been used over and over.
Hydrogenated oils are also used by the food industry to change the texture and shelf life of processed foods. Some studies link chocolate to acne. I believe this is in part due to the high sugar content of many chocolate candies and may also be linked to the use of hydrogenated oils in many poor quality chocolate products. Chocolate is made from cacao beans that do not have any qualities related to acne risk in themselves.
Acne Causing Foods = Inflammation Causing Foods
The vegan diet contains no animal products of any kind, so the dairy was not there when my skin improved. I was also eating a lot more fruits and vegetables, less sugar, more whole grains, and these changes would also improve the overall nutritional quality of a diet. Eating more unprocessed and plant based foods, meant less added sugars and more vitamins, minerals, and fiber.
Being on a vegan diet also, for me, meant ultra processed foods became off limits as part of an overall withdrawal from the mainstream that provided a much needed detox and attunement with my body and health. A healthier diet quality undoubtedly lessens inflammation in the body, and inflammatory markers have been found to be higher in those with acne.
I stayed vegan for a few years, transitioned to a vegetarian diet after working on a farm with great eggs and when I started dreaming of cheese. After 10 or 11 years I didn’t get why I wasn’t improving athletically, learned I was anemic, was feeling anxious and depressed, and decided to start eating some pasture raised, grass fed, organic animal products. Thankfully by this time grass fed and pasture raised animal products were becoming more commonly available in stores.
The Microbiome and Probiotics: Gut Health Impacts Skin Health
Emerging research is also shedding light on another intriguing player in the intricate world of acne: the skin microbiome and probiotics. Another benefit to eating less processed and more whole foods is that you support healthy bacteria in your gut. Your gut microbiome is a collective term for all the different microbes that reside in your gut.
Whether beneficial or harmful bacteria exist in your gut depends on one primary thing: the ones you feed. Your diet is their diet.
The Skin and Gut Microbiomes: Our skin and our guts are home to a diverse community of microorganisms, collectively known as the microbiome. These microscopic inhabitants include bacteria, fungi, and viruses, which coexist in a delicate balance. When this equilibrium is disrupted, it can have consequences for skin health, potentially triggering or exacerbating conditions like acne.
The Role of Probiotics: Probiotics, often associated with digestive health, are beneficial microorganisms that can support the delicate balance of our skin’s microbiome. When applied topically or consumed as supplements, these friendly bacteria can influence the skin microbiome’s composition and functionality in several ways:
- Restoring Balance: Probiotics can help restore a healthy balance among skin microorganisms, reducing the growth of acne-causing bacteria like Propionibacterium acnes (P. acnes).
- Strengthening the Skin Barrier: Probiotics may enhance the skin’s natural barrier function, making it less susceptible to inflammation and external irritants that can trigger acne breakouts.
- Anti-Inflammatory Effects: Some probiotic strains produce anti-inflammatory compounds that help soothe the skin and reduce the redness and swelling associated with acne lesions.
- Modulating the Immune Response: Probiotics can influence the skin’s immune response, helping to regulate the overproduction of sebum (skin oil) and preventing clogged pores, a common precursor to acne.
- Enhancing Skin Health: By fostering a healthier microbiome, probiotics may contribute to overall skin health and radiance, potentially reducing the frequency and severity of acne outbreaks.
The effectiveness of probiotics in managing acne can vary from person to person. Factors like the specific strains of probiotics used, the overall health of the microbiome, and individual genetics play a role in determining outcomes.
While the potential benefits of probiotics in acne management are promising, they should not be viewed as a standalone solution. A holistic approach to acne care, which includes proper skin care practices, a balanced diet, and, if needed, medical interventions prescribed by a dermatologist, is typically recommended.
Vitamin A Issues Impact Acne Risk
While I was still vegan in college, my chemistry professor said if you eat a lot of carrots, the palms of your hands may turn orange. I was already drinking fresh carrot juice, so as an experiment, I tried having it every day for a while. And to my amazement, my palms indeed, did turn orange. I did not know it at the time my palms were orange, but nutrigenomics had another piece of the puzzle.
