The ketogenic diet, or keto diet for short, has gained immense popularity in recent years as a weight-loss strategy. This low-carb, high-fat diet forces the body into a metabolic state called ketosis, where it burns fat for fuel instead of sugar. While the keto diet delivers desired results when balanced with other nutritious food items and offers several health benefits, its impact on the skin, particularly concerning acne, is less clear-cut. The relationship between the ketogenic diet and acne is complex and multifaceted, with both potential benefits and drawbacks.
Understanding the Keto Diet
The ketogenic diet isn’t about eating less and starving yourself. Keto dieters eat foods that are high in fat but low in carbs. With a normal diet with plenty of carbs, your body breaks down the carbs into sugar. This sugar (mostly glucose) is used to fuel your body. If you switch to a diet that’s low in carbs, your body doesn’t have enough sugar to fuel itself. So, it starts to burn fat instead. After a few days on the keto diet your body enters a state called ketosis where your liver uses your fat reserves to create a different fuel source called ketones. Essentially, the keto diet makes your body burn fat rather than sugar.
Foods like pasta, rice, bread, potatoes, chocolate, cake, sweets, and beer are out. Whilst eggs, cheese, meat, seafood, butter and oils are in. The keto diet is famously known as the diet that lets you eat bacon.
Acne: A Multifactorial Inflammatory Condition
Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit, resulting from androgen-induced increased sebum production, altered keratinization, inflammation, and bacterial colonization of the hair follicles. Acne is a common skin condition that affects up to 50 million Americans yearly. It is characterized by pimples, blackheads, and red bumps, primarily affecting the face, neck, chest, and back. Acne is an inflammatory skin disorder in which hair follicles are clogged with sebum (oil) and dead skin cells. While anyone can develop acne, it’s more common among teens (especially males) and young adults.
The primary symptoms of acne vulgaris - pimples, blackheads, and red bumps - affect more than 85% of adolescents and ~50% of people over 25.
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The Four Key Factors Driving Acne Development
- Excess sebum production: Excess sebum production by the sebaceous glands.
- Altered keratinization: As a result of these four factors, dead skin cells will stick together with the help of the excess sebum.
- Inflammation: Overall, inflammation and immune responses are strongly implicated in the pathogenesis of acne.
- Bacterial colonization: Colonization of the uppermost layer of the skin (stratum corneum) by a bacterium called Propionibacterium acnes (P. acnes). Given the right conditions, dead skin cells shed rapidly, along with excess oil production. Moreover, the bacterium p. acnes feeds on sebum, which serves as its fuel source. Note that p. acnes feeds on sebum, which serves as its fuel source.
Hormonal Influence on Acne
The four factors that drive this skin condition are mediated in large part by insulin and other hormones that are impacted by insulin, such as testosterone, dihydrotestosterone (DHT), and dehydroepiandrosterone (DHEA), growth hormone (GH), and insulin-like growth factor 1 (IGF-1). A helpful example of how impactful these hormones are on skin health can be found when we look at particular medical conditions that result from an imbalance of sex hormones. Polycystic ovary syndrome (PCOS), for example, typically is caused by unhealthy increases in androgens like DHT in women. As a result, many women with PCOS also have acne. Conversely, people who lack androgens or are insensitive to the effects of androgens rarely have acne. A more common example of how closely linked hormonal levels are to acne prevalence can be found in teenagers. Puberty induces rapid increases in many of the hormones we mentioned above.
The Role of Diet in Acne: A Growing Research Topic
The influence of diet on acne disease is a growing research topic, yet few studies have examined the effects of diet on the development and clinical severity of acne disease, and the results have often been contradictory. Although early colonization with Propionibacterium acnes and family history may play an important role in the disease, it remains unclear exactly what triggers acne and how treatment affects disease progression.
Potential Benefits of the Keto Diet for Acne
Interestingly, very low-calorie ketogenic diet (VLCKD) has been associated with both significant reductions in body weight and inflammatory status through the production of ketone bodies and thus it has been expected to reduce the exacerbation of clinical manifestations or even block the trigger of acne disease. There’s a stronger association with sugar and carbohydrates and acne. It’s thought this is because carbs and sugars increase the levels of certain hormones in your body, like insulin, that can cause acne. A number of studies have shown the keto diet can reduce the levels of these hormones. The keto diet has also been shown to reduce inflammatory processes in the body.
Reducing Insulin Levels
Insulin and basal IGF-I plasma levels are major players when it comes to acne, and processed carbs aren’t the only thing that increases IGF-1 and insulin substantially. The keto diet decreases insulin levels, often dramatically.
People who live in non-westernized societies tend to eat more whole foods that don’t require high insulin levels to maintain homeostasis, while people in westernized societies eat much more processed food that causes a rapid increase in blood sugar. As a result of the western diet, the pancreas continuously releases insulin to keep blood sugar from getting too high. Yet, this is purely a contention held by many researchers.
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To our knowledge, there is one study that explored the therapeutic effects of a specific dietary intervention on acne. At 12 weeks, the average number of lesions in the low glycemic load diet group fell by 51% - nearly twice the reduction that was found in the high glycemic load diet. These are pretty astounding results, especially when you consider what the researchers defined as a low glycemic load diet. The LGL [low glycemic load] group was instructed to substitute high-GI foods with foods higher in protein (e.g., lean meat, poultry, or fish) or with foods with a lower GI (e.g., whole-grain bread, pasta, and fruit). Some staple foods were supplied, and the participants were urged to consume these or similar foods daily.
