Nutrition and acne
Introduction
Much has been written about hormonal influences in acne, most of the work directed at the effect of the traditional endogenous reproductive hormones. Gradually, however, we are learning to give due consideration to exogenous hormones and the effects they have on endogenous growth factors and androgen metabolism.
As background, all mammals rely on exogenous hormones from their first feeding. The entire milk complex evolved as it did to provide a precisely balanced synergistic stimulus to growth and maturation. Each species' milk provides the specific optimal mix of proteins, carbohydrates, fats, hormones, and growth factors needed by its babies. It is not generally appreciated that we actually start our lives with our first food laced with anabolic steroids. Little wonder that, in nature, this enriched material is withdrawn from the infant in due course. The growing youngster, whether human or bovine or whale, no longer needs such enriched food when it is capable of feeding itself, and the continued drain on the mother's fat and protein reserves must stop if she is to remain healthy to produce further robust offspring.
Section snippets
Background
Acne is well known to respond to hormones, both endogenous and exogenous. Androgenic progestins in birth control pills and now in intrauterine devices can cause significant acne in women,1 and the highly androgenic progestin, medroxyprogesterone acetate, is a known acnegen whether taken orally or as an intramuscular depot injection.
In men, we used to see acne caused by anabolic steroid use in weight lifters and body builders fairly regularly. Over time, the level of sophistication in this
The nonreproductive hormones
Although acne is regarded as androgen-dependent,10 its course during the teen years corresponds more closely to the serum levels of growth hormone (GH) than to androgen levels.11 The world of the nonreproductive hormones is even more complex than the steroids. A full explanation of the interactions of these hormones with the pilosebaceous units is beyond this contribution; indeed, it still awaits full clarification. What follows is a précis of the present concepts necessary for the appreciation
Conclusions
The complex interrelationships detailed in this contribution support to a high degree the case for dietary effects on acne (Figure 4). The typical Western diet, consisting of numerous dairy sources and foods with high glycemic indices, appears to have solidly-documented potentiating effects on serum insulin and IGF-1 levels, thereby promoting the androgens that are at the basis of the intraductal changes that lead to the development of acne vulgaris. More recent work, in progress, seems to
References (49)
Hormones in milk
Vitam Horm
(1995)- et al.
Occurrence of steroidogenic enzymes in the bovine mammary gland at different functional stages
J Steroid Biochem Mol Biol
(1996) - et al.
High school dietary dairy intake and teenage acne
J Am Acad Dermatol
(2005) - et al.
Milk consumption and acne in teenaged boys
J Am Acad Dermatol
(2008) - et al.
The role of IGF-I in human skin and its appendages: morphogen as well as mitogen?
J Invest Dermatol
(1997) - et al.
Molecular interactions of the IGF system
Cytokine Growth Factor Rev
(2005) - et al.
Interplay of IGF-I and 17beta-estradiol at age-specific levels in human sebocytes and fibroblasts in vitro
Exp Gerontol
(2008) - et al.
Insulin-like growth factor-1 induces lipid production in human SEB-1 sebocytes via sterol response element-binding protein-1
J Invest Dermatol
(2006) - et al.
SREBP transcription factors: master regulators of lipid homeostasis
Biochimie
(2004) - et al.
IGF-1 induces SREBP-1 expression and lipogenesis in SEB-1 sebocytes via activation of the phosphoinositide 3-kinase/Akt pathway
J Invest Dermatol
(2008)