The influence of nutrition on skin health is a growing research area but the findings of various studies on the effect of diet on the development of acne have often been contradictory. The general opinion among researchers has oscillated between two different, opposing positions: that diet either is or is not a key factor for acne development. This review examines the evidence supporting an influence of various dietary components on the development of acne particularly focusing on the role played by carbohydrates. The physiological and biochemical effects of the ketogenic diet are examined from this perspective and mechanisms will be proposed via which this type of diet could have a role in the treatment of acne.
© 2012 S. Karger AG, Basel
- Ketogenic diet
- Acne vulgaris
- Schaefer O: When the Eskimo comes to town. Nutr Today 1977;12:21.
- Bowe WP, Joshi SS, Shalita AR: Diet and acne. J Am Acad Dermatol 2010;63:124-141.
- Petry R: Nutrition and diet. Influence on skin surface fats and acne vulgaris. Munch Med Wochenschr 1972;114:513-514.
- Glickman FS, Silvers SH: Dietary factors in acne vulgaris. Arch Dermatol 1972;106:129.
- Cornbleet T, Gigli I: Should we limit sugar in acne? Arch Dermatol 1961;83:968-969.
- Fulton JE Jr, Plewig G, Kligman AM: Effect of chocolate on acne vulgaris. JAMA 1969;210:2071-2074.
- Melnik BC: Evidence for acne-promoting effects of milk and other insulinotropic dairy products. Nestle Nutr Workshop Ser Pediatr Program 2011;67:131-145.
- Smith RN, Mann NJ, Braue A, Makelainen H, Varigos GA: A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Am J Clin Nutr 2007;86:107-115.
- Smith RN, Mann NJ, Braue A, Makelainen 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;57:247-256.
- Foster-Powell K, Holt SH, Brand-Miller JC: International table of glycemic index and glycemic load values 2002. Am J Clin Nutr 2002;76:5-56.
- Anderson PC: Foods as the cause of acne. Am Fam Physician 1971;3:102-103.
- Treloar V: Diet and acne redux. Arch Dermatol 2003;139:941; author reply 942-943.
- Berra B, Rizzo AM: Glycemic index, glycemic load: new evidence for a link with acne. J Am Coll Nutr 2009;28(suppl):450S-454S.
- Kaymak Y, Adisen E, Ilter N, Bideci A, Gurler D, Celik B: Dietary glycemic index and glucose, insulin, insulin-like growth factor-I, insulin-like growth factor binding protein 3, and leptin levels in patients with acne. J Am Acad Dermatol 2007;57:819-823.
- Ferdowsian HR, Levin S: Does diet really affect acne? Skin Therapy Lett 2010;15:1, 2, 5.
- Cordain L: Implications for the role of diet in acne. Semin Cutan Med Surg 2005;24:84-91.
- Adebamowo CA, Spiegelman D, Berkey CS, Danby FW, Rockett HH, Colditz GA, Willett WC, Holmes MD: Milk consumption and acne in teenaged boys. J Am Acad Dermatol 2008;58:787-793.
- Adebamowo CA, Spiegelman D, Berkey CS, Danby FW, Rockett HH, Colditz GA, Willett WC, Holmes MD: Milk consumption and acne in adolescent girls. Dermatol Online J 2006;12:1.
- Smith R, Mann N: Acne in adolescence: a role for nutrition? Nutr Diet 2007;64:S147-S149.
- Tomb R: Skin and eating, their relationship to myths. J Med Liban 2009;57:258-260.
- Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, Brand-Miller J: Acne vulgaris: a disease of Western civilization. Arch Dermatol 2002;138:1584-1590.
- Cordain L, Eaton SB, Sebastian A, Mann N, Lindeberg S, Watkins BA, O'Keefe JH, Brand-Miller J: Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr 2005;81:341-354.
- Cordain L, Eades MR, Eades MD: Hyperinsulinemic diseases of civilization: more than just Syndrome X. Comp Biochem Physiol A Mol Integr Physiol 2003;136:95-112.
- Eaton SB, Cordain L, Sparling PB: Evolution, body composition, insulin receptor competition, and insulin resistance. Prev Med 2009;49:283-285.
- Kristiansen SB, Endoh A, Casson PR, Buster JE, Hornsby PJ: Induction of steroidogenic enzyme genes by insulin and IGF-I in cultured adult human adrenocortical cells. Steroids 1997;62:258-265.
