Eating your way to better skin when you have acne: an elimination diet may help
If you have acne, avoiding certain foods may help. This certainly won't work for everybody, but some people have been helped with an acne "elimination" diet.
Acne elimination diets: supportive evidence from randomized controlled trials
Researchers have looked at the link between acne and our diet. They've even performed randomized controlled trials looking at certain diets as acne treatments. This is considered one of the highest levels of evidence for studying the effects of diet on our health. In one particular study, researchers asked one group of patients to follow a low glycemic index diet for 12 weeks. The other group ate their standard diet. [A low glycemic index food diet (known as a low GI diet) consists of foods that don't cause high elevations in blood sugar levels.]
At the end of 12 weeks, the two groups were compared. In the low GI diet group, the volunteers had a much greater improvement in their acne. By improvement, we mean that this group had fewer acne lesions, including red bumps (papules) and pustules. They even had less whiteheads and blackheads. It's important to note that this wasn't a "low carb" diet or a "keto" diet. The changes the volunteers were asked to make were not drastic. They were asked to use, for example, whole wheat bread instead of white bread, and higher protein foods instead of some of their processed carbs.
Other researchers have done similar studies. In another study, the low GI diet group had even more testing done, including biopsies of their skin. These skin biopsies showed that their skin had less inflammation and smaller oil glands. By blood testing, they also had lower levels of certain hormones (that are known to make acne worse).
If avoiding certain foods can help your skin, can eating more of other foods help?
We don't have the same level of evidence to say for certain that specific foods will help in the treatment of acne. Having said that, though, there are a few promising human studies, and there are many promising laboratory studies. Since these foods have many other health benefits, I recommend adding more of them to your diet.
Fiber from fruits and vegetables: eating more foods naturally rich in fiber may help with acne
The main foods I recommend eating more of are those that are naturally high in fiber. This includes more fruits and vegetables. Focusing on foods that are rich in fiber also means replacing refined carbohydrates (such as white bread) with whole grains, such as intact whole kernels (such as old-fashioned oats, brown rice, bulgur, and others). Why do I consider fiber (the kind that's naturally found in foods) such an important nutrient for patients with acne? First, foods are high in fiber naturally help to limit the rise in blood sugar levels following a meal. When you eat a meal, your food is digested and broken down for energy. That means that your blood sugar will naturally rise after a meal. Ideally, you want a slow, steady rise in blood sugar, to provide for sustained energy. Fiber does that well; it slows down the release of blood sugar into your bloodstream, and keeps those levels steady.
What happens if you eat a meal with little or no fiber? Like a big bowl of mac and cheese? Without any fiber, your blood sugar is more likely to spike to high levels. Those spikes seem to play a role in triggering certain hormones that can lead to acne.
Other nutrients can help slow down those sugar spikes, including protein and fat. But fiber is a favorite because it works so well AND because it has other important roles. One of the most important is keeping a healthy gut. Foods that are rich in fiber do a great job of feeding the good bacteria and the good microbes that live in our GI tract. Studies have found that those good bacteria may help reduce skin inflammation.
Probiotics: why the good microbes found in fermented and cultured foods may be helpful
While foods that are naturally rich in fiber help promote the growth of beneficial gut microbes, and are the most important factor in maintaining healthy gut microbes, it may be possible that eating those good microbes may be helpful as well. Probiotics are "good" microbes that you consume, either via foods (such as yogurt with live active cultures) or via supplements. In one small study, volunteers who consumed a probiotic supplement daily for 4 weeks had an improvement in their acne.
While we don't have enough data yet to recommend particular probiotic supplements, the research is compelling enough that I do recommend adding fermented and cultured foods to your diet. Examples include yogurt with live, active cultures, kefir, miso, sauerkraut, kimchi, pickled vegetables with active cultures, and many other foods.
Antioxidants: eating more foods rich in antioxidants may help reduce the skin damage from free radicals
Acne is due to inflammation of the skin. That inflammation is visible: many acne patients develop red inflamed bumps, or even pus-filled bumps (pustules), on their face, chest, and back.