Acne has genetic and environmental factors involved. Since the Human Genome was mapped in 2003, science has studied this blueprint for over 20,000 different proteins, which are the building blocks of the human body giving risk to the various structural components of the body, hormones, neurotransmitters, and other cell-signaling that make the body is run smoothly.
Actually, just 2% of the genome codes for protein while much of the rest it thought to be involved with the tight regulation of gene expression. Let’s just define a few things so this next part will make more sense.
- The human genome functions as a blueprint for proteins, which is genetics. Genomics is how nutrition and our environment interacts with our biology based on that blueprint. SNPs are Single Nucleotide Polymorphisms which are slight variations in the coding for proteins, resulting in changes in how proteins are built, and therefore how the enzymes (for example) they are building function.
- The blueprint, gene sequencing, SNPs
- Examples of SNPs: BCMO1, MTHFR
- The blueprint, gene sequencing, SNPs
- Consider how nutrition and environment can impact physiology based on blueprint.
- The influence of diet on gene expression is nutrigenomics.
Many years later, when I started learning integrative and functional nutrition, I investigated the raw data from my 23andMe test and ran it through Pure Encapsulations Pure Genomics report.
I found out I have two SNPs on BCMO1. BCMO1 converts beta carotene, a precursor to vitamin A that we get from orange plant foods like carrot or sweet potato, into retinol, the active form of vitamin A. Having 2 SNPs in this area of my genes meant that I don’t do this conversion very effectively at all. In fact, having 1 SNP results in a 32% reduced conversion, while having 2 SNPs results in a 69% reduction.
So going back to the carrot juice days, I now think that all that beta carotene was backing up a bit as it was in a sort of bottleneck traffic jam trying to get converted to retinol with poor efficiency.
Vitamin A’s Role in Skin Health
Vitamin A is used by the body to grow new skin cells, break down dead skin cells, and regulate keratin production in the skin so dead skin cells don’t clump together to allow acne causing blockages in your hair follicles. It also regulates skin tone and impacts the scars left by acne on the skin. And, it affects your oil glands’ size and productivity.
So you can see how having a less effective inner vitamin A factory could impact one’s risk of developing acne. I did end up going on 2 rounds of Accutane, a vitamin A derivative, which helped a lot, but was no picnic.
You really have to be careful with vitamin A, and I cannot emphasize this enough. When I was on Accutane, there were many warnings about avoiding pregnancy as it causes birth defects if you become pregnant while taking it. It is recommended by Accutane to wait at least 1 month after completing a course of Accutane until becoming pregnant. This is the kind of thing you really have to discuss with your doctor rather than take into your own hands.
That said, the dose makes the difference. From a strictly daily multivitamin standpoint, one approach would be to choose a multivitamin with some amount of preformed vitamin A. Some supplements will have all of the vitamin A provided as beta carotene, whereas some will provide part beta carotene, and part a preformed vitamin A. This can be helpful if you are someone with the SNPs that impact conversion of beta carotene to retinol as I mentioned before. The amount of vitamin A provided in a daily multivitamin would not typically exceed the RDI, which is 900 mcg for adult men and 700 mcg for adult women. Preformed vitamin A is possibly unsafe when taken in doses greater than 3,000 mcg (or 10,000 units) daily.
Can a Food Sensitivity Test Help with Acne?
Some studies suggest, yes. To determine what foods you are sensitive too would take a long process of following an elimination diet, or trying a food sensitivity test. But, not all food sensitivity tests are the same, and it would not make sense to go that route without considering all of the other information in this article as well.
The FIT test measures something called complement protein, which has been linked to the inflammation involved in acne. Read more about FIT testing in my blog post that compares it to an elimination diet.
Get Your Guide to Clear Skin!
