What is the connection between acne and diet? Let us turn to the area of investigation which will give us the answer to the problem. The science of epidemiology is not new (it is just the study of how many cases of a certain disease are present in certain segments of the population), but its practical application to acne is new. Many observers have noticed the beautiful complexions of the Latin races in those countries bordering the northern Mediterranean and have commented that “Italians just do not get pimples,” and let it go at that. In the United States, however, third generation Italians have as much acne as anyone. So it appears that race is not the answer.
Population surveys show that there are other areas of the world that have very little acne. The northern Pacific islands such as Okinawa, Japan, Formosa, and the peninsula of Korea show less than a five percent incidence of acne in surveys done by the National Institutes of Health and by others. Islands near the equator, such as the Philippines and Indonesia, have a lot of acne. The Bantu African has no acne problem, but the African at Mombasa does. The Alaskan Indian in the interior has ten times as much acne as the Eskimo on the coast. However, when any person comes from a low acne area and moves to the United States, his descendants have acne as soon as they have changed over to an American diet.
Diet is the answer to the acne problem. Diet is the only common denominator that explains why acne varies so widely in different parts of the world. It is not race; it is not climate; it is not the amount of food eaten; it is the kind of food.
Acne and diet has been controversial between patients and their dermatologists for years. It has created even more sound and fury between doctors themselves. The medical literature abounds with theories about it from 1714 to the present. If you were to omit from your diet everything that has been suspected of causing acne, you would be left with only water, and not even that if it has iodides or fluorides in it. Due to the glaring inconsistencies in the suggested acne diets, many dermatologists turn from diet therapy with disdain. The young research men who are looking for a magic potion to cure acne view diet theories with tolerant amusement or open contempt.
Does this mean that there is no connection with acne and diet? How can it be that what we eat does not affect our bodies? Surely everyone must admit that diet affects our health, and that our health affects our ability to withstand infection. Most of us were thrust out into a cold world weighing less than ten pounds and what we are now has been at least partially determined by the food we have eaten. The contempt shown for the connection between acne and diet is irrational and unrealistic. Our marvelous body can alter the food we eat, it can make enzymes out of amino acids, it can manufacture hormones and digestive juices, but it needs the basic building blocks for everything it makes. If it gets no salt it cannot make salt. It can conserve it and manage to get along on a salt deficient diet for quite a while, but “back-up” systems are for emergency use only and are rarely as efficient as the primary system—whether in space labs or in our bodies.
Purely clinical observation of a patient is not as highly esteemed as the stainless steel research center with its electron microscopes, its data-spewing computers, and its thin layer chromatography. After all, anyone can venture observations on acne and diet and this menaces the scientist who is delving into the enzyme systems and hormone levels of the rabbit ear. You can’t challenge him unless you have your own electron microscope.
So acne and diet, like many of the simple virtues, is the butt of jests and jokes. This is not unique to acne; comedians can bring the house down by ridiculing marriage, fidelity, and love. The careful student, the policeman, and the peace corps worker are typified as buffoons and bumbling idiots, while the dance hall girl, the town drunk, or the madman are portrayed as the real human ideal.
The food we eat is a very personal part of our social sphere. We are all rather sensitive about the food we enjoy, so it’s human for us to rationalize our taste for anything that might be unhealthy for us. We lose our perception and act emotionally, and even childishly, to protect that which titillates our taste buds. The smoker supports smoking, the drinker argues for booze, the diabetic sanctions sweets, the coronary prone counters articles against cholesterol. If they have no scientific proof for their stand, they will resort to ridicule—still the weapon of the ignorant and the biased. Since most things are estimated according to our own prejudices, it is hard to convince many researchers that something as ordinary and simple as diet could affect acne. They would rather discover something much more esoteric and reject the claim that acne and diet are interconnected.
Let’s look at the early restrictions on acne and diet. L. D. Buckley in 1882 had a big advantage over the rest of us because acne was rare then. He noticed that if slender girls tried to put on curves by eating chocolate and rich milk, they developed pimples in about three months. In his day, drinking milk after infancy was uncommon and chocolate was a rare and expensive delicacy imported from the new world. Undoubtedly the new acne detracted from any curves that the girls had gained. In 1940, Sutton, Jr., very discerningly condemned pork and milk. In three articles written in 1935, 1950, and 1959, Sulzberger noted the link between acne and diet and blamed sweets, chocolate, fats, sharp cheeses, and nuts. Baer and Witten in 1960 said to avoid chocolate, nuts, and sharp cheeses.
The men I have mentioned were outstanding leaders and teachers in dermatology, so their observations must be given some credence. It would be brash and foolhardy to ignore all of their experience. One “Great Chocolate Study” is not sufficient grounds to ignore the clinical acumen of the giants of dermatology.
Contrary to these opinions, as early as 1924, J. A. Scott states: “I have not found that dieting exerts much influence on the disease.” He has had, and still has, many followers. Between these two extremes the majority of dermatologists have been rather undecided concerning acne and diet. The dominant therapeutic measures have been X-ray, ultraviolet, hormones, antibiotics, steroids, and topical therapy. The patients were also often given vague general directions to avoid sweets, fried foods, seafood, and nuts. No one was convinced of the efficacy of acne and diet, but it made the practice of dermatology much easier. Whenever a patient relapsed it was easy for him to recall that he had indulged in some sweets or fried foods. His own willfulness and lack of Spartan self-control were the causes of his suffering. The dermatologist was vindicated and could continue with the regular therapy, uninterrupted by complaints that the therapy was ineffective.