Acne is a common skin condition that affects up to 50 million Americans yearly (*). Depending on its severity, acne can affect a person’s self-image and quality of life (*).
When it comes to treating acne, topical and oral treatments help; however, you might be wondering if a dietary strategy such as keto can heal your skin further by reducing inflammation and facial breakouts.
In this article, you’ll learn what causes acne, the connection between keto and acne, and how the keto diet can prevent it (or possibly make it worse if you’re already on keto). Finally, if you’re considering keto, we’ll show you how to maximize it for skin health.
What is Acne?
Acne is an inflammatory skin disorder in which hair follicles are clogged with sebum (oil) and dead skin cells. People with acne get pimple outbreaks on their face, back, shoulders, and chest (*).
While anyone can develop acne, it’s more common among teens (especially males) and young adults. However, if it persists into adulthood, you’ll notice it more among females (*).
If you live with acne, you might have noticed that some pimples or bumps look different from others. That’s because acne comes in various types, such as:
- Whiteheads: These are flesh-colored bumps caused by clogged dirt, dead skin cells, and sebum in your pores. In the case of whiteheads, pores are closed, which is also why they’re called “closed comedones.”
- Blackheads: They appear as small black dots on the skin and can sometimes be mistaken for dirt. Blackheads are also called “open comedones” since the clogged pores are open.
- Papules: These are bumps that are pinkish or reddish — a sign that they’re inflamed. Papules are painful to touch, and pinching them can make inflammation worse.
- Cysts: These are pus-filled, large, and should be treated with care (by a dermatologist) or else scarring can occur. Cysts or cystic acne is a severe form of acne and usually involves oral antibiotic treatment.
- Nodules: These bumps can be skin-toned or red, depending on whether inflammation is present. They’re hard and painful to touch and can appear as patches in a large area like your chest or back.
If a form of treatment is effective, acne may go away within 4 to 6 weeks. Your dermatologist may prescribe different treatments as part of your overall plan, as well as advise you to avoid using harsh skin products, touching, and scrubbing your skin.
Furthermore, the American Academy of Dermatology states that eating a low-glycemic diet — foods that are less likely to spike your blood sugar levels — can reduce acne flare-ups (*).
How Does Acne Develop?
A lot of factors can play a role in how likely your pores are to get clogged. For starters, acne can be genetic if one or both of your parents have had a history of acne (*).
Apart from that, factors like puberty hormones and hormonal imbalances (which cause oily skin and the bacteria p. acnes to increase), inflammation (which can be controlled by your diet), insulin, and insulin-like growth factor 1 (or IGF-1) create an environment for acne to develop.
Given the right conditions, dead skin cells shed rapidly, along with excess oil production. Moreover, the bacterium p. acnes feeds on sebum, which serves as its fuel source. Note that p. acnes forms part of your normal flora; however, its increase can trigger inflammation (*).
Here’s more about each factor that contributes to acne:
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- Excess androgen hormones: One of the most common culprits for acne is an excess of androgen hormones. This is why during puberty, when hormones are naturally shifting around, many people experience acne breakouts. This is also common in women with PCOS, a condition that results from excess androgens, acne is a common symptom (*).
- Inflammation: A high glycemic diet, one that’s rich in refined carbohydrates and sugar, will result in blood sugar spikes. This causes your body to create more sebum and simultaneously produces inflammation (*).
- Insulin and Insulin-Like Growth Factor (IGF-1): When blood sugar is high, insulin is secreted to bring glucose from the blood into your cells. The problem is that excess insulin also increases your levels of insulin-like growth factor (IGF-1). Like androgens, IGF-1 increases sebum production, which sets the stage for acne. Furthermore, IGF-1 can also initiate inflammation, which contributes to acne (*).
How Sugar and Carbs Contribute to Acne Formation
Multiple studies have found that eating sugar and carbohydrates (especially simple or refined carbs) cause acne or make it even worse. Sugar and carbs increase blood glucose, which then causes a rise in your insulin levels. In women, too much insulin signals their ovaries to make testosterone (*).
A study published in the Journal of American Academy of Dermatology found that subjects who consumed chocolate experienced an increased severity of their acne. Although the type of chocolate wasn’t specified, milk chocolate may lead to more flare-ups than dark chocolate (*).
In a randomized controlled trial, males with facial acne were assigned to one of two groups — the low-glycemic load group (where high-GI foods were substituted for lower-GI foods or high-protein foods), and the control group (where participants ate carb-rich foods) (*).
The results showed that at 12 weeks, the number of acne lesions decreased by 51% in the low-glycemic load group and only by 23% in the control group (*).
This shows that lowering blood sugar, therefore, helps to keep your skin clear.
Can Keto Help Prevent Acne?
Yes, a ketogenic diet can improve skin problems like acne. Eating fewer carbohydrates (up to 50 grams per day only) leads to a dramatic reduction in blood sugar, insulin, and inflammation, which prevents acne from happening in the first place.
Controlling all three also helps regulate androgen levels and decreases insulin-like growth factor (IGF-1) to reduce sebum production.
Additionally, the keto diet encourages you to eat healthy fats, omega-3 fatty acids in particular, which have anti-inflammatory properties.
So, does keto help acne? Absolutely. It’s the combination of reduced carbs (to a great extent) and increased fats that improve skin health.
However, note that while the keto diet and acne are a good combination, sometimes people eat foods that can actually make acne worse. You’ll find out more in the next section.
Why Does Acne Get Worse on Keto In Some People?
You’ve probably heard that dairy could trigger acne or make it worse (in people who already have it). Some research studies support the idea that consuming dairy, whether or not you’re on the keto diet, can aggravate acne.
For example, a systematic review and meta-analysis of 78,529 children, adolescents, and young adults have found that any type of dairy — milk, yogurt, and cheese — was linked to increased acne in individuals ages 7 to 30 years (*).
There are some theories to explain why dairy may cause acne (*):
- Milk contains growth hormones and anabolic steroids
- Dairy products have carbohydrates in them, which increases insulin and IGF-1
- A lot of cows are treated with bovine growth hormone and their milk supply may contain higher levels of IGF-1
If you’re using the keto diet for acne, avoiding dairy may be a good idea to clear up your skin. This is especially true if you like meeting your dietary fat intake from dairy. Experiment with your keto diet this way and see if it works for you.
However, if your acne persists despite making adjustments to your current diet, be sure to speak with your doctor or dermatologist. Keep in mind that certain health conditions may cause acne.
Tips for Maximