Acne Nutrition: Myths, Tips And Menus

There is no more common skin disease than acne.

Scars that remain a silent reminder, psychological trauma and disorders such as low self-esteem, depression and anxiety - all this negatively affects the quality of life of both a teenage girl and an adult, self-sufficient woman.

A 10-year-old respondent once said, “You focus on your acne a lot because it’s the first thing you see when you look in the mirror.”

However, this is not only a problem teenagers face during puberty. According to statistics, 50.9% of women aged 20 to 29 and 26.3% of women aged 40-49 suffer from acne. So what is its cause and how to deal with it?

Causes of acne

The main factors leading to acne are:

1. Change in follicular keratinization (this is the process of deposition of specific protein substances in the epidermis, the uppermost layer of the skin, as well as fats in the stratum corneum, due to which it acquires strength and elasticity), which leads to the formation of comedones.

2. Increased sebum production under the influence of androgens - the main actors and culprits of acne. This is evidenced by the absence of acne in women who are insensitive to male sex hormones, as well as an increase in the level of dehydroepiandrosterone sulfate due to the appearance of acne in girls in the premenarchal period (that is, before the onset of the first menstruation).

   With a lack of androgen receptors in the follicles, seborrhea can develop, but there are no comedones and inflammatory lesions, as studies have shown.

3. Adverse effects of propionobacteria.

   Propionobacteria, the most common inhabitants of human skin, generally help maintain its natural microbial balance.

   On the one hand, they do not play a leading role in the mechanisms of acne - in most people, they do not even cause any kind of aesthetic problems and health in general.

   On the other hand, some species produce large amounts of lipases - enzymes that break down sebum and thereby promote the formation of pro-inflammatory substances (in particular, short-chain fatty acids). Together, these factors, by activating various receptors, lead to the production of signal cytokine molecules by the cells of the immune system, and also stimulate the release of peptidases that destroy extracellular matrix proteins.

   Study: Propionibacterium acnes and Acne Vulgaris: New Insights from the Integration of Population Genetic, Multi-Omic, Biochemical and Host-Microbe Studies

4. Complex inflammatory mechanisms that involve both innate and adaptive immunity.

Symptoms of hyperandrogenism

• Acne.

• Hirsutism is the excess growth of coarse, dark, and long hair in a male pattern (i.e., on the chin, in the sternum, and around the areola of the nipples, upper back, and abdomen).

  It is observed in 70% of women, thus being the most common symptom. It is closely associated with elevated serum free testosterone levels.

  Given that hair removal may interfere with the diagnosis of hirsutism, patients should be asked about the nature and frequency of hair removal methods, as well as areas of excessive hair growth. You can also ask them to self-assess the presence or absence of excess hair on the following scale:

   

• Seborrhea is a violation of the sebaceous glands, accompanied by excessive production of their secret with a high content of free fatty acids.

• Androgenetic alopecia - thinning of hair and subsequent baldness of the parietal, frontal areas and thinning of the central parting of the head.

• Amenorrhea - the absence of menstruation for 6 months, subject to a normal earlier cycle.

• Oligomenorrhea - scanty, infrequent menstruation.

• Virilization is a complex of symptoms manifested by the appearance of masculine facial features, physique and voice timbre in women.

• Clitoromegaly is an abnormal enlargement of the outer part of the clitoris.

• Infertility.

• Polycystic ovaries.

• Increase in muscle mass.

• Breast size reduction.

• Anovulation in two of three cycles. (However, up to three cycles per year can normally be anovulatory).

Other factors for acne

The use of aggressive skin care products and inappropriate cosmetics can exacerbate acne by changing the skin barrier and microbiota balance (especially in the sebaceous glands), thereby activating innate immune mechanisms and causing inflammation.

Acne cosmetic, first described in 1972, is characterized by scattered comedones on the face with very few inflammatory lesions such as pustules and papules. Triggers are ingredients in cosmetics such as essential oils, harsh skin cleansers, and pH 8.0 soaps.

Briolin, used for hair care, giving them shine, as well as for fixing them, as noted, can cause comedones in the forehead and temples.

There is evidence that psychosocial and lifestyle factors, including stress, emotions, lack of sleep, influence the development of inflammatory skin diseases.

The short-wavelength visible light emitted by smartphone screens, according to recent studies, increased the proliferation of Staphylococcus aureus, thereby disturbing the balance of the skin microbiota.

