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Acne and the Diet Dilemma

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Bethany Sibbitt

on 14 August 2014

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Transcript of Acne and the Diet Dilemma

Acne and the Diet Dilemma

Outline
Introduction
Acne Overview
Does diet matter?
Socioeconomic considerations
Biblical perspective
Conclusion
Search strategy and References
Acne: An overview
Acne: Treatment
Acne and the diet: Pros
Big ideas:
New studies address pathogenesis of acne
No specific trigger has been identified
New evidence suggests diet plays role in development of acne
Two most common components of diet associated with acne are milk and high glycemic load diets
Acne and the diet: Cons
The diet controversy:
Historical Overview
Prior to 1960 individual diet was connected to acne
Little significant scientific evidence
Primarily personal experience
Dietary advice was a standard part of acne therapy
In 1969 and 1971 critical evidence challenged this way of thinking

The big question
Does diet play a role in the prevention and/or treatment of acne? If so, how?
Diets high in milk associated with increased risk of acne
Skim milk
Acne could be due to hormonal content
Milk contains:
estrogen
progesterone
androgen precursors
steroids
Implications in comedogenesis

Conclusion
The evidence suggests an association between diet and acne
Certain diets may aggravate or influence acne
Questions and concerns must be answered before establishing evidence-based medical nutrition guidelines
Investigated relationship between chocolate and acne
Crossover single blinded study
total of 65 study subjects
two groups:
treatment and control groups
chocolate group and control bar group
Each group ate the bar daily for 4 weeks
3 week rest period then switched groups
No difference between groups
Case Series
Methods
27 students were included in the study
divided into four different groups
chocolate, milk, roasted peanuts, or cola group for 1 week under direct supervision
Results
None of the groups produced flares of acne

Fulton et al, Anderson foundational studies
Despite major design flaws
Majority of dermatologists were convinced
Textbooks were re-written
Last 15 years
New research and dietary mechanisms were proposed



Epidemiolgy
Acne vulgaris is a common dermatological disease
Can occur from infancy to adulthood
Prevalence in adolescents and teenagers can range from 70- over 85%
No significant differences between genders
Lifetime prevalence >90%
Higher prevalence seen in Western cultures
Etiology
Sebaceous hyperplasia under the influence of increased androgen levels
Alterations in follicular growth and differentiation
Colonization of the follicle by Propionibacterium acnes (P acnes)
Consequent immune response and inflammation

Non-Pharmacological
Cleansers
Shaving
Comedone extraction
UV light
Prevention of cosmetic acne
Pharmacological
Topical BPO
Topical Retinoids
Topical Antibiotics
Topical Antimicrobials
Oral Antibiotics/antimicrobials
Oral Isotretinoin

Based on Jim Harvey's speech structures
Group 6: Henry, Nicholls, Paine, Richardson, Sibbitt, Wilkie
Biblical integration
Search strategy
Clinical Recommendation
1. Sibbald D. Chapter 106. Acne Vulgaris. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. eds. Pharmacotherapy: A Pathophysiologic Approach, 8e. New York: McGraw-Hill; 2011. http://0-accesspharmacy.mhmedical.com.library.cedarville.edu/content.aspx?bookid=462&Sectionid=41100888. Accessed February 01, 2014.

2. Eichenfield LF, et al. Evidence-Based Recommendations for the Diagnosis and Treatment of Pediatric Acne. Pediatrics 2013;131;S163. Accessed at: http://pediatrics.aappublications.org/content/131/Supplement_3/S163.full.html.
1. Sibbald D. Chapter 106. Acne Vulgaris. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. eds. Pharmacotherapy: A Pathophysiologic Approach, 8e. New York: McGraw-Hill; 2011. http://0-accesspharmacy.mhmedical.com.library.cedarville.edu/content.aspx?bookid=462&Sectionid=41100888. Accessed February 01, 2014.
1. Sibbald D. Chapter 106. Acne Vulgaris. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. eds. Pharmacotherapy: A Pathophysiologic Approach, 8e. New York: McGraw-Hill; 2011. http://0-accesspharmacy.mhmedical.com.library.cedarville.edu/content.aspx?bookid=462&Sectionid=41100888. Accessed February 01, 2014.
1.Sibbald D. Chapter 106. Acne Vulgaris. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. eds. Pharmacotherapy: A Pathophysiologic Approach, 8e. New York: McGraw-Hill; 2011. http://0-accesspharmacy.mhmedical.com.library.cedarville.edu/content.aspx?bookid=462&Sectionid=41100888. Accessed February 01, 2014.
Dietary changes?
Beauty is within (1 Peter 3:3-4)
God looks at the heart - not the outside appearance (1 Sam. 16:7)
Relationship with Christ
God will use a person regardless of acne
Body is the Temple of the Holy Spirit (1 Cor. 6:19)
Acne and Milk
The IGF-1 connection
Milk associated with increase in IGF-1 levels
Stimulates acne via hyperinsulinemia
Insulin may increase androgen production, which causes intraductal changes and acne development
Sebum production increases in response to androgens and IGF-1
Acne’s course follows IGF-1 levels more closely than androgen levels

