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Module: 5

Diet Plan

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This module is all about the connection between diet and acne, and how you can modify your diet to

ensure it is not a contributing factor to any issues you may be having with your skin. The first section

will explore the links between diet and acne, debunking the myths that caused the dermatology industry

to declare there was no connection. Next, we move onto which foods should be avoided, including sugar,

gluten, refined carbs, phytoestrogens, a high calorie diet, and milk. Next you’ll learn about what is good

to eat. The module will finish with a section on the paleo diet, including the principles behind the diet,

and what that diet looks like in practice.

5.1 Links between diet and acne

5.2 Foods to avoid

5.3 Beneficial foods

5.4 Paleo diet

5.1 Links between diet and acne

In this section we’ll study the links between diet and acne, so you can understand how what you eat

affects what appears on your skin.

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5.1.1 Debunking the myth

Whether you’ve been researching online, or have been to a dermatologist’s office in search of a cure for

acne, you may have been told that there is no link between acne and diet. Unfortunately, this myth has

been around for a long time and is probably preventing people from making the diet changes that could

make a massive difference to their acne.

This myth started in the late 1960s and early 1970s. Two prominent studies were published, that

claimed to indicate there was no link between diet and acne. These were then widely cited, particularly

in dermatology courses and textbooks, which led to large amounts of professionals holding the opinion

that diet does not affect acne.

However, there were major flaws with these studies. Let’s examine them.

5.1.2 Fullerton’s study

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The first study was in 1969, by Fullerton and other researchers. In this study, they split a group of 65

into two. To one group, they gave a candy bar containing chocolate to eat every day, while the other

group was given a candy bar without chocolate. One month later, the researchers examined the acne of

all the participants, and found that there was no difference in acne between the groups. This led people

to believe there was no link between diet and acne.

But there are many things wrong with this study:

Both of the candy bars were equally high in sugar, calories and fat.

The bar without chocolate contained plenty of trans-fats. These are known to cause inflammation,

which is linked to acne.

All we can tell from this study is that cocoa itself does not seem to cause acne. It could be that

chocolate is a contributing factor to acne or makes acne worse, but that would be on the basis of its

sugar, calorific or fat content rather than its cocoa content.

5.1.3 Anderson’s study

The second study was in 1971. Anderson and a group of researchers studied 27 university students,

who had reported that eating different foods affected their acne levels. He split them into four

groups, and gave each group one of the following: chocolate, roasted peanuts, milk or cola. After

one week, he studied their acne, and found no difference between the groups.

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But here’s how that study’s flawed:

At one week, the study is far too short. Many acne related studies run for 12 weeks.

There is no account taken for the other foods the students were eating.

Ironically, all the foods he gave to the students are thought to be acne triggers. Chocolate and cola

because of their sugar content, and peanuts and milk because of their hormone content. Based on our

current knowledge of the link between diet and acne, we would expect all these foods to cause acne.

The idea that there is no link between diet and acne has come from these two deeply flawed studies, and

many dermatologists and scientists are now beginning to reject this conclusion and investigate the links

between diet and acne in a more open minded way.

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5.2 Foods to avoid

In this section, we’ll show you the foods which have been linked to acne by researchers, scientists and

others in the acne treatment community. You’ll read about studies, experiments and theories behind

why the food causes acne.

5.2.1 Sugar

Sugar is said to cause acne in three ways:

Hormonal responses

Inflammation

Candida

Hormonal responses - The male sex hormones, androgens, make the skin increase its cell

growth, and make oil glands produce more sebum. This results in blocked pores. When you

eat sugar, this causes the blood sugar levels to increase. The pancreas responds by

releasing insulin, a hormone that works to take sugar into cells, thereby reducing blood sugar

levels. Elevated insulin levels increase the levels and bioavailability of IGF-1. These are

hormones related to acne, leading to increased pore size and sebum production.

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Inflammation – Sugar causes inflammation, which depletes antioxidants and leaves skin

vulnerable. Inflammation of sebum, which sugar causes, creates the ideal environment for the

bacteria which cause acne (P. Acnes) to thrive. In turn, the bacteria add to the inflammation.

In a study, 29 healthy young men who rarely drank soda were tested. They were given either 1

or 2 12oz cans of soda to drink every day for three weeks. Following this, their C reactive

protein levels (CRP) were measured. This is one of the best measures of inflammation.

The results were staggering. In the men who were given one can per day, inflammation levels

went up by 87%. In the men who were given two cans per day, inflammation levels went up by

105%.

Candida - Excessive sugar intake can make candida grow out of control. Candida overgrowth in

the digestive tract or the skin can cause gut problems and inflammation that can contribute to

acne.

