Anti-Acne Diet Based on 70 Studies (2020): What to Eat for Clear Skin!

Let me first acknowledge the fact that I’m perfectly aware there’s plenty of pushback on this topic. Some people wholeheartedly believe in the acne and diet connection; others are somewhat skeptical about this entire holistic approach. I’m somewhere in the middle, and that’s probably the tone that this article will take.

While yes, I do think health is of the upmost importance, I have a fair warning for everybody: the journey of elimination dieting to weed out every possible trigger or food intolerance to achieve clear skin is a loooooong one. Don’t underestimate the length of this process.

And more importantly, if you decide to go this route, don’t subvert yourself to psychological stress! The last thing you wanna do is scrutinize every morsel of food thinking it’ll cause a breakout. Peace of mind is just as important as a healthy diet. Have balance, take it slow, and treat yourself occasionally!

Without further ado, let’s get into it. I’ll try my best to be as objective as possible. Hopefully you find it resourceful!

What’s the Link Between Diet and Acne?

For the longest time dermatologists and researchers were outright denying any sort of link between diet and skin. It all started in the 1960s with a study that examined the effects of eating chocolate and acne. (1) 65 participants with “moderate acne” were asked to eat chocolate bars every day for a month. Some were even consuming an excess of 1,200 calories daily from just chocolate!

Surprisingly, the study found nothing. Nada. Zip. Everyone went, “Welp. The juries out. No link here! Let’s go get some snickers, chocolate shakes, and avoid this topic for the next 40 years.” And that’s roughly what happened. This subject wasn’t revisited again until the mid 2000’s! Almost 40 years later. Crazy right?

What caused the newfound interest?

The fact that acne appears to be a westernized disease. (2) In other words, it’s completely non-existent outside of many industrialized civilizations! Two examples being the Kitavans from Papua New Guinea, and the Aché hunter-gatherers from Paraguay.

Could you imagine that? Two civilizations that have never known what the damn of existence of a pimple feels like. LUCKY SONS OF BEES!

So why have the skincare gods blessed these people with pimple-free faces? Turns out it’s (probably) their diet. The foods they consume, by and large, allow them to remain free of any blemishes.

If you’re anything like me, hearing this news may have you thinking: “WHAT THE HELL DO THEY EAT?!?? I’M ABOUT TO BECOME A HUNTER GATHER PARAGUAYAN/KITAVAN!!’

Great question! Let’s focus on the Kitavans who are northeast of Australia on this little island in the middle of nowhere (haha).

Unsurprisingly, their cuisine is very different than the Standard American Diet.

Staples include sweet potato, taro, cassava, leafy greens, breadfruit, coconut, and fruits like papaya, banana, guava, pineapple, mango, and watermelon. They also eat lots of fish and occasionally have pork. (3) Their macronutrient composition is roughly 69% carbohydrates, 21% fat, and 10% protein. (4)

You may have noticed that this is a rather low-glycemic diet, free of dairy, grains, polyunsaturated oils, alcohol, coffee, tea, or processed sugar. Or uh…. essentially EVERYTHING that puts the SAD in Standard American Diet.

Fun fact #1: SAD is the actual acronym for the Standard American Diet. The insinuation couldn’t be anymore obvious here — eat SAD and pimples will make you sad.

And that’s really the crux of the argument that kick-started this research again. That is;

• Acne is non-existent in places that don’t follow a western diet.
• People that follow a western diet sometimes have acne.
• Therefore, something about the western diet leads to acne.

How Does Diet Affect Acne?

In the most basic sense improving acne (and health) through diet comes down to just 4 factors. (5)

1. Increase nutrient density.

We are what we eat. Our body is a very complex system that requires a variety of vitamins, minerals, fatty acids, amino acids, and antioxidants to function optimally. Eating foods devoid of nutritional content gives our bodies little support and hinders its ability to heal damaged tissue and reduce inflammation.

2 Improve gut health.

As outlined in my guide about probiotics for skin health, we have trillions of bacteria in our guts that play a humongous role in quite literally everything: mental health, nutrient absorption, disease prevention, immune system regulation etc.

Scientist don’t call our gut the second brain for sh*ts and giggles! (6) Keep your gut health happy, and your skin will be happy.

3. Regulate hormones.

Hormonal acne, anyone? Yeah, it’s no secret that’s a thing. Turns out a lot of foods can disrupt hormones. Needless to say, if you’re suffering from hormonal acne you’ll want to avoid these. Don’t worry, we will go over those foods in a bit.

4. Regulate the immune system.

This one goes hand in hand with all the points above. We regulate our immune system by restoring our gut barrier function, giving support to our gut microorganisms, balancing hormones, and focusing on micronutrients. This can all be done with food!

