What types of foods trigger acne?

Foods That Trigger Acne

High glycemic load foods, dairy products (especially skim milk), and whey protein supplements are the main dietary triggers for acne, and eliminating these from the diet should be recommended as an adjunctive treatment for acne patients. 1

High Glycemic Load Foods

High glycemic load diets (HGLDs) play a significant role in acne development through several mechanisms:

• Increase insulin-like growth factor 1 (IGF-1) levels, which stimulates:
  • Keratinocyte proliferation
  • Sebocyte proliferation
  • Androgen production 1

While the evidence is not conclusive (a 2015 Cochrane review found insufficient evidence), multiple randomized trials have demonstrated that low glycemic load diets (LGLDs) can:

• Decrease sebum production
• Reduce acne lesion counts
• Reduce the size of sebaceous glands 1

Additionally, LGLDs often provide other health benefits such as weight loss and improved insulin sensitivity, making them a low-risk recommendation for acne patients 1.

Dairy Products

Dairy consumption has a well-established association with acne, particularly:

• Skim milk shows the strongest correlation with acne development 1
• Low-fat milk has a stronger association than whole milk 1
• Multiple observational studies confirm this relationship 1

The mechanisms behind dairy's acne-promoting effects include:

• Increased insulin and IGF-1 levels
• Presence of bovine IGF-1 that binds to human IGF-1 receptors
• Contains dihydrotestosterone precursors:
  • Placenta-derived progesterone
  • 5α-pregnanedione
  • 5α-androstanedione 1, 2

A meta-analysis of 14 observational studies found a positive relationship between acne and milk intake, with stronger associations for low-fat and skim milk compared to whole milk 1.

Whey Protein

Whey protein supplements are particularly problematic for acne-prone individuals:

• Constitutes 20% of protein in cow's milk
• Has insulin-promoting properties
• Case reports show acne development with whey protein consumption that resolves upon discontinuation 1
• Bodybuilders may consume 40-80g daily (equivalent to 6-12 liters of milk) 1

Clinical Recommendations

For patients with acne, implement the following dietary modifications:

1. Screen for whey protein supplement use and recommend discontinuation if acne occurs in those consuming it 1

2. Recommend a low glycemic load diet as a helpful adjuvant treatment for acne, focusing on:

   • Whole grains instead of refined carbohydrates
   • Limiting added sugars
   • Increasing fiber intake 1

3. Reduce dairy consumption, particularly:

   • Skim milk and low-fat milk
   • Whey protein supplements 1

4. Monitor for improvement - dietary changes typically require several weeks to show effects on acne

Important Considerations

• The evidence for dietary modification is stronger for some patients than others, particularly those with:

  • Adult female acne 3
  • Treatment-resistant acne
  • Acne that worsens with specific food consumption

• While the American Academy of Dermatology acknowledges the emerging evidence for dietary factors in acne, they note that additional research is still needed, particularly long-term prospective studies on low-glycemic index diets and milk consumption 1

• Other potential dietary factors with limited evidence include:

  • Omega-3 fatty acids (possibly protective)
  • Antioxidants including zinc
  • Probiotics 1, 4

By addressing these dietary triggers alongside conventional acne treatments, patients may experience improved outcomes and potentially reduce their need for medications with more significant side effects.