Elizabeth Shimer Bowers
Stephanie S. Gardner, MD
Whenever dermatologist Ellen Marmur, MD, eats chocolate, she breaks out two days later. Although she admits there is no hard science to explain why, she takes comfort in knowing she’s not alone. More than one-third of people with acne see a connection between what they eat and their blemishes.
“It’s true that we don’t have studies to prove again and again that certain foods cause or prevent acne,” says Marmur, author of Simple Skin Beauty. “But if you surveyed a group of dermatologists, many of us would say, ‘Yes, diet has an effect,’” she says.
Put simply, acne is a disorder of the turnover of skin cells, called keratinization. Improper skin turnover leads to retained cells, which block the oil glands and pores and trap protein and sebum (your skin’s natural oil) under the skin. Those proteins and oils become food for P. acnes, the bacteria that cause acne.
Marmur, who is also a professor of dermatology at Mt. Sinai Hospital, explains that there are hundreds of steps involved in the cycle of skin renewal, of which the foods you eat are components. The body, skin included, is constantly under construction. “And it uses vitamins and nutrients from food to repair and rebuild,” she says.
However, Marmur warns not to overestimate the relationship between skin and nutrition.
“Food is only about 25% of the picture when it comes to acne,” she says. The other 75% is influenced by hormones, stress, sleep levels, and where you live. Good skin care also plays a role. “So there are really no ‘super foods’ when it comes to acne prevention,” she says.
Overall, promoting healthy skin with diet is all about adopting good nutritional habits.
"We all eat the same basic five to 10 meals,” Marmur says. “So if you give yourself five to 10 meals that provide a balanced diet, it will go a long way in preventing skin problems,” she says. For acne-prone skin, she recommends eating low-fat, whole (not processed) foods and avoiding hormone-laden dairy products and meats, chocolate, french fries, and other junk foods.
The studies on diet and skin don’t reveal anything we don’t already know. Diets rich in fruits and vegetables are good for us, skin included. Healthful foods appear to reduce inflammation and decrease the likelihood of breakouts. Here are some of the big players when it comes to healthy skin:
Vitamin A. “Vitamin A helps regulate the skin cycle, so no acne-causing protein and oil get trapped,” Marmur says. It’s the main ingredient in Accutane, an effective prescription medicine for acne. Good food sources of vitamin A include fish oil, salmon, carrots, spinach, and broccoli. Too much vitamin A can lead to toxic side effects, however. Limit your daily dose to 10,000 IU and never take it while pregnant or nursing.
Zinc. There is some evidence that people with acne have lower than normal levels of the mineral zinc. Zinc appears to help prevent acne by creating an environment inhospitable to the growth of P. acnes. It also helps calm skin irritated by breakouts. Zinc is found in turkey, almonds, Brazil nuts, and wheat germ.
Vitamins E and C. The antioxidants vitamin E and vitamin C have a calming effect on the skin. “And they are thought to work synergistically,” Marmur says. Sources of vitamin C include oranges, lemons, grapefruit, papaya, and tomatoes. You can get vitamin E from sweet potatoes, nuts, olive oil, sunflower seeds, avocados, broccoli, and leafy green vegetables.
Selenium. The mineral selenium has antioxidant properties that help protect skin from free radical damage. And one study showed that, together with vitamin E, it may improve acne as well. “A small Swedish study on 42 men and 47 women found that those who consumed selenium together with vitamin E for 12 weeks saw improvements in their acne,” says New York City dermatologist Francesca Fusco, MD. Food sources of selenium include wheat germ, tuna, salmon, garlic, Brazil nuts, eggs, and brown rice.
Omega-3 fatty acids. “Omega-3 fatty acids inhibit certain molecules that lead to inflammation and resulting skin problems,” Fusco says. They also support the normal healthy skin cell turnover that helps keep acne at bay. You can get omega-3 fatty acids from cold water fish, such as salmon and sardines; flaxseed oil; walnuts; sunflower seeds; and almonds.
Water. “It’s a good mantra for people to remember to drink water,” Marmur says. “Many of us have our morning coffee and then drink only one drink during the day and one at night.” Water helps hydrate your body and leads to plump, healthy skin. Adequate hydration helps flush out toxins that can cause skin problems. It is also essential for skin metabolism and regeneration.
That being said, Marmur cautions against attaching yourself to the water cooler. “By drinking gallons of water, you won’t clear up your skin; you’ll just dilute your blood and put yourself at risk for seizures.” Marmur suggests drinking five to eight glasses of water per day. “Athletes should drink more, however.”
Anecdotal evidence shows that certain food types increase the likelihood of an acne flare. These foods include the chocolate and junk foods to which Marmur refers.
There are also a few studies that scientifically support the role of two food groups in acne promotion: dairy products and simple carbohydrates.
Dairy. According to a review done at The George Washington University Medical Center, cow’s milk can spark or worsen breakouts in some people. The culprit is hormones used to encourage growth in cows.
“It is a complex situation. Put simply, through a series of interactions, the hormones in dairy products increase levels of male hormones called androgens. Androgens increase sebum production, which leads to acne,” Fusco says.
Simple sugars. Foods with a high glycemic index appear to cause acne breakouts in some people. High glycemic index foods break down quickly during digestion. They include white bread, potatoes, and sugary drinks and snacks.
Researchers at Colorado State University compared the skin of those eating a high glycemic index Western diet with the skin of two groups who eat traditionally low glycemic index foods. Specifically, they looked at the Kitivan Islanders, who eat a diet rich in fruit and fish, and the Aches hunter-gatherers of Paraguay, who eat lots of peanuts and wild game. Both groups had healthy skin and no cases of acne. In comparison, those eating a Western diet high in refined grains, sugary soft drinks, and processed baked goods had high rates of acne. Specifically, the study found that 79% to 95% of adolescents and 40% to 54% of adults 25 and older had acne.
What is it about simple sugars that lead to breakouts? They cause high insulin levels. “High insulin leads to a series of reactions that increase androgen levels; increased androgens stimulate sebum production and clog pores,” Fusco says.
Research aside, you are the only one who knows the true relationship between your diet and skin problems. To find out which foods send your skin into a tizzy, Marmur suggests keeping a food journal for a month. “Then read over it and highlight your worst breakouts. Look back 72 hours prior to what you eat and see if a pattern emerges,” she says.
SOURCES:Ellen Marmur, MD, associate professor of dermatology, Mt. Sinai Medical Center; author, Simple Skin Beauty.Francesca Fusco, MD, New York.Audrey Kunin, MD, president, DERMAdoctor.com.David J. Goldberg, MD, founder, Skin Laser and Surgery Specialists of New York and New Jersey.Suzanne Friedler, MD, New York.Linda Stein Gold, MD, director, dermatology clinical research; division head, dermatology, Henry Ford Health System, Detroit.Expert Review of Dermatology, 2008; vol 3(4): pp 437-440.Klor, H. Journal der Deutschen Dermatologischen Gesellschaft, March 2011.Bae, Y. Dermatologic Clinics, July 2010.Michaëlsson, G. Acta Dermato-Venereologica, 1984; vol 64(1): pp 9-14.Ferdowsian, H. Skin Therapy Letter, March 2010; vol 15(3): pp 1-2, 5.Danby, F. Clinics in Dermatology, Nov-Dec 2010; vol 28: pp 598-604.Treloar, V. Journal of the American Academy of Dermatology, January 2008; vol 58(1): pp 175-177.
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