If this blogpost has sounded confusing so far, don’t worry! I will tell you exactly what foods to avoid and which to consume as we go. Let’s first start out by focusing on something that gets a lot of attention, and for good reason — dairy.

DUN DUN DUN.

Dairy and Acne.

There’s a fair amount of research on this topic. Scientists have now found an association between dairy and acne across 3 different populations (United States, Italy, and Malaysia). Let’s go over the research done in the U.S. first.

Quick disclaimer: a lot of the studies weren’t very well controlled and relied on questionnaires, so the association here is a bit weak. With that said, I have no doubt there may be some truth to this, but from an epidemiological perspective the evidence is still lacking.

Anyway, here’s what the studies found:

• A food frequency questionnaire involving 47,355 young ladies in high school, found a positive association between dairy intake and acne. The link was strongest for skim milk, followed by whole milk, instant breakfast drink, sherbet, cream cheese, and cottage cheese. Surprisingly, no significant association was found for pizza, chocolate candy, and other dairy foods. (7)
• A prospective cohort study (in other words, it followed the same participants for 4 years — in this case 4,273 teenaged boys), found a positive association between skim milk and acne through a food questionnaire. The link was weaker for milk with higher fat content. (8)

• Another longitudinal questionnaire involving 6,094 adolescent girls found a positive association between acne and the consumption of whole milk, low-fat milk, and skim milk. (9)

Moving on to the studies outside the U.S. These were both published more recently (2012).

• A case-control study involving 88 patients from Malaysia (44 of which had acne), were asked to log their food for 3 days straight. The researchers found that a higher intake of diary, particularly milk and ice cream, was associated with acne. (10)
• A case-control study conducted in Italy involving 563 patients between the ages of 11 and 24 (205 with moderate or severe acne, and 358 with mild or no acne), found a higher association of acne with increased dairy intake via a food frequency questionnaire. The association was strongest for skim milk, but other types of milk didn’t reach statistical significance. In other words, all types of milk pretty much sucked balls. (11)

Lastly, a 2018 meta-analysis (i.e. a study that reviews and combines all other studies) found an association between acne and dairy consumption.

And that’s really it in terms of the research! Just a bunch of questionnaires and food surveys, all finding that dairy (especially milk), is linked to acne.

However, the biggest problem with this data set is that it’s all correlational. This means it’s entirely possible there are other confounding variables skewing the results. For example, maybe people that eat dairy also consume more sugar which we know disturbs endocrinologic function.

Questionnaires are also considered low-quality evidence because people are notoriously bad at self-reporting data. Case in point, do you remember what you had for dinner three nights ago? You’re probably struggling to think of that right now :p

Why Does Milk Cause Acne (Potentially)?

There are currently three different hypotheses.

1. Cow milk was intended to help little baby calves grow, and as such contains all kinds of growth hormones and anabolic steroids. This stuff ain’t good for acne.

“Milk contains estrogens, progesterone, the androgen precursors androstenedione and dehydroepiandrosterone-sulfate, and 5a-reduced steroids like 5a-androstanedione, 5a-pregnanedione, and dihydrotestosterone, some of which have been implicated in comedogenesis.” (7)

In other words, these highly scientific findings can be summarized with one e-card.

*~SCIENCE!~*

2. Processed milk may contain synthetic bovine somatotropin (bST or rbST).

That’s right. As if the natural hormones in milk weren’t bad enough already, our brilliant human minds decided to give cow’s additional ones (bST) to help increase their milk production.

bST may increase insulin-like growth factor 1 (IGF-1) in humans. And long story short, IGF-1 enhances a person’s sensitivity to insulin. (12, 13) Insulin being the hormone produced by the pancreas, which basically keeps your blood sugar levels in check.

Why is it bad that milk increases both of insulin and IGF-1? Because IGF-1 and increased levels of insulin have been linked to the pathology of acne. (14, 15, 16, 17) Specifically by increasing sebum production and keratinocyte proliferation.

English translation = it causes your skin to become more oily and “sticky.” Sticky meaning that the skin cells don’t separate like they should and begin clumping together. This occurs because keratinocytes (a type of skin cell) begin growing excessively, and don’t “differentiate,” or separate as they should. (18) This excess cell growth eventually leads to clogged pores > clogged pores lead to inflammation > and lalalala…. BAM! A sexy new pimple.

“Sebum production may be influenced by androgens and hormonal mediators, such as sex hormone binding globulin (SHBG) and insulin-like growth factor-I (IGF-I), all of which may be influenced by dietary factors.” (19)

And last but not least….

3. The carbohydrate content of dairy also increases insulin and IGF-1. Again, this is bad for the reasons listed above.

Here’s the major takeaway: dairy is bad for acne because it has natural (and sometimes synthetic) growth hormones and anabolic steroids. These increase serum insulin levels and insulin-like growth factor 1 (IGF-1), which have been linked to the pathology of acne.