Cigarette smoke, a complex aerosol with over a thousand chemicals, including nicotine, carbon monoxide, tar, formaldehyde, hydrocyanic acid, ammonia, mercury, lead, and cadmium, increases trans-epidermal water loss, connective tissue degeneration, and also activates metalloproteinases that destroy collagen and elastic fibers.

Demodicosis is an ectoparasitosis that is manifested by skin diseases of the scalp and is caused by mites.

Ticks can migrate from one follicle to another at a rate of 8-16 mm within 7 hours. It is believed that females lay their eggs in deeper areas of the hairline, where the young can continue to develop until they reach the size of mature individuals.

The body of the tick is covered with a hard exoskeleton, and the presence of chitin in it can act as a foreign body and contribute to the formation of granulomas.

Most likely, when Demodex disrupts the integrity of the epithelial barrier, its antigens are recognized by the host's immune system and cause a type 4 (delayed) hypersensitivity reaction.

Their metabolic products directly or together with associated bacteria can activate elements of the innate immune system.

High glycemic index foods and insulin resistance cause hyperandrogenism and provoke the development of acne. The study, which involved volunteers aged 10 to 24 years, showed that the risk of developing acne in individuals with a lower body mass index (BMI) is significantly less than in patients with its high values.

It is also reported that the adverse effects caused by ticks in obese people were more severe compared to healthy control groups.

Some authors have suggested that dysregulation of blood glucose levels, overweight, and metabolic syndrome increase susceptibility to Demodex infection.

Thus, it was noted that the serum concentration and expression in skin tissues of insulin-like growth factor-2 (IGF-2) increases not only in generalized demodex in dogs, but also in patients with acne.

Foods that cause acne

• Milk

Most dermatology textbooks still define acne as an androgen-dependent skin disease - and indeed, there is no doubt that an excess of these hormones contributes to acne and seborrhea. The absence of acne in the conditions of the loss of its function of androgen receptors and, as a result, the insensitivity of cells to these hormones, only once again prove the importance of their role in the pathogenesis of acne.

Scientists suggested that not androgens, but serum levels of insulin-like growth factor-1 (increasing during puberty under the influence of somatotropin - growth hormone) play a major role in the mechanisms of acne pathogenesis.

Insulin-like growth factor-1 (IGF-1) or somatomedin C is a protein synthesized by liver cells and has a similar structure and function to insulin molecules (and, as we already know, it has an anabolic effect).

There is such a hereditary disease as Laron's syndrome - these patients have short stature due to defects in the gene responsible for the expression of growth hormone receptor (known as growth hormone). This mutation also results in congenital IGF-1 deficiency. It is noteworthy that patients who are not treated with recombinant IGF-1 never develop acne, while its administration causes hyperandrogenism and the appearance of acne as a result - this already suggests that IGF-1 enhances transcriptional activity. androgen receptors.

Moreover, by binding to its receptor, IGF-1, by triggering a cascade of signaling pathways, it stimulates the growth and division of cells, in particular, epithelial cells of the sebaceous glands.

In addition, IGF-1 is a powerful inducer of testosterone synthesis in the gonads (sex glands) and dehydroepiandrostenedione (DHEA) in the adrenal cortex. It also inhibits the formation of sex hormone-binding globulin (SHBG) in the liver, which leads to an increase in the blood fractions of free, and therefore active androgens.

It also promotes the intradermal conversion of testosterone to dihydrotestosterone (the most physiologically potent androgen) by increasing the activity of the 5-alpha reductase enzyme. At the same time, androgens, in turn, induce IGF-1 in the hair follicle.

Milk is a special product of evolution, the main task of which is to stimulate the processes of anabolism, that is, synthesis, and the active growth of newborn mammals. Specific amino acids in its composition increases the secretion of insulin and IGF-1.

Consumption of 710 ml of ultra-heat-treated milk in children not accustomed to this type of diet during the prepubertal period for four weeks significantly increased the level of IGF-1 and growth hormone in serum - this was not due to the content of IGF-1 in it , but due to its production by the liver under the action of specific amino acids.

Notably, the main whey protein in milk, alpha-lactalbumin, has the highest tryptophan content of any other dietary protein source. The presence of this amino acid is crucial in the synthesis of IGF-1 by hepatocytes.

In addition, the branched-chain amino acids (BCAAs) of milk - leucine, isoleucine, valine - cause the cells of the pancreas to secrete insulin - this explains the high insulin index of both whole and skimmed milk.

The prevalence of acne has been observed to increase significantly among Okinawans and Chinese after the transition from their traditional diet to Western diets.

