Jennifer Burris, dietician, researcher, and doctoral candidate in the Steinhardt School of Culture, Education, and Human Development, and her colleagues Kathleen Woolf of Steinhardt and William Rietkerk of New York Medical College and Manhattan Dermatology and Cosmetic Surgery, recently conducted a literature review to evaluate evidence for the diet-acne connection.
Their study, “Acne: The Role of Medical Nutrition Therapy,” published in the March issue of the Journal of the Academy of Nutrition and Dietetics, determined that there is increasing evidence of a relationship between diet and acne. According to their findings, the link is stronger in high glycemic load and dairy diets.
Burris, the team’s lead researcher, took a moment to speak with NYU Research Digest about her findings.
What sparked your interest in this topic?
About a year ago, I came across a brief article in a magazine mentioning the historical studies on acne. I was really surprised at the gap in the literature—there were hardly any studies examining the association between diet and acne over the last 40 years. And these older studies had major limitations in study designs. The researchers used very small samples and inappropriate interventions and placebos.
There was a controversy among the medical community, including dietitians, that diet and acne were not associated. The more I read, the more interested and invested I became in the topic.
So what types of food are associated with an increase in acne?
The growing body of data seems to suggest a relationship between diet and acne, particularly a high glycemic load diet—foods like white bread, pasta, and cookies—and frequent dairy consumption. The evidence is most convincing for high glycemic load diets, compared to dairy and other dietary factors.
What is it in these foods that cause the skin to react?
The largest influence on acne development is probably an increase in sebum, or oil production. Androgen hormones and other hormonal mediators including insulin growth factor-1 can influence sebum production.
The glycemic index is a system ranking how carbohydrate foods will increase your blood sugar. High glycemic index foods, like white flour, sugary sweetened beverages, and sugar, increase blood glucose more, compared to low glycemic load foods. High glycemic load foods trigger an increase in blood glucose and insulin as well as an increase in insulin-like growth factor-1. These hormones and hyperinsulinemia in turn increase sebum production. It’s like a domino effect.
Similar to a high glycemic diet, milk consumption also promotes a glucose and insulin response.
You encourage diet therapy as a way to treat acne. How does this work?
I believe the suggestion of diet is a reasonable option for patients with acne. A diet lower in dairy, but still adequate in calcium and vitamin D may be a reasonable option for a subset of acne patients.
At this time, I cannot tell patients exactly the quality and quantity of carbohydrates to eat or the maximum servings of dairy to have per day to decrease acne. Instead, I would suggest the best approach is to look at each person as an individual, including an assessment of his or her usual dietary patterns. It is important for both the dietitian and dermatologist to work collaboratively, to give the ultimate patient care.