- Plymate SR, Matej LA, Jones RE, Friedl KE: Inhibition of sex hormone-binding globulin production in the human hepatoma (Hep G2) cell line by insulin and prolactin. J Clin Endocrinol Metab 1988;67:460-464.
- Haffner SM: Sex hormone-binding protein, hyperinsulinemia, insulin resistance and noninsulin-dependent diabetes. Horm Res 1996;45:233-237.
- Goodman-Gruen D, Barrett-Connor E: Sex hormone-binding globulin and glucose tolerance in postmenopausal women. The Rancho Bernardo Study. Diabetes Care 1997;20:645-649.
- Powell DR, Suwanichkul A, Cubbage ML, DePaolis LA, Snuggs MB, Lee PD: Insulin inhibits transcription of the human gene for insulin-like growth factor-binding protein-1. J Biol Chem 1991;266:18868-18876.
- Berga SL: The obstetrician-gynecologist's role in the practical management of polycystic ovary syndrome. Am J Obstet Gynecol 1998;179:S109-S113.
- Kahn JA, Gordon CM: Polycystic ovary syndrome. Adolesc Med 1999;10:321-336.
- Meer A, Duprey J, Fiet J, Boudou P, Ducornet B, Sultan M, Lifchitz E: Late onset hyperandrogenism caused by 3-beta-hydroxysteroid dehydrogenase deficiency. Presse Med 1994;23:1339-1343.
- Mavropoulos JC, Yancy WS, Hepburn J, Westman EC: The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nutr Metab (Lond) 2005;2:35.
- Hutchison SK, Stepto NK, Harrison CL, Moran LJ, Strauss BJ, Teede HJ: Effects of exercise on insulin resistance and body composition in overweight and obese women with and without polycystic ovary syndrome. J Clin Endocrinol Metab 2011;96:E48-E56.
- Feinman RD, Fine EJ: Thermodynamics and metabolic advantage of weight loss diets. Metab Syndr Relat Disord 2003;1:209-219.
- Krilanovich NJ: Benefits of ketogenic diets. Am J Clin Nutr 2007;85:238-239; author reply 239-240.
- Cahill GF Jr: Fuel metabolism in starvation. Annu Rev Nutr 2006;26:1-22.
- Owen OE: Ketone bodies as a fuel for the brain during starvation. Biochem Mol Biol Educ 2005;33:246-251.
- Owen OE, Morgan AP, Kemp HG, Sullivan JM, Herrera MG, Cahill GF Jr: Brain metabolism during fasting. J Clin Invest 1967;46:1589-1595.
- Owen OE, Felig P, Morgan AP, Wahren J, Cahill GF Jr: Liver and kidney metabolism during prolonged starvation. J Clin Invest 1969;48:574-583.
- Freeman J, Veggiotti P, Lanzi G, Tagliabue A, Perucca E, Institute of Neurology IRCCS C Mondino Foundation: The ketogenic diet: from molecular mechanisms to clinical effects. Epilepsy Res 2006;68:145-180.
- Hartman AL, Gasior M, Vining EP, Rogawski MA: The neuropharmacology of the ketogenic diet. Pediatr Neurol 2007;36:281-292.
- Hartman AL, Vining EP: Clinical aspects of the ketogenic diet. Epilepsia 2007;48:31-42.
- Sharman MJ, Kraemer WJ, Love DM, Avery NG, Gomez AL, Scheett TP, Volek JS: A ketogenic diet favorably affects serum biomarkers for cardiovascular disease in normal-weight men. J Nutr 2002;132:1879-1885.
- Paoli A, Canato M, Toniolo L, Bargossi AM, Neri M, Mediati M, Alesso D, Sanna G, Grimaldi KA, Fazzari AL, Bianco A: The ketogenic diet: an underappreciated therapeutic option? Clin Ter 2011;162:e145-e153.
- Felig P, Owen OE, Wahren J, Cahill GF Jr: Amino acid metabolism during prolonged starvation, J Clin Invest 1969;48:584-594.
- Jitrapakdee S, Vidal-Puig A, Wallace JC: Anaplerotic roles of pyruvate carboxylase in mammalian tissues. Cell Mol Life Sci 2006;63:843-854.
- Fukao T, Lopaschuk GD, Mitchell GA: Pathways and control of ketone body metabolism: on the fringe of lipid biochemistry. Prostaglandins Leukot Essent Fatty Acids 2004;70:243-251.
