ORLANDO, January 22, 2024 – For all of the hype, claims and confusion, there's evidence that certain foods and drinks have an increased risk of pimples, psoriasis, atopic dermatitis, rosacea and other common skin conditions. So what's the connection in each case? And how can individuals with certainly one of these skin conditions possibly improve their health and quality of life through dietary changes?
What's clear is that interest in learning which foods can improve or worsen skin problems has exploded.
One of the important areas of interest is nutrition and pimples. “We've all heard that sugar and dairy are bad, and the Western diet is high in sugar and dairy,” said Vivian Shi, MD, associate professor of dermatology on the University of Arkansas for Medical Sciences, Little Rock, at a recent dermatology clinic Conference.
Dairy products, pork and carbohydrates can break down into leucine, a necessary amino acid present in proteins. Leucine and sugar together can produce insulin, which may enter the skin via various routes. This can result in more acne-causing bacteria forming Cutibacterium acnes.
Milk and other dairy products can even increase certain compounds that increase the danger of pimples.
However, not all kinds of milk are created equal in terms of pimples. Shi wondered why 2% milk overall has a really similar color and dietary content to whole milk. She discovered that when milk manufacturers remove the fat, they often add whey proteins to revive some nutrients. Whey protein can increase pimples, Shi said.
“So if you choose milk to drink, I think it's better to use whole milk from an acne perspective. If you get it organic, it's even better.” Skim milk is the most likely to cause acne, she said.
psoriasis
A comprehensive review of 55 studies evaluating diet and psoriasis found that obesity can worsen the disease. The strongest evidence for weight loss suggests lower calorie diets in people who are overweight or obese. Other evidence suggests that alcohol may reduce response to treatment and is associated with more severe psoriasis. Additionally, a gluten-free diet or vitamin D supplements may help some people with psoriasis.
“An overwhelming majority of our psoriasis patients are vitamin D deficient,” Shi said.
The National Psoriasis Foundation publishes dietary guidelines that were just updated in November. The foundation says: “There isn't any weight loss plan that may cure the disease psoriasis, but there are lots of ways in which maintaining a healthy diet foods can reduce the severity of symptoms and help reduce the likelihood of developing comorbidities.”
Healthier options include fruits, vegetables, whole grains, and fat-free or low-fat dairy products. These include lean meat, poultry, fish, beans, eggs and nuts. Adherence to a Mediterranean diet has been associated with lower psoriasis severity.
Atopic dermatitis
Atopic dermatitis is “one of the prototypical diet-related diseases,” Shi said. Another meta-analysis examined randomized controlled trials of synbiotics (a combination of prebiotics and probiotics) for the treatment of AD.
These researchers found that synbiotics do not prevent eczema but can help treat it in adults and children over a year old. Additionally, synbiotics are more beneficial than probiotics in treating the condition, although there are no direct comparative studies. In addition, the meta-analysis also found that prebiotics alone can alleviate the disease.
However, there are no recommendations from the American Academy of Dermatology, Shi said on prebiotics or probiotics for atopic dermatitis, and the group does not recommend supplements or essential oils for it either.
In a 2022 review, researchers evaluated the effectiveness of various dietary supplements for atopic dermatitis based on the available evidence. They found that vitamin D supplements provided the most benefit, followed by vitamin E, probiotics, hemp seed oil, histidine and oolong tea. They also found that the Six Food Elimination Diet and Autoimmune Protocol contained the least evidence of this.
Rosacea
Rosacea appears to be caused by “all of the fun things in life” such as sunlight, alcohol, chocolate, spicy foods and caffeine, Shi said. In people with rosacea, they can cause facial flushing, edema, burning, and an inflammatory reaction.
Certain foods can activate skin receptors and sensory neurons, which can release compounds that act on mast cells in the blood, causing a hot flash. There is evidence that the skin-gut axis may also be involved.
“And that's why food has a reasonably large impact on rosacea,” Shi said.