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Back to Roles on Certain Health Conditions

Is There a Link Between Acne and Milk Products? Summary of Evidence

The relationship between diet and acne is highly controversial. Historically, acne has anecdotally been attributed to diet by individuals with this skin condition. While milk has been suggested as one of the diet components that may be linked to acne, no conclusive evidence to date has shown that milk and milk products are implicated in the etiology of acne.

Highlights

  • There is a lack of strong evidence to show a cause-and-effect link between milk and milk product consumption and acne;
  • The whey milk protein lactoferrin has been shown to significantly decrease inflammatory acne lesion counts and acne grade;
  • A low glycemic load diet seems to have a favourable role against the pathogenesis of acne;
  • More research is needed regarding the role of diet and specific foods on acne.

Background

Acne is a chronic inflammatory disease of skin hair follicles that are associated with an oil gland. It is the most prevalent skin problem and is especially common among adolescents, affecting up to 98% of individuals in this age category.1

The role of diet in the management and prevention of acne has been controversial for the past century. Myths surrounding diet have persisted for many years, and certain foods, including high-carbohydrate and high-fat foods, sweets, chocolates, and milk and milk products have been suggested to exacerbate acne.2

However, to date, there is a lack of strong evidence to indicate that milk and milk products have a role in acne.

The Evidence

Before the 1960s, standard acne therapy consisted of making various diet restrictions, such as limiting high-carbohydrate and high-fat foods. A case series study published in 1949 of 1,925 subjects who kept strict food diaries documented that milk was a commonly implicated food in acne flares.3 However, this evidence is very weak, given that no summary of statistics and statistical analyses was reported. In addition, the report was anecdotal and descriptive, based on the author’s experience.4

Around the 1970’s, two studies were published and indicated that there was no association between diet and acne.5,6 However, these studies were similarly criticized because of major methodological limitations. One of the studies, a case series, investigated the relationship of milk with acne and found that daily consumption of milk did not produce acne flares.6

Owing to non-conclusive evidence of any true effects of diet on acne, the consensus that diet is unrelated to the etiology or progression of acne was reached within the dermatology community.

Yet, recent studies have re-examined the link between diet, including the link between milk and milk products, and acne.

In 2005, Adebamowo et al. published a retrospective analysis of data from the Nurses' Health Study II (NHS II), which evaluated whether milk product consumption during high school was associated with diagnosed teenage acne. The study consisted of 47,355 women who were asked to complete a food frequency questionnaire on high school diet.7

  • There was a positive association between acne and milk consumption, particularly skim milk;
  • Positive associations were also found for instant breakfast drink, sherbet and Cottage cheese, and the associations were attributed to the milk content of the foods.

In 2006, the same researchers investigated the association between milk consumption and the occurrence of acne among 6,094 girls aged 9 to 15 years at baseline and who were prospectively followed for up to 3 years.8

  • Acne prevalence was found to be positively associated with the consumption of total, whole, low-fat and skim milk;
  • As was the case in the previous study, there was no association between dairy fat and acne.

Another similar study published in 2008 (also conducted by Adebamowo et al.) used a prospective cohort method to examine the association between milk product consumption and acne among 4,273 teenage boys.9

  • There was a positive association between skim milk and acne;
  • There were no significant associations between acne and total, whole and low-fat milk consumption;
  • There was no association between total milk or milk fat consumption and acne.

Overall, however, the three studies by Adebamowo et al. all had major limitations:4

  • Unvalidated self-reports of acne instead of objective measures;
  • Observational study designs rather than randomized controlled trials;
  • Weak associations according to epidemiologic standards, making the clinical significance of the results questionable.

Furthermore, major drawbacks of the first study in 2005 included:4

  • No control of confounding variables;
  • A retrospective design with the high likelihood of inaccurate food reports, since subjects had to recall to the distant past.

Since the time these studies were published, further studies have shown an association between diet and acne that cannot be dismissed.

A recent study published in 2010 examined the effect of lactoferrin on acne. In this 12-week, open, double-blind, placebo-controlled trial, 56 patients aged 18 to 30 years were randomly assigned to a daily serving of fermented probiotic milk enriched with 200 mg of lactoferrin or fermented milk containing probiotics only.10

  • The lactoferrin group showed significant improvements in acne, with significant decreases in inflammatory acne lesion count by 38.6%, total lesion count by 23.1% and acne grade by 20.3% compared with the placebo group;
  • Sebum content in the lactoferrin group was decreased by 31.1% compared with the placebo group;
  • Amount of total skin surface lipids decreased in both groups, which was significantly correlated with decreases in sebum content;
  • Decreases in triacylglycerols were significantly correlated with decreases in sebum content, acne lesion counts and acne grade;
  • It was concluded that lactoferrin-enriched fermented milk ameliorates acne by selectively decreasing triacylglycerols in skin surface lipids.

In 2007, Smith et al. examined the effects of a low glycemic load diet on acne lesion counts. In a 12-week, parallel design, investigator-blinded dermatology assessment, 43 healthy young men aged 15 to 25 years were assigned to either the experimental treatment, consisting of a low glycemic load diet, or the control diet, which emphasized carbohydrate-dense foods.11

  • Total lesion counts decreased more in the low glycemic load group (-23.5%) than in the control group (-12%);
  • The low glycemic diet also resulted in greater improvement in insulin sensitivity, Body Mass Index (BMI) and weight loss.