1. Adebamowo CA, Spiegelman D, Danby FW, Frazier AL, Willett WC, Holmes MD. High school dietary dairy intake and teenage acne. J Am Acad Dermatol. 2005;52(2):207–214.
2. Adebamowo CA, Spiegelman D, Berkey CS, et al. Milk consumption and acne in teenaged boys. J Am Acad Dermatol. 2008; 58(5):787–793
3. Smith RN, Mann NJ, Braue A, Mäkeläinen H, Varigos GA. A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Am J Clin Nutr. 2007;86(1):107–115.
4. Danby FW. Nutrition and acne. Clin Dermatol. 2010;28(6):598-604.
1. Di landro A, Cazzaniga S, Parazzini F, et al. Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults. J Am Acad Dermatol. 2012;67(6):1129-35.
2. Adebamowo CA, Spiegelman D, Danby FW, Frazier AL, Willett WC, Holmes MD. High school dietary dairy intake and teenage acne. J Am Acad Dermatol. 2005;52(2):207–214.
The role of IGF-1
IGF-1 is a powerful mediator of cellular growth
Unregulated tissue and follicular growth
Amplifies androgen bioavailability
IGF-1 stimulates sebum production
Supporting evidence
Deficiencies in hormones ( IGF-1) associated with decreased acne severity
Some IGF-1 polymorphisms associated with increased circulating IGF-1 concentrations and acne severity
Hormone management effective in treating acne
1. Burris J, Rietkerk W, Woolf K. Acne: the role of medical nutrition therapy. J Acad Nutr Diet. 2013;113(3):416-30.
Glycemic Load
Smith, et al
Low glycemic load (LGL) diets have shown significantly greater reductions in total lesion counts
High glycemic load (HGL) diets increase the insulin demand
Produces endocrine response by stimulates IGF-1 and suppresses IGFBP-3

1. Smith RN, Mann NJ, Braue A, Mäkeläinen H, Varigos GA. The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters associated with acne vulgaris: a randomized, investigator masked, controlled trial. J Am Acad Dermatol. 2007;57(2):247–256.
2. Smith RN, Braue A, Varigos GA, Mann NJ. The effect of a low glycemic load diet on acne vulgaris and the fatty acid composition of skin surface triglycerides. J Dermatol Sci. 2008;50(1):41–52.
3. Smith RN, Mann NJ, Braue A, Mäkeläinen H, Varigos GA. A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Am J Clin Nutr. 2007;86(1):107–115
Burris, et al
Insulin-induced suppression of IGFBP-3 and SHBP results in increase in IGF-1 and androgen hormones
Increases acne development
Hyperinsulinemia-mediated reduction of IGFBP-3 increases follicular growth
Through the nuclear retinoid-signaling pathway
Decreased IGFBP-3 decreases the activity of the retinoid X receptor-alpha
Increases cellular growth and enhances acne development

1. Burris J, Rietkerk W, Woolf K. Acne: the role of medical nutrition therapy. J Acad Nutr Diet. 2013;113(3):416-30.
1. Burris J, Rietkerk W, Woolf K. Acne: the role of medical nutrition therapy. J Acad Nutr Diet. 2013;113(3):416-30.