Acne and Glycemic Load.

Remember those Kitavans we were talking about earlier? Well, here’s some food for thought (pun intended)! 😀 Sorry, I’m bad at puns and got excited. :p

“The Western diet has also been researched as a potential cause of acne. It has been noted that acne is absent in native non-Westernized populations, such as in Papua New Guinea and Paraguay. Therefore, investigators have examined the role of the Western diet, which typically corresponds to a high glycemic load diet.” (2)

Notice the emphasis on “high glycemic load diet.”

Turns out that certain carbs can cause acne. Namely those with a “high-glycemic index.” I will list these in just a bit, but first let’s go over what glycemic load is.

Glycemic load is simply the measure of how a specific food will raise a person’s blood sugar levels. If you recall from the information above, this is bad because having more glucose in your blood requires the body to produce more insulin. More insulin > more sebocyte activity > more sebum production and….

BAM AGAIN! That new pimple on your chin.

“Insulin and high-glycemic index are perhaps the two most scientifically and clinically, associated factors with acne.” (19)

Let me repeat that again just to make sure I got the point across.

• Excess insulin = bad for acne.
• High glycemic-index diet = more insulin.

Got it? Cool. Therefore, avoiding foods with high glycemic loads should reduce insulin levels and decrease acne. That’s exactly what studies have found. Let’s quickly summarize them.

• A study involving 31 dudes (males) with acne between the ages of 15 and 25, found a low glycemic diet reduced total acne count by 59% after 12 weeks. (20)
• A 12 weeks study with 43 male participant with mild to moderate acne found a low glycemic diet high in protein reduced acne. Whereas a diet high in glycemic load made acne worse. Here’s some before and afters from 2 participants following the low-glycemic diet. (21)

Source: Smith, Robyn N., Neil J. Mann, Anna Braue, Henna Mäkeläinen, and George A. Varigos. “The Effect of a High-protein, Low Glycemic–load Diet versus a Conventional, High Glycemic–load Diet on Biochemical Parameters Associated with Acne Vulgaris: A Randomized, Investigator-masked, Controlled Trial.” Journal of the American Academy of Dermatology 57.2 (2007): 247-56.

And last but not least….

• A 12 week study with 43 male acne patients aged 15-25, found a low-glycemic diet helped decrease acne count. (P=0.03) (22)

How Does a Low-Glycemic Diet Help Acne?

In all these studies a low-glycemic diet did 3 things.

1. It increased insulin sensitivity so the body wouldn’t have to create more insulin to keep glucose levels in check.

2. Reduced androgen levels, a hormone mostly known for controlling male sex characteristics (though women have androgens too!).

You’ve probably heard of “testosterone” before. That would an example of an androgen hormone. Anti-androgen therapy (for example, birth control) reduces overall sebum production and comedone formation. (23) In other words, having less androgen makes skin less oily and prone to clogged pores.

3. It increased sex hormone-binding globulin (SHBG) levels!

SHBG is protein produced by the liver that binds to 3 different hormones: estrogen, dihydrotestosterone (DHT), and testosterone. Think of it as the thing that keeps your hormones in balance. The more of this you have, the better your hormones stay regulated.

Guess what decreases SHBG? INSULIN and IGF-1! (24)

Phew. That insulin and IGF-1 be causing all kinds of acne, huh?

By now you’re probably thinking, “JUST TELL ME WHAT FOODS TO AVOID DAMN IT.” I gotchu! Here’s an extensive list of foods with their respective glycemic index numbers. All credit goes to the Harvard Health Publications for this chart. Foods below 55 would be considered low GI value, whereas foods above 55 are considered high GI (things to avoid). (25)

Glycemic Index Food List.

Omega 6 and Omega 3 for Acne.

Another key differentiator between the Western diet, and hunter gatherers is the ratio of omega 6 to omega 3 fatty acids.

Omega 6 and  omega 3 fatty acids are considered “essential fats” because the human body cannot synthesize them. They can only be obtained through food. These fats play a crucial role in the health of cells and maintaining brain and nerve function. (26)

It is assumed that humans evolved on a diet that had a 1:1 omega 6 to 3 ratio. In other words, our primal ancestors were eating equal parts omega 6 to omega 3 fatty acids in their diet. Moreover, the current scientific evidence suggests that the ideal ratio for optimum health is roughly 4 to 1 or lower.