5.2.2 Gluten sensitivity and celiac disease

Gluten is a protein found in wheat and other grains such as barley, rye and spelt. It makes dough

sticky and is used as a binding agent in household products such as toothpaste and shampoo. It is

also contained in processed foods, imitation meat, and oats (by contamination).

Gluten sensitivity is where the immune system reacts negatively to gluten, causing an inflammatory

reaction in the gut and leading to small intestine damage over time. Researchers have identified

‘silent gluten sensitivity’, which describes people who don’t show the normal range of symptoms of

celiac disease but still find that eating gluten causes problems for them. It is thought that 6% of

people could suffer from this. Celiac disease is severe form, in which the reaction to gluten

consumption immediate and can be very painful. About 1% are said to suffer from this.

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Symptoms of gluten sensitivity include:

Headache

Digestive problems

Neurological issues

Joint and muscle pain

Feeling of weakness

Skin problems

Gut problems can cause damage to the intestines, increasing inflammation throughout the body and

decreasing antioxidants. This can directly hurt the skin. There are no studies that directly link acne with

gluten consumption as yet, but there are studies linking gluten to other skin disorders, which might

suggest a link.

Studies have found that the severity of psoriasis in sufferers is correlated with sensitivity to gluten. This

means that when a person has a stronger sensitivity to gluten, their psoriasis gets worse.

Two studies, one in Egypt, one in India, found that those with psoriasis were more likely to have

sensitivity to gluten than people without psoriasis.

A Swedish study found that people with gluten sensitivity and psoriasis had a significant decline in the

severity of their psoriasis when they adopted a gluten free diet for three months.

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To find out if your acne is linked to gluten sensitivity, you might want to ask your doctor if you can get

tested for gluten antibodies, particularly if you have noticed any digestive problems or any discomfort

after eating gluten. Alternatively, you can test with an elimination diet. Cut gluten out of your diet for

one to two months and see if there is any improvement in your acne.

5.2.3 Refined carbohydrates and high GI foods

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Any food high in refined carbohydrates, which includes sugars and grains, will spike blood sugar. High

GI foods cause blood sugar levels to rise very quickly. This rapid rise in glucose in the blood causes the

pancreas to release insulin into the bloodstream, as explained in section 4.2.1. When blood sugar levels

are continually spiked (by eating high-sugar, high-carb meals), cells begin to become insulin resistant.

This means more insulin needs to be produced, and eventually the body becomes resistant to insulin.

This is a key factor that has been linked to acne.

Those who struggle with acne have been advised to avoid sugar and grains, and other high GI foods,

because they contribute to insulin resistance. Studies have shown that switching from a high GI diet to

low GI diet can reduce acne 30 to 50%.

Low GI foods are listed in section 4.3.2.

High GI foods to avoid include:

Honey

Molasses

Corn

Bananas

Pineapple

Melon

Raisins

White breads

White flours

Corn breads

Parsnips

Turnips

Beets

Carrots

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Potatoes

Corn

Rice

Rice products

Pasta

Most cereals

Popcorn

Corn chips

Potato chips

Beers

Liquors

All alcohol except red wine

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5.2.4 Phytoestrogens

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As you will know from reading module 1, hormones have a significant role to play in the

occurrence of acne. In women, the female sex hormones (estrogens) need to be balanced

with a certain amount of male sex hormones (androgens, such as testosterone). If a woman

has too much estrogen in her body, this can lead to breast cancer. If she has too much

androgen, this can lead to PCOS and/or acne. As mentioned in 4.2.1, diet affects this

delicate balance of hormones.

One particular component in foods, phytoestrogens, can have a serious effect on

hormones. Phytoestrogens can reduce the amount of estrogen the body produces, and can

block its effect. This happens because phytoestrogens bind to estrogen receptor sites, but

don’t provide you with any benefit. This leads them to block real estrogens you would see

benefit from. Not only that, phytoestrogens also reduce the amount of estrogen produced

by the body.

A month of eating foods rich in phytoestrogen can make the estrogen levels in the body 20-

50% lower. This is bad news for acne sufferers, because estrogen can help prevent acne.

Estrogens oppose androgens in the skin cells, preventing androgens from boosting sebum

production and excessive skin cell growth, both of which could lead to acne. Thus, estrogen

plays a role in preventing acne, but phytoestrogen can block this.

The foods with the highest phytoestrogens are flaxseeds, soy, and sesame seeds. Flaxseeds

are by far the worst, with 379380 micrograms per 100g of food, while soy has 103920

micrograms, and sesame seeds 8008 micrograms. Hummus and garlic have elevated levels

too, but nowhere near as high as these three with 993 and 603 respectively.