- Veech RL: The therapeutic implications of ketone bodies: the effects of ketone bodies in pathological conditions: ketosis, ketogenic diet, redox states, insulin resistance, and mitochondrial metabolism. Prostaglandins Leukot Essent Fatty Acids 2004;70:309-319.
- Leino RL, Gerhart DZ, Duelli R, Enerson BE, Drewes LR: Diet-induced ketosis increases monocarboxylate transporter (MCT1) levels in rat brain. Neurochem Int 2001;38:519-527.
- Amen-Ra N: Humans are evolutionarily adapted to caloric restriction resulting from ecologically dictated dietary deprivation imposed during the Plio-Pleistocene period. Med Hypotheses 2006;66:978-984.
- Krebs HA: The regulation of the release of ketone bodies by the liver. Adv Enzyme Regul 1966;4:339-354.
- Manninen AH: Metabolic effects of the very-low-carbohydrate diets: misunderstood ‘villains' of human metabolism. J Int Soc Sports Nutr 2004;1:7-11.
- McCue MD: Starvation physiology: reviewing the different strategies animals use to survive a common challenge. Comp Biochem Physiol A Mol Integr Physiol 2010;156:1-18.
- Robinson AM, Williamson DH: Physiological roles of ketone bodies as substrates and signals in mammalian tissues. Physiol Rev 1980;60:143-187.
- Sato K, Kashiwaya Y, Keon CA, Tsuchiya N, King MT, Radda GK, Chance B, Clarke K, Veech RL: Insulin, ketone bodies, and mitochondrial energy transduction. FASEB J 1995;9:651-658.
- Kashiwaya Y, Sato K, Tsuchiya N, Thomas S, Fell DA, Veech RL, Passonneau JV: Control of glucose utilization in working perfused rat heart. J Biol Chem 1994;269:25502-25514.
- Seyfried BT, Kiebish M, Marsh J, Mukherjee P: Targeting energy metabolism in brain cancer through calorie restriction and the ketogenic diet. J Cancer Res Ther 2009;5(suppl 1):S7-S15.
- Vazquez JA, Kazi U: Lipolysis and gluconeogenesis from glycerol during weight reduction with very-low-calorie diets. Metabolism 1994;43:1293-1299.
- Veldhorst MA, Westerterp-Plantenga MS, Westerterp KR: Gluconeogenesis and energy expenditure after a high-protein, carbohydrate-free diet. Am J Clin Nutr 2009;90:519-526.
- Kinzig KP, Honors MA, Hargrave SL: Insulin sensitivity and glucose tolerance are altered by maintenance on a ketogenic diet. Endocrinology 2010;151:3105-3114.
- Badman MK, Kennedy AR, Adams AC, Pissios P, Maratos-Flier E: A very low carbohydrate ketogenic diet improves glucose tolerance in ob/ob mice independent of weight loss. Am J Physiol Endocrinol Metab 2009, E-pub ahead of print.
- Sankar R, Sotero de Menezes M: Metabolic and endocrine aspects of the ketogenic diet. Epilepsy Res 1999;37:191-201.
- Ruskin DN, Kawamura M, Masino SA: Reduced pain and inflammation in juvenile and adult rats fed a ketogenic diet. PLoS One 2009;4:e8349.
- Forsythe CE, Phinney SD, Fernandez ML, Quann EE, Wood RJ, Bibus DM, Kraemer WJ, Feinman RD, Volek JS: Comparison of low fat and low carbohydrate diets on circulating fatty acid composition and markers of inflammation. Lipids 2008;43:65-77.
- Volek JS, Sharman MJ, Gomez AL, Scheett TP, Kraemer WJ: An isoenergetic very low carbohydrate diet improves serum HDL cholesterol and triacylglycerol concentrations, the total cholesterol to HDL cholesterol ratio and postprandial pipemic responses compared with a low fat diet in normal weight, normolipidemic women. J Nutr 2003;133:2756-2761.
- Spulber G, Spulber S, Hagenas L, Amark P, Dahlin M: Growth dependence on insulin-like growth factor-1 during the ketogenic diet. Epilepsia 2009;50:297-303.
- Fraser DA, Thoen J, Bondhus S, Haugen M, Reseland JE, Djoseland O, Forre O, Kjeldsen-Kragh J: Reduction in serum leptin and IGF-1 but preserved T-lymphocyte numbers and activation after a ketogenic diet in rheumatoid arthritis patients. Clin Exp Rheumatol 2000;18:209-214.