Indeed, studies have shown that an omega 6 to omega 3 ratio of 2-4:1 is beneficial for many diseases including rheumatoid arthritis, asthma, colorectal cancer etc., whereas an excessive amount of omega 6 is linked to chronic inflammation, heart disease, arthritis, and cancer. (27, 28, 29)

Excess omega-6 fatty acids from vegetable oils interfere with the health benefits of omega-3 fats, in part because they compete for the same rate-limiting enzymes. A high proportion of omega-6 to omega-3 fat in the diet shifts the physiological state in the tissues toward the pathogenesis of many diseases: prothrombotic, proinflammatory, and proconstrictive. (30)

So what is the omega 6 to 3 ratio for the modern Western diet? The average is 15/1-16.7/1! (31)

O_o

You read that right! Around 16 to FREAKING 1! That means that the modern Western diet sees an excess of 4 to 16 times the amount of omega 6 fatty acids than is recommended! And we wonder why so many health epidemics are on the rise. Sigh….

Guess what the ratio is for hunter-gatherer civilizations with no acne and few chronic inflammatory diseases? You guessed it…. around the recommended 1-3:1.

To make matters more interesting, research has shown that eczema, acne, and psoriasis are all linked to abnormalities in the metabolism of essential fatty acids. (32) For example, the skin surface lipids of acne-prone individuals are deficient in linoleic acid — an essential omega 6 fatty acid and structural component of skin ceramides. (33)

If you recall from my guide about pH and the acid mantle, ceramides and fatty acids play an important role in the health of the skin’s barrier function. A weakened moisture barrier is less capable of fighting off pathogens, which can lead to various skin diseases.

This suggests that an imbalance of omega 6 to omega 3 through diet manifest itself on the skin level. This might occur for a number of reasons. One hypothesis being that omega 6 and omega 3 essential fatty acids have a push-pull relationship by competing for the same enzymes, which often leads to a deficiency of one or the other. (34)

But the question remains, does an ideal omega 6 to 3 ratio (1-4:1) change the composition of fatty acids in the skin enough to eliminate or reduce acne?

It’s hard to say, but the science is heading in the direction of yes. For example, two study on guinea pigs found that increasing the intake of essential fatty acids through diet increases the levels of those fatty acids in skin. (35, 36)

Of course, we’re not guinea pigs so that’s not entirely relevant to us. But more convincingly, a 12 week study done on women found that daily supplementation with 2.2 grams of flaxseed or borage oil had skin benefits!

Specifically, skin hydration significantly increased, transepidermal water loss (TEWL) decreased, and major improvements in scaling, roughness, and redness were also seen. (37) This occurred because borage oil has high levels of linoleic and gamma-linolenic acid, and flaxseed oil has high levels alpha-linolenic acid and linoleic acid. This may be good for acne because acne-prone individuals are deficient in these specific fatty acids!

And more recently another study found that daily supplementation with 2.2 grams of flaxseed oil improves barrier function, decreases skin sensitivity, and reduces erythema induced redness. (38)

In other words, this might help with post inflammatory erythema (PIE)! (The red marks left behind from old acne.) We will discuss this in more detail in the supplements section of this blogpost.

Fun fact #2: there’s also some evidence that flaxseed oil helps with multiple sclerosis. (39) Yeah, flaxseed oil is pretty cool.

The major takeaway: keep your omega 6 to 3 ratio in check (approximately 1-3:1)! Doing so balances the lipid structure of skin which could help acne, reduce skin dryness, redness, scaling, and roughness. Here’s a quote from a research paper that said it best.

“The Omega-6 fatty acids are thought to induce more pro-inflammatory mediators and have been associated with the development of inflammatory acne. On the other hand, intake of high levels of omega-3 fatty acids is associated with decreases in inflammatory factors. In addition there are epidemiological studies that demonstrate that increasing the intake of omega-3 fatty acids through a diet rich in fish and seafood results in lower rates of inflammatory disease.” (19)

As for which foods are high in omega 6 and omega 3…

List of Omega 6 and Omega 3 Foods.

Omega 6 (things to reduce):

• Borage Oil (supplementing with this is good for skin)
• Barley (sorry beer lovers :/)
• Cereals
• Corn
• Cottonseed oil
• Durum Wheat
• Eggs
• Millet
• Nuts (cashews, pecans, pine nuts, walnuts, almonds etc.)
• Oats
• Oat Flour
• Pasta
• Poultry (Chicken, Turkey, Pork, Ham)
• Pumpkin Seeds
• Quinoa (uncooked)
• Rye
• Spelt
• Vegetable Oils (Soybean Oil, Sunflower Seed Oil, Safflower Oil, Canola oil, Grape Seed Oil, Evening Primrose Oil, Blackcurrant Seed Oil, Hemp Oil, Olive Oil, Corn Oil)
• Wheat Germ

Omega 3 (things to consume more of):

• Brussels sprouts
• Chia Seeds
• Cod Liver Oil (this is the one I use)
• Egg Yolks
• Fish (Mackerel, Salmon, Tuna, White Fish, Sardines, Anchovies, Halibut, Herring, Trout)
• Flaxseed Oil (supplementing with this is good for skin; has a 1:3 omega 6 to 3 ratio. This is the one I use.)
• Grass Fed Beef
• Ground Flax Seed
• Hemp Seeds
• Kale
• Mint
• Natto
• Oysters
• Parsley
• Spinach
• Watercress
• Walnuts

Vitamins for Acne: A, D, and E.

