Acne Has Nothing to Do with Diet – Wrong!

November 2003

Standard dogma from your medical doctor is that your oily skin and acne have nothing to do with the foods you eat. Next time you hear this message, ask for the evidence. You will find this learned professional speechless and almost empty-handed , because this incorrect information dates back to a single article published by Dr. James Fulton in the Journal of the American Medical Association almost 35 years ago (in 1969). Furthermore, the results of this study have been justly criticized and effectively discounted for more than 25 years.2 Still countless millions suffer needlessly.

Dr. Fulton studied 30 adolescents (14 girls and 16 boys) attending an acne clinic and 35 young adult male prisoners with mild to moderate acne. The Chocolate Manufacturers Association of America provided the study with two kinds of candy bars – one with and one without chocolate. Both bars were made mostly of fat and sugar and had similar amounts of calories (557 to 592 calories per bar). The subjects then added one or the other bar to their usual daily food intake for the next 4 weeks. Nothing else was changed in their diet during the experiment, except for the addition of the candy bars. Dr. Fulton and colleagues then counted the pimples on their young faces. Forty-six of the 65 subjects stayed the same, 10 were better and 9 were worse. (Not unexpectedly, the rate of sebum excretion increased by 60% with the addition of either kind of the high-fat, high-sugar candy bar (with or without chocolate) in all subjects.3) (Sebum is a fatty substance secreted by the skin.) Yet the results of this single, seriously flawed, and completely irrelevant (it only tested the effects of chocolate candy bars), experiment are the heart and soul of the claim that “diet has nothing to do with acne.”

The “Acne Plague” is Found Only Where Rich Food is Eaten

Acne develops when the pores in the skin (sebaceous follicles) become blocked with dead skin (hyperkeratinization); then fatty materials (sebum) accumulate within the blocked pore. This overstuffed pore then becomes infected by bacteria, resulting in inflammation – the pimple. The bacteria eat the sebum and thrive. Prevention and treatment are now directed at unblocking the pore, reducing the accumulation of the sebum, lessening inflammation, and killing the bacteria, by various pharmaceuticals sold over-the counter and by prescription. As with all Western diseases, there is a better way – and that is attacking the cause and invoking the cure with a healthy diet.

Incidence of acne in Western Countries4




Adolescents
79% to 95%

Older than 25
40% to 54%

Middle aged
3% to 12%

Incidence of acne in
underdeveloped countries: often 0%

Multiple studies of people living on their traditional native diets – almost all of which are low fat-diets, based on starches, vegetables, and fruits – have found these people have little or no acne. When these healthy people learn the Western diet, acne becomes an epidemic – as do the other diseases of modern civilization (obesity, heart disease, diabetes, prostate and breast cancer). Examples of well-studied populations include the Kitavan Islanders of Papua New Guinea who live on a diet of 70% carbohydrate from plant foods, and the Ache’ of Eastern Paraguay with a diet of about 70% of the calories coming from manioc (cassava – a root vegetable).4 Acne is completely absent – not a single sufferer – in these two populations living primarily on unprocessed, low-fat plant-foods.

People living in Africa on plant-food-based diets show similar freedom from acne. Southern African Bantu adolescents have an incidence of acne of 16%, compared to the whites in Africa with a 45% incidence.4 Zulu have been reported to develop acne only after they move from the villages to the cities and learn a Western diet.5 People in both Kenya and Zambia have far less acne than do blacks in the USA.5 People from Malaysia living on rice-based diets have been reported to have no acne problems.6 A rice-centered diet is also the reason people in rural Japan have very few skin troubles. Even those Europeans on lower-fat diets (Crete, Southern Italy) have less acne compared to those in Western Europe on higher fat diets.6 The Yemenite Jews following a healthier, lower-fat diet than European Jews report less acne, too.6 The picture is clear to me: switch from a plant-based-diet to a high fat Western diet centered on meat and dairy, and your face lights up.

Undoubtedly, there are components of the Western diet that cause the skin to become unsightly – this is not a normal, natural condition – this is a disease.

