Acne is a miserable condition, particularly severe acne. When I used to work in research into acne I often used to get people asking me if it was affected by what they ate. A lot of people claimed that chocolate, particularly Mars bars for some reason, seemed to make their spots worse. I used to reply by quoting what I think is the consensus amongst dermatologists. Studies have failed to pick up any link between diet and acne.
I am a big fan of the scientific method and I think it is an amazingly powerful tool for solving problems – so when people apply a scientific approach to answer a question like the effect of diet on acne my initial reaction is to accept this.
But it is also true that sometimes you have to question what you have previously believed. Anecdotal evidence is weaker than evidence from proper trials – and anyone who eats a bar of chocolate one day and gets an outbreak of acne the next day could simply be coincidence. But the number of people who have told me this is very large. And they all seem to report the same thing – the timescale is from a few hours up to about a day. It has been troubling me for some time.
The trouble is, you can prove anything if you are selective with the evidence. To really make some progress you need to explain all the observations. Why are so many people convinced that chocolate is a cause of acne? But also why have dermatologists and doctors not picked up on the link?
Personally, I am very lucky in being one of the very small number of people who has never suffered from acne either as a teenager or as an adult. I am also someone who likes to experiment, so I have over the years tried a number of diets. Not one of them has had the slightest impact on my skin – which has always remained resolutely healthy and in good condition. In fact I have never really found that changing my diet has had very much impact on my day to day life.
That is until very recently. I have just been trialling a raw food diet. The principle behind this one is fairly simple. You just eat uncooked fruit and vegetables. The is in effect to avoid eating large amounts of sugar or simple carbohydrates. I don’t know if this is obvious to non-chemists, but eating bread is very similar to eating to sugar from a nutritional point of view. The body breaks down the carbohydrate to sugar very quickly. Try keeping a bit of bread in your mouth for a few minutes, chewing it occasionally. It will soon begin to taste sweet. Eating a lot of sugar very quickly gives your body the problem of dealing with it. The body responds by producing insulin. The suggestion is that once the insulin has dealt with the sugar spike it then depletes your blood stream of sugar making you feel hungry and short of energy – so you feel like a snack. This cycle leads to continual munching of sweets and crisps between meals while also making you feel tired.
That at any rate is the theory – but theories are only interesting if you test them. I have to say that this raw food diet does seem to bear out the claims made for it. I feel less hungry during the day and have more energy. (This isn’t a diet that you could stay on for very long. It is deficient in proteins and fats, and if you kept on it for more than a few weeks you would get ill and eventually die.)
I was mulling all this over and I remembered a piece of medical technology that I had come some time ago aimed at diabetics. This is a way of monitoring blood sugar levels, which are key if you are a serious diabetic, by microanalysis of sweat. The reason this wasn’t easy, and the idea behind the patent granted, is that normally excess sugar in sweat is absorbed by the eccrine glands. The eccrine glands are of course precisely the thing that is inflammed in acne!
So maybe if the eccrine glands have to handle a large amount of sugar in the blood, this could provide food for the bacteria that are living there and lead them to multiply and cause a flair up in the acne. This would only happen in an individual who was already predisposed to acne and had a population of bacteria in their glands. This would explain why I can cheerfully knock back a king size Mars bar with no effect on my particular skin. It would also be a temporary effect. Once the high sugar spike had passed there would be no new influx of sugar to the glands and the bacteria would die off and the spots would recover. But most importantly, knowing the way the body works to maintain itself in balance, if you ate chocolate regularly, say once a day, the body’s immune system would probably find a way of dealing with the infection. So my idea predicts that people who eat chocolate, or any other very rich sugar source, infrequently would be then ones who get the spots.
This explains why surveys haven’t found the link. If you look at a large group of people the ones who eat lots of carbohydrate won’t show up as the ones who get the most acne. In any case, the key factor would be food that gets converted to sugar quickly. So things like chips, white bread and sweets are all equally likely to raise blood sugar levels. But I don’t think most people would see the link. So if you try cutting out chocolate for instance, but eat a sandwich instead, it would probably not have make any difference.
I am still thinking about this idea. I am surprised it hasn’t been suggested before – but I haven’t found anything like it via Google yet. If anyone can point me to any work that has been done in this area I would be very interested. I am also looking through the scientific literature to find evidence that either supports or contradicts it. So far I have found a paper that points out that a society with a very different diet to the Western one has a very low incidence of acne indeed. The Kitavan Islanders of Papua New Guinea and the Aché hunter-gatherers of Paraguay don’t eat what we eat and they don’t get acne. Of course there are quite of lot of other differences as well, so on its own this observation doesn’t prove very much. But it is at least consistent with the idea that sugar levels in the diet might contribute to acne.
What I would really like would be to find someone who believes that chocolate, or some other sugar rich food, brings them out in spots. If they could induce an acne outbreak, then go onto a largely raw diet for a couple of weeks, and then have another chocolate binge that would be a really strong piece of evidence in favour of the theory.
In the mean time, to answer my question: yes I think there might be cases where avoiding a high sugar and high carbohydrate diet might be beneficial for acne. Any observations or references relevant to this would be much appreciated.
You might also be interested in a product for acne that probably doesn’t work.
Arch Dermatol. 2002 Dec;138(12):1584-90. Acne vulgaris: a disease of Western civilization. Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, Brand-Miller J.
Eli Lily Patent on Blood Sugar Monitoring Device