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Diet and acne: an exploratory survey study of patient beliefs Quynh-Giao Nguyen1, Ramsey Markus1, Rajani Katta1 1 Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
Key words: acne, diet, Internet, dermatologist, foods Citation: Nguyen QG, Markus R, Katta R. Diet and acne: an exploratory survey study of patient beliefs. Dermatol Pract Concept 2016;6(2):5. doi: 10.5826/dpc.0602a05 Received: November 6, 2015; Accepted: January 10, 2016; Published: April 30, 2016 Copyright: ©2016 Nguyen et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: None. Competing interests: The authors have no conflicts of interest to disclose. All authors have contributed significantly to this publication. Corresponding author: Rajani Katta, MD, Professor of Dermatology, Baylor College of Medicine, 1977 Butler Blvd, 6th Floor, Suite E6.200, Houston, TX 77030, USA. Email: [email protected]
ABSTRACT
Background: In the past, medical literature reflected that diet was not a proven cause of acne. However, studies in recent years have substantiated a link between certain dietary factors and acne. It is unclear whether patients are aware of recent research findings. Objectives: Acne patients were surveyed to explore beliefs regarding the link between diet and acne, to determine whether these beliefs translated into behavior change and to identify health information sources. Patients/Methods: Upon Institutional Review Board (IRB) approval, surveys were administered to 50 acne patients at an academic dermatology clinic in 2014, with 49 completed in full and included in this analysis. Results: Ninety-two percent of respondents believed that diet could affect acne. Seventy-one percent attempted to change their diet to improve acne. Seventy-one percent believed acne to be caused by fried or greasy foods, although chocolate (53%), dairy (47%), and soda drinks (35%) were highly implicated. Patients obtained information from Google searches (49%), dermatologists (43%), family members and TV (41% each), and medical websites (31%). Conclusions: In this exploratory study, patients reported utilizing a diversity of information sources, a majority from the Internet. In those surveyed, there was a persistence of long-held belief that fried/ greasy foods and chocolate may serve as acne triggers, and less belief in trigger foods supported by recent research, including refined carbohydrates and sugar. Given the multiplicity of beliefs and utilized sources among acne patients in our survey, there is a need to establish up-to-date and reliable methods to educate patients on diet and acne.
Introduction
one of the largest studies involved 65 patients. Over a four-
Research on the link between diet and acne goes back decades.
bar or a placebo bar, and no difference in acne severity was
In the 1960s, several research groups studied this subject, and
seen [1]. Based on such studies, patients were counseled
Research | Dermatol Pract Concept 2015;6(2):5
week period, subjects were administered either a chocolate
21
that diet did not impact acne. This belief was reflected in
This study was designed to be an initial, exploratory
textbooks, patient information brochures, and the medical
survey study of current patient perceptions about the link
literature [2].
between diet and acne. The aim was to identify common
However, later researchers noted methodological flaws
beliefs, misconceptions, and current information sources
in the original study, including the fact that the placebo bar
regarding the connection between diet and acne. As in other
contained a similar total sugar and fat content as the choco-
exploratory survey studies [13], these findings would help
late bar [3]. Further studies have now correlated a number
indicate directions for future research and would be of benefit
of dietary factors and acne. The strongest studies to date
to clinicians when counseling patients.
indicate that dietary glycemic load may contribute to acne. A randomized controlled trial of Australian males [4] demonstrated significant improvement of acne severity after 12
Materials and methods
weeks of adherence to a low-glycemic-load diet, compared to
This protocol was approved by the Baylor College of Medi-
the high-glycemic-load diet control group. Follow-up studies
cine Institutional Review Board. Patients presenting to an
[5,6] have noted that switching to a low glycemic diet led to
academic dermatology clinic for the treatment of acne or
better insulin sensitivity, lower androgen bioavailability, and
acne scarring were asked if they wished to participate in a
altered skin sebum production. It is not known, however,
survey study about the link between diet and acne. If so,
what role individual differences, duration of dietary changes,
they completed a self-administered questionnaire prior to
and other factors play in this association. Therefore, studies
the physician visit. Subjects were asked to classify their acne
such as Di Landro et al.’s [7] have documented the opposing
from mild to severe, based on their personal perception of
view that weekly consumption of cakes, sweets, and choco-
the disease’s impact. Demographic data, such as age, gender,
late—foods high in glycemic load—was not associated with
weight, height, and education level, was included in the
a higher risk of acne.
