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Yesterday, when my friend Tina came in through my front door, her first words to me were: “Don’t look too closely, I’m having an adult acne day!”  I could easily relate, as I’m currently on course number three of Accutane.

I’ve been interested in (and have noticed) the link between diet and acne for years, though for a long time there were only a handful of studies available on the subject.  I’d found that my flares of cystic acne over the years always happened after vacations. I normally stay away from refined flours, sugar, and dairy products (I’m milk protein allergic), but faced with limited healthy options while away, I typically end up eating everything in sight, and end up looking like one of my favourite “cheat” foods: a pizza.

I’d been on Accutane (a very potent vitamin-A related prescription oral medication for acne) for a few days, when I ran into naturopath Alan Logan at an event in Vancouver.  Logan, who lectures at Harvard, caught my attention years ago because of his emphatic commitment to evidence-based medicine as the basis for his nutritional recommendations.  Logan told me that he had just published The Clear Skin Diet, a literature-based book on diet and acne with Massachusetts dermatologist Dr. Valori Treloar.  He gave me a copy, and it was all I could do not to stay up all night reading it.

I’ve written articles in the past about the relationship between pro-inflammatory foods, high glycemic foods, milk and acne.  The plot has thickened considerably since, supported by a wave of recent research.   One of the leaders continues to be prominent Dartmouth University dermatologist (and former president of the Canadian Dermatology Association) F. William Danby, whose website www.acnemilk.com details the mounting evidence supporting his theory linking milk consumption and acne.  Several new studies have been published over the last few years.  One of the most recent ran in the January 2008 Journal of the American Academy of Dermatology: researchers from the Department of Nutrition at the Harvard School of Public Health studied over four thousand teenage boys, and found a significant association between skim milk intake and acne.

Experts give several explanations for this dairy-acne link.  According to Logan and Treloar, there are at least four precursors to DHEA (the “acne hormone”) in milk from pregnant cows.  And though milk has a low glycemic index, research from the 2001 European Journal of Clinical Nutrition demonstrated that milk-containing meals increase levels of insulin.  Insulin may be a “significant player” in excess sebum production, leading to blockage of skin follicles and acne.

In a previously published article, a few years ago, I had expressed a hope that one day we would have clinical trials supporting the diet-acne relationship.  In 2007, the Journal of the American Academy of Dermatology published a clinical trial from Australian researchers, that assigned acne patients to a “high protein, low glycemic load diet” based on lean meats, poultry, fish, whole grains and whole fruits.  Those in the dietary intervention group had significantly less acne lesion counts than controls, demonstrated reduced androgen (male hormone) levels, and had increased levels of insulin-like growth factor (IGF) binding proteins that lower levels of acne-causing hormones.

I filled the margins of Logan and Treloar’s book with notes, and I’ll share some of the highlights.   Excess inflammation, which “fans the flames” of acne, results from both lack of dietary antioxidants and excess omega-6-rich oils in the North American diet.  Omega-3-rich fish, particularly salmon and sardines, continue to be the most important part of an anti-inflammatory, anti-acne diet.

Studies have found that acne sufferers demonstrate lower blood levels of antioxidants, and several studies in Turkey concluded that levels of enzymes which control the antioxidant defense system are altered in people with acne.  Logan and Treloar hypothesize that “blood levels of antioxidants are used up more readily in those with acne because there is a greater demand to deal with free radicals – this is actually a common occurrence in chronic medical conditions characterized by both oxidative stress and inflammation”.  Other studies have also found that acne sufferers eat less fruits and vegetables than clear-skinned controls.

Fibre also gets a nod as a force against acne-causing hormones, while anti-inflammatory antioxidant green tea gets additional credit as the “ultimate anti-stress beverage”, lowering the acne-linked stress response through GABA effects in the brain.  According to research in the 2005 American Journal of Clinical Nutrition, dairy-free dark chocolate or cocoa improve blood flow to skin cells and prevent oxidative skin damage and stress.

All of this is very exciting news for me and anyone else who would far rather look like a peach than a pizza.  However, I appreciate the fact that Treloar and Logan temper their hopeful message with practical guidance:  “While most people will see improvement with the diet and lifestyle changes we propose, a few will not.  They may find that their overall health, energy levels, and perhaps mental outlook improve, yet the acne stubbornly persists.”  They emphasize that traditional dermatology still holds a necessary place in the acne treatment.  However, this “clear skin diet” offers real hope to countless acne sufferers, and may help prevent relapses following conventional therapies.

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