For these reasons it is advised that women with acne, or acne prone women, avoid eating

sesame seeds, soy, and especially flaxseeds.

5.2.5 High-calorie diet

A high-calorie diet has been linked to acne. Increased calories often result in higher androgen levels.

Increased androgens lead to increased sebum production and more skin cell growth. This can lead to

clogged pores and worsening acne.

This was confirmed by doctors who investigated those in parts of the world who have access to very low

calorie levels. Those on the border of starvation see a dramatic decrease in sebum levels, and no acne

symptoms. Obviously this is not a method of acne treatment that anyone would want to use. Usefully,

though, researchers have found that when we cut down on calories, the body becomes more sensitive to

insulin. When we are more sensitive to insulin, our insulin levels decrease. This causes a hormonal

reaction which prevents the skin from producing excess sebum and stops pores becoming blocked.

However, when regular amounts of calories are consumed, the acne symptoms are likely to reappear.

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In a couple of studies, a high BMI (body mass index) was found to be correlated with acne in young

men and women, though other studies show no link.

On the basis of these findings, and for your general health, it would be beneficial to ensure you are

eating within the recommended calories for your gender and age.

5.2.6 Milk

Studies have found that drinking milk correlates with acne. For example:

Adebamowo et al (2005) tested 47,000 nurses. They were asked about how much milk they drank in

high school, and whether they had acne. The results showed that those who drank milk has a 22%

higher risk of having acne, than those who drank no milk at all. For those who drank skimmed milk,

there was a 44% higher risk.

Adebamowo et al went on to do further studies, with both teenage girls and boys. They followed each

group for three years, asking them how often they ate certain foods. The results showed that those two

drank two servings or more of milk a day were 20% more likely to have acne than those who had less

than one serving a week.

A study in Italy found a 78% increase in acne in adults drinking more than three servings of milk a week.

The results for skimmed milk were the strongest.

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5.3 Beneficial foods

Though there are many foods that have been linked to acne that you are likely to want to avoid,

there are many foods that do not have an effect on acne, or that might even help acne to clear.

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5.3.1 Low GI foods

We have been through the high GI foods it would be wise to avoid. In this section, we look at foods which

are lower GI, which you may want to incorporate in your diet in the place of other foods. It is important,

though, that you examine these foods according to other information given you in this module. For

example, dairy has a low GI count, but you still may choose to eliminate it from your diet because of the

information included in section 4.2.6.

Low GI foods include:

All fruits except those in 4.2.3, particularly low GI are:

cherries

grapefruit

plum

peachstrawberries

pear

apple

apricots

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All vegetables except those in 4.2.3, particularly low GI are:

water chestnuts

yellow squash

all green vegetables

sauerkraut

bean sprouts

eggplant

cauliflower

peppers

radishes

onion

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All meats

All dairy products

Foods sweetened with fructose

Foods sweetened with aspartame

Foods sweetened with saccharin

Whole rye bread

Pumpernickel bread

Wholewheat pita

Wholewheat pasta

Oatmeal

Special K

All Bran

Nuts

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Cheese

Pita chips

Olives

Fired pork rinds

Red wine

Peanut butter

Soy beans

Red lentils

Black beans

Kidney beans

Green lentils

Butter beans

Split peas

Chick peas

Pinto beans

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5.3.2 Fermented foods

Some advisers on acne recommend consuming fermented foods.

In Gut Pathogens, researchers say:

"The lines of communication, as mediated by gut microbes, may be direct and indirect -- ultimately

influencing the degree of acne by a systemic effect on inflammation, oxidative stress, glycemic control,

tissue lipid levels, pathogenic bacteria, as well as levels of neuropeptides and mood-regulating

neurotransmitters. …there appears to be more than enough supportive evidence to suggest that gut

microbes, and the integrity of the gastrointestinal tract itself, are contributing factors in the acne

process."

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This means that the microorganisms in the gut send signals throughout the body. These interact with

the organisms in the skin. Researchers are currently investigating how the interactions between

organisms in the gut and those in the skin are linked, and how gut health can influence skin dryness,

can improve collagen, and how it can cause or prevent acne.

Eating fermented foods provides you with essential nutrients such as vitamin K2, and many B

vitamins, as well as boosting your immune system. The beneficial bacteria in fermented foods also

have detoxifying effects for the body.