If there were three vitamins that you should focus on the most for skin health they would be vitamins A, D, and E. Let’s first start with vitamin A.

By now you’ve probably heard of the acne-killing badass Accutane (a.k.a. isotretinoin). If you haven’t, worry not. It’s a prescription drug for severe cases of acne. Consider it the nuclear option for all things acne murdering. To this day, there isn’t anything more effective for treating acne, and its success rate teeters around 90% across all users. It does however, come with its share of potential side effects.

Why did I bring this up?

Because Accutane is just a synthetic metabolite of vitamin A. LOTS OF IT! Hence, there is an assumption that consuming lots of vitamin A from whole foods would have a similar impact on skin and reduce acne. What evidence is there of this?

For one, a higher level of vitamin A in the body is linked to lower skin pH and reduced sebum content! (40) Two things which help reduce acne.

Furthermore, a deficiency in vitamin A can cause numerous complications like dry skin, dry hair, brittle fingernails, and if severe enough — blinding. (41, 42) Brittle skin is less capable of healing itself, which is bad for acne.

Vitamin A is also found in the sebaceous (oil) glands of skin.

Fun fact #3: that’s actually how the anti-aging all star tretinoin works. It attaches to our natural retinoid receptors which synthesizes vitamin A in the skin.

Quick aside, not all vitamin A is treated equal. We will discuss this later, but don’t think eating copious amounts of carrots will get rid of your acne overnight.

Anyhow, remember how we discussed that milk messes with keratinocyte biology by causing skin cells (keratinocytes) to grow excessively and “stick” together?

Studies have shown that vitamin A and D both have “antiproliferative effects” on skin. (43,44, 45, 46) In other words, they help keep things working optimally on a cellular level by regulating growth and differentiation.

This is why vitamin A and D are approved treatments for stuff like acne, photoaging, aging skin, kaposi sarcoma (a type of cancer), and psoriasis — they both help regulate defects in cell biology which are a major culprit in many of these conditions.

Perhaps you’ve wondered why Retin-A (tretinoin) is a commonly prescribed acne treatment? That would be because it’s a derivative of vitamin A.

Fun fact #4: supplementing with vitamin A and getting modest amounts of sunshine (vitamin D) completely eliminated my body psoriasis.

How do I know this? Because I literally did nothing else. I’ve yet to use any fancy lotions or treatments on my body. If you’re wondering why — no particularly reason other than me being lazy.

Lastly, there is evidence that vitamin E is delivered onto the skin through our sebaceous glands which might reduce inflammatory acne. (47) And perhaps unsurprisingly, research has shown that supplementing with vitamin E orally increases the vitamin E content in human sebum (oil). (48)

Overall, the evidence on whether vitamins are beneficial for acne isn’t clear cut. We know they work well topically, but ingesting them orally through diet or supplementation is another story. I happen to believe it makes a major difference, but that’s just my personal bias.

With all that said, let’s discuss good sources of vitamin A and D.

Where Can I Get Vitamins A and D?

For vitamin D, the sun! Yes, sun protection is important for anti-aging but don’t go overboard and turn yourself into a vampire. I understand the word “aging” terrifies some of you, but let’s not forget that sun-avoiders have a lower life expectancy of about 2.1 years on average compared to those who get lots of sun exposure. (49)

What good is it to have sexy youthful skin if you’re just gonna die 2 years earlier?

For most people, all you need is 600 IU of vitamin D a day, which is about 15 minutes of sunshine every day. Of course this will depend on your location, altitude, and forecast but aim to be outside when the UV index is around 3 or greater. This is generally around noon. I like to use app called “dminder,” which allows you track everything to let you know approximately how much vitamin D you generated.

When looking for dietary sources of vitamin A, focus on retinol not beta-carotene! Beta-carotene is great and all, but not nearly as bioavailable as retinol. (50) This is why I said carrots won’t cure your acne woes. Vegetables don’t contain retinol. Their form of vitamin A is beta-carotene.

Unfortunately, naturally occurring retinol can only be sourced from animal products. Sorry vegetarians and vegans… Please don’t be mad at me. 

The vitamin A content of vegetables also pales in comparison to some animal products. For example, let’s consider the most nutritiously dense food on planet earth: f*cking beef liver.

