Whether a patient presents with acne, wrinkles or brown spots, traditional treatments have skewed toward topical remedies and devices, but aesthetic professionals can help patients achieve optimal outcomes—and improve their overall health—by understanding the role that certain foods play in reducing or exacerbating common skin concerns.
“The notion that nutrition is important to skin health is gaining traction. I tell my patients that just like diet affects your heart, kidneys and immune system, it plays a role in keeping your skin healthy,” says Patricia Farris, MD, FAAD, a dermatologist in Metairie, Louisiana. “We need a balanced diet rich in antioxidants and healthy fats to maintain barrier function, normalize keratinocyte proliferation and preserve our extracellular matrix.”
Diet and Acne
In the early 1900s, acne patients were discouraged from eating foods like chocolate, sugar and fat, says Jennifer Burris, PhD, RD, a professor and researcher at New York University’s Department of Nutrition and Food Studies. “This changed in the 1960s and 70s after two influential studies showed no connection between diet and acne.”
More recent research, however, has reignited the debate about a possible link between diet and acne. A 2016 study with 225 subjects, published in the Journal of American Academy of Dermatology (August) showed that the consumption of low-fat or skim milk, but not full-fat milk, was positively associated with acne. And while the mechanism behind the association is unclear, Whitney P. Bowe, MD, FAAD, clinical assistant professor of dermatology at State University of New York (SUNY) Downstate College of Medicine in Brooklyn, and co-author of “Guidelines of care for the management of acne vulgaris,” (Journal of the American Academy of Dermatology, May 2016), noted in a 2016 paper written for the American Academy of Dermatology that hormones and growth factors in milk might play a role.
“The studies that have been done on dairy and acne have been mainly food recall studies, which are a weaker type of evidence,” says Rajani Katta, MD, clinical assistant professor of dermatology at Baylor College of Medicine in Houston. “In addition, the results have shown a weak association so there are still many unknowns. I believe that some patients are affected by dairy consumption, while others are not. We require further research to predict who might be helped by avoiding dairy.”
A stronger association exists between high glycemic index diets and acne severity. A 2007 study from Australia, published in the Journal of the American Academy of Dermatology (March), found that acne patients who followed a low-glycemic load (LGL) diet experienced a significant decrease in lesions compared to those who followed a high-glycemic load (HGL) diet.
A 12-week study of 43 male acne patients aged 15-25 published in the American Journal of Clinical Nutrition (July 2007) also showed a decrease in acne lesions in those who followed an LGL diet. “The first group—following an HGL, Western diet—developed high levels of acne sebum and clogged pores,” says Jeannette Graf, MD, assistant clinical professor of dermatology at Mount Sinai Medical Center in New York. “The second group had much clearer, healthier skin and a much lower incidence of breakouts.”
“The evidence does not demonstrate that certain foods cause acne, but rather what a patient eats may aggravate or influence it,” says Burris. “We know that some foods, such as dairy and a high glycemic index diet, are associated with acne. However, additional research is needed before we can provide patients with evidence-based dietary guidelines.”
William Rietkerk, MD, FAAD, a dermatologist in Thousand Oaks, California, urges his acne patients to adopt a Mediterranean diet rich in whole grains, fresh fruit and vegetables, fish, beans, and healthy fats from olive oil and nuts, to help decrease acne severity. (Mediterranean diets —which avoid heavily processed and sugary foods—are similar to low-glycemic eating plans.)
“Have the patient keep a food journal, whether they try an LGL eating plan or decrease or eliminate dairy,” says Burris. “Because it may take as long as 12 weeks to notice a change in the acne, patients should only try one dietary change at a time.”
Nutrition for Aging Skin
Patients concerned with reducing—or preventing—the visible signs of skin aging also benefit from dietary counseling. A study published in the Journal of the American College of Nutrition (February 2001) examined a group of elderly individuals—177 Greek-born subjects living in Australia, 69 Greek subjects living in rural Greece, 48 Anglo-Celtic Australians and 159 Swedish subjects living in Sweden—and graded their wrinkles. Those who followed a diet high in vegetables, legumes and olive oil had the least sun damage, while those who reported a high intake of meat, dairy and butter had the most severe skin wrinkling.
