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Perfect Skin from Inside Out Module 24

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Module 24: Diet

Table of Contents

Module 24: Diet ............................................................................................................................................................. 1

Introduction ................................................................................................................................................. 2

24.1 Links between diet and acne ............................................................................................................... 3

24.2 Foods to avoid .................................................................................................................................... 4

24.3 Beneficial foods .................................................................................................................................. 9

24.4 Paleo diet .......................................................................................................................................... 12

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Introduction

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.

24.1 Links between diet and acne

24.2 Foods to avoid

24.3 Beneficial foods

24.4 Paleo diet

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24.1 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.

24.1.1 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.

24.1.2 Fullerton’s study

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.

24.1.3 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.

24.2 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.

24.2.1 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.

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.

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24.2.2 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.

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.

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.

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24.2.3 Refined carbohydrates and high GI foods

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

Potatoes

Corn

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Rice

Rice products

Pasta

Most cereals

Popcorn

Corn chips

Potato chips

Beers

Liquors

All alcohol except red wine

24.2.4 Phytoestrogens

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.

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24.2.5 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.

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.

24.2.6 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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24.3 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.

24.3.1 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

All vegetables except those in 24.2.3, 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

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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24.3.2 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."

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.

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

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24.4 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.

24.4.1 Principles of the paleo diet

Dr Cordain 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).

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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24.4.2 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.

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.