Acne and Dairy Products
New studies are putting to rest the longstanding debate about whether milk and dairy products cause acne. The verdict? Read further.
Until recently, diet was believed to play no significant role in the development of acne. However, new evidence has established a solid link between acne and dairy products along with high sugar diets.
Acne is a common skin disease which is caused by hormonal imbalance and bacterial colonization of the skin. Hormonal imbalance can be caused by a number of factors including diet, stress, puberty, menopause, pregnancy, birth control pills and some drugs.
Any physiological change in the body that involves a sharp and sustained rise in the production of male sex hormones will cause acne. This is why acne is at its worst during the teenage years when sexual development is rapid.
The male sex hormones chiefly responsible for acne development are androgens. The most prominent of these androgens are testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone sulfate (DHEAS).
Although called male sex hormones, androgens are produced in both sexes. These androgens stimulate the sebaceous gland to increase the production of sebum. Therefore, the skin becomes oilier and makes an ideal environment for bacterial growth.
The androgens are not the only hormones that can cause acne. Another identified hormone is insulin-like growth factor-1 or IGF-1. Its production in the body peaks during the puberty years.
The two bacteria that contribute to acne the most are Propionibacterium acnes and Staphylococcus epidermis. These microbes also increase sebum production. In addition, they cause a cycle of inflammation and the breakdown of keratin.
As the skin becomes filled with dead skin cells, bacteria and sebum, the pores increasingly get blocked. This blockage gives rise to acne lesions such as pimples and comedones. In severe cases of acne, nodules, cysts and scars may also be formed.
Dairy products are high-energy food products obtained from the milk of mammals. Cows are the prime source of most dairy products consumed but the milks of goats, camels and sheep are also used in food production in some cultures.
The manner in which milk is processed largely determines the type of dairy products made from it. Milk is usually separated into fatty cream and fat-free skim milk.
The resulting cream can be dried and powdered, evaporated or made into butter. Skimmed milk, on the other hand, is sold as low-fat milk after a little cream is added back.
Other constituents of milk include proteins such as casein and whey. Popular milk products include cheese, yogurt, ice cream, butter and gelato.
Different studies have identified a link between milk ingestion and incidence of acne breakout as well as severity. In fact, among all dairy products, milk had the strongest link to acne.
Besides whole milk, only chocolate milk, cottage cheese and sherbet were linked to acne. Other dairy products caused no negative effects on the skin.
The studies also found that skim milk was a worse offender than whole milk. Since skim milk has no or very little fat, the results showed that the fat in milk was not responsible for acne breakouts.
Fat is not the only constituent of milk that the results showed did not cause acne. Vitamin D was also absolved simply because people who also took vitamin D supplements during the studies did not experience acne more frequently than those who only took milk products.
So if fat is not responsible for the tendency of milk to cause acne breakouts, what is?
Researchers now believe that the constituents of milk responsible for acne are hormones; more specifically, androgen hormones and growth hormones.
Since milk is an essential food for growth especially in young animals, it is fortified with hormones needed to cause growth spurts. Therefore, milk is a reservoir of androgens such as testosterone and growth hormones such as insulin-like growth factor 1.
Cows are routinely fed growth hormone too, and some of these hormones find their way into the animal’s milk.
Even in cows raised naturally, growth hormones are still present in the milk. Raw, organic milk obtained from cows that are raised on pasture and not on a diet of steroids still yield more than 60 of these hormones.
When androgens are ingested in high amounts from milk and other dairy products, they interfere with the hormonal balance of the body. Therefore, teenagers who drink milk a lot are more prone to acne attacks than those who abstain from milk.
Testosterone and its metabolite, DHT, are known to stimulate the sebaceous gland to increase the production of sebum.
The excess sebum makes the face oily and creates the ideal environment for bacterial colonization, inflammation of the skin and clogging of the pores which leads to acne breakouts.