Fermented foods you can use in your diet include:

Chutneys

Condiments e.g. salsa, mayonnaise, soy sauce

Cultured dairy products e.g. sour cream, yogurt, kefir. But commercial versions are not suitable, as they

often do not have live cultures, and can be loaded with sugars which promote ‘bad’ bacteria.

Fish e.g. mackerel, Swedish gravlax

Lassi (Indian yogurt drink)

Tempeh (fermented soybean dish)

Natto (Japanese fermented soybean dish)

Kim chee (Korean side dish of fermented vegetables)

All kinds of fermented vegetables

You should make sure that any fermented food you buy or make has not been through

pasteurization, as this process destroys the beneficial probiotics.

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You might also choose to ferment your own vegetables at home.

5.4 Paleo diet

The paleo diet was created by Dr. Loren Cordain, after extensive research on the diets of more

traditional and hunter gatherer societies, where there was little to no acne present.

Many people with acne, and other conditions, have found this diet to decrease or even eliminate

their symptoms. In this section we’ll explain the principles behind the diet, and the diet in practice.

5.4.1 Principles of the paleo diet

DrCordain found that virtually all skin disorders are inflammatory in nature. Also known as ‘diseases of

civilization’, they are more common, or sometimes even exclusive to, westernized lifestyles. The paleo

diet was put together as an alternative. It is an anti-inflammatory diet that eliminates the highly

processed foods that provoke inflammation e.g. excess sugar, refined flour, and industrial seed oils.

In addition, it addresses another common cause behind skin disorders – nutrient deficiency. More than

half of Americans are deficient in vitamin A, vitamin B6, magnesium, zinc and calcium. About one third

of Americans are also deficient in vitamin B1 (thiamine), vitamin B9 (folate), vitamin C, iron, and vitamin

B2 (riboflavin).

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Another reason the paleo diet is effective at clearing the skin of some acne sufferers, is because it was

created to be friendly on the gut. Given the strong link between gut health and skin health, this should

not be overlooked.

The paleo diet was designed to be nutrient-dense. Studies have illustrated that the seeds, nuts,

vegetables, meat, fish, starchy tubers and fruit contained in the diet are some of the most nutrient-dense

foods available to us.

The foods in the paleo diet have a low glycemic load. This reduces the production of insulin, and

therefore of androgens that stimulate excess sebum production.

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5.4.2 The paleo diet in practice

Fat - A paleo diet should be high in fat. When on a paleo diet, you are not encouraged to count

calories or control portions in an attempt to lose weight or be healthier. It is recommended to eat

large amounts of saturated fats, such as butter and coconut oil. Olive oil, macadamia oil and

avocado oil are also recommended, but should not be cooked. Instead they can be drizzled over

food or used in salads. Also advised are beef tallow, lamb tallow, lard and duck fat. Eliminate all

vegetable oils, including sunflower oil, peanut oil, corn oil, soybean oil, canola oil, and margarine.

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Protein – A paleo diet recommends good amounts of animal protein. All meals that contain animal

proteins should include fats with them, and eating the fatty cuts is encouraged. Animal proteins such as

red meat, pork, eggs, poultry, organs, fish and shellfish all come into this category. Quite popular among

the paleo movement are broths and stocks that include bones. Try to find grass-fed meat from local

farms that are environmentally conscious and raise their animals in a pasture.

Vegetables – Generous amounts of vegetables should be eaten, and always served with fat. They can be

either raw or cooked. Starchy vegetables like yams and sweet potatoes are encouraged. It is advised to

eat vegetable that is in season, local, and preferably organic.

Fruit – Low to medium amounts of fruit are advised, especially fruits that are low in sugar, and high in

antioxidants. Berries are a good example of this.

Nuts – Nuts should be low in omega-6, high in omega-3, and have low polyunsaturated fats. Macadamia

nuts are good examples. If you are trying to lose weight, have digestive problems or an autoimmune

disease, paleo suggests you might want to eliminate them from your diet altogether.

Cereal grains – Eliminate rye, barley, wheat, corn, oats and brown rice.

Legumes – Eliminate all legumes, including pinto beans, black eyed peas, navy beans, soy and peanuts.

Dairy – Apart from butter and thick cream, eliminate all dairy products. If you do decide to retain dairy

in your diet, eat fermented, raw and full fat.

Processed foods – Avoid every processed food. If it comes in a package, it should not be eaten.

Sugar – Eliminate all sugar from the diet, including juices.

If you decide to follow the paleo diet, you may have to eliminate a lot of your favorite foods, and you may

worry about what you’re going to eat and how you will cook. Keep in mind that there are plenty of

websites with paleo guidance, and numerous paleo recipe websites to keep you on track and give you

ideas.