Ways Diet Causes Acne

1) A high-fat diet increases the amounts of fats in and on the skin (sebum). With extreme changes in food intake such as almost total avoidance of fat (like the McDougall diet) or inclusion of fat as the sole source of food the amount of sebum production has been found to be greatly altered.3 Please note that it does not take much fat on the skin to plug the pores, feed the bacteria, and cause acne in susceptible people. Also note the bacteria eat vegetable oil as well as animal fats.

2) The rich Western diet increases sex hormones causing precocious puberty (girls mature at 12 rather than 16 – boys mature earlier too). Earlier maturation of women is known to be associated with more severe acne.7 Excess male hormones (androgens) in men and women are well known to cause acne and increase production of sebum.

3) Growth hormones adversely affect the sebaceous glands causing them to become easily plugged. Insulin-like growth hormone-1 (IGF-1) is known to be increased by dietary protein (meat, poultry, etc.), and especially by dairy products. Research shows elevated IGF-1 levels are associated with more acne.4

Other factors that may play a lesser role are:

4) Acne is promoted by lack of antioxidants and other plant-derived nutrients that keep the skin healthy.8

5) Poor circulation to the skin from a high-fat diet allows the skin to be more susceptible to acne.9,10

6) Fat and oils, brought to the skin by hands picking up greasy French fries and burgers, cause acne – this directly-applied grease plugs the pores and feeds the bacteria.

Preventing and Curing Acne

Everyone knows that acne is related to surging hormones during adolescence, but to blame acne on puberty is like blaming heart disease on old age. People get more heart disease as they get older, but only when they eat the wrong diet. Heart disease does not exist where people eat healthy, such as in rural Africa and Asia. Heart disease is also cured when sick people change to a healthy diet. Same story with acne.

Acne may be the best angle you will ever use to sell a healthy diet to your teenage children. After changing to plant-based, low-fat foods you (and they) should expect to experience a noticeable reduction in the oiliness of your face and hair within about 4 to 7 days. The pimples start to resolve shortly after that, but sometimes it takes as long as a month to start to show improvement. Strict adherence to the diet is absolutely essential, because I have found that small indiscretions result in a crop of pimples within a day or two. One night out to the pizza parlor will mean a face-full of flare-ups before you can say, “I shouldn’t have ordered the extra cheese and pepperoni.” This means you must follow a diet based on starches with fruits and vegetables – strictly avoiding all added fats, including nuts, seeds, avocados, olives, soybeans, and vegetable oils – even the so-called “good” fats. Wash all oils from your hands before touching your face, shampoo the oil from your hair daily, and use a “buff pad” to help open your pores and thoroughly clean your skin. If your skin is not improving, then my first guess is you are not adhering strictly enough to your diet and skin care. After all, millions of people living in Papua New Guinea, Paraguay, rural Africa and Asia who eat a plant-based diet are acne-free throughout their lives – so why can’t you also be acne-free, if you behave like they do?

References:

1) Fulton JE Jr. Effect of chocolate on acne vulgaris. JAMA. 1969 Dec 15;210(11):2071-4.

2) Michaelsson G. Diet and acne. Nutr Rev. 1981 Feb;39(2):104-6.

3) Rasmussen JE. Diet and acne. Int J Dermatol. 1977 Jul-Aug;16(6):488-92.

4) Cordain L. Acne vulgaris: a disease of Western civilization. Arch Dermatol. 2002 Dec;138(12):1584-90.

5) Rosenberg EW . Acne diet reconsidered. Arch Dermatol. 1981 Apr;117(4):193-5.

6) Hoehn GH. Acne and diet. Cutis. 1966; 2:389-94.

7) Thiboutot DM. Diet and acne revisited. Arch Dermatol. 2002 Dec;138(12):1591-2.

8) Logan AC. Omega-3 fatty acids and acne. Arch Dermatol. 2003 Jul;139(7):941-2;

9) Rim SJ. Decrease in coronary blood flow reserve during hyperlipidemia is secondary to an increase in blood viscosity. Circulation. 2001 Nov 27;104(22):2704-9.

10) Kuo P. The effect of lipemia upon coronary and peripheral arterial circulation in patients with essential hyperlipemia.