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How Does Chocolate Cause Acne?
The chocolate-acne question may never be conclusively answered but it is difficult to find a strong link between pure chocolate and acne.
It is an old wives’ tale that chocolate can cause acne. Up to the 1950s, dermatologists believe this and recommended that their acne patients avoid chocolate.
However, when medical research became increasingly applied to human nutrition, this belief was closely studied. Over the next three decades, different studies were published on the subject and not one of them found such link. But in the last decade, a few recent studies are bringing back the old link.
These small studies were mostly presented at seminars and the published ones agreed that there was no conclusive proof yet.
Evidently, there is a need for more studies. But while researchers have been wary about equating correlation to causation, journalists and bloggers are quick to jump to misleading conclusions.
The link between acne and chocolate intake is weak at best since most sensational studies on the subject do not completely account for other factors. While there is a need to fully answer the chocolate-flavored acne question, it is worth knowing why chocolate was believed to cause acne and how none of the studies for and against such link have been conclusive.
Chocolate refers to the raw or processed food obtained from the seeds of cocoa (Theobroma cacao) tree. It was first made by the ancient civilizations of Latin America. The seed of the tree is extremely bitter and only acquires the beloved chocolaty taste after fermentation.
Theobromine is responsible for most of the therapeutic benefits of chocolate and is also why chocolate is poisonous to animals such as dogs and cats. The second alkaloid contained in chocolate is phenethylamine.
Together, these two compounds are responsible for chocolate’s ability to regulate serotonin levels in the brain as well as lower blood pressure.
There are different types of chocolate. Bitter chocolate or baking chocolate is unsweetened and mostly contains cocoa solids and cocoa butter which are the pure, unrefined forms of chocolate.
Sweet chocolate, which is the most popular type of chocolate eaten today, contains cocoa solids, cocoa butter, some fats and sugar. Milk chocolate adds condensed milk or milk powder to the formula of sweet chocolate.
White chocolate is milk chocolate but without cocoa solids. Therefore, it does not contain theobromine. It is also non-toxic to animals but it is not used for cooking and not considered true chocolate in some cultures.
Dark chocolate contains more antioxidants than other forms of chocolate, and it is the one sold for its health benefits. It is made by combining fat and sugars with cocoa solids and cocoa butter. Because it contains gallic acid and epicatechin, regular and moderate consumption of dark chocolate can reduce the risk of heart attacks.
When the sugar content of dark chocolate is sufficiently low, it is called semisweet chocolate.
Raw, unprocessed chocolate is considered the healthiest form of chocolate. At least, three quarters of it is cacao (cocoa solids and butter) and it is always dark in color. Since it is unprocessed, it has the full complement of vitamins and minerals.
When manufacturing the various chocolate products sold in stores, the fat (cocoa butter) is removed from raw chocolate when refining the pure form and then added in differing amounts during the manufacturing.
Other fats as well as sugar and milk are also added. In fact, the white specks known as chocolate bloom and observed on dark chocolates sold in stores are the added sugar and fat separating out of the chocolate.
The average chocolate bar also contains other substances such as vegetable oils, lecithin, nuts, dextrose, lactose and flavoring. It is these added substances that are responsible for most presentations of acne observed after taking chocolate.
More fats and sugar increase the caloric value and the glycemic load of chocolate.
Furthermore, milk, which is added to chocolate, is also associated with acne breakouts.
Fats contribute to the production of androgens such as testosterone. Increased production of testosterone also means increased syntheses of its metabolites such as dihydrotestosterone or DHT and dehydroepiandrosterone sulfate or DHEAS.
These androgens cause hormonal imbalance and affect the sebaceous follicles. They cause the enlargement of the sebaceous gland and the increased production of sebum. Sebum then combines with dead skin cells and bacteria to clog the skin pores and lead to the development of acne lesions.
Furthermore, the added sugars dramatically increase the glycemic content of chocolate.
They increase blood sugar and insulin levels which triggers the adrenal gland to increase sebum production.