On the other hand, the insulin and insulin-like growth factors contained in milk can trigger a sharp increase in the level of insulin in the body.
It is estimated that a glass of milk increases insulin levels by 300%. This is a rise that is comparable to the ingestion of high caloric, high carb diets that provide high glycemic loads.
The increased production of insulin from milk ingestion not only causes acne breakouts but can also be the beginning of diabetes in the future.
While some milk products are labeled to contain “hormone-free milk”, it is worth knowing that there is no such thing as hormone-free milk.
These dairy products may have been prepared from milk obtained from cows that were not spiked with bovine somatotropin (which helps increase milk production in cows) but cows do produce their own natural growth and anabolic hormones which can be found in their milk.
Similarly, lactose-free milk and organic milk are not free of these hormones and they can also cause acne breakouts.
The earliest link between acne and milk was established in a 1949 paper published in South Medical Journal by HM Robinson.
This dermatologist did a prospective study involving over 1500 male and female participants between the ages of 16 and 25. From the diet records, the researcher found a positive link between milk products and acne breakouts.
Another study published in Journal of the American Academy of Dermatology in 2005 by six researchers including two of the most prolific authors in acne research (C.A. Adebamowo and F.W. Danby) established that both total milk and skim milk are strongly associated with acne in teenagers.
The study involved 47,355 women who were questioned about their diets in high school and the severity of their acne breakouts.
The study results established the strongest association between acne and skim milk, total milk, cottage cheese, cream cheese and sherbet.
Then in 2006 and 2008, Adebamowo published the findings of two more studies on the subject. In one study, the researcher examined diet records of females between ages 16 and 25 over 3 years. The second study was targeted at male participants over the same time period and within the same age group.
Both studies involved more than 10,000 participants and found a strong, positive link between total milk intake and acne.
In 2011, a paper presented by Melnick BC at a Nestle Nutrition Workshop and titled Milk and Milk Products in Human Nutrition, agreed that milk does cause acne and suggested that, to reduce the prevalence of the skin disease, milk consumption should be reduced and that insulin-like growth factors be removed from final milk products.
However, even in the face of overwhelming proofs that milk and some dairy products are associated with acne, researchers are cautious about declaring outright that milk causes acne. This is understandable because correlation does not always mean causation.
Clearly, a more rigorous proof is needed. This will require a randomized, double-blind controlled study of the roles of milk and dairy products in acne development.
Sadly, there is no way to conduct such a study and eliminate all bias since there is no other liquid known that can serve as an excellent placebo for milk.
Milk does not cause acne breakouts in everybody but it does in most people. Obviously, the way in which individuals process the hormones found in milk differ.
The link between acne and milk is not restricted to teenagers; adult acne is also worsened by milk and improved when milk is cut off from one’s diet.
If you find out that milk causes your acne flare-ups, a total restriction may be advised. This requires that you do not consume milk or milk products.
Goat milk or other animal milks do not serve as a good substitute since it may also contain growth hormones. However, you can switch to milk substitutes such as soy products.
While milk is an important source of calcium, you can get your daily recommended calcium intake from other dietary sources and supplements. Vitamin D supplements may also be required while abstaining from milk.
If you must take some milk products, then it is best to get to know what your personal threshold of milk tolerance is. This refers to the amount of milk you can safely ingest without the hormonal content causing acne breakouts.
First, you need to clear off your acne by staying away from milk and dairy products. This total restriction phase may take as long as 6 months.
This can be followed by a maintenance phase which spans the teenage years and during which you are allowed to take small amounts of milk products every now and then.
However, since it can take a while for the effect of the hormones contained in milk to trigger acne flare-ups, it is difficult to establish how much milk you can tolerate at this stage.
A slow reintroduction phase can then follow when you enter your 20s. During this time, the oily nature of the skin changes into the dry, adult skin, and hormones may not play a major role in acne development.
Still, some people do respond greatly to milk products even at this stage. For such people with adult acne, milk and dairy products may never be reintroduced.
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