As part of the previous trial, Smith et al. also aimed to determine the effect of low glycemic load diets on acne and the fatty acid composition of skin surface triglycerides among 31 male acne patients.12

  • Compared to the control diet, the low glycemic load diet led to an increase in saturated relative to monounsaturated fatty acids, and this increase was predictive of clinical improvement in acne.

Unlike what was demonstrated in the past, these findings suggest that the pathogenesis of acne may be influenced by nutrition-related lifestyle factors, specifically a low glycemic load diet, which may have a beneficial impact on acne.

Moreover, a recent population-based study published in 2012 investigated whether there was an association between BMI and acne among 3,600 Norwegian adolescents aged 18 or 19 years.13

  • Girls who were overweight or obese were twice as likely to have acne than their leaner peers;
  • Among boys, no association was found between acne and overweight.

Other studies have also indicated a link between diet and acne and that certain food components, such as omega-3 fatty acids and antioxidants, offer possible benefits.4

Potential Mechanisms

Hormones and IGF-1 (Insulin-like Growth Factor 1)

It has been hypothesized that the association found between milk and acne may be due to the presence of hormones in milk and the impact on IGF-1. IGF-1 is a hormone important for growth and development. Higher caloric, protein and milk intakes have been associated with higher levels of plasma IGF-1, and it has also been shown that reducing total protein intake may decrease circulating IGF-1 levels.14,15

However, if hormones in milk were the cause of acne, then a positive association should have been seen with milk products of a higher fat content and not just with skim milk, especially since hormones are fat-soluble. Furthermore, no association has been observed between dairy fat and acne.7-9

Lactoferrin

Lactoferrin is a whey milk protein with antibacterial and anti-inflammatory activities. As an iron-binding protein, it sequesters iron that is essential for bacterial membrane growth. It can also increase bacterial membrane permeability for bacteriocidal activity. As well, it modulates the immune system by inhibiting the production of proinflammatory cytokines, and this would be beneficial against acne, which is an inflammatory condition. Additionally, it has been demonstrated that lactoferrin can selectively decrease triacylglycerol in skin surface lipids as well as sebum content.10

Low glycemic load diets

It has been shown that a low glycemic load diet can improve acne by decreasing serum insulin and IGF-1 levels and blood glucose and insulin responses. This in turn may modify androgen and glycogen pathways to counteract increased sebum production, which is an obligatory condition for acne development. An increase in the 16:0/16:1∆6+∆9 ratio has also been observed with low glycemic load diets, suggesting a decrease in the enzymatic desaturation of 16:0 with such diets. As a result, the role of desaturase enzyme in sebaceous lipogenesis has been proposed as a potential mechanism to explain the decrease in sebum production that has been observed with low glycemic load diets.11,12

Conclusions

The evidence to date does not support a detrimental role for milk and milk products in the etiology of acne.

Other nutrition-related factors, such as low glycemic load diets, appear to be beneficial against acne.

More evidence is needed, especially from randomized controlled trials and mechanistic studies, regarding the role of milk products of varying fat contents as well as specific types of milk products on acne etiology.

References

  1. Chan JJ and Rohr JB. Acne vulgaris: yesterday, today and tomorrow . Australas J Dermatol 2000;41(Suppl):S69-72.
  2. Spencer EH et al. Diet and acne: a review of the evidence . Int J Dermatol 2009;48(4):339-47.
  3. Robinson HM. The acne problem . South Med J 1949;42(12):1050-60.
  4. Bowe WP et al. Diet and acne . J Am Acad Dermatol 2010;63(1):124-41.
  5. Fulton JE Jr et al. Effect of chocolate on acne vulgaris . JAMA 1969;210(11):2071-4.
  6. Anderson PC. Foods as the cause of acne . Am Fam Physician 1971;3(3):102-3.
  7. Adebamowo CA et al. High school dietary dairy intake and teenage acne . J Am Acad Dermatol 2005;52(2):207-14.
  8. Adebamowo CA et al. Milk consumption and acne in adolescent girls . Dermatol Online J 2006;12(4):1
  9. Adebamowo CA et al. Milk consumption and acne in teenaged boys . J Am Acad Dermatol 2008;58(5):787-93.
  10. Kim J et al. Dietary effect of lactoferrin-enriched fermented milk on skin surface lipid and clinical improvement of acne vulgaris . Nutrition 2010;26(9):902-9.
  11. Smith RN et al. A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial . Am J Clin Nutr 2007;86(1):107-15.
  12. Smith RN et al. The effect of a low glycemic load diet on acne vulgaris and the fatty acid composition of skin surface triglycerides . J Dermatol Sci 2008;50(1):41-52.
  13. Halvorsen JA et al. A population-based study of acne and body mass index in adolescents . Arch Dermatol 2012;148(1):131-2.
  14. Holmes MD et al. Dietary correlates of plasma insulin-like growth factor I and insulin-like growth factor binding protein 3 concentrations . Cancer Epidemiol Biomarkers Prev 2002;11(9):852-61.
  15. Fontana L et al. Long-term effects of calorie or protein restriction on serum IGF-1 and IGFBP-3 concentration in humans . Aging Cell 2008;7(5):681-7.

Keywords: glycemic index , lactoferrin , whey protein


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