Research highlights that 75-90% of all commercial milk in the US comes from pregnant cows - and it contains dihydrotestosterone precursors (5-alpha-androstenedione) as well as placenta-derived progesterone. Also during this period, the adrenal glands of the animal produce significant amounts of DHEA, which can be converted under the action of the enzyme 3-beta-hydroxysteroid dehydrogenase into androstenedione.

Many studies have shown that skimmed milk is more comedogenic than whole milk. Its production is believed to alter the biological activity of glucocorticoids and transforming growth factor beta, as well as hormones similar to thyrotropin and opiates, all of which lead to a change in their interactions with binding proteins. In addition, to maintain the proper consistency, manufacturers add whey proteins (such as alpha-lactoalbumin) to it, the role of which in the pathogenesis of acne is also far from the last.

Nutritional supplements used by athletes (such as whey proteins) contain leucine and can therefore cause and/or worsen acne: this amino acid stimulates insulin-like growth factor-1 (IGF-1). Scientists, given the anabolic role of insulin and similar biologically active molecules, call for considering, similarly to the abuse of androgens in bodybuilding, excessive consumption of milk protein as a form of doping.

• simple sugars

A high intake of refined sugars plays a key role in the pathogenesis of acne. The effect of high glycemic load diets on the induction and exacerbation of acne has been confirmed by many placebo-controlled studies.

A diet with a low glycemic load increased the secretion of IGF-1 binding proteins, while a diet high in carbohydrates decreased the secretion of sex hormone binding globulin - thus, serum levels of FREE androgens increased.

A high concentration of glucose in the blood activates the expression of miRNA-21 in macrophages, which is the central regulator of cell division and inflammation mechanisms.

• Chocolate

Chocolate has always been regarded as a factor that can cause an exacerbation of acne - for example, dermatologists note the appearance of new acne in their patients a few days after eating it.

The Journal of the American Academy of Dermatology published an article in 2011 reporting worsening of acne in respondents after a single ingestion of chocolate, but there was no information about the type of chocolate or the percentage of cocoa it contained.

As you know, dark chocolate contains more antioxidants than milk chocolate and, as a result, has much less comedogenic effects. However, the question of its role as a whole still remains open.

Another study added even more controversy: it showed that eating small amounts of 99% dark chocolate for four weeks led to a statistically significant increase in acne severity. This was due to the high concentration of cocoa butter, which contains a large amount of oleic acid, which can affect the keratinization of the skin and thereby contribute to the development of comedones.

• Trans fats

Palmitate activates the proliferation of keratinocytes (epidermal cells) and promotes the formation of comedones.

Notably, it is a major fatty acid, making up 32% of all milk triglycerides.

Trans fats, the main components of fast food, are structurally similar to palmitic acid. They have replaced natural solid fats and liquid oils in such snacks, fried foods and baked goods.

• Iodine

Iodine is a mineral necessary for the normal and proper functioning of not only the thyroid gland, but the whole organism as a whole.

Acne that occurs after eating a meal rich in iodine appears suddenly and is characterized by many papules. Hence, it has been suggested that the relationship between acne and milk consumption may also be related to the content of this halogen in dairy products and, accordingly, depend on the season, location, additives in animal nutrition and the use of iodophor as disinfectant solutions.

Food that helps get rid of acne

Recommendations:

1. Replace milk with dairy products.

   Yogurt consumption in this study did not correlate with acne. This is explained by the fact that probiotic bacteria (in particular, lactobacilli) added to milk during the fermentation process utilize IGF-1 and thereby reduce its concentration by 4 times compared to skim milk.

   It has also recently been noted that lactoferrin-fortified dairy products effectively reduce triglyceride levels in lipids on the skin surface, which reduces sebum production.

2. Avoid simple sugars.

   Treatment of acne cannot be considered separately from the treatment of insulin resistance. Normalization of carbohydrate metabolism is an indisputable guarantee of success and clean, beautiful skin.

3. Add fiber to your diet.

   In one study, acne patients ate 30 grams of cereal each day for breakfast, containing 13 grams of fiber per serving. At the same time, they noted a significant improvement in the condition of the skin. It was also present after introducing other volunteers to a diet with a low glycemic load - this was due to the large amount of dietary fiber, as the researchers suggested.

4. Eat more fermented foods.

   Probiotics can also provide significant benefits: dietary supplementation with Lactobacillus rhamnosus was associated with better clinical outcomes in 20 patients compared with the placebo group; Lactobacillus acidophilus and Bifidobacterium bifidum, in addition to standard antibiotics, also improved the skin condition. Oral probiotics are able to reduce systemic oxidative stress, regulate cytokine production, and reduce markers of inflammation.

