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Conventional wisdom may be right about acne

When I was a kid I recall that the conventional wisdom was that eating chocolate would give you acne. Decades later the claim was that what you ate had nothing to do with acne, but that it was genetic or was due to not using the right cleansing products. Or using too much of them. Or too little.

While the treatments for acne have advanced by light years over what treatments were available when I was young, it seems that there's still some uncertainty over whether acne is affected by diet.

Fortunately, a long-term, large-scale ongoing cohort study, the NutriNet-Sante study, surveyed their participants with a specific, optional questionnaire about acne between late 2018 through mid-2019 (JAMA Dermatol. 2020; doi:10.1001/jamadermatol.2020.1602).

The NutriNet-Sante study began in 2009 with series of 3 non-consecutive 24-hour dietary records and a survey of health and demographic information administered to each of the over 170,000 initial participants. The questionnaires are re-administered every six months. As the acne questionnaire was optional, the authors utilized only the information from respondents who both responded to the acne questionnaire and provided at least 3 complete dietary records: 24,452 individuals.

The authors assigned those who responded to the acne questionnaire to one of three categories: never acne, past acne (that is, acne in the past but not at the time of the survey response), or current acne. It should be noted that the average age of the participants for this portion of the study was 57 years, so this study is focused on adult acne, not adolescent acne.

Using the dietary questionnaires, the authors were able to broadly group the participants into three dietary "patterns": a "healthy pattern" of higher consumption of fruit, vegetables, and fish; a "fatty and sugary pattern" of greater consumption of saturated fat and sugar products, including chocolate; and an "animal products and refined cereals pattern" characterized by greater consumption of meat, milk, and refined cereals.

After taking into account total caloric intake, age, sex, smoking status, body mass index, and history of chronic conditions, the authors compared the dietary patterns of those who had never experienced acne with those who were experiencing current acne.

The results? Compared to those who had never experienced acne (and how lucky are they?), those who followed a "healthy pattern" were 12% less likely to report current acne, while those following a "fatty and sugary" pattern were 12% more likely to have acne - and those with an "animal products and refined cereals" pattern were just 3% more likely to have current acne.

With additional analysis the authors could drill down into exactly which food types might be associated with greater risk of acne. Interestingly, they found that while greater intake of meats, fish, vegetables, or fruits were associated with a slight-to-moderately lower risk of acne, drinking milk or sugary beverages as well as consuming "fatty and sugary products" were more significantly associated with greater risk of adult acne.

What this means for you

While this study can't show that milk or chocolate or anything else causes acne directly, it certainly strongly suggests that a diet of higher saturated fat and refined grains is linked to a greater risk of adult acne.

Given that such a diet is also known to be linked to greater risk of heart disease and other chronic conditions, this is just another reason to take a look at the ways you can improve your Mediterranean Diet score. Here's a quiz for you to assess your Mediterranean Diet score - with ways you might improve.

First posted: July 1, 2020