100 grams of beef liver has 28,571 IU of vitamin A, whereas 100 grams of carrots has 16,705 IU of vitamin A. (51). ISN’T THAT NUTS? (Recall that beta-carotene is far less bioavailable in the human body compared to retinol)

Only problem is that beef liver tastes like death. I can’t even explain to you how bad it is. Especially when you overcook it…. Oh god, it has the texture of a pink eraser and taste like used bandaids. Just awful. Can’t say I recommend.

But uh…. desperate times call for desperate measures. And acne makes us do some pretty weird sh*t.

Fun fact #5: I once tried swallowing 6 lbs of raw beef liver for my acne. True story. Can be found here. If only I had known you can take desiccated beef liver supplements and achieve the same result without the accompanying agony! Oh, what a fool I was.

UPDATE 12/21/17: just wanted to clarify that I am NOT against provitamin A (beta-carotene). It’s definitely possible to get an adequate amount of vitamin A through vegetables like sweet potato, winter squash, kale, collards etc. Just make sure to consume them with other fats as this markedly enhances their intestinal absorption / conversion of beta-carotene. (71)

Foods With High Vitamin A Content.

• Beef Liver (for the faint of heart, use desiccated beef liver supplements instead)
• Butter Oil a.k.a Ghee (good if you’re avoiding dairy)
• Chicken Liver
• Cod Liver Oil (second to beef liver in terms of vitamin A content. 4,500 IUs of vitamin A per teaspoon)
• Dairy*
• Egg Yolks
• Grassfed Beef, Calf
• Grassfed Butter
• Organ Meats
• Salmon

*For reasons outlined earlier be cautious with dairy. If dairy doesn’t give you acne use whole milk, whole milk yogurt, whole milk cottage cheese. It’s best to use raw dairy.

Does Coffee Cause Acne? Food Intolerances and Other Things to Consider.

“Wait, wtf? COFFEE CAUSES ACNE?!?” Literally my reaction when I first read that it “technically” can. For christ’s sake it’s coffee! Sounds innocent enough, right? Wrong. It’s an acne trigger in disguise.

(Bear with me here! I’m including this section for a reason! Make sure to actually read it before disagreeing!)

So…. what evidence is there that coffee acne causes acne?

Firstly, the caffeine levels of coffee negatively impact the body’s hormonal stress response by increasing levels of cortisol (a stress hormone). (52) This is bad because stress is linked to acne. (53)

Secondly, remember all that info above about how excess insulin is bad for acne? Well guess what else messes with insulin? Coffee. (54)

Thirdly, coffee can interfere with iron absorption and sometimes contains mycotoxins. (55, 56) Two things that could cause systemic inflammation and worsen acne.

Fourthly, coffee is often consumed with milk and sugar. Two more things that are bad for acne. Wah wah wah. So on and so forth.

There you have it: coffee causes acne. Boohoo.

You see what I’m doing here? I’m trying to show you that literally EVERYTHING and ANYTHING can be an acne trigger if you reach far enough. That’s the problem with acne and diet. If you dig too deep, you’ll paralyze yourself with research and begin scrutinizing every morsel of food thinking it’ll make you break out.

It’s what happened to me, and it’s the last thing you need. Trust me on this one — having an unhealthy relationship with food is a million times worse for stress than any nefarious effects of coffee.

So did I just make this all up, or does coffee actually cause acne? It depends.

The problem is that everyone is unique! No two people respond identically to the same stimuli. For example, I just showed you how the caffeine levels of coffee can negatively impact cortisol levels. Does that mean coffee negatively impacts everyone’s cortisol levels? No!

Turns out that 50% of people have a subset of the CYP1A2 gene that leads to the slow processing of caffeine.  (57, 58) If you’re one of these unlucky souls it means that your body can’t metabolize and eliminate caffeine from the bloodstream as quickly, resulting in a constant stream of cortisol.

Oh… and people with this gene also have an increased risk of heart disease if they drink coffee. (59) Bummer right? Coffee and heart disease all from having a stupid gene.

Point being, that at the end of the day everyone has different food sensitivities or intolerances. You may be sensitive to coffee. You may be sensitive to oranges. It depends on your unique genetic makeup (among other things), and it’s not something you’ll know unless you do an elimination diet (e.g. AIP) or get medical testing.

I’ve done both. Even got my stools examined once! I’d show you the little tube I had to put my poop in, but that’s probably TMI. :p Here’s a picture from a food allergy test I did instead.

Note: this was a skin prick test. Skin prick test are helpful for determining food allergies, not food intolerances! To determine what foods you’re sensitive to, an IgG blood test is best but even these have their flaws. (60)

Here’s the major takeaway: everyone is different! Literally anything can cause acne. Just because some online guru tells you X food causes THEM acne, doesn’t mean it will cause YOU acne! Remember this when trying to eat healthier for clearer skin. You need to have balance and a healthy relationship with food before anything else!

