Hormonal Acne: The Effects of Your Diet.

Acne is a chronic inflammatory disease that appears as pimples on the face and/or body. There are many causes: genetic factors, hormonal imbalance, stress, certain medications, etc.

In the case of acne, we observe a hypersecretion of sebum (we speak of hyperseborrhea) at the level of the pilosebaceous follicles, as well as hyperkeratinization. The sebum will clog the pores, which are the openings of the sebaceous glands on the surface of the skin. This environment is conducive to the proliferation of the bacteria responsible for the appearance of acne, Cutibacterium acnes (formerly Propionibacterium acnes), which feeds mainly on sebum. This bacterium secretes pro-inflammatory substances that cause inflammation and the formation of pimples.

Acne appears very frequently under hormonal influence. Hormones stimulate the activity of the sebaceous glands that produce sebum. This is the case during periods of hormonal changes such as adolescence, menstrual cycles, pregnancy, and menopause:

• Puberty: Acne is a condition that affects the majority of adolescents (about 80% of them) at the time of puberty. This is due to the start of the production of sexual hormones. In fact, these hormones stimulate the sebaceous glands, which hyper-secrete sebum, thus favoring the appearance of acne.

• Menstrual cycle: Acne can also affect adults. Women in particular (about 25% of them) are affected by hormonal acne. In the first part of the menstrual cycle, the ovaries produce estrogens, female sex hormones. In the second part of the cycle, estrogen levels drop and progesterone levels rise following ovulation. Progesterone is the hormone that prepares you for a possible pregnancy. If there is no pregnancy, the progesterone level drops. About one week before the beginning of menstruation, testosterone, although in small quantities, reaches a higher level than the female hormones. Testosterone is an androgenic hormone that stimulates the sebaceous glands, causing acne breakouts.

• Pregnancy: Pregnancy acne is caused by hormonal variations during this period. During pregnancy, progesterone, and estrogen levels rise dramatically. These hormones can act on receptors in the sebaceous glands and stimulate sebum production. This hypersecretion of sebum results in the appearance of acne.

Note: Adult women are more affected by hormonal acne than men. Men's sex hormone levels stabilize after puberty, while women's hormones fluctuate throughout their lives (menstrual cycle, pregnancy, and menopause). In addition, adult female acne can be aggravated by a variety of other factors, including diet.

Many studies have focused on the link between acne and the glycemic index of food. The glycemic index of food indicates its ability to increase the concentration of glucose in the blood. When food has a high glycemic index, the glucose level in the blood will increase rapidly. In response, the pancreas will stimulate the secretion of insulin, which is a hypoglycemic hormone.

Note: A hormone is said to be hypoglycemic when it decreases the level of sugar in the blood. On the contrary, a hyperglycemic hormone increases the blood sugar level.

Foods with a high glycemic index include white bread, potatoes, processed foods, cooked carrots, fruit juices, etc. It is also important to know that dairy products have a low glycemic index, but powerful insulin-stimulating properties.

Insulin stimulates the secretion of IGF-1 (Insulin-like Growth Factor-1), also known as Somatomedin C, which increases androgen levels in the blood. Androgens also stimulate the secretion of IGF-1. Thus, androgens and IGF-1 stimulate the secretion of sebum that causes acne. In addition to stimulating androgen secretion, IGF-1 decreases the amount of the transcription factor FOXO1 in the cell nucleus, resulting in the activation of mTORC1, which is involved in sebum hypersecretion and hyperkeratinization. mTORC1 is also activated by leucine, an amino acid found in meat and dairy products.

Thus, foods with a high glycemic index, dairy products and meat are risk factors in the development of acne.

A healthy diet allows you to limit the development of acne pimples by soothing the inflammation of the skin. The following foods are best for taking care of acne-prone skin:

• Low glycemic index foods:

  Foods with a high glycemic index stimulate the secretion of insulin, which is the cause of acne-prone reactions. Replace them with foods with a moderate or low glycemic index, such as whole grains, fruits and vegetables, legumes and nuts.

• Omega-3 rich foods:

  Foods rich in omega-3 inhibit the secretion of IGF-1 and thus decrease sebum hypersecretion and hyperkeratinization. In addition, they inhibit the synthesis of leukotriene B4 (LTB4) which is a contributor to inflammation. Thus, the consumption of foods rich in omega-3, such as fatty fish (salmon, mackerel, etc.), oilseeds (walnuts, etc.), flaxseed and walnut oils, reduces inflammatory and non-inflammatory acne lesions. According to the recommendations, the intake of omega-3 should be between 0.8 and 1.1 g/day.

• Zinc-rich foods:

  Zinc is a trace element that has anti-inflammatory and anti-bacterial properties that are very beneficial against acne. In fact, it inhibits the growth of the bacteria responsible for acne, P. acnes, and reduces the activity of the sebaceous glands through its anti-androgenic activity. Therefore, consume foods rich in zinc, such as oysters, eggs, whole grains, vegetables, and nuts.

• Dairy substitutes:

  Dairy products are rich in leucine and significantly stimulate the secretion of insulin, promoting the appearance of acne. Therefore, replace dairy products with substitutes such as plant-based milks (almond milk, oat milk, etc.).

• VARIGOS G. A . & al. A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. The American Journal of Clinical Nutrition (2007).

• PUSHPINDER S. Therapy in dermatology: A review. (2014).

• TAN J. & al. Effects of diet on acne and its response to treatment. American Journal of Clinical Dermatology (2021).

• MICALI M. D. & al. Diet and acne: review of the evidence from 2009 to 2020. International Journal of Dermatology (2021).