Sugar and acne

You wake up. Your chin feels tender. Great – a whopping doozy of a zit is swamping half your face (well, maybe not half your face, but it feels that way).

Pimples are commonplace, and often disappear within a few days. Acne, on the other hand, is a much more sustained and complex condition, which can affect nearly every teen at some point, though in varying degrees of severity, and can continue into adulthood.¹

What is it?

Acne, broadly speaking, is a skin condition that can affect the blood vessels and/or the pilosebaceous glands (those oil glands shared with hair).

Acne vulgaris is primarily a skin disorder of teens and young adults – though it can definitely persist or manifest in adulthood. It mostly commonly manifests on the face, but can also appear on the chest and back.²

At puberty or in times of hormonal imbalance, androgen hormones, such as testosterone, stimulate oily sebum production from pilosebaceous glands. Small cysts form, known as comedomes, which can become inflamed and infected, due to the presence of specific bacteria within the cysts who love the oily environment.

Various things may alter the expression and severity of the condition, including (though not limited to) medications, skin trauma, certain cosmetics and chemicals, and the menstrual cycle. Genetics and polycystic ovarian syndrome may also have a role to play.²

Unlike its vulgaris cousin, acne rosacea is more common in adults over 30 years. It presents with inflamed, dilated capillaries creating a red, spidery appearance. Whilst there mightn’t be the cysts that acne vulgaris presents with, small pimples can manifest as part of the condition.²

Does diet have anything to do with it?

There appears to be certain foods that exacerbate flare-ups of acne rosacea, including alcohol, hot drinks and spicy foods, though this can vary from person to person.²

For acne vulgaris, popular belief is that junk food and chocolate are the culprits for worsening the situation.

As far as science is concerned, the jury is still out as whether certain foods can cause acne. But are there things we can do that minimise the severity?

Looking specifically at acne vulgaris, balancing androgen production by reducing levels of free androgen may be an avenue to consider. And a way to do this is via managing levels of insulin-like growth factor.

Acne vulgaris and insulin

The theory is that excessive free levels of insulin-like growth factor-1 is encouraged in states of high insulin – such as hyperinsulinemia or insulin resistance.³ Increased insulin-like growth factor-1 increases the production of free androgens. Together, they can contribute to greater keratinocyte proliferation and sebum production, leading to acne.^1;3

Therefore, a diet high in sugar and refined, heavily processed foods may exacerbate acne presentation, while a low glycaemic, whole food diet may reduce the severity and used in treatment and symptom prevention. In fact, a small Australian clinical trial has shown improvement in lesion counts, fasting insulin and free androgen levels, insulin resistance and body mass in those adopting a low-GI diet over 12 weeks (25% protein, 65% low GI carbhydrates, and 30% fat), compared with those on a high GI diet.⁴

A more recent cross-sectional study of 2,300 15-18 year old students found a correlation between increased risk of acne and higher consumption of ‘junk food’ – including sausages, burgers, pastries and cakes.⁵

But why doesn’t everyone with raised insulin or resistance present with acne?

Acne may not be caused by diet, per se, and more research is needed. But perhaps certain dietary factors may aggravate the condition in susceptible individuals.⁶

Where does that leave us?

Ultimately, acne is a difficult condition to treat. Medications include retinoids, antibiotics, or hormonal agents such as the oral contraceptive pill.

And while hitting up hard-core medications long-term mightn’t be ideal, they can be considered necessary for short-term treatment due to the psychosocial impact felt by those with the condition, especially teens.⁷

If we can take advice from what research is inferring, by adopting a dietary regime rammed with real, whole foods, symptoms may be eased. Foods like lean meats, oily fish, nuts, seeds and an array of vegetables are not only low GI, but also packed with skin supporting nutrients such as zinc, omega-3 fatty acids, and vitamins A, C and E, which may help with skin integrity and recovery.

In severe cases, we would always advocate seeking assistance and advice from your healthcare practitioner, who can work with you and your individual situation, to ensure the short and long-term impact is minimised.

By Angela Johnson (BHSc Nut. Med.)

References:

1. Hechtman, L 2012, Clinical Naturopathic Medicine, Churchill Livingstone, Chatswood, N.S.W
2. McCall, CO & Lawley, TJ 2008, ‘Eczema, Psoriasis, Cutaneous Infections, Acne, and Other Common Skin Disorders’, in A Fauci, E Braunwald, D Kasper, S Hauser, D Longo, J Jameson & J Loscalso (eds), Harrison’s Principles of Internal Medicine, 17th edn, McGraw Hill Medical, Sydney, pp. 312–320
3. Liakou, AI, Theodorakis, MJ, Melnik, BC, Pappas, A, & Zouboulis, CC 2013, ‘Nutritional clinical studies in dermatology’, Journal of Drugs in Dermatology, no. 10, p. 1104.
4. Smith, RN, Mann, NJ, Braue, A, Mäkeläinen, H, & Varigos, GA 2007, ‘A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial’, The American Journal Of Clinical Nutrition, vol. 86, no. 1, pp. 107-115.
5. Aksu, AK, Metintas, S, Saracoglu, ZN, Gurel, G, Sabuncu, I, Arikan, I, & Kalyoncu, C 2012, ‘Acne: prevalence and relationship with dietary habits in Eskisehir, Turkey’, Journal Of The European Academy Of Dermatology And Venereology: JEADV, vol. 26, no. 12, pp. 1503-1509.
6. Pappas, A 2009, ‘The relationship of diet and acne: A review’, Dermato-Endocrinology, vol. 1, no. 5, pp. 262-267.
7. Revol, O, Milliez, N, & Gerard, D 2015, ‘Psychological impact of acne on 21st-century adolescents: decoding for better care’, British Journal of Dermatology, vol. 172, pp. 52-58.