Best Supplements for Acne.

Now that we’ve discussed all the major foods that can cause acne, let’s quickly go over some supplements that are beneficial for skin. I will make an extensive blog post about this in the future, but for now I’ll only list the supplements I think are worth taking. These are the ones I use personally.

First and foremost…..

Cod Liver Oil.

If you don’t plan on eating beef liver or using desiccated beef liver supplements then this is the next big thing in terms of vitamin A content. One teaspoon of cod liver oil contains approximately 4,500 IUs of vitamin A, which is about half that of beef liver. (61)

I know drinking the oil of fish liver might sound disgusting to some, but compared to eating beef liver it’s a million times better. More convenient too. Simply pop a teaspoon, swallow, BOOM — you’re done.

If you decide to take cod liver oil, please don’t try overdosing on this stuff thinking you can mimic the effects of accutane. Vitamin A toxicity is very real and can cause liver damage and bone degradation (among other things). (62)

Keep the dosage below 10,000 IU per day. This is the recommended amount for a healthy adult. (63) I personally only do one teaspoon a day (4,500 IU) and that’s enough for me to notice its effects on skin.

Another reason to supplement with cod liver oil is it’s vitamin D content. This will be especially important if you live in a region that gets very little sunlight. One teaspoon of cod liver oil has approximately 500 IU of vitamin D.

Lastly, when looking for cod liver oil supplements try and find one with roughly equal DHA to EPA proportion as this is what the most thorough study on acne showed. (72, 73, 74)

One reason we take cod liver oil is because of it’s omega 3 fatty acids. DHA and EPA are both omega 3s. Recall how excess omega 6 fatty acids are bad for inflammation and health?

And don’t get capsules. It takes several pills to match the daily serving of liquid, which makes it way less cost effective per ounce.

As for which cod liver oil supplement is best — Garden of Life’s Icelandic Cod Liver Oil and Green Pasture’s Fermented Cod Liver Oil are two popular choices.

I used Green Pasture religiously until there was some controversy about their products being rancid. I won’t go into details, but it was enough for me to question the purity of their supplements. You can read a full breakdown of what happened here.

I now use Garden of Life’s Icelandic Cod Liver Oil and it works great. Way cheaper too. The fishy taste is very mild, and it has kept my acne at bay just as much as Green Pasture.

Fun fact #6: Skinacea (one of my favorite bloggers) accredits fish oil supplementation for clearing up her hormonal acne. That woman helped me get through some very dark times.

EDIT: it has been brought to my attention that Algal Oil is a fish-free vegan alternative to cod liver oil! (70)

Secondly….

Flaxseed Oil.

This is something I just bought and am currently using. So far so good!

Like I briefly mentioned above, some recent studies have shown flaxseed oil has tremendous benefits for skin. (64, 65)

To quickly highlight some of the main takeaways from the research, 3 months of daily supplementation with 2,220 mg of flaxseed oil did the following:

• Reduced transepidermal water loss (TEWL) by 31%.
• Increased skin hydration by 39%.

• Decreased skin roughness by 30%.
• Decreased scaling by 31%.
• Increased smoothness by 7%.

And most impressively….

• Reduced capillary blood flow by 66%!

Why should you get excited about this? Because post inflammatory erythema a.k.a. PIE (the red marks leftover from acne) are incredibly hard to get rid of, and at this point in time there’s really only one viable treatment option — vascular lasers. These can get incredibly expensive, especially if you need more than one session which is often the case.

Vascular lasers are the only thing that work for PIE because it disperses the dilated capillaries (small blood vessels) that are causing the red marks. Unfortunately, treatments geared toward post inflammatory hyperpigmentation (PIH) don’t work for PIE, because PIH is a problem with melanin — PIE is not! You can read more about treating PIE vs. PIH in this blog post.

Anyhow, supplementing with flaxseed oil reduces the redness caused by capillaries! Or as the researches put it themselves,

“After supplementation with flaxseed oil, both erythema formation and capillary blood flow were diminished.” (66)

Whether this will help PIE directly is just my hypothesis, but at the very least it will definitely reduce overall skin redness.

The benefits of flaxseed oil come from its omega 3 and omega 6 essentially fatty acid content. It’s considered one of the highest containing omega 3 foods to date. (67) Even more so than cod liver oil and other fatty fish like salmon!

However, unlike fish whose omega fatty acid comes from docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), flaxseed oil’s omega fatty acids come from linoleic acid (LA), alpha linolenic acid (ALA), and gamma-linolenic acid (GLA). (68)

If you recall from the information above, this is particularly good for acne prone individuals because their surface lipids are deficient in linoleic acid. (69)

As for which flaxseed oil supplement is best, I use NatureWise Organic Flaxseed Oil.

