ReachMD Announcer:
You’re listening to Clinician’s Roundtable on ReachMD. On this episode, we’ll hear from Dr. John Barbieri, who’s an Associate Professor of Dermatology at Harvard Medical School and the Director of the Advanced Acne Therapeutics Clinic at the Brigham and Women’s Hospital. He’ll be discussing how dietary interventions can support patients with acne. Let’s hear from Dr. Barbieri now.
Dr. Barbieri:
Diet and acne is so challenging because if we want to try and look at it from an epidemiologic standpoint, there are just so many confounders with diet that it’s really difficult to be able to make any sort of causal inference if any specific dietary change or intervention leads to improvement in acne. And unfortunately, we don’t have that many randomized controlled trials in the space, but we do have some that can help guide us.
There are a couple of randomized controlled trials that support that a low-glycemic index diet—this is basically eating less carbohydrates and less refined sugars—is associated with improvements in acne. This can be a very helpful recommendation for people who are looking for a dietary strategy for their acne to try a low carbohydrate or even a ketogenic diet, and it’s probably something that’s good for our overall health as well. We know that these refined sugars and high carbohydrates can lead to diabetes and other issues, so this is probably good in general, and certainly, there’s some compelling evidence both mechanistically and from clinical trials that it can help with acne.
Another aspect of nutrition is vitamin D. There are epidemiologic studies that have identified that those with acne tend to have lower levels of vitamin D than those who don’t, and this has a dose-response relationship with severity, so the more severe your acne is, the lower your vitamin D levels tend to be. Again, whether this is causal is always tricky, but there is a randomized control trial where they took people with low vitamin D level and they randomized them to vitamin D supplementation or to placebo, and those who got vitamin D supplementation had greater improvements in inflammatory lesions of acne than those who did not. So I do think in people with acne, considering whether or not they might have low vitamin D and vitamin D supplementation can be other helpful low-risk strategies to address acne through diet and nutrition.
And then we get to some things that I think have a lower quality of evidence but are worth considering. These are things like omega-3 supplementation. Again, there’s some epidemiologic evidence that supports an association between lower levels of omega-3, particularly DHA and EPA, and acne. And there are some small trials that support that omega-3 supplementation and Mediterranean diet can be helpful in acne. Evidence, again, here is a little bit weaker, but I think it’s a pretty low risk and maybe even an intervention that may help overall health.
Then there’s some evidence around zinc. There are a couple of randomized controlled trials that support that zinc supplementation can improve acne. Now, the doses in these trials are very, very high. These are doses that you start to worry about copper deficiency and you probably want to supplement with copper too if you’re going to do this, and many people may have some challenges with stomach upset or nausea at these doses. It’s going to depend on the specific formulation of zinc you’re using. But zinc is another option for those who are looking for more nutritional or lifestyle strategies to improve their acne.
For me, the most important thing here is thinking about potential harms of dietary changes as cutting out certain foods might lead to macro or micronutrient deficiencies. If someone cuts out all dairy, they might have lower levels of calcium, vitamin D, or protein, and that might influence their overall health. If someone cuts out chocolate, they might just be less happy because they like eating chocolate. So when people get into these really restrictive dietary approaches for acne, I do think we have to think about, is this helping? And what are the potential consequences of this? And if someone does some dietary change and they found it’s helpful and it’s something that’s not affecting their overall health or their macro-micronutrients, I think that’s great. But I do think we want to be thoughtful because people really like to try to find root cause of their acne. They try to look for things like something they’re eating or doing that they can address, and sometimes this leads them to making a lot of interventions that may not help their acne and, on top of that, might make them unhappy because they’re hard to do, restrictive, and may impact their overall health through these dietary patterns.
I think diet can be an important part of a comprehensive acne management plan. I mean, first off, patients are really interested in diet. When we do surveys, this is one of the most common things that they’re trying. They’re doing dietary interventions more often than they’re even using over-the-counter products and certainly more often than they’re using prescription products for acne, so there’s a lot of interest in this. I think having that conversation helps the patient feel heard and that you’re really fully considering them and their acne. That can help to comprehensively come up with a treatment plan for our patients with acne.
ReachMD Announcer:
That was Dr. John Barbieri talking about the role of nutrition in acne management. To access this and other episodes in our series, visit Clinician’s Roundtable on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!