Levitical law was designed to maintain health
Clean meats
Fresh fruit and grain
Low glycemic intake
Daniel and friends go vegetarian
10 day test
Healthier in appearance afterwards

God is more concerned with the heart

Appearance of His temple is still important

Many of the dietary considerations are healthy overall

1. Bowe W, Joshi S, Shalita A. Diet and acne. J Am Acad Dermatol. 2010 July;63(1):124-141. http://www.sciencedirect.com/science/article/pii/S0190962209009670. Accessed February 1, 2014.
2. Cordain L. Implications for the role of diet in acne. Seminars In Cutaneous Medicine And Surgery. 2005 June;24(2):84-91. http://www.direct-ms.org/sites/default/files/Role%20of%20diet%20in%20acne.pdf. Accessed January 30, 2014.
Fulton, et al
1. Bowe W, Joshi S, Shalita A. Diet and acne. J Am Acad Dermatol. 2010 July;63(1):124-141. http://www.sciencedirect.com/science/article/pii/S0190962209009670. Accessed February 1, 2014.
2. Cordain L. Implications for the role of diet in acne. Seminars In Cutaneous Medicine And Surgery. 2005 June;24(2):84-91. http://www.direct-ms.org/sites/default/files/Role%20of%20diet%20in%20acne.pdf. Accessed January 30, 2014.
Anderson
1. Bowe W, Joshi S, Shalita A. Diet and acne. J Am Acad Dermatol. 2010 July;63(1):124-141. http://www.sciencedirect.com/science/article/pii/S0190962209009670. Accessed February 1, 2014.
2. Cordain L. Implications for the role of diet in acne. Seminars In Cutaneous Medicine And Surgery. 2005 June;24(2):84-91. http://www.direct-ms.org/sites/default/files/Role%20of%20diet%20in%20acne.pdf. Accessed January 30, 2014.
Conclusions
1. Bowe W, Joshi S, Shalita A. Diet and acne. J Am Acad Dermatol. 2010 July;63(1):124-141. http://www.sciencedirect.com/science/article/pii/S0190962209009670. Accessed February 1, 2014.
2. Cordain L. Implications for the role of diet in acne. Seminars In Cutaneous Medicine And Surgery. 2005 June;24(2):84-91. http://www.direct-ms.org/sites/default/files/Role%20of%20diet%20in%20acne.pdf. Accessed January 30, 2014.
We conducted a thorough literature review including primary, secondary, and tertiary sources.
Our scholarly articles were obtained by using the following search terms in secondary databases (PubMed, Academic Search Complete, CINAHL, Medline, Ebsco and Google Scholar):
“acne and diet ”, “acne and nutrition”, “acne and dairy”, “acne milk”, “acne and glycemic index”, “low glycemic load and acne”, “acne diet controversy”, “link between diet and acne”, “myth diet and acne”, “mechanism diet and acne”, “review connection diet and acne”, “socioeconomics and acne", “glycemic index and cost”, “glycemic index and knowledge level", “acne vulgaris and economics”, “psychosocial acne”, and “acne coping”
While there is still no definitive consensus on the role of diet in acne, current evidence indicates a positive correlation with managing acne. It is our recommendation that encouraging healthier eating habits and lifestyles will provide benefits extending beyond the scope of dermatological care and should be implemented as a first line option for prevention and treatment.
Limitations
Study duration far too short
Clinical trials for acne must last 12 weeks to allow for natural cycle of acne to take place
Placebo bar contained other ingredients combined with other normal diet
Sample size far too small
lack of generalizability
1. Bowe W, Joshi S, Shalita A. Diet and acne. J Am Acad Dermatol. 2010 July;63(1):124-141. http://www.sciencedirect.com/science/article/pii/S0190962209009670. Accessed February 1, 2014.
2. Cordain L. Implications for the role of diet in acne. Seminars In Cutaneous Medicine And Surgery. 2005 June;24(2):84-91. http://www.direct-ms.org/sites/default/files/Role%20of%20diet%20in%20acne.pdf. Accessed January 30, 2014.
Limitations
Lesion counts not reported
No statistical analyses were performed
Extremely small sample size
No generalizability
No control groups, no blinding, and no randomization
No baseline dietary measures made
1. Bowe W, Joshi S, Shalita A. Diet and acne. J Am Acad Dermatol. 2010 July;63(1):124-141. http://www.sciencedirect.com/science/article/pii/S0190962209009670. Accessed February 1, 2014.
2. Cordain L. Implications for the role of diet in acne. Seminars In Cutaneous Medicine And Surgery. 2005 June;24(2):84-91. http://www.direct-ms.org/sites/default/files/Role%20of%20diet%20in%20acne.pdf. Accessed January 30, 2014.
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