Acne is one of the commonest diseases of the skin and about $4 billion is spent on treatment yearly. There are also significant social and emotional costs. Although acne affects all ages, prevalence starts to increase from the age of 8 years, and peaks at 16 to 18 years when 75% to 98% of the population is affected.
An association between diet and acne has long been postulated but remains unproven and hence controversial.Most dermatology text books state that there is no role and majority of dermatologists toe the beaten path.
My experience and observations with acne patients, however, tell a different story. Many of my patients who have been on remission(without clinical lesions of acne) after treatment and on a "no milk, no chocolate, no ice cream, no cola, no fried fast food' regimen have come back experiencing severe outbreaks after they restarted their junk food habits! More than two decades of such consistent observations have convinced me that certain food items do stimulate the tell-tale facial eruptions. After all, medicine and human disease management is not an exact science, and we cannot always abide by evidence based therapeutics(though preferable), as all medical practitioners would realize sooner or later in their career.
A scan of the medical literature shows that I am not alone in these convictions. There have been dozens of studies, mostly in favor, of a positive acne-diet relationship. Let us examine a few of these now:
1. Role of iodide in causation of acne
It has long been known that iodine and its salt iodide stimulate the sebaceous glands and cause acne eruptions.Many natural and cooked foods contain iodide and iodine in varying amounts. It stands to reason then to infer that such food when taken regularly and in excess could induce or aggravate acne lesions in predisposed individuals.
Following is a list of iodide containing items on our gastronomical shelf with the amount of iodide in each. Only a selected few with high content and, for comparison, a few with low content are mentioned here. Iodide content measured as ppm (part per million) is shown in brackets:
Seafood
Squid (39); Crab(33); Shrimp(17)
Meat & Poultry
Beef liver(325); Turkey(132); Chicken(67)
Vegetables
Asparagus(169); Broccoli(90); Onions(82); Corn(45)
Diary Products
Butter(26) ; Cheddar cheese(27); Cottage cheese(5); Milk(11); Yogurt(3)
Miscellaneous
Drinking water (8); Iodized Salt(54); Potato chips(40); Tortilla chips(80); White bread(8)
Now, with a list like that, who would deny that food is an aggravating factor for acne?
2. Acne inducing medications.
In addition to iodides, the following drugs can either cause or exacerbate acne(list not complete):
Corticosteroids (both systemic and local)
Bromides
Phenytoin (anti-epileptic)
Lithium (anti-psychotic)
Isoniazid (anti-tuberculous)
Some oral contraceptive pills like Ovral, Loestrin, Norlestrin, and Norinyl etc increase acne formation, while some, like Diane 35 are used to treat certain types of hormone induced acne.
So how do these support the "acne-food" theory?
The fact that there are many medications which influence acne can be related to the food-acne scenario thus:
1. Ingested food is absorbed and utilized by our body exactly in the same way it metabolizes oral medications. In other words, food is no different from any other drugs (treats hunger?) which can have both positive and negative effects on the body and its organs including skin! Now, my question is this, if certain medications can affect acne by worsening or improving it, why can food not affect acne? Is there any rationale or proof to counter this deduction derived from pure common sense?
2. Many medications used to treat diseases in the cattle are found in varying amounts in their yields: the milk and the meat. If such medications can worsen acne, it follows that milk/meat consumption could affect acne adversely!
3. Anabolic steroids are used(as injectables and in feeds) to increase the mass and bulk of meat and poultry.Naturally varying levels of these hormones are found in the final diary and butchery/poultry products. Steroids, both anabolic and corticosteroids, are known to induce and exacerbate acneiform eruptions, not only on the face, but also on the back and front of the trunk. So would not such diary, meat and poultry trigger acne eruption? Unless of course, we can prove that all such medications are completely destroyed during the pasteurization(milk) and cooking processes, which is highly unlikely!
3. Acne, Vitamins and Minerals.
A number of studies have proven the beneficial effects of some vitamins and minerals on acne. These are Vitamin A, Zinc, Magnesium, Selenium and Essential Fatty Acids(Omega 3). There are many food items which contain these vitamins and trace elements. Though the amount of these molecules to produce any clinical changes may be high, who can refute the possibility that even the minute amount(s) present do not affect acne?
There are conflicting reports on B Complex Vitamins and Vitamin E , some studies finding a positive effect on acne while others noting that high amounts of these vitamins actually worsen the acne eruptions.
