I work as a dermatologist in London and for more than a decade I have had patients with skin problems in my office. Acne is one of my main areas of interest. In recent years, I have been deeply concerned with the spread of habits that should be linked to a healthy lifestyle. I am mainly concerned about how this has affected our relationship to food – and its impact on the problems that occur in our skin.
Let me give you some context. First of all, I know that the patients who come to my office do not represent the whole community. But many have a long history of acne, most are female and have good socio-economic conditions. They are intelligent and insightful women who care not only of the health of the skin but also of public health.
When they decide to see me, they have gone through different types of treatment, including changing skin care, have often spent a lot of money on finding the right product, as well as providing nutritional monitoring.
The latter is a difficult aspect to ignore. Most of my patients say they have cut dairy, gluten and sugar in an attempt to get rid of pimples. In my view, this food restriction has reached the level of unhealthy obsession. They make excuses not to go for dinner with friends, refuse to eat a piece of cake on birthdays and skip meals when they eat out. It's like a doctor, I'm not just about acne but also with a very real fear of some foods.
But let's go to the proof: What is really the relationship between acne and diet?
This relationship has been discussed for decades and is still controversial. Carrying out studies on the subject is very difficult and many people stop relying on their personal experiences. If you can hardly remember what you ate last week, how much more ten years ago?
What we know is that there is a growing relationship between the development of acne and food that has a high glycemic index (GI) – so potential sugar plays a role in it. But that does not mean we should suck sugar completely, but be aware of the consumption. This is not only good for your skin but also for your overall well-being.
The relationship with dairy products is actually much weaker. However, it can play a role in the development of acne for a small and selected group of people – not everyone is the same! For the reasons that are not fully understood, low fat milk products appear to be worse than those with high fat content. Among doctors there is no clear guideline that recommends cutting milk products to fight acne. Evidence of this is that vegans also have pimples.
I also cater to many patients who cut entire food groups from their diets but failed to get rid of acne. Labeling of food as a problem is very simplified and does not take into account the multifactorial nature of acne, which includes variations in hormones and genetics.
If dietary restrictions were not bad enough on their own, the other I can not ignore the shame to eat some foods. Many people think it is socially acceptable to advise or judge their eating habits by blaming them for the quality of the skin. It also happened to me.
A stranger on the street tells you that you have acne because you are eating ice cream on a hot summer day. The worried relative who says you're going to cut chocolate. Social media troll that says it's not surprising that you have a "bad skin" because you sent a photo of a piece of pizza.
We live in a world that is overloaded with information. Everyone thinks they have the right to express their opinion. Social media has strengthened this, which had not been possible for 20 years. But how do you distinguish scientifically credible voices from virtual quacks?
If you feel desperate because of your pimples and your self-esteem lies on the ground, it's perfectly understandable that you seek advice from Google. The problem is that each person is different and there is very contradictory information – sometimes even from the healthcare professionals themselves. Just because something works for a person does not mean it will work for you. We are all different, with our DNA, the environment and individual bowel and cutaneous microbiome.
Acne has been associated with a number of psychological problems such as anxiety, depression, social isolation and low self esteem. To tell people to limit their diet, when they are already exposed to psychological problems, worry me a lot. But it happens in all social networks, where people – bloggers, via herbal and functional medicine – promise to come to the root of the problem.
No one denies that good nutrition is important to your skin. Food has several roles in health and dermatological diseases.
But there is an uneven difference between good food choices and people feeling bad about eating some foods by offering advice that is not scientifically proven. This creates a culture of unfair debt. Many patients tell me that such comments affect their mental health or cause eating disorders. Conclusion: They care much more about what they eat, or think twice before they eat some foods in general. Friends who work with nutrition and psychology tell me that I'm not alone and that they look the same at their offices.
So what's the solution? If you suffer from acne and identify with what I said here, it is important to seek medical help. If you realize that a loved one becomes paranoid about what they eat because of their pimples, tell them to talk to a doctor. Be honest with your doctor and share your concern with your diet. Sometimes it is worth running other healthcare professionals, like a nutritionist or a psychologist, as well as a dermatologist.
The food does not have to be "good" or "bad" – these labels are very binary. Eating good to maintain healthy skin means keeping a sustainable eating pattern over time. It's not because you eat a bun candy or a chocolate bar full of pimples.
Anjali Mahto is a dermatologist and author of The Skincare Bible: Your No-Nonsense Guide to Good Skin
BBC News Brazil – All Rights Reserved. All reproduction is prohibited without written permission from BBC News Brazil.