5. Add omega-3 fatty acids to your diet.

   Eicosapentaenoic acid (EPA) - the main omega-3 fatty acid in fish oil - inhibits the development of acne.

   Studies have shown significant improvements in acne when patients take 3 grams of fish oil containing 930 mg of EPA for 12 weeks. The addition of borage oil with gamma-linolenic acid to the diet also reduced skin lesions, both inflammatory and non-inflammatory.

   Omega-3 fatty acids have the ability to reduce the level of IGF-1, which has a beneficial effect in the treatment of acne.

   A North Carolina study of 1,000 teenagers found that those who ate large amounts of fish and seafood had less acne.

   Eicosapentoenoic acid and gamma-linolenic acid have been reported to inhibit the conversion of arachidonic acid to the sebum-stimulating inflammatory leukotriene B4, to the same extent as the proven acne drug zileuton.

The role of vitamins and antioxidants in the fight against acne

Reactive oxygen species produced by neutrophils are involved in the inflammatory progression of acne. It has been suggested that oxidative stress may be related to the origin of acne and that drugs with antioxidant effects may be valuable aids in the treatment of acne.

A 2008 study of 100 healthy volunteers and 100 acne patients found that the latter had significantly lower concentrations of vitamins A and E, fat-soluble antioxidants. They also had a low concentration of selenium, a mineral necessary for the functioning of the enzyme glutathione peroxidase.

• Green tea catechins have been shown to inhibit sebum production in simulated hamster studies.

• Nobiletin, a flavonoid found in Taiwanese mandarin juice (Citrus depressa), inhibits lipogenesis (fat synthesis) and proliferation of sebaceous gland cells.

• Resveratrol, a polyphenolic flavonoid found in red grape skins, peanuts, and mulberries, inhibits Mtorc1 signaling and also inhibits P. acnes growth and biofilm formation.

  Topical treatment of acne on the faces of 20 patients with a gel containing resveratrol significantly reduced the number of comedones, papules and pustules compared to the control group.

  In addition, it has antioxidant properties, improves cell sensitivity to insulin and increases the number of mitochondria.

• Selenium is part of glutathione peroxidase, an enzyme that, together with vitamin E, is part of the antioxidant system that protects the human body from relentlessly generated free radicals.

It is an essential mineral that plays a key role in physical growth and development, immune system function, reproductive health, and neurobehavioral development.

A decrease in serum zinc levels can also lead to an increase in androgen production, which will directly affect the activity of the sebaceous glands.

This mineral also inhibits P. acne, activates natural killer cells and stimulates the phagocytic ability of granulocytes. Its anti-inflammatory activity in acne also includes a decrease in the production of tumor necrosis factor and interleukin-6.

Zinc is required for the synthesis and secretion of retinol-binding protein (RBP), a specific transporter that reflects the amount of vitamin A available to tissues.

The study involved 173 patients - it was shown that in those with more severe acne, the level of RBP was lower than in those who had less acne. A similar situation was with their levels of zinc - this became the rationale for its use for the treatment of acne.

Plasma zinc concentrations must be interpreted with caution, and the sample must be taken on an empty stomach: the level of this mineral has been noted to decrease by 20% after a meal. Low values ​​can, in addition to deficient conditions, be observed in tumors and chronic liver diseases - therefore, C-reactive protein (a marker of the acute phase of inflammation) can help with the interpretation of the analysis.

It is better to use its chelated forms (picolinate, glycinate, acetate) as oral supplements.

Zinc is found in wheat bran, eggs, pine nuts, asparagus, herring, lentils.

It must be remembered that this mineral reduces the absorption of copper (they are antagonists), which can contribute to the development of anemia.

Vitamin A is a group of compounds that can be found in animal and plant foods.

Retinol and its derivatives are found mainly in milk, dairy products, eggs, liver, and fish. Plant foods contain mainly provitamin A (carotenoids).

Beta-carotene turns into retinol under the action of the enzyme beta-carotene monooxygenase-1, the formation of which is responsible for the BCMO1 gene, which is why it is so important to look at the genetic panel of vitamins for the presence of polymorphisms when switching to vegetarianism.

Vitamin A is a fat-soluble vitamin that can be stored in the liver.

Studies have noted that oral retinol supplements at high doses are indicated for the treatment of acne, with cheilitis and xerosis being the only side effects observed.

