Zits Happen: But is it in Your Greens or Genes?

Acne. Zits. Pimples. Pizza face. We know it all too well. Acne is the most common skin condition and affects around 50 million people in the United States.  Some of us struggled with acne during our teenage years, some of us didn’t get it until after we turned 30 and some of us have dealt with pimples off and on our entire lives. And the rare precious few, have never dealt with pimples. Don’t we hate those people? No…well maybe a little, but they sure are lucky to not experience breakouts like the rest of us.

But why do we get acne? Acne results from several factors including too much oil production, clogged pores, bacteria and inflammation. Hormonal changes can also fuel acne by increasing oil production.  Skin products like moisturizers or make up or even sweating may add to acne by clogging pores. Pollution, smoking and stress can also make acne worse. What about our parents? Can we blame them too? Probably. If someone has a family history of acne, they are more likely to have acne. Studies have linked acne to variations in several genes, including the insulin-like growth factor-1 (IGF-1) and androgen receptor (AR) genes.  

What you’re eating may also be why Mt. Vesuvius is about to erupt on your chin. A high glycemic diet is linked to acne and includes foods that raise blood sugar levels quickly, such as soda, white bread, white pasta, and processed foods. High glycemic foods may increase inflammation or cause hormonal changes that make acne worse. There is evidence that following a low glycemic diet can improve acne. Two randomized clinical trials showed that acne patients that consumed a low glycemic diet, had improvement in their acne. And bonus, they also lost weight!

Dairy might also be a trigger for acne. Milk, particularly skim milk, has also been shown to increase the risk of developing acne.  And for you protein shake users, whey protein may also promote pimples. If you eat whey protein and struggle with breakouts, then cutting back might be helpful or switching to a plant source, like pea protein, might be a better option. The likely explanation behind why dairy and whey contribute to acne is increased production of IGF-1. IGF-1 increases oil production and inflammation in the hair follicle, both of which contribute to acne. 

If you are a chocolate lover, there’s more bad news. Some argue that milk chocolate can cause acne because it’s a high glycemic food or because it contains milk.  One study suggested that cocoa itself is the acne culprit.  For dark chocolate, it’s divided. On one hand, some advocate that dark chocolate might be helpful for acne because it contains antioxidants called flavonoids, the powerful ingredients that are known to calm inflammation and help reverse skin damage.  On the other hand, dark chocolate might also aggravate acne because it contains oleic acid and stearic acid which can cause clogged pores.  

For those of you thinking about supplements and acne, there are some good options to consider. Vitamin D probably has some of the strongest evidence and we know how important vitamin D levels are, especially for our immune health. Studies have shown that acne sufferers tend to have lower levels of vitamin D and as acne gets worse, vitamin D levels tend to decrease. Supplementing with vitamin D 1000 IU daily showed a 35% reduction in acne.  Another player for immune health is zinc.  Studies looking at zinc and acne support a potential benefit but the zinc doses used are very high and may result in many side effects, particularly upset stomach. Zinc might be worthwhile to consider if you can tolerate it. 

Vitamin B5, pantothenic acid, might also be helpful in the fight against breakouts as well.  Studies have shown benefits for acne, but at much higher doses than typically recommended. One study showed a 70% reduction in pimple counts for those taking vitamin B5 but it should be noted that the doses were significantly higher than the recommended daily allowance. However,  as a water soluble vitamin, the body can take care of any excess vitamin B5 by peeing it out, so overdosing usually isn’t a concern. Typically, pantothenic acid at 1-2 g daily can be used safely to treat acne with good results.

Any Accutane users out there? You might recall that isotretinoin, the generic for Accutane, is a vitamin A derived drug so it makes sense that you might think about vitamin A supplements for acne.  Research has shown some benefit for vitamin A supplements and acne. However,  the challenge is that the doses are very high which can lead to toxicity issues and other side effects. So the general consensus is that the potential risks with vitamin A supplementation are not worth the possible benefit. Unlike vitamin B5, vitamin A is fat soluble which means it can accumulate in the body and result in serious side effects.

Trotter’s Take:  If you have acne, the strongest evidence is to follow a low glycemic diet. If you notice that certain foods cause you to break out, then avoid them. But… sometimes that piece of chocolate cake might be worth the zit that comes later.