questionnaire. Surveys were administered from March to
In addition, researchers examining the link between dairy
November of 2014.
consumption and acne have noted some association. Studies [8,9,10] have demonstrated this link in three separate populations, though in each instance the correlation results
Results
were considered relatively weak. Closer evaluation of this
Of the 50 questionnaires administered, 49 were completed
link revealed that only skim milk showed a statistically significant correlation with acne, perhaps due to its increased
in full and were included in the analysis. The mean age of
processing and/or decreased estrogen content in comparison to whole milk [8]. A number of other dietary factors have been studied for their potential role in improving acne. For example, an inverse relationship has been found between acne severity and con-
TABLE IA. Sample characteristics, N (%). [Copyright: ©2016 Nguyen et al.] Gender
sumption of omega-3-rich fish [11,7] with the mechanism of
Male
11 (22.4)
action postulated as omega-3-mediated reduction of inflam-
Female
38 (77.6)
matory acne [12]. While some promising results have been
Age
noted from in vitro or animal studies, studies in humans are
16-19
5 (10.2)
limited, and each of these dietary factors requires further
20-29
24 (48.9)
30-39
17 (34.7)
40-45
3 (6.1)
investigation before recommendations may be made to patients. These include foods or supplements containing vitamin A, omega-3 fatty acids, zinc, antioxidants, and fiber. [12].
BMI
Given that the scientific literature on this topic is rapidly evolving, it would be expected that patients might receive
Diet and acne: an exploratory survey study of patient beliefs Quynh-Giao Nguyen1, Ramsey Markus1, Rajani Katta1 1 Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
Key words: acne, diet, Internet, dermatologist, foods Citation: Nguyen QG, Markus R, Katta R. Diet and acne: an exploratory survey study of patient beliefs. Dermatol Pract Concept 2016;6(2):5. doi: 10.5826/dpc.0602a05 Received: November 6, 2015; Accepted: January 10, 2016; Published: April 30, 2016 Copyright: ©2016 Nguyen et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: None. Competing interests: The authors have no conflicts of interest to disclose. All authors have contributed significantly to this publication. Corresponding author: Rajani Katta, MD, Professor of Dermatology, Baylor College of Medicine, 1977 Butler Blvd, 6th Floor, Suite E6.200, Houston, TX 77030, USA. Email: [email protected]
ABSTRACT
Background: In the past, medical literature reflected that diet was not a proven cause of acne. However, studies in recent years have substantiated a link between certain dietary factors and acne. It is unclear whether patients are aware of recent research findings. Objectives: Acne patients were surveyed to explore beliefs regarding the link between diet and acne, to determine whether these beliefs translated into behavior change and to identify health information sources. Patients/Methods: Upon Institutional Review Board (IRB) approval, surveys were administered to 50 acne patients at an academic dermatology clinic in 2014, with 49 completed in full and included in this analysis. Results: Ninety-two percent of respondents believed that diet could affect acne. Seventy-one percent attempted to change their diet to improve acne. Seventy-one percent believed acne to be caused by fried or greasy foods, although chocolate (53%), dairy (47%), and soda drinks (35%) were highly implicated. Patients obtained information from Google searches (49%), dermatologists (43%), family members and TV (41% each), and medical websites (31%). Conclusions: In this exploratory study, patients reported utilizing a diversity of information sources, a majority from the Internet. In those surveyed, there was a persistence of long-held belief that fried/ greasy foods and chocolate may serve as acne triggers, and less belief in trigger foods supported by recent research, including refined carbohydrates and sugar. Given the multiplicity of beliefs and utilized sources among acne patients in our survey, there is a need to establish up-to-date and reliable methods to educate patients on diet and acne.