Isotretinoin (13-cis-retinoic acid) 20 mg/day for three months was also effective and had a lower incidence of side effects than higher doses.

Oxidative stress during lipid peroxidation may be the initiator of the release of inflammatory agents that contribute to the development of various pathologies.

Ascorbate normalizes the lipid profile of the epidermis (in particular, glucosphingolipids and ceramides).

Vitamin C is found in rose hips, currants, strawberries, kiwi, sauerkraut. Does not accumulate in the body.

This vitamin is highly active in scavenging free radicals, including singlet oxygen, superoxide, and hydroxyl radicals.

Studies have shown that daily oral intake of alpha-tocopherol leads to a significant increase in vitamin E levels in human skin - especially in areas with a high density of sebaceous glands.

Since oral vitamin E does not have an effect on sebum until several weeks later, its topical use in the treatment of acne has also attracted dermatologists. Doctors noted that using it in tandem with benzoyl peroxide (used instead of antibiotics) made it possible to achieve much stronger effects.

Green tea contains polyphenols, the most common being EGCG (epigallocatechin gallate). It is mainly absorbed in the small intestine and metabolized by the microflora of the large intestine.

Has high bioavailability: EGCG is present in plasma immediately after green tea ingestion. Its oral bioavailability is increased by starvation, fish oil, albumin, piperine, and vitamin C, while oxidation by air, metal ions, catechol-O-methyltransferase polymorphisms, and gastrointestinal inactivation significantly decrease it.

Studies of the penetration of tea polyphenols into human skin are limited - at the moment, some scientists note that higher levels of EGCG are found in the stratum corneum, then in the epidermis and dermis, which indicates the unpopularity of this compound.

There is evidence that 98% of P.acnes, P.granulosum, S.aureus. S. epidermidis, implicated in the pathogenesis of acne, were inhibited by a concentration of 400 μg of gallic acid contained in green tea.

EGCG also increased apoptosis of the SEB-1 cell line of sebocytes and had a lipogenic and anti-inflammatory effect.

Myoinositol is increasingly used by nutritionists to correct impaired carbohydrate metabolism. Its functions, however, are not limited to this: it is involved in the mechanisms of cell growth, development and functioning of the peripheral nervous system, osteogenesis, lowering the level of LDL (low density lipoprotein), as well as increasing HDL (high density lipoprotein).

It plays an important role in maintaining reproductive function, improving the quality of oocytes, restoring ovulation and fertility, reducing the manifestations of hyperandrogenism and insulin resistance - thanks to these properties, it is actively used in the treatment of polycystic ovary syndrome.

It is believed that myoinositol leads to an increase in the transport of glucose into the cell through the specific transporter GLUT4, and thereby enhances the action of endogenous insulin.

Chromium is a mineral responsible for glucose metabolism. Its absorption is enhanced by vitamin C.

Found in broccoli (11 mcg/0.5 cup) and turkey (10.4 mcg/3 oz).

Using Antibiotics to Treat Acne

Interesting fact: dermatologists make up no more than 1% of all doctors, but they are responsible for 4.9% of all antibiotic prescriptions. They use them primarily to treat acne, a practice that plays a significant role in how bacteria develop resistance to antibiotics.

Although acne is not caused by an excess of P.acne, microbicides have long dominated the treatment of acne and have been used as monotherapy.

It is believed that the therapeutic effect of systemic antibiotics is primarily due to their anti-inflammatory properties - this is especially true for tetracyclines.

However, their abuse led to serious consequences: if in 1978 only 20% of P.acne were resistant to antibiotics, then today about ⅔ of the population is resistant to them.

Both systemic and topical antibiotics can change bacterial resistance. Topical erythromycin has been shown to cause overgrowth of bacteria resistant to it, both locally and in more distant locations.

Moreover, their use is accompanied by damage to the normal flora of the skin and increase the risk of its colonization by pathological microorganisms. For example, prolonged courses of tetracycline treatment cause an overgrowth of Gram-negative bacteria in the nostrils, which is associated with folliculitis.

Also, there is an active reproduction of Streptococcus peogenes and Staphylococcus aureus in the pharynx and oral cavity, which leads to chronic pharyngitis.

In addition, colonization with antibiotic-resistant bacteria is observed not only in patients undergoing treatment, but also in their family members.

An example of a diet in the treatment of acne

As mentioned earlier, the main task is to reduce the amount of simple, easily digestible sugars that provoke increased secretion of insulin by pancreatic cells, as well as eliminate all food waste in the form of fast food, soda and any other sources of trans fats and sugar.

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