There is a nutrition based solution to acne. If you are eating acne causing foods and have any susceptibility to acne, you can expect to repsond poorly to other forms of treatment (topical treatments for example). Applying this diet information will only support your efforts to break the breakout cycle while also getting healthy overall!
To help you integrate this information, I’ve created an easy, informative guide so you can start seeing clearer skin.
If you are ready to put an end to your acne woes, and to make some changes to your diet, then you’ll want to get my PDF guide that gives you all the deets on changing your diet to stop acne in its tracks. Experience the relief and joy of not feeling like a helpless victim, living a small life as you shyly hide your face from the world.
In the guide, I also suggest the right vitamins and supplements you can take to support your skin (and overall) health. Get your guide to clear skin today!
Kim H, Moon SY, Sohn MY, Lee WJ. Insulin-Like Growth Factor-1 Increases the Expression of Inflammatory Biomarkers and Sebum Production in Cultured Sebocytes. Ann Dermatol. 2017 Feb;29(1):20-25. doi: 10.5021/ad.2017.29.1.20. Epub 2017 Feb 3. PMID: 28223742; PMCID: PMC5318522.
Meixiong J, Ricco C, Vasavda C, Ho BK. Diet and acne: A systematic review. JAAD Int. 2022 Mar 29;7:95-112. doi: 10.1016/j.jdin.2022.02.012. PMID: 35373155; PMCID: PMC8971946.
Penso L, Touvier M, Deschasaux M, Szabo de Edelenyi F, Hercberg S, Ezzedine K, Sbidian E. Association Between Adult Acne and Dietary Behaviors: Findings From the NutriNet-Santé Prospective Cohort Study. JAMA Dermatol. 2020 Aug 1;156(8):854-862. doi: 10.1001/jamadermatol.2020.1602. PMID: 32520303; PMCID: PMC7287950.
Aghasi M, Golzarand M, Shab-Bidar S, Aminianfar A, Omidian M, Taheri F. Dairy intake and acne development: A meta-analysis of observational studies. Clin Nutr. 2019 Jun;38(3):1067-1075. doi: 10.1016/j.clnu.2018.04.015. Epub 2018 May 8. PMID: 29778512.
Pilkington SM, Rhodes LE, Al-Aasswad NM, Massey KA, Nicolaou A. Impact of EPA ingestion on COX- and LOX-mediated eicosanoid synthesis in skin with and without a pro-inflammatory UVR challenge–report of a randomised controlled study in humans. Mol Nutr Food Res. 2014 Mar;58(3):580-90. doi: 10.1002/mnfr.201300405. Epub 2013 Dec 5. PMID: 24311515; PMCID: PMC4377077.
Chilicka K, Dzieńdziora-Urbińska I, Szyguła R, Asanova B, Nowicka D. Microbiome and Probiotics in Acne Vulgaris-A Narrative Review. Life (Basel). 2022 Mar 15;12(3):422. doi: 10.3390/life12030422. PMID: 35330173; PMCID: PMC8953587.
Cook M, Perche P, Feldman S. Oral Vitamin A for Acne Management: A Possible Substitute for Isotretinoin. J Drugs Dermatol. 2022 Jun 1;21(6):683-686. doi: 10.36849/JDD.6781. PMID: 35674761.
Giang J, Seelen MAJ, van Doorn MBA, Rissmann R, Prens EP, Damman J. Complement Activation in Inflammatory Skin Diseases. Front Immunol. 2018 Apr 16;9:639. doi: 10.3389/fimmu.2018.00639. PMID: 29713318; PMCID: PMC5911619.
Anne Marie Berggren RDN, MS, CDN, CNSC is a Registered Dietitian with a Master's Degree in Nutrition, training in integrative and functional nutrition, nutrition for mental health, obesity and weight management, is a board certified nutrition support clinician, and an adjunct professor for the Stony Brook Graduate Nutrition Program teaching advanced clinical nutrition.