While acne is generally thought of as an adolescent affliction, my experience suggests otherwise. In my practice, I see a pretty regular stream of individuals who, long after the hormonal rush that comes with puberty has died down, continue to suffer from ‘bad skin’. In fact, statistics show that more than one in two women and 40 per cent of men over the age of 25 have at least some acne, and for quite a few this problem can even persist into middle age. Traditional nutritional advice for those prone to acne is to avoid fatty food, with chocolate often singled out as particularly spot-inducing fare. However, recent evidence suggests that it is not fat, but another commonly-found ingredient in chockie bars, that may incite the skin breakouts that plague so many of us.
Clues to the cause of acne may be had by comparing the nutritional habits of populations with differing susceptibilities to this skin condition. With this in mind, researchers recently took an in-depth look at the diets and dermatological health of two indigenous populations: the Kitavan islanders from Papua New Guinea and the Aché hunter-gatherers from Paraguay. While the Kitavans subsist mainly on fruit, vegetables, fish, and coconut, the Aché diet is comprised almost entirely of wild, foraged for and locally cultivated foods. Intriguingly, the prevalence of acne in both these groups eating essentially natural foods was found to be nil, even in those caught in the hormonal maelstrom that comes with puberty and adolescence. This, clearly, is in stark contrast to the rip-roaring rates of acne seen in industrialised nations.
Some have suggested that such differing propensities to acne are a matter of genetics. However, the observation that populations swapping their traditional diet for something less natural become more acne-prone points strongly to nutrition as the critical factor. The typically Western diet is renowned for its overly fatty nature, and this supports the commonly-held belief that fatty foods cause spots. However, some researchers have put forward the notion that rather than fat, it is sugars and starches (carbohydrates) that are the major protagonists in acne eruptions. While carbohydrates in traditional diets generally come in whole, unadulterated forms, those consumed in the West are typically refined, and may contain a load of sugar too. It seems that eating a diet rich in foods such as white bread, biscuits, cakes, confectionery, sweet drinks and sugary breakfast cereals may have important implications for our skin.
One effect these foods tend to have is stimulate the production of copious quantities of the blood sugar regulating hormone insulin. Laboratory experiments show that rushes of insulin in the system encourage the secretion of a skin waterproofing agent called sebum, and also may initiate changes in the skin that tend to block the glands that make it. It is this backlog of sebum in the skin, often coupled with a bacterial infection, that cause spots, pimples and acne. The evidence suggests that keeping the carbs in our diet based on natural sources such as fruits, vegetables, beans, pulses and brown rice, rather than more processed fare, makes for healthier skin in the long term. The good news is that chocolate isn’t necessarily off the menu: dark varieties containing 70 per cent or more cocoa solids are relatively low in sugar, and are therefore the treats of choice for those keen to clear their skin from within.