Can keto or low-carb diets improve acne?

If you’re an acne sufferer, you may have wondered whether following a low-carb or keto diet can help clear up your skin.

While medical opinions on the matter have differed over the years, more recent research suggests carbohydrate consumption may just be the reason for pesky facial breakouts.

By avoiding carbohydrates in your diet, you may be able to improve the quality of your skin and prevent future flare-ups.

In this guide, you’ll learn about the connection between diet and acne, plus what you can do to potentially decrease the frequency and severity of your acne through food.

How does acne develop?
Although nearly 90% of adolescents and teens have acne, it’s fairly common in adults, too. In fact, it’s estimated that in Western countries, around 50% of people in their 20s and 30s struggle with acne.1 Yet, it’s very rare in many cultures that follow traditional diets.

Acne develops as a result of complex interactions that take place within the skin. Sebaceous glands located in the skin’s outer layer are connected to hair follicles. These glands produce sebum, an oily substance that lubricates the hair and skin cells, which are constantly being shed and replaced.

In the case of acne, this system is impaired. Elevated levels of androgens (male hormones) cause increased sebum production, leading to oily skin.
Additionally, skin cell production ramps up, and dead skin cells aren’t shed in the normal fashion. Instead, these cells combine with excess sebum, causing blocks or plugs. While this process is occurring, bacteria that feed on sebum also enter the picture.

Similar to the gut microbiome, skin maintains its own bacterial balance. One type of bacteria known as P. Acnes lives deep within the hair follicles and is normally present in the outer skin layer in small amounts.

But in people who have acne, concentrations of P. Acnes increase dramatically, causing inflammation that leads to whiteheads, pustules, and cysts.

The role of sugar and carbs in acne

Early studies prior to the 1960s led to the belief that diets high in sugar and refined carbs worsened acne.4 However, after experimental research failed to show a link between specific foods and acne, diet was no longer considered a major contributor.

Within the last 15 years, however, the tide has turned again as mounting research suggests refined carbohydrates may be the main dietary culprit in causing acne.

For instance, a 2007 study observing 43 young acne-prone men found that a low-glycemic load (GL) diet led to a greater reduction in acne lesions than a high-GL diet.

What’s more, the low-GL group experienced a decrease in androgen and insulin levels, improvement in insulin sensitivity, and weight loss. By contrast, the other group had increases in weight, insulin levels, and insulin resistance.
It’s important to point out that this wasn’t really a low-carb diet; the low-glycemic-load carbs accounted for about 44% of the total dietary intake (roughly 220 grams of carbs for someone consuming 2,000 calories a day).

Could there have been an even greater improvement with a low-carb or keto diet providing less than 10% of energy from carbs?

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