This is the most characteristically similar flaxseed oil supplement I found to the study above. In other words, it’s fatty acid content is approximately 16% omega 6 and 49% omega 3 (15.61% LA, 48.76% ALA, 0.14% GLA).

And last but definitely not least….

Probiotics! 

I’ve written an extensive guide all about probiotics supplementation. It’s just as long as this blog post, so I won’t go into details here, but feel free to check it out! I cannot recommend probiotics enough for all things skin health, especially if you happen to have a lot of digestive issues.

Fun fact #7: besides skin, probiotics had a tremendous impact on my mental wellbeing. They turned me into a happy lad. 🙂

If you don’t want to supplement with probiotics, you can always get them from foods like kombucha, kimchi, kefir, yogurt, sauerkraut, and raw diary.

Summary.

Alrighty. Now that we’ve gone over the all major research on diet and acne let’s sum it up into 2 sections — foods to avoid or reduce, and foods to consume.

Note: most fruits and vegetables aren’t listed below but these are completely fine! In fact, it’s recommended that we consume about 5-9 servings of vegetables a day. The more variety the better. Keep the fruit intake below 4 servings a day. Fruit comes with fiber which slows the absorption of sugar into our blood, but it can still cause problems with insulin if consumed excessively.

Foods to Avoid for Acne.

Avoid or reduce your intake of diary. This includes:

• Butter (grass fed butter might be okay because of it’s high vitamin A content)
• Cheese (cottage, parmesan, mozzarella, cheddar etc.)
• Frozen Deserts (e.g. ice cream cake)
• Ice Cream
• Milk (especially skim milk)
• Milk Powder
• Sour Cream
• Yogurt (probiotic yogurt might be okay)
• Whey Protein

Avoid or reduce your intake of foods with high glycemic loads. These include:

• Bagels
• Cereals
• Instant Oatmeal
• Pasta
• Pineapple
• Pumpkin
• Popcorn
• Potatoes (White and Russet)
• Rice
• Rice Cakes
• Sodas (Coke, Fanta, Dr. Pepper etc.)
• Wheat (this is in many foods! Check the ingredient list for this sneaky one)
• White Flour (e.g. pita bread, white bread, pizza dough, muffins, waffles, pancakes etc.)
• Watermelon

For a more extensive list see the chart above in the glycemic index section.

Reduce your intake of foods rich in omega 6 fatty acids. These include:

• Borage Oil (supplementing with this is good for skin)
• Barley (sorry beer lovers :/)
• Cereals
• Corn
• Cottonseed oil
• Durum Wheat
• Eggs
• Millet
• Nuts (Cashews, Pecans, Pine Nuts, Walnuts, Almonds etc.)
• Oats
• Oat Flour
• Pasta
• Poultry (Chicken, Turkey, Pork, Ham)
• Pumpkin Seeds
• Quinoa (Uncooked)
• Rye
• Spelt
• Vegetable Oils (Soybean Oil, Sunflower Seed Oil, Safflower Oil, Canola oil, Grape Seed Oil, Evening Primrose Oil, Blackcurrant Seed Oil, Hemp Oil, Olive Oil, Corn Oil)
• Wheat Germ

Foods that Prevent Acne.

Eat more foods rich in omega 3 fatty acids. These include:

• Brussels sprouts
• Chia Seeds
• Egg Yolks
• Fish (Mackerel, Salmon, Cod Liver Oil, Tuna, White Fish, Sardines, Anchovies, Halibut, Herring, Trout)
• Flaxseed Oil
• Grass Fed Beef
• Ground Flax Seed
• Hemp Seeds
• Kale
• Mint
• Natto
• Oysters
• Parsley
• Spinach
• Watercress
• Walnuts

Eat more foods rich in vitamin A (retinol) and D. These include:

• Beef Liver (YUM! Sarcasm. Use desiccated beef liver supplements to save yourself some agony!)
• Chicken Liver
• Cod Liver Oil (second to beef liver in terms of vitamin A content)
• Egg Yolks
• Fatty Fish (e.g. Salmon)
• Ghee a.k.a. Butter Oil (good if you’re avoiding dairy)
• Grassfed Beef, Calf
• Grassfed Butter
• Organ Meats (Offal)

Eat more probiotic-rich foods. These include:

• Kefir
• Kimchi
• Kombucha
• Miso
• Natto
• Raw Dairy
• Sauerkraut
• Tempeh
• Yogurt

Supplements to consider taking:

• Cod Liver Oil (high vitamin A and D content)
• Flaxseed Oil (very high omega 3 content; high linoleic acid)
• Probiotics (good for all things health)
• Zinc Gluconate (beneficial for inflammatory acne)

Welp, that does it for this blog post on acne and diet. I hope you found it useful! 🙂

Warmly,

—f.c.

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