The New Science Of Clear Skin

Toss the tubes and fill your cart with greens: The acne solution that dermatologists swore wouldn't work is here.

Peter Rosa

Loren Cordain might have been the only person in the auditorium without an MD that April night in 2004. He wasn't even a skin specialist. But for over an hour at the Society for Investigative Dermatology's annual meeting, he shocked the dermatological luminaries in the room by upending the current thinking about a growing new problem: adult acne.

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Cordain, an anthropologist, tells me later that his skin obsession started with an article about Canadian Inuit in a 1971 issue of Nutrition Today. One observation arrested his attention: The Inuit population started getting acne only when they began eating processed foods. But why? He'd clung to that question, letting it take over his research. Diet, he decided, irrefutably affects acne.

He knew it wouldn't be an easy sell to that night's audience, Cordain says. The idea of a diet-acne connection had been anathema since the '60s, when a few dermatologists (two of whom were onstage with him that evening) found that chocolate, long fingered as an acne culprit, didn't worsen breakouts. Study subjects who ate placebo bars developed the same number of zits as those who munched on chocolate bars. The case was considered settled and the study canonized (which explains why all five of the dermatologists I've seen as a grown-up have insisted that diet has nothing to do with my adult acne).

While Cordain stood at that lectern, he cited research he'd done on remote populations and explained how a high-glycemic American-style diet could result in a crop of pimples. He debunked the chocolate study by pointing out its flawed methodology: The placebo bar packed the same glycemic load as the chocolate one, and because they contained the same amount of sugar, the bars were almost nutritionally identical.

After Cordain returned to his seat, one of the authors of the chocolate paper leaned over and shook Cordain's hand. "Thank you for correcting our mistake," he said.

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Oily fish for oily skin? We’re in. The anti-inflammatory impacts might just swim to your skin’s surface too.

More people see dermatologists for acne than for any other reason. A full 62% of acne patients are adults, and most are women. And every day, exam rooms ring with one consistent query from patients: "Does what I eat affect my acne?" It's a question that forces dermatologists to take sides. Some still consider the debate settled with the chocolate study. The rest either believe in the research that shows food can affect the skin or deem the evidence too weak. Attitudes have evolved since that conference 10 years ago, and now there's enough research on diet and acne to demand it be taken seriously.

I was one of those patients. Since middle school, my face and back have been home to deep cystic acne ranging from moderate to severe. For more than 10 years, I asked various dermatologists if food could be the culprit behind my crazy-making skin problems. "It's a myth," they all told me. But when my rounds of antibiotics and isotretinoin (Accutane), a prescription drug that delivers high doses of a vitamin A derivative, weren't working, I started looking for answers. Dietary changes were touted as a magical cure on acne message boards online, and it seemed like common sense: Everyone knows that after a week of too few vegetables and too much beer, we don't look our best. And when we indulge in greasy food, a little always seems to shimmy its way through our pores.

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It wasn't until I was reporting a story for Prevention that I heard there was science to back up the claims. A researcher specializing in gut bacteria suggested I ditch my acne antibiotic and change my diet. "Drop all refined carbs and eat a sh*t-ton of plants," he told me. People with diverse gut microflora also tend to sport beautiful skin, he said. Days after I began following his command, my skin was radiant. I had an even complexion, fading red dots, and a magical, vegetable-fueled glow. Could I have stumbled upon an acne treatment as simple as kale and complex carbs?

The cadre of scientists and leading-edge researchers who think so is growing fast. Five years ago, when New York City dermatologist Whitney Bowe began lecturing on the ties between diet and acne for the American Academy of Dermatology, doctors were confused. "They'd say, 'But wait, my textbooks said there was no link,' " she says. At her most recent talk in March, the audience had grown dramatically and, instead of questioning her, asked for handouts for their own practices.

Most dermatologists' go-to options for acne are still drugs: antibiotics, topical retinoids, and Accutane. But these can be costly and come with unpleasant side effects like excessive dry-ness and nosebleeds, and the benefits often don't last. Add in the fact that it's difficult to predict which drug will work best for a patient and a natural cure sounds pretty appealing.

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We know what a pimple isa tiny blocked hair follicle attached to an oil glandbut nobody knows exactly what causes pimples or how to prevent them. What science does know is that adult acne is often a hormonal process. In excess, hormones known as androgens trigger growth in oil-producing cells, leading to acne. Most adult women with breakouts, though, don't have a hormonal imbalancetheir androgen receptors are just more sensitive than average. Psychological stress can also play a role, because the hormone cortisol increases oil production.

Understanding the birth of a pimple gets even dicier once you factor in diet. But the idea that food may be connected to acne isn't new: Back in the 1800s, doctors prescribed dietary changes for acne patients. By the mid-1900s, small studies linked acne to excessive carbs, milk, sugar, and fat. One 1959 article published in the Canadian Medical Association Journal nicknamed acne "skin diabetes" because of its positive response to a diabetes drug.

The 1969 chocolate study settled the diet-acne debate in medical textbooks, but then, in 2002, Cordain published his research on 1,200 islanders in Papua New Guinea and 115 hunter-gatherers in Paraguay. "There was not a single case of acne," he says. He attributes the populations' clear skin to their clean diets. He became so convinced that he started the Paleo diet movementand people paid attention. "In 2002, the diet-acne notion was a complete joke in the dermatology community," he says. "This paper reopened the case."

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One way diet could affect acne is through inflammation. The new theory among scientists is that acne is a Western disease like obesity, type 2 diabetes, and cancer, triggered by overstimulation of a certain cell-growth system. The mechanism: A high sugar load increases blood levels of the hormone insulin, which triggers androgens, growth hormones, and cell-signaling pathways, resulting in low-grade inflammation, more oil secretion, clogged pores, and acne flares.

