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While chocolate, fats, and sweets were suspected of aggravating acne as early as the 1930s, two studies published in 1969 and 1971 cast doubt on a link between diet and acne, and diet as a significant factor was relegated to myth status for several decades.
Beginning in 2005, a series of studies linking consumption of dairy products with acne jumpstarted the controversy and drew some dermatologists — even those who found the studies seriously flawed — to reconsider the role of diet. The quality of the evidence goes to the heart of the disagreement between those who are convinced of a link between diet and acne and those who are not.
A co-author of several studies examining the relationship between dairy products and acne stands by his findings and vigorously recommends a dairy- free and low glycemic load (LGL) diet for teenagers and adults with acne. The strongest evidence points to a high glycemic load (HGL) diet as a significant factor in acne, Dr. Once a prime suspect in the hunt for a dietary villain, chocolate has again come under scrutiny by researchers at the University of Miami Miller School of Medicine. The team recruited 10 healthy male subjects, aged 13 to 35, with one to four acneiform lesions. An audience member at the AAD presentation noted that microcomedo formation is thought to occur over six to eight weeks, and questioned how the chocolate could have impacted formation so quickly.
Although he said he is thoroughly convinced that both dairy and an HGL diet adversely affect acne, Dr.
Danby examined data from the Nurses Health Study II, in which 47,355 women provided information about their high school diet and whether they had physician-diagnosed severe teenage acne.
Danby theorizes that steroid hormones and other components of bovine milk precipitate a complex cascade that acts to overstimulate the pilosebaceous unit. When the investigators statistically adjusted the data for changes in BMI, the effect of the LGL diet on several clinical parameters was lost.

Webster and Thiboutot also singled out the Australian study as the strongest evidence to date that diet can affect acne, but both warned against jumping to conclusions. Bowe is in the early stages of investigating antioxidants (from both nutritional and topical sources) and probiotics as potential acne-fighting agents.
The acne question was included in the first survey in 1989, when the participants were aged 25 to 42. Although this effect cannot be ignored, the effect of dairy on acne appears to be incremental,” said Dr. Cordain’s evidence might be stronger if the acne-free subjects had been given a high glycemic load (HGL) diet and had subsequently developed acne. In addition, the subjects were all male, and the results could not be generalized to female adolescents. The notion that chocolate and acne are not related is based on previous studies which did not assess the effect of pure chocolate on acne. Berman replied that the subjects may have had microscopic microcomedones at baseline, and the chocolate may have hastened their development.
She noted that there are patients who request “more of a natural approach to their acne; they don’t want all the prescriptions and chemicals. Webster was responding to publication of a specific study linking milk consumption and acne in teenaged boys, the current discussion extends to a range of other potential dietary culprits, including foods with a high glycemic index and chocolate. Webster maintained that this explanation remains a “tantalizing hypothesis” until a controlled study is conducted that assesses the effects of a dairy- free diet on teenagers at risk for acne. The researchers counted the number of acneiform lesions on day four and day seven following the chocolate consumption.

You can recommend that maybe they start by cutting out those high glycemic foods, and give them a list.
At one end of the spectrum you’d have the people who don’t have the genes for developing acne — they’d be at zero — and at the other end would be people who are at three to five times the risk, but the mean is .44. Their results, presented in poster form at the American Academy of Dermatology’s 2011 Annual Meeting, showed a statistically significant increase in the mean number of total lesions and a dose-dependent relationship between the amount of chocolate consumed and the number of lesions on days four and seven. Thus, acne was positively associated with the reported quantity of milk ingested, particularly skim milk. Bowe and her co-authors include the study’s retrospective design, and the fact that the women were asked to recall their milk consumption in the distant past.
A lot of this data is theoretical linkages and possible associations, but not really a cause and effect.” Dr. But we have to be responsible, and if we’re going to encourage patients to try these dietary modifications, we also have to provide information regarding supplementation of calcium and vitamin D.
Webster noted that a low-carbohydrate, high-protein diet is expensive and could impose a burden on low-income patients.

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