I received this letter from a reader:

Hi from Spain. I am independent journalist in nutrition and cosmetics and I have been reading your new book The Original Beauty Bible (its great) and I noted you talk about anti-inflammatory diet. First of all I believe you are so influenced in nutrition by Dr Weil, but the original creator of anti-inflamatory nutrition is Dr Barry Sears (read for example THE ANTI-INFLAMMATION ZONE). Second, it’s so odd for me that you recommend anti-inflammatory diet and then you say diet is not linked with acne and there aren’t studies about this. Really there are many important clinical and published studies about how a high glycemic diet and a low Omega 3 diet worsen acne. You can read chapter 8 of “Cosmetic Dermatology” (2009) by Leslie Baumann MD or all literature of Loren Cordain (in “The Dietary Cure for Acne” explains based on studies how diet affects acne, for me the very best book about this topic). And really all my readers have improved their acne condition following an Omega3 anti-inflammatory diet.

Here are my comments:

While I apprecaited the feedback and the great compliment there were a few things wrong with the assessment. First, in terms of influence, I actually rarely use Dr. Weil, rather I use a vast number of research journals that I have online access to. In terms of Cosmetic Dermatology, I know that publication well and have a subscription to it, though it is a bit suspect because so much of the research published is paid for by manufacturers of skin care products (both prescription and non-prescription brands) and some of the doctors who write the articles are on the payroll of cosmetic companies.

Yes, nutrition is important to skin care, after all if we don’t eat we die and then we don’t look so good, but the research about a specific diet and skin care is lacking, especially for acne (research about diet and wrinkles is also sparse but growing).

In terms of diet and acne I have seen the research about the glycemic index association but that is hardly conclusive and is more theory at this point then anything else.

Here is some information you may find interesting from the American Academy of Dermatology:

The American Academy of Dermatology (Academy) still says that diet does not cause acne. After all, haven’t research studies found that certain foods cause acne? If you have acne, you may even have noticed that when you eat certain foods you break out. With all this evidence, why does the Academy still say that food does not cause acne?

What the Research Really Shows
While studies have been conducted, more research is needed to conclude that what we eat can cause or prevent acne. What these studies have found suggests that diet may play a role in acne. Here is what the research has shown so far.

Milk and acne. Could drinking milk cause acne? One researcher reports that between 75% and 90% of the milk and milk products consumed in the United States come from pregnant cows. Could acne develop because drinking milk exposes us to the hormones that cows produce when they are pregnant? We know that hormones clearly play a role in acne.

To answer these questions, researchers began by asking people to recall what they ate. One such study asked 47,355 women to remember what they ate in high school 9 years prior. Another study asked teenage boys to recall what they ate and to determine the severity of their acne.

After analyzing the foods eaten, researchers concluded that there was one association. Sodas, chocolate, and even potato chips were not associated with acne. Only drinking milk was.

These studies had limitations. Trying to accurately recall what you ate years ago — or even days ago — can be difficult, so the collected data cannot be considered entirely reliable. What the data does show is that there maybe an association between drinking milk and acne. An association means that more research is needed to prove whether this is just an association or a cause.

It is possible that other causes were at work. These studies did not account for known causes of acne, such as heredity. Acne is known to run in families, and some of the women and teenage boys may have had acne because they inherited genes for acne. The researchers acknowledge the limitations of these studies and conclude that more research is needed.

Western diet and acne. Some researchers hypothesize (explanation that needs to be proven) that more than milk could be causing acne. It could be our Western diet, a diet rich in refined carbohydrates. A few studies have looked at this possibility. One study observed that people in 2 non-westernized societies — Kitavan Islanders (remote islands off the coast of Papua New Guinea) and the Aché hunter-gathers of Paraguay — did not have acne. The researchers attributed this to the people’s low-glycemic diet. A low-glycemic diet consists of fresh fruits, vegetables, and lean proteins.

When people eat a low-glycemic diet, the body works more efficiently. The body needs only produce relatively small amounts of insulin to keep blood glucose levels (glucose gives us energy) within the normal range. When the body works this way, the person is said to be insulin sensitive. This means the body requires relatively small amounts of insulin.

A high-glycemic diet can lead to insulin resistance, which means the body needs to produce a lot more insulin to maintain glucose levels. Insulin resistance can cause numerous health problems including high blood pressure, heart disease, and diabetes.

The researchers concluded that a Western diet, which often causes insulin resistance, might also be fueling known causes of acne such as the production of excess sebum (oily substance) and inflammation. More research is needed to find out if a low-glycemic diet can prevent acne and lead to clearer skin.

To find out, small studies have been conducted to look at the effect of a low-glycemic diet on acne. These studies suggest that a low-glycemic diet maybe helpful, but further research is needed to explain the role that diet plays.

There are still many unanswered questions. One question researchers must answer is why every obese person does not have long-term acne. Individuals who are obese generally have had insulin resistance for years. If insulin resistance leads to acne, then everyone living with diabetes would be expected to have acne. Why is this not the case?

The diet-recall studies also did not show an association between eating high-glycemic foods such as soda and chocolate and acne. Why is this?

More Research Needed
While the research shows that there may be an association between diet and acne, the researchers conclude that more evidence is needed to prove this association. Until research proves that diet causes acne, this site will continue to state what the research shows. To date, the research does not prove that diet causes acne.

References:
Adebamowo CA, Spiegelman D, Berkey CS et al. Milk consumption and acne in teenaged boys. J Am Acad Dermatol 2008; 58: 787-93.

Adebamowo CA, Spiegelman D, Danby FW et al. High school dietary dairy intake and teenage acne. J Am Acad Dermatol 2005; 52: 207-14.

Arbesman H. Dairy and acne–the iodine connection. J Am Acad Dermatol 2005; 53: 1102.
Bershad SV. Diet and acne–slim evidence, again. J Am Acad Dermatol 2005; 53: 1102; author reply 3.

Cordain L, Lindeberg S, Hurtado M et al. Acne vulgaris: a disease of Western civilization. Arch Dermatol 2002; 138: 1584-90.

Danby FW. Acne and milk, the diet myth, and beyond. J Am Acad Dermatol 2005; 52: 360-2.

Smith RN, Braue A, Varigos GA et al. The effect of a low glycemic load diet on acne vulgaris and the fatty acid composition of skin surface triglycerides. J Dermatol Sci 2008; 50: 41-52.

Smith RN, Mann NJ, Braue A et al. A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Am J Clin Nutr 2007; 86: 107-15.

Smith RN, Mann NJ, Braue A et al. The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters associated with acne vulgaris: a randomized, investigator-masked, controlled trial. J Am Acad Dermatol 2007; 57: 247-56.

Thiboutot DM, Strauss JS. Diet and acne revisited. Arch Dermatol 2002; 138: 1591-2.

Treloar V, Logan AC, Danby FW et al. Comment on acne and glycemic index. J Am Acad Dermatol 2008; 58: 175-7.

Webster GF. Commentary: Diet and acne. J Am Acad Dermatol 2008; 58: 794-5.

However, what is 100% certain is that anecdotal feedback about what helps acne makes for good reading. Yet anecdotal information isn’t solid research. Someone’s individual success, and I’ve seen it all, includes things that could not possibly help and if anything can hurt skin. For example, you can start a diet at the same time your hormones are changing (such as associated with stress or someone’s menstrual cycle) and you would mistakenly associate that with your diet. When the acne returns you may not be the one to hear about it (that’s the nature of anecdotal information). I do suggest experimenting with diet and I mention the relation to certain foods to see what may work for you, including specific allergies to nuts or milk, but that is still not fact, just theory and personal experience.