Colleen Sloan, PA-C, RDN

Acne is a common yet frustrating condition that affects nearly 85% of teenagers, often affecting their self-esteem and mental health.¹ Acne is influenced by a combination of internal and external factors, including genetics, hormones, lifestyle, and potentially diet. As pediatric providers, we frequently prescribe topical treatments, but how often do we discuss nutrition as a potential pillar of treatment? With the rise of social media platforms such as TikTok offering quick access to a wide array of opinions, misinformation and confusion abound. This article unpacks common acne/diet claims and examines the research behind them.

1. Dairy and acne

Claim: Cutting out all dairy eliminates acne.

Research:

The relationship between dairy and acne is controversial due to limited and poor-quality studies. Findings from observational studies suggest a correlation, particularly with skim milk, potentially due to hormones such as insulinlike growth factor 1 (IGF-1) and bioactive molecules in milk that may exacerbate sebum production and inflammation.² However, causation remains unproven, and randomized controlled trials are lacking.

Advice:
Encourage teenagers to monitor their skin’s response to different types of dairy rather than eliminate it entirely. Suggest they keep a food and skin log to identify any patterns. For those who choose to adopt a dairy-free diet, emphasize maintaining adequate calcium and vitamin D intake through foods such as beans, soy milk, eggs, salmon, sardines, figs, and leafy green vegetables.³

2. High glycemic foods and acne

Claim: Reducing high glycemic foods will improve acne.

Research:

The glycemic index (GI) ranks carbohydrate-containing foods on a scale of 1 to 100 based on how quickly they are digested and increase blood glucose levels. Evidence increasingly suggests that high-GI foods can worsen acne. Foods such as white bread, sugary cereals, and sweetened beverages cause rapid spikes in blood sugar and insulin, potentially triggering elevated IGF-1 production and androgen activity. Findings from clinical trials have linked high-GI diets to poor glycemic control, elevated postprandial insulin levels, and increased IGF-1 concentrations.² Conversely, low-GI diets rich in whole grains, vegetables, and lean proteins have been shown to improve acne severity in findings from several studies.

However, it’s essential not to recommend a low-GI diet indiscriminately to all patients. An important distinction must be made between GI and glycemic load (GL). Although GI measures how much a specific food increases blood sugar level, GL considers both the quantity of carbohydrates in a serving and its overall impact on blood sugar levels. GI alone does not reflect how prolonged or significant a blood sugar rise will be after consuming a particular amount of food. GL provides a more accurate representation of a food’s real-life effect on postprandial glycemia. For instance, watermelon has a high GI of 74 but a low GL of just 4 per 100-g serving due to its low carbohydrate content.⁴

Advice:

Despite conflicting research in this area, having your patient focus on more complex carbohydrates that contain fiber rather than simple carbohydrates and sugary snacks will prove beneficial for their overall health and possibly their skin. Take caution in the words you use to avoid fear or excessive carbohydrate restriction in this population.

3. Chocolate and acne

Claim: Chocolate causes acne.

Research:

The link between chocolate and acne is complex. Pure cocoa may not trigger acne, but the sugar and dairy in milk chocolate might play a role.⁵ Findings from small studies suggest chocolate consumption may increase inflammatory markers in the skin, but larger studies are needed for definitive conclusions.⁶

Advice:

Encourage moderation rather than elimination. Teenagers can enjoy chocolate occasionally without exacerbating acne, especially if they choose dark chocolate with minimal added sugar. Discuss the importance of overall dietary patterns rather than singling out specific foods.

4. Fried foods cause acne

Claim: Fried and greasy foods clog pores.

Research:
Although greasy foods are unlikely to directly cause acne, diets high in unhealthy fats, such as trans and saturated fats, may promote inflammation.⁵ Acne is an inflammatory condition, so a pro-inflammatory diet could exacerbate it. Conversely, healthy fats from sources such as avocados, nuts, and fatty fish may support skin health.

Advice:
Focus on promoting anti-inflammatory foods rather than avoiding fried foods entirely. Suggest simple swaps such as roasted vegetables instead of fries or grilled chicken instead of fried options.

Educating teens: A balanced approach

Addressing diet and acne with teenagers requires sensitivity and a focus on empowerment. The best dietary approach is to address each patient with acne individually, carefully considering the possibility of dietary counseling. Here are some strategies to make dietary guidance effective and relatable:

1. Avoid food shaming: Teenagers are already navigating a complex relationship with food and body image and are faced with a constant stream of information and sales tactics. Avoid framing acne as a punishment for poor eating habits. Instead, highlight the benefits of nutrient-rich foods for overall health and well-being.

2. Start small: Suggest 1 or 2 manageable changes rather than a complete dietary overhaul. For example, recommend swapping sugary drinks for water or eating a handful of nuts as a snack.

3. Focus on additions, not restrictions: Encourage teenagers to add more fruits, vegetables, and whole grains rather than focusing on foods to avoid. This positive framing can make dietary changes feel less daunting.

Conclusion

Educating teenagers about the nuanced relationship between diet and acne empowers them to make informed choices without falling prey to exaggerated claims or restrictive regimens. With your guidance, teenagers can adopt a compassionate, realistic approach to managing their skin health, one that integrates lifestyle modifications, evidence-based dietary adjustments, and medical treatments. By doing so, you not only address acne but also help shape their relationship with their body and food—an outcome far more important than the state of their skin alone.

References:

1. Gallitano SM, Berson DS. How acne bumps cause the blues: the influence of acne vulgaris on self-esteem. Int J Womens Dermatol. 2017;4(1):12-17. doi:10.1016/j.ijwd.2017.10.004

2. Meixiong J, Ricco C, Vasavda C, Ho BK. Diet and acne: a systematic review. JAAD Int. 2022;7:95-112. doi:10.1016/j.jdin.2022.02.012

3. Calcium. National Institutes of Health Office of Dietary Supplements. Updated July 24, 2024. Accessed December 20, 2024. https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

4. Vlachos D, Malisova S, Lindberg FA, Karaniki G. Glycemic index (GI) or glycemic load (GL) and dietary interventions for optimizing postprandial hyperglycemia in patients with T2 diabetes: a review. Nutrients. 2020;12(6):1561. doi:10.3390/nu12061561

5. Baldwin H, Tan J. Effects of diet on acne and its response to treatment. Am J Clin Dermatol. 2021;22(1):55-65. doi:10.1007/s40257-020-00542-y

6. Caperton C, Block S, Viera M, Keri J, Berman B. Double-blind, placebo-controlled study assessing the effect of chocolate consumption in subjects with a history of acne vulgaris. J Clin Aesthet Dermatol. 2014;7(5):19-23.