acne and western dietWe’ve probably all heard that acne can be aggravated by chocolate, right?  (Apparently there’s evidence for that on both sides of the fence, just fyi.)

What you may not know, though, is that there is substantial evidence that acne is aggravated by a so-called “Western Diet” – high in processed carbohydrates, sugar, and trans fats.  Why is this?

What Causes Acne

Skin and hair both are mostly comprised of a protein called keratin.  When keratin cells multiply, they can cause the hair follicle in the skin (pore) to narrow, and then sebum (the oil your skin naturally produces, made of lipids – fats – and cell fragments) builds up in the blocked follicle.  The bacteria so often associated with acne (Propionibacterium acnes) live off that sebum, and this sets off an inflammatory cascade.

The Thought Process Behind Traditional Treatments

Traditional treatments focus on killing the bacteria (which can control symptoms, but misses the root cause, since the bacteria associated with acne also exists in clear-skinned individuals), decreasing inflammation (steroids), changing the sebum chemistry and quantity (retinoids and hormone-based treatments), and preventing the keratin cells from multiplying in the first place (again, these are the retinoids, like Accutane and isotretinoin).

Are We Missing Something?  The Western Diet Link

But it turns out that indigenous populations don’t get acne.  And as non-Western populations increasingly adopt Western diets, their incidence of acne concurrently increases as well.

So bacteria doesn’t seem to be the cause – Propionibacterium acnes can be present with or without acne vulgaris.  It’s just an organism that takes advantage of an opportunity to invade and infect when one is presented to it.  (We call this an opportunistic organism.)

However, we do know at least in part that sebum production and chemistry is the product of our environments.  Good food, clean air and water, lower stress, getting enough sleep, proper digestion, and avoiding environmental pollutants all seem to contribute to lowering sebum production and making it less attractive to the bacteria that invariably lurks about.  Specifically, low glycemic index (i.e. low sugar), high protein diets seem to improve sebum quality and discourage infection.

Now, it is the case that some people can eat crap and maintain perfect skin, while others eat very well and still have trouble (at which point the treatment must be more involved).  This seems to be a function of a few things – among them, the way your body processes sugar.  Insulin spikes can lead to hormone byproducts that stimulate both increased activity of keratin cells and increased sebum production. Some people’s bodies are just better at processing high glycemic foods and regulating hormones than others, and for those, diet changes may not clear up the whole case (though they will certainly help).

Just another reason to EAT LESS CRAP and eat more real food.

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