Introduction
one of the largest studies involved 65 patients. Over a four-
Research on the link between diet and acne goes back decades.
bar or a placebo bar, and no difference in acne severity was
In the 1960s, several research groups studied this subject, and
seen [1]. Based on such studies, patients were counseled
Research | Dermatol Pract Concept 2015;6(2):5
week period, subjects were administered either a chocolate
21
that diet did not impact acne. This belief was reflected in
This study was designed to be an initial, exploratory
textbooks, patient information brochures, and the medical
survey study of current patient perceptions about the link
literature [2].
between diet and acne. The aim was to identify common
However, later researchers noted methodological flaws
beliefs, misconceptions, and current information sources
in the original study, including the fact that the placebo bar
regarding the connection between diet and acne. As in other
contained a similar total sugar and fat content as the choco-
exploratory survey studies [13], these findings would help
late bar [3]. Further studies have now correlated a number
indicate directions for future research and would be of benefit
of dietary factors and acne. The strongest studies to date
to clinicians when counseling patients.
indicate that dietary glycemic load may contribute to acne. A randomized controlled trial of Australian males [4] demonstrated significant improvement of acne severity after 12
Materials and methods
weeks of adherence to a low-glycemic-load diet, compared to
This protocol was approved by the Baylor College of Medi-
the high-glycemic-load diet control group. Follow-up studies
cine Institutional Review Board. Patients presenting to an
[5,6] have noted that switching to a low glycemic diet led to
academic dermatology clinic for the treatment of acne or
better insulin sensitivity, lower androgen bioavailability, and
acne scarring were asked if they wished to participate in a
altered skin sebum production. It is not known, however,
survey study about the link between diet and acne. If so,
what role individual differences, duration of dietary changes,
they completed a self-administered questionnaire prior to
and other factors play in this association. Therefore, studies
the physician visit. Subjects were asked to classify their acne
such as Di Landro et al.’s [7] have documented the opposing
from mild to severe, based on their personal perception of
view that weekly consumption of cakes, sweets, and choco-
the disease’s impact. Demographic data, such as age, gender,
late—foods high in glycemic load—was not associated with
weight, height, and education level, was included in the
a higher risk of acne.
questionnaire. Surveys were administered from March to
In addition, researchers examining the link between dairy
November of 2014.
consumption and acne have noted some association. Studies [8,9,10] have demonstrated this link in three separate populations, though in each instance the correlation results
Results
were considered relatively weak. Closer evaluation of this
Of the 50 questionnaires administered, 49 were completed
link revealed that only skim milk showed a statistically significant correlation with acne, perhaps due to its increased
in full and were included in the analysis. The mean age of
processing and/or decreased estrogen content in comparison to whole milk [8]. A number of other dietary factors have been studied for their potential role in improving acne. For example, an inverse relationship has been found between acne severity and con-
TABLE IA. Sample characteristics, N (%). [Copyright: ©2016 Nguyen et al.] Gender
sumption of omega-3-rich fish [11,7] with the mechanism of
Male
11 (22.4)
action postulated as omega-3-mediated reduction of inflam-
Female
38 (77.6)
matory acne [12]. While some promising results have been
Age
noted from in vitro or animal studies, studies in humans are
16-19
5 (10.2)
limited, and each of these dietary factors requires further
20-29
24 (48.9)
30-39
17 (34.7)
40-45
3 (6.1)
investigation before recommendations may be made to patients. These include foods or supplements containing vitamin A, omega-3 fatty acids, zinc, antioxidants, and fiber. [12].
BMI
Given that the scientific literature on this topic is rapidly evolving, it would be expected that patients might receive