Dr. Katta endorses a variation of the DASH (Dietary Approaches to Stop Hypertension) diet for her antiaging patients. The diet includes low-sodium foods and encourages eating a variety of foods rich in potassium, calcium and magnesium to help lower blood pressure. These are many of the same foods that support skin health. She notes that low-fat diets are no longer recommended; instead patients of all ages should be counseled to consume “good fats.” “Walnuts, avocado and salmon are good fats that maintain healthy skin and help heal dry, sensitive skin,” says Dr. Katta. “It’s also important to eat a variety of fruits and vegetables because each one comes with a different profile of vitamins, minerals and phytonutrients.”
Because many aesthetic patients take part in detox or juicing diets, Dr. Katta reminds her patients that juice is not as beneficial as whole fruits and vegetables which contain fiber—important for a healthy diet.
Diet and Skin Health
In addition to understanding the health benefits of fruits, vegetables and good fats, patients also should be aware that food preparation may affect skin aging. “Charring food through grilling or roasting at high temperatures could lead to higher levels of advanced glycation end products (AGEs), which adversely affect collagen and elastin in the skin,” says Dr. Katta.
Other cooking methods, like boiling, may decrease the antioxidant levels in vegetables, notes Burris, who recommends using distilled water when making soup to get a potassium-rich broth.
The term “sugar sag” has been gaining traction in the cosmetic arena, but “nobody knows how much sugar is too much,” says Dr. Farris. Still, she notes that “excess sugar consumption results in glycation of proteins, such as collagen and elastin, leaving these molecules stiff and ineffective. Lowering the intake of both sugar and foods high on the glycemic index is always helpful.”
Dr. Katta, who recommends limiting sugar to six teaspoons (or 24 grams) a day as suggested by the World Health Organization, notes that different people react to sugar differently. A study of 800 people, published in Cell (November 2015), found high variability in post-meal glucose based on individual gut microbiomes. The researchers continuously monitored glucose levels in response to 46,898 meals and found high variability to identical meals, “suggesting that universal dietary recommendations may have limited utility,” they wrote.
Benefits in a Bottle
Certain vitamins and supplements may aid both acne and antiaging patients as they seek to improve skin health. According to a 2015 study, “The effect of probiotics on immune regulation, acne, and photoaging,” published in the International Journal of Women’s Dermatology (April), probiotics may be beneficial in the treatment of acne and rosacea, and provide protection against skin aging and photodamage.
“Probiotics, such as lactobacillus and acidophilus, help detoxify foods that otherwise might be absorbed and create breakouts in acne patients,” says Dr. Graf. Additionally, probiotics help counter the side effects associated with antibiotic use, a treatment frequently used for acne.
Other vitamins and minerals that have been studied in acne patients include vitamin D, zinc and omega-3 fatty acids. Dr. Graf recommends vitamin D3 supplements to her acne patients because the vitamin helps regulate the skin’s ability to produce antibacterial peptides.
Participants who took omega-3 fatty acid supplements had a significant reduction in acne lesions, according to a study published in Acta Dermata Venereologica (September 2014). Because zinc is an anti-inflammatory, some suggest it may improve acne, and multiple studies have shown a decrease in lesions following supplementation with the trace mineral. But Dr. Katta notes that zinc’s potential gastrointestinal side effects, including nausea, vomiting and GI distress, limit its use. “Researchers are currently looking for a particular dose and formulation of zinc that might be helpful,” she says.
There is also evidence that some supplements may be benefical in protecting the skin against photodamage and improving overall skin health. Subjects who took a flaxseed oil supplement for 12 weeks saw improved skin hydration, a reduction in skin roughness and decreased sensitivity to irritation, according to a study published by Skin Pharmacology and Physiology in January 2011.
But Heliocare (Ferndale Healthcare) is the supplement with the most science behind it, says Dr. Farris. It contains a fern extract (polypodium leucotomos) that has been shown to provide protection against sunburn, oxidative stress and sunburn cell formation, and even reduces DNA damage that occurs after sun exposure. Oral polypodium leucotomos is “beneficial in the treatment of atopic dermatitis, vitiligo and psoriasis, and for prevention of polymorphic light eruption, sunburn and squamous cell carcinoma,” researchers noted in a review of in vivo animal, in vitro human and human clinical studies published by the Journal of Drugs in Dermatology (February 2016).
Dr. Farris would also like to see larger scale studies to confirm or disprove the potential benefits of collagen hydrolysates and antioxidant supplements on aging skin. “Supplements should be viewed as part of a comprehensive skin rejuvenation plan,” she says. “They aren’t going to work miracles, but they are an excellent adjunct to traditional antiaging therapies.”
Heather Larson is a freelance writer based in Washington State.
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