Some of the most-studied acne aggravators are refined sugars and processed grains, so a low-glycemic diet tends to improve skin. A study published in the American Journal of Clinical Nutrition in 2007 found that when 43 Australian boys followed a low-glycemic diet for 12 weeks, they had significantly fewer lesions and a healthier insulin sensitivity than those with a high glycemic load. A 2012 Korean study produced similar results: The skin of men on a low-glycemic diet had less inflammation, and their oil glands shrank.

In my personal, unscientific study of one, sticking to a diet free of pasta and doughnuts really did seem to shrink pimples and prevent massive breakouts. I'm not alone: According to a questionnaire of about 1,900 mostly female followers of the low-glycemic South Beach Diet who had acne, 87% reported better skin. And 91% of those being treated for acne decreased the dosage or amount of their treatment.

It's not just pastries that cause problemsresearch suggests that milk can also alter insulin production. Fat-free seems especially bad: One Harvard School of Public Health study examined 47,000 dietary questionnaires and found that acne was associated with total milk intake, especially fat-free milk. But because there haven't been any randomized controlled trials, the evidence isn't as strong.

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If you need an excuse to eat a juicy peach, cite your skin: Beta-carotene gives it a glow.

And yet the case for using diet to heal acne isn't settled. Because of a dearth of large randomized controlled trials, there's no proof that diet has a significant impact, says Susan Bershad, associate clinical professor of dermatology at Icahn School of Medicine at Mount Sinai. In a 2003 correspondence she wrote for JAMA Dermatology called "The Unwelcome Return of the Acne Diet," she likened the reemerging belief in a diet-acne link to Samuel Johnson's 18th-century view of remarriage: It's a "triumph of hope over experience."

Bershad often prescribes hormone therapy to female acne patients via birth control pills or spironolactone, a medication that blocks the effects of androgens. HT yields quicker and more pronounced results, she says. "It's much easier to alter a person's hormonal levels with actual hormonal therapy than with diet," she says. "Most diets fail, and most patients give up on them."

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The new believers tell a more hopeful story. "I have people traveling 2 to 3 hours to see methey're very motivated about their diet," says Bowe. She has patients keep a 3-day food log and puts them on a low-glycemic, milk-free, vegetable-rich diet. She's seen a dramatic increase in adult female acne patients and believes it's due to stress and high-glycemic food (Not sure about what makes a food high-glycemic or low? Here's a handy guide.). "I'm not saying that diet alone is going to do what Accutane, an antibiotic, or a topical retinoid is going to do," she says. "When you look at the studies, they're small changes, but they're not meant to be a substitute for tried-and-true acne therapy."

That neither-black-nor-white message came as a relief to me. My case isn't mild, my body is sensitive, and my willpower in the face of cheese pizza is changeable. So, after months of trying to stick to a diet, only to wake up post-slippage with massive breakouts (and guilt of the same proportion), I decided to give a dermatologist one last try. My new doctor put me on spironolactone; it's only been a month, but not since my perfect-diet experiment has a treatment worked so fast.

Now that my medication is doing the heavy lifting of hormone balancing, I put less pressure on myself to eat my way to perfect skin. The truth is that having acne is not my fault, no matter what I eat. But maybe if I pair a tasty salmon salad with a nice pharmaceutical, I can get closer to the clear adult skin I've chased for so long.



Your Emergency Acne Kit
Even the best diet plan goes awry every now and then. Keep this anti-acne arsenal at the ready to take care of any rogue breakouts.
WASH IT OFF. When acne is brewing, your regular cleanser might not be enough. L'Oreal Paris Go 360° Clean Anti-Breakout Facial Cleanser ($7; drugstores) with salicylic acid gently exfoliates to unclog pores and kills the bacteria that lead to acne.
SPOT TREAT. Dab on La Roche-Posay Effaclar Duo Dual Action Acne Treatment ($37; when you have a sudden breakout. "Spot treatments containing sulfur compounds or benzoyl peroxide, like this one, are drying and anti-inflammatory," says dermatologist Susan Bershad.
COVER UP. To camouflage on-the-mend breakouts, look for something thick that stays put. Matte-finish Make Up For Ever Full Cover Concealer ($32; is so opaque that it can cover tattoos, and it contains allantoin, a compound that promotes new tissue growth.

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Your Get-Clear Eating Plan
For the ultimate evidence-based anti-acne diet, follow these steps from dermatalogist Whitney Bowe.
1. ELIMINATE high-glycemic foods. Research shows that these trigger a cascade of endocrine responses that can promote acne. Avoid anything with a glycemic index score 70, including white bread, pretzels, baked potatoes, and junk food.
2. ADD low-glycemic foods. These won't spike your blood sugar as fast. Look for foods with glycemic index scores under 55, like vegetables, sweet potatoes, barley, beans, and multigrain bread. (Check out this list of foods with their glycemic index ratings.)
3. LIMIT milk. The evidence isn't as damning as with high-glycemic foods, but epidemiological studies have linked fat-free milk with acne. Milk's proteins and added hormones would be the likely culprits. Try almond milk, a dairy alternative with the added bonus of being low-glycemic.
4. ADD antioxidants. Evidence is weaker here, but some research shows that antioxidants, like vitamin C and those in green tea, can ease oxidative stress and therefore breakouts. Inflammatory acne might also be improved by omega-3 supplementation or oily fish.
5. TRY a probiotic. The gut-brain-skin theory suggests that helping good bacteria bloom, via probiotics or yogurt, may help breakouts.


MORE: 7 Signs Your Essential Oils Are Fake


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