The caffeine content also acts in this way but to a lesser degree. It promotes inflammatory response from the immune system and, therefore, can cause both superficial (pimples and papules) and deep acne (nodules and cysts) inflammations.
Therefore, it might be justified to believe that chocolate causes acne but this is not entirely true. Some chocolate products do cause acne but not because of their chocolate content. In fact, the healthy, raw, dark and unprocessed chocolate does not cause or worsen acne.
Many chocolate lovers especially those who have taken the time to study their body’s response to the food know that chocolate containing at least 70% cacao does not trigger acne breakouts.
The bad chocolates, the ones that cause chocolate-flavored acne, are the extensively refined, sugar- and fat-fortified, store-bought chocolate products.
After half a century of searching for a link between acne and chocolate, most of the published studies have not established one and the few that did are badly designed.
Below is a rundown of the major researches on the topic.
In 1965, Grant and Anderson conducted an interventional study on the effect of milk chocolate bars on 8 study participants and found no such link. The subjects were fed on milk chocolate bars for 2 days and then observed for 5 days.
However, this study had no control group. It was also criticized for its short duration and small sample size. Therefore, four years later, Fulton et al. expanded the study to 65 adolescents and adults and divided them into test and control groups.
The second study took 7 weeks with a 4-week period during which half of the participants was fed non-milk chocolate bars and the other half took placebos. A 3-week rest period was allowed before the participants were examined. The study result showed no association between acne and chocolate.
Over the last two decades, different studies have attempted to get to the root of the problem.
In some studies, adolescents and young adults were asked if they thought chocolate caused acne. An overwhelmingly high percentage of them believed there is a link between the two.
However, finding that link proved impossible for another study where the fats in chocolate were tagged with radioactive isotopes. At the end of the study, none of the radioactive fats was found in the sebum secreted on the skin.
Therefore, the researchers concluded that the fat content of chocolate is unlikely to cause acne.
Yet another study conducted among adolescents at the University of Pennsylvania by Dr. Albert Kligman found no difference in the incidence and severity of acnes between teenagers who ate chocolate bars and those who ate chocolate-free but chocolate-tasting bars.
In 2005, Adebamowo et al. questioned over 47,000 nurses about their diets when they were teenagers and if, and to what extent, they developed acne. The study found no link between acne and chocolate.
It is worth noting that in this study, only Vitamin D supplements and foods supplying high glycemic loads were linked to acne breakouts.
Earlier in 1999, the same researcher finished a 3-year study of the dietary intakes of over 10,000 boys and girls between ages 9 and 15. In the fourth year when the prevalence and severity of acne was assessed in the study participants, no significant link was found between acne and chocolate.
The strongest correlation between acne and chocolate was established by a 2011 study which was done by Samantha Block, a second year medical student at Miller School of Medicine of the University of Miami.
She and her colleagues fed 10 men aged between 18 and 45 with as much pure chocolate as they wanted. The men were then asked to abstain from chocolate for a week. The study findings showed that all the men had new outbreaks of acne with the most severe ones seen with men who ate the most chocolate.
However, this study has not been peer-reviewed and published yet.
Like the Anderson study, it will most likely be criticized for using a very small sample size, for not including a control group and for not taking long enough.
While Block et al. argued that they used pure, unadulterated chocolate containing 100% cocoa, this is doubtful considering that they mentioned using 4-ounce candy bars which were most likely store-bought.
It is unlikely that such chocolate bars are pure considering that the process of refinement during manufacturing would have removed some cocoa, vitamins and minerals while adding fats and sugars.
There is still no final agreement on the link between acne and chocolate but without a well-designed study that provides such a link, researchers and dermatologists do not believe chocolate causes acne.
Still, it is difficult to deny reports of people who experienced acne breakouts shortly after eating chocolate.
Therefore, while some chocolate products (especially chocolate milk) may trigger or worsen acne in some people, most people will never experience acne breakouts as a direct result of eating chocolate.
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