Most people follow a low-carb or keto diet expecting to lose weight, achieve better blood sugar control, and/or lower their blood pressure. In most cases, these are exactly the type of results that occur.
However, some individuals may also experience an unexpected bonus: improvement in skin quality, including a decrease in the frequency and severity of acne.
Indeed, there’s emerging evidence that this way of eating may help control acne due to its effects on hormonal health.
How does acne develop?
Although nearly 90% of adolescents and teens have acne, it’s fairly common in adults as well. In fact, it’s estimated that in Western countries, around 50% of people in their 20s and 30s struggle with acne. On the other hand, it’s very rare in many cultures who follow traditional diets.
Acne develops as a result of complex interactions that take place within the skin. Sebaceous glands located in the skin’s outer layer are connected to hair follicles. These glands produce sebum, an oily substance that lubricates the hair and skin cells, which are constantly being shed and replaced.
In the case of acne, this system is impaired. Elevated levels of androgens (male hormones) cause increased sebum production, leading to oily skin. In addition, skin cell production ramps up, and dead skin cells aren’t shed in the normal fashion. Instead, these cells combine with excess sebum, causing blocks or plugs. While this process is occurring, bacteria that feed on sebum also enter the picture.
Similar to the gut microbiome, skin maintains its own bacterial balance. One type of bacteria known as P. Acnes lives deep within the hair follicles and is normally present in the outer skin layer in small amounts. However, during acne, concentrations of P. Acnes increase dramatically, causing inflammation that leads to whiteheads, pustules and cysts.
The role of diet in acne
Up until the 1960s, based on early studies, diets high in sugar and refined carbs were believed to worsen acne. However, after experimental research failed to show a link between specific foods and acne, diet was no longer considered much of a contributor.
Today, the tide has turned yet again, in light of mounting research published within the past decade suggesting that carbohydrates may be the main dietary culprit in acne due to their negative effects on hormonal regulation.
Carbohydrates may be the main dietary culprit in acne due to their negative effects on hormonal regulation.
For instance, a 2007 controlled study in 43 young acne-prone men by Smith, et al, found that a low-glycemic-load diet led to a greater reduction in acne lesions than a higher-glycemic-load diet. What’s more, the low-glycemic-load group experienced a decrease in androgen and insulin levels, improvement in insulin sensitivity, and weight loss. By contrast, the other group had increases in weight, insulin levels, and insulin resistance.
It’s important to point out that this wasn’t really a low-carb diet; the low-glycemic-load carbs accounted for about 44% of the total dietary intake. Would there have been an even greater improvement with a low-carb or keto diet providing less than 15% of energy from carbs?
Low-carb and ketogenic diets for acne
Many people have reported that their skin has become much clearer as a result of following a low-carb or keto diet.
Although controlled research on carb restriction for acne has yet to be done, many people have reported that their skin has become much clearer as a result of following a low-carb or keto diet.
Moreover, there are logical reasons why minimizing carb intake would be helpful for acne sufferers.
A 2012 article by Italian researchers discusses the potential benefits of ketogenic diets for acne, including the following:
Reduction in insulin levels: Elevated insulin levels stimulate increased production of skin cells, sebum, and androgens – setting the stage for acne eruptions. Ketogenic diets decrease insulin levels, often dramatically.
Anti-inflammatory effects: Inflammation drives acne progression. Very-low-carb and ketogenic diets have been shown to reduce inflammation.
Decrease in IGF-1 (insulin-like growth factor 1): Ketogenic diets decrease levels of IGF-1. Like insulin, IGF-1 increases sebum production and has been found to play a large role in acne.
In a compelling 2013 review on therapeutic uses of ketogenic diets for various conditions, Paoli, et al, state that although the emerging evidence for the use of keto diets in acne is promising, randomized controlled trials (RCTs) are needed to confirm these benefits.
Keto or low carb: Which is best for acne?
As there aren’t yet any studies on stricter low-carb or keto diets for acne at this time, it’s difficult to determine the degree of carb restriction needed to achieve the best results. Similar to losing weight or reducing blood sugar, the necessary carb reduction for potential acne control likely varies from person to person. It’s possible that stricter low-carb diets are more effective.
Tips for maximizing the benefits of a keto or low-carb diet for acne
Below are some additional dietary tweaks that may or may not be useful. They are based on preliminary evidence, small studies that need to be repeated to know for sure whether the suggested effects are real.
Consume fatty fish often: Long-chain omega-3 fatty acids found in fish are anti-inflammatory and have been credited with possibly improving acne. The best sources include salmon, mackerel, sardines, herring and anchovies.
Eat low-carb vegetables: Leafy green and cruciferous vegetables may help promote hormonal regulation and improve skin health. Notable dermatology researcher Bodo Melnik recommends a Paleo diet rich in vegetables for acne management.
Avoid or limit dairy: Dairy has been shown to increase levels of insulin and IGF-1. Although skim milk seems to have the the strongest link to acne, cheese has also been implicated as a potential issue.
Drink green tea: Green tea is the best source of the antioxidant EGCG (Epigallocatechin gallate). A 2016 study found that green tea extract appeared to significantly reduce acne lesions in adult women with moderate to severe acne.
Avoid or limit dark chocolate: Although earlier studies showed no difference in acne response when chocolate was compared to other sweets, a 2016 study found that even virtually sugar-free 99% dark chocolate might significantly worsen breakouts in acne-prone men. For this reason you may want to limit even dark chocolate intake, just to be safe.
Focus on fresh low-carb foods: Even if you don’t eat sugary and starchy foods, you may still be consuming ingredients that can cause skin issues. Bologna and other processed meats often contain sugar, corn syrup, fillers or other additives that raise insulin levels and potentially provoke inflammation. Stick to fresh food whenever possible, and read labels on processed meats and other packaged foods.
Give the diet some time: Paradoxically, some people report a worsening of acne shortly after starting a keto or low-carb diet. However, this appears to be short-lived and may be part of the keto-adapatation process. Overall, breakouts seem to improve with carb restriction long term in the vast majority of people.
While the evidence is still somewhat preliminary, there are many reasons to believe that low-carb and keto diets can improve acne. Feel free to read several stories below from people who have tried it, and to use our free guides linked below to get started.
By choosing nutrient-dense low-carb whole foods that minimize insulin levels and reduce inflammation, you may be giving yourself the best shot at clearer, healthier skin.
Trying a low-carb diet is safe, and besides the cost of buying real food, it’s also free. So why not try it out for a few weeks, and see what happens to your skin?
Have you already tried a low-carb or keto diet for acne? Feel free to leave a comment below, and share your experiences.