That's why researchers have studied treatments that reduce inflammation. Some of the inflammation in acne is due to free radicals such as reactive oxygen species. These are molecules that can cause damage to the DNA, proteins, and cell membranes in our skin. In acne, some of our own immune cells actually produce some of these free radicals. We know that this causes damage; patients with acne actually have higher blood levels of a chemical that measures the level of oxidative damage. How do you combat these free radicals? One potential way is by consuming more antioxidants. In fact, a number of laboratory and animal studies have now supported the use of antioxidants in fighting the inflammation in acne. Human studies are limited, though, so more research is definitely needed in this area.
It's because of this promising data, though, that I strongly recommend foods that are naturally rich in antioxidants. This includes more fruits and vegetables. It also includes less commonly known sources of antioxidants, such as herbs, spices, and green tea. [It's also important to recognize that in study after study, antioxidant supplements simply haven't been able to produce the same results as the antioxidants that are naturally found in foods. In fact, some high dose antioxidant supplements have resulted in harmful side effects.]
Zinc and acne: why more red kidney beans may be a good thing for your skin
Zinc is a mineral that has an important role to play in many of your body's functions. That's because zinc acts as a cofactor (a necessary ingredient) for many of the enzymes that control the vital processes of the human body.
Zinc is also known to have several powerful anti-inflammatory effects. In laboratory studies, it's helped to stop the movement of certain inflammatory cells. In other studies, it's helped to reduce the production of certain inflammatory cytokines, which act as chemical messengers to promote inflammation in the skin.
Since it has anti-inflammatory effects, could zinc have a role to play in the treatment of acne?
Researchers have studied this question. Some studies have found that patients with acne actually have low levels of zinc in their bloodstream. Based on these studies, researchers started studying whether giving these patients zinc supplements would help.
The results? Some of these studies did find that zinc was helpful, and in some cases even similar to taking antibiotics by mouth. BUT there are still too many unknowns in this area. For one thing, some of the studies had serious flaws. Some gave patients supplements of zinc, but didn't take into account how much zinc these individuals were consuming through their diet. (As I discuss later on, there are several foods that are known to be great sources of zinc.)
In this case, there are still too many unknowns in this area for us to recommend zinc supplements without a thorough knowledge of your medical history and possibly testing. There are other important considerations also: there are several different forms of zinc, and several different dosages that have been studied. In some forms, and at some dosages, patients have experienced some notable GI side effects, including nausea and vomiting.
As more studies are done, we may have some more definitive recommendations, but at this time, I focus on obtaining zinc from food sources.
Foods that are known to be good sources of zinc include certain vegetables, such as spinach and kidney beans. Seafood is another great source, including shrimp and oysters. Pumpkin seeds and flaxseeds are other great sources.
Omega-3 fatty acids: could salmon twice a week help your skin?
This definitely seems like an area worth studying more. Multiple studies have shown that eating more omega-3 polyunsaturated fatty acids, relative to omega-6 fatty acids, is beneficial when it comes to reducing inflammation.
One study from the 1960s found that adolescents who consume large amounts of fish and seafood were less likely to develop acne. In terms of supplements, unfortunately we only have limited studies. Some of these have been promising enough that we recommend more studies, but because of limited data I'm not yet able to recommend them. One study found some preliminary but promising results. In a small randomized trial, patients with acne were given omega-3 fatty acid supplements for 10 weeks. They were compared to a group that received no supplements. After 10 weeks, the group consuming the supplements showed less acne, with less inflammatory lesions. Skin biopsies also showed less inflammation.
While I can't yet recommend supplements because of the need for more research, ensuring that your diet contains plenty of natural sources of omega-3 fatty acids is one healthy, and skin healthy, strategy that I CAN recommend. That translates to more salmon, sardines, and herring. But seafood isn't the only source of omega-3 fatty acids. Other strong sources include walnuts, flaxseeds, chia seeds, and soybeans.
The Bottom Line: For foods that may be helpful in acne, one of the best options are those that are naturally rich in fiber. Probiotic foods, foods rich in zinc, and foods rich in omega-3 fatty acids may also be helpful. For more on foods that may worsen acne, check out this post.
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Dr. Rajani Katta is the author of Glow: The Dermatologist's Guide to a Whole Foods Younger Skin Diet. To receive future updates on preventive dermatology and the role of diet, sign up here.