Calming Inflammation
Inflammation is what makes acne so red, sore, and tender.
Decreasing IGF-1 Levels
Restricting carbs helps keep IGF-1 levels low.
Potential Drawbacks of the Keto Diet for Acne
The keto diet causes the secretion of sebum in excess, which is the food for the bacteria type P. Acnes that live deep within the hair follicles and outer skin layer. Whilst eating more dairy and more fat can be associated with causing acne, there’s a stronger association with sugar and carbohydrates and acne.
The Keto Rash
The keto diet can cause a red and itchy skin rash. The medical term for the rash is prurigo pigmentosa, but it’s more commonly called the keto rash.
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Dairy Consumption
Some authors have reported that the hormones in milk (designed to help the calves grow into massive animals) may survive milk processing and stimulate the many processes that lead to acne production. When you consider the fact that a staple of many ketogenic diets is high-fat dairy, it makes sense that some (but not all) people can experience an increase in acne while they restrict carbs. Common keto-friendly dairy products like high-fat yogurt and heavy cream will contain some of the hormones and whey protein that can stimulate acne production.
High-Fat Intake
One study found that high-fat diets may increase sebum production and acne.
Navigating the Keto Diet for Clearer Skin: Practical Tips
With the keto diet, you could end up eating more of the food that causes acne, or possibly less of it. And the diet could both increase and decrease inflammation. Confused yet? The truth is, we can’t say for sure. The link between diet and acne is complicated and is still hotly debated by scientists. Everyone responds to food and diets differently.
If you do decide to try keto, do it in a way that prevents acne and breakouts. Be sure to get the other nutrients your skin needs by eating leafy greens or fatty fish that are rich in vitamin A and omega-3 fatty acids that tend to your skin.
Here's how to get your skin under control if you're on the keto diet:
- Adopt a daily skincare routine: Firstly, you should adopt a daily skincare routine that helps keep acne at bay. It should involve cleansing, toning, the use of acne treatment, and moisturizing.
- Consider topical acne treatments: When it comes to acne treatments, while you can buy plenty over the counter, stronger medications require a prescription. At nowpatient.com, we sell a topical acne treatment called tretinoin, also sold under the brand Retin A. Tretinoin helps fight acne by removing the dead skin cells and oil that build up on your face. It can also reduce inflammation, kill bacterial infections in your spots, and improve the overall quality of your skin.
- Limit or eliminate dairy: If your acne is getting worse after starting keto, then I recommend replacing most of your milk, half and half, heavy cream, and yogurt with dairy alternatives for at least a month. Altogether, limiting your carb and dairy intake should have a massive impact on your skin health. Replace milk with coconut milk. Replace heavy cream with coconut cream. Replace dairy-based cheese with vegan cheese. There are plenty of dairy-free cheeses on the market right now. My personal favorite dairy-free cheese-making companies are Treeline and Miyoko’s Kitchen. Their cheeses are some of the best I’ve ever tasted. In fact, many people think that they are better than traditional dairy-based cheese. If Treeline or Miyoko’s Kitchen doesn’t have the cheese you are looking for, then try Follow Your Heart’s vegan cheese.
- Prioritize whole, unprocessed foods: Eat mostly whole, minimally-processed 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 and inflammation levels. In other words, keep your keto diet clean. If you can’t avoid them completely, protect yourself by making a habit of reading food labels, including the ingredients list. Don’t settle for the claims on front labels, which can sometimes be false and misleading.
- Incorporate anti-inflammatory foods: Consume fatty fish a couple of times a week. Long-chain omega-3 fatty acids found in fish are anti-inflammatory and may improve skin health. Eat low-carb vegetables with every meal. Leafy green and cruciferous vegetables may help promote hormonal regulation and improve skin health.
- Consider intermittent fasting: Experiment with intermittent fasting. By restricting your calorie intake to an 8-hour eating window every day, you can decrease your insulin and IGF-1 levels more than you would by eating normally throughout the day. Common intermittent fasting practices include alternate-day fasting, the 16/8 method, a 24-hour fast, and skipping breakfast.
- Limit alcohol intake: Limit alcohol intake. Alcohol is toxic to the body, so the liver’s top priority is to detoxify it immediately upon consumption.
- Stay hydrated: Since the keto diet can suck moisture out of your skin, up your water intake."I recommend patients increase their water intake to make sure their skin cells are adequately hydrated," says Dr. Radusky.
- Exercise Regularly: Exercise can help with acne by regulating blood sugar, reducing insulin resistance, and flushing toxins out of your system. There are plenty of exercises you can do while in ketosis. Try running, biking, weight lifting, and yoga.
- Be Patient: Follow the keto diet for at least a month. It took almost three months for the subjects in the low glycemic load diet group to experience an average of 50% reduction in acne.
- Prioritize Sleep: Sleep affects your skin. Research has shown that poor sleep quality doesn’t only increase your risk of overall all-cause mortality, but at a superficial level, it may also worsen acne (*). If you’re not making sleep a priority, now is the time to consider your sleep hygiene.
- Clean your phone!
The Importance of Consulting a Healthcare Professional
During a complete keto diet, your body is forced to enter a natural metabolic state called ketosis. While this dramatic change in diet habits have immediate effects on your overall health, it also has some particular impact on your skin. The keto diet delivers the desired results when balanced with other nutritious food items. Consult your doctor before starting a keto diet so you can get the desired benefits. It should go without saying that it’s important to talk with your doctor and possibly even a nutritionist or dietician before you approach a dietary change of this size.
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