- Freedland SJ, Mavropoulos J, Wang A, Darshan M, Demark-Wahnefried W, Aronson WJ, Cohen P, Hwang D, Peterson B, Fields T, Pizzo SV, Isaacs WB: Carbohydrate restriction, prostate cancer growth, and the insulin-like growth factor axis. Prostate 2008;68:11-19.
- Westerterp-Plantenga MS, Nieuwenhuizen A, Tome D, Soenen S, Westerterp KR: Dietary protein, weight loss, and weight maintenance. Annu Rev Nutr 2009;29:21-41.
- Jia Y, Hwang SY, House JD, Ogborn MR, Weiler HA, O K, Aukema HM: Long-term high intake of whole proteins results in renal damage in pigs. J Nutr 2010;140:1646-1652.
- Wakefield AP, House JD, Ogborn MR, Weiler HA, Aukema HM: A diet with 35% of energy from protein leads to kidney damage in female Sprague-Dawley rats. Br J Nutr 2011;106:656-663.
- Skov AR, Haulrik N, Toubro S, Molgaard C, Astrup A: Effect of protein intake on bone mineralization during weight loss: a 6-month trial. Obes Res 2002;10:432-438.
- Martin WF, Armstrong LE, Rodriguez NR: Dietary protein intake and renal function. Nutr Metab (Lond) 2005;2:25.
- Pijls LT, de Vries H, Donker AJ, van Eijk JT: The effect of protein restriction on albuminuria in patients with type 2 diabetes mellitus: a randomized trial. Nephrol Dial Transplant 1999;14:1445-1453.
- Pijls LT, de Vries H, van Eijk JT, Donker AJ: Protein restriction, glomerular filtration rate and albuminuria in patients with type 2 diabetes mellitus: a randomized trial. Eur J Clin Nutr 2002;56:1200-1207.
- Westerterp-Plantenga MS: How are normal, high- or low-protein diets defined? Br J Nutr 2007;97:217-218.
- Fine EJ, Feinman RD: Thermodynamics of weight loss diets. Nutr Metab (Lond) 2004;1:15.
- Poplawski MM, Mastaitis JW, Isoda F, Grosjean F, Zheng F, Mobbs CV: Reversal of diabetic nephropathy by a ketogenic diet. PLoS One 2011;6:e18604.
- Brehm BJ, Seeley RJ, Daniels SR, D'Alessio DA: A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. J Clin Endocrinol Metab 2003;88:1617-1623.
- Dyson PA, Beatty S, Matthews DR: A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects. Diabet Med 2007;24:1430-1435.
- Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR, Kraemer HC, King AC: Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA 2007;297:969-977.
- Nordmann AJ, Nordmann A, Briel M, Keller U, Yancy WS Jr, Brehm BJ, Bucher HC: Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med 2006;166:285-293.
- Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, Golan R, Fraser D, Bolotin A, Vardi H, Tangi-Rozental O, Zuk-Ramot R, Sarusi B, Brickner D, Schwartz Z, Sheiner E, Marko R, Katorza E, Thiery J, Fiedler GM, Bluher M, Stumvoll M, Stampfer MJ, Dietary Intervention Randomized Controlled Trial (DIRECT) Group: Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008;359:229-241.
- Anderson GH, Moore SE: Dietary proteins in the regulation of food intake and body weight in humans. J Nutr 2004;134:974S-979S.
- Paoli A, Cenci L, Fancelli M, Parmagnani A, Fratter A, Cucchi A, Bianco A: Ketogenic diet and phytoextracts Comparison of the efficacy of Mediterranean, zone and tisano-reica diet on some health risk factors. Agro Food Ind Hi-Tech 2010;21:24.
- Paoli A, Cenci L, Grimaldi KA: Effect of ketogenic mediterranean diet with phytoextracts and low carbohydrates/high-protein meals on weight, cardiovascular risk factors, body composition and diet compliance in Italian council employees. Nutr J 2011;10:112.
- Adam-Perrot A, Clifton P, Brouns F: Low-carbohydrate diets: nutritional and physiological aspects. Obes Rev 2006;7:49-58.
