October 3, 2016

Acne continues to be a chronic issue in our young adolescents and people in their 20's. What is really the cause of acne?

Acne, simplistically, is a hormonally driven disorder of skin where increased amounts of an oily substance called sebum builds up and clogs hair follicle pores. Secondarily, bacteria begin to grow and cause inflammation in the pores. The word inflammation here is the key. If you can control the root causes of the hormone dys-regulation and the bacterial growth, you have a method to reduce the acne problem.

Currently, most dermatologists utilize drugs that reduce bacterial growth and reduce the development of oil plugs to control acne. Topically, these are mostly safe. My concern is that when acne worsens the drugs switch to oral and systemic with huge downstream negative consequences to the gut micro biome and other organs with some drugs like chronic antibiotics or worse, accutane, where the side effect list is very long.

This piece is an alternative view of therapy. A recent review of the dietary influences on acne was published in the Journal Advances in Dermatology and Allergology, April 2016 by Dr. A. Kurcharska and colleagues.

If we know that acne is driven primarily by testosterone, other androgenic hormones and growth hormones, then we need to look at causes of excess hormone production.

Dairy has been implicated in many studies as a driving force behind part of the modern acne story. Cow's milk contains lots of anabolic hormones that help a baby cow grow. These hormones, like insulin like growth factor 1, IGF-1, increase the production of sebum and thus worsen acne. In many studies, the IGF-1 level correlates with the number of acne lesions and sebum production.

Many young men consume dairy based protein shakes to build muscle in the gym only to have severe acne develop that subsequently disappears when they stop using the supplements. This is clear cause and effect in susceptible patients.

Sugar consumption is also a player in acne pathogenesis. When humans consume large volumes of sugar and flour based foods they increase their insulin production and insulin resistance which in turn has effects on the production of androgens and IGF-1 both of which can increase the number of acne lesions.

The paradox that has puzzled researchers for years has been that not all people that over consume dairy or sugar develop acne issues, however, some clearly do. As with all things in genetics and medicine, certain pathways likely responsible for these issues are active in only certain individuals. For example, polycystic ovary disease, which is devastating to young women, is clearly not just a food issue. There are many things going wrong simultaneously to become ill.

What science has shown in recent years is that inflammation in the human body is directly related to diet, genetics, stress, exercise and lifestyle factors.

What I find fascinating and frankly frustrating is that the American Academy of Dermatology does not discuss diet at all on their acne tips page???

If 50% (guessing) of acne sufferers could reduce or clear their acne with a healthy low glycemic and dairy free diet, why not at least let this group attempt to achieve success without drugs? My patients often tell me that my comments are the first that they have ever heard of this possibility.

Clearly the answer is always that we should try safer alternatives before exposing our children to toxic substances. Read the article and judge for yourself. And if you are really bold, there are hundreds of articles on this topic. Read them as well.

I am sufficiently convinced by the data that I tell all acne sufferers to try to remove all dairy and dramatically reduce the consumption of refined flour and sugar from their diet for a few months and reassess. This happens to be a fabulously healthy diet with a potential win win. If no change occurs, then at least you have ruled out a safe therapy before proceeding with risk based options.

Dr. M


Adebamawo CA, Spiegelman D, Danby FW, et al. High school dietary dairy intake and teenage acne. J Am Acad Dermatol. 2005;52:207-14.