Acne: Pathways, Causes and Cures

And ... We're back! To my readers, I'd like to extend my sincerest apologies about the recent lack of articles. As the stresses and pressures of life built up, I found myself needing a short hiatus to collect and compose myself so that I could keep churning out quality information to those of you who read it!

However, that doesn't mean I've been sitting on my hands. The first article off the bat is one suggested to me by a friend and aims to debunk and clarify the myths behind the causes of acne.

It can be hard to believe that acne is yet another health outcome that we may have greater control over than social norms dictate. When we're teenagers, we shut up and put up with the aptly named acne vulgaris and hope that it will pass quickly. As adults, we dread it's return - petrified by dormant memories of social exclusion and stigma.

Diet and Acne - The Hypothetical Association

It is believed that the hypothetical association between diet and acne lies in the stimulation of Insulin-like Growth Factor (IGF-1) that occurs when the body is placed in a hyperinsulinemic state. Simply put, spikes in insulin caused by High GI foods would cause an increase in IGF-1 which would then increase the amount of circulating androgens in the blood, decrease sex hormone binding protein and increase 'sebum synthesis' (which is crucial in acne development). 

*Sebum keeps skin and hair soft and supple. Like anything, it requires balance. Too much sebum and you'll be battling acne; too little and you'll be fighting dry and cracked skin.

Thus, it could be suggested that a typical 'Western' diet rich in high glycaemic index foods such as pasta, flour, bread, sugar, etc may contribute to the formation of acne by causing hormonal variations in the body.

Acne & It's Recognised Causes

There is a progressive increase in acne from pre-adolescence to early adulthood which coincides with the pubertal androgenic spurt. As we learned above, greater circulating androgens contribute to sebum synthesis. Indeed, the density of acne has been found to be positively correlated with the sebum excretion rate.

With regard to diet, a number of studies have determined that dietary factors particularly high glycaemic foods and diets with a high glycemic load (GL), as well as greater dairy intake are positively associated with the development of acne.

A study of over 1,200 individuals from two non-Western societies found that there was an absence of acne in these populations. Interestingly, epidemiological studies of the Inuit Eskimo population, have observed that this culture had not presented with the symptoms of acne until the introduction of Westernized food habits.

With regard to the ingestion of milk, the paradox lies in the fact that, although lactose is a low-GI nutrient, milk increases levels of IGF-1 in the body. Ironically, for all of you 'skim milk' or 'fat free' drinkers - the aggravation of acne is more severe with the ingestion of fat-free milk than the regular variety.

The following image summarises the above quite succinctly -

Chocolate & Acne

Bad news for choc-a-holics! The theory of association between acne and chocolate is almost entirely confirmed by various clinical findings. 

For those who wonder about the mechanism behind it; it is postulated that chocolate is rich in various biologically active compounds including caffeine, teobromine, serotonin, phenylethylamine, etc which increase secretion of and resistance to insulin. At the same time, it contains insulinogenic amino acids including arginine and leucine which, when igested with carbohydrates and the artificial sugars within chocolate can contribute to acne formation.

Caffeine & Acne?

Unfortunately, little scientific evidence exists to directly link caffeine consumption of the development of acne. Once again, the theoretical tie-in is that caffeine consumption is purported to increase androgen levels in the blood, leading to the sebum synthesis slippery slope. However, a recent study into the effects of caffeinated and decaffeinated coffee on sex hormone-binding globulin and other sex hormone levels was unable to find a consistent effect of caffeinated coffee consumption on SHBG in participants.

One could surmise that caffeine may contribute to the development of acne by -

• disrupting sleep patterns
• causing adrenal fatigue (in chronic consumption)
• slow down kidney function, thus inhibiting the body's ability to release it's toxins

Treating Acne?

Given what we've just learned about the formation and causes of acne, it seems illogical that prescription medication and harsh creams are the only possible pathway for treating the condition.

Some tips for keeping those nasty pimples away include:

• Ensure that your Omega 3, Zinc and Vitamin A levels are adequate: All three of these nutrients help to reduce inflammation and zinc serves the double purpose of boosting immunity.
• De-Stress: Stress raises cortisol which increases the production of oil in the skin.
• Avoid High GI foods: for the reasons stated in the ENTIRE ARTICLE.
• Keep your Kidney Happy (& I don't mean through a Lemon Detox): having appropriate detoxification pathways that aren't clogged by junk can assist your body in moving toxins where they need to go (rather than to your skin). So, cut the junk and give your kidney the much needed break it deserves.
• Watch the Wheat & Grains: many people are sensitive to wheat gluten. Sensitivities can aggravate acne as it is a signal of a heightened immune response in reaction to a nutrient that the body has difficulty in processing. 
• Drink plenty of water and keep regular: You heard me ... The kidney can detox your body but your physical excretion of waste matter is one of the best ways you have of ridding yourself of unwanted toxins. So go and grab some Psyllium Husk and let the good times flow.

References:

Wedick, N.M., et al. (2012). The effects of caffeinated and decaffeinated coffee on sex hormone binding globulin and endogenous sex hormone levels: a randomized controlled trial. Nutr J., 11 (86), 1475-2891.

Taylor, M., et al. (2011). Pathways to inflammation: acne pathophysiology. European Journal of Dermatology, 21(3), 323-33.

Reynolds, R.C., et al. (2010). Effects of the Glycemic Index of Cabohydrates on acne vulgaris. Nutrients, 2(10), 1060-1072.

Costa, A., Lage, D., & Moises, T.A. (2010). Acne and Diet: Truth of myth? Anais Brasilieros de Dermatologia, 83(3), 346-53.

Ismail, N. H., Manaf, Z. A., & Azizan, N. Z. (2012). High glycemic load diet, milk and ice cream consumption are related to acne vulgaris in Malaysian young adults: a case control study. BMC Dermatol., 12(13), doi: 10.1186/1471-5945-12-13.

Magin, P., et al. (2004). A systematic review of the evidence for 'myths and misconceptions' in acne management: diet, face-washing and sunlight. Family Practice, 22(1), 62-70.