- Accurso A, Bernstein RK, Dahlqvist A, Draznin B, Feinman RD, Fine EJ, Gleed A, Jacobs DB, Larson G, Lustig RH, Manninen AH, McFarlane SI, Morrison K, Nielsen JV, Ravnskov U, Roth KS, Silvestre R, Sowers JR, Sundberg R, Volek JS, Westman EC, Wood RJ, Wortman J, Vernon MC: Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal. Nutr Metab (Lond) 2008;5:9.
- Al-Khalifa A, Mathew TC, Al-Zaid NS, Mathew E, Dashti HM: Therapeutic role of low-carbohydrate ketogenic diet in diabetes. Nutrition 2009;25:1177-1185.
- Erlanson-Albertsson C, Mei J: The effect of low carbohydrate on energy metabolism. Int J Obes (Lond) 2005;29(suppl 2):S26-S30.
- Dashti HM, Al-Zaid NS, Mathew TC, Al-Mousawi M, Talib H, Asfar SK, Behbahani AI: Long term effects of ketogenic diet in obese subjects with high cholesterol level. Mol Cell Biochem 2006;286:1-9.
- Dashti HM, Mathew TC, Hussein T, Asfar SK, Behbahani A, Khoursheed MA, Al-Sayer HM, Bo-Abbas YY, Al-Zaid NS: Long-term effects of a ketogenic diet in obese patients. Exp Clin Cardiol 2004;9:200-205.
- Dashti HM, Mathew TC, Khadada M, Al-Mousawi M, Talib H, Asfar SK, Behbahani AI, Al-Zaid NS: Beneficial effects of ketogenic diet in obese diabetic subjects. Mol Cell Biochem 2007;302:249-256.
- Noakes M, Foster PR, Keogh JB, James AP, Mamo JC, Clifton PM: Comparison of isocaloric very low carbohydrate/high saturated fat and high carbohydrate/low saturated fat diets on body composition and cardiovascular risk. Nutr Metab (Lond) 2006;3:7.
- Volek JS, Feinman RD: Carbohydrate restriction improves the features of metabolic syndrome. Metabolic syndrome may be defined by the response to carbohydrate restriction. Nutr Metab (Lond) 2005;2:31.
- Volek JS, Fernandez ML, Feinman RD, Phinney SD: Dietary carbohydrate restriction induces a unique metabolic state positively affecting atherogenic dyslipidemia, fatty acid partitioning, and metabolic syndrome. Prog Lipid Res 2008;47:307-318.
- Volek JS, Phinney SD, Forsythe CE, Quann EE, Wood RJ, Puglisi MJ, Kraemer WJ, Bibus DM, Fernandez ML, Feinman RD: Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids 2009;44:297-309.
- Bowe WP, Joshi SS, Shalita AR: Diet and acne. J Am Acad Dermatol 2010;63:124-141.
- Katzman M, Logan AC: Acne vulgaris: nutritional factors may be influencing psychological sequelae. Med Hypotheses 2007;69:1080-1084.
- Liepa GU, Sengupta A, Karsies D: Polycystic ovary syndrome (PCOS) and other androgen excess-related conditions: can changes in dietary intake make a difference? Nutr Clin Pract 2008;23:63-71.
- Logan AC: Dietary fat, fiber, and acne vulgaris. J Am Acad Dermatol 2007;57:1092-1093.
- Logan AC: Omega-3 fatty acids and acne. Arch Dermatol 2003;139:941-942; author reply 942-943.
- McCusker MM, Grant-Kels JM: Healing fats of the skin: the structural and immunologic roles of the omega-6 and omega-3 fatty acids. Clin Dermatol 2010;28:440-451.
- Rubin MG, Kim K, Logan AC: Acne vulgaris, mental health and omega-3 fatty acids: a report of cases. Lipids Health Dis 2008;7:36.
Department of Biomedical Sciences
University of Padova, Via Marzolo 3
IT-35131 Padova (Italy)
Tel. +39 04 9827 5318, E-Mail firstname.lastname@example.org
Received: December 5, 2011
Accepted: January 3, 2012
Published online: February 11, 2012
Number of Print Pages : 7
Number of Figures : 2, Number of Tables : 1, Number of References : 105
Skin Pharmacology and Physiology (Journal of Pharmacological and Biophysical Research)
Vol. 25, No. 3, Year 2012 (Cover Date: April 2012)
Journal Editor: Lademann J. (Berlin)
ISSN: 1660-5527 (Print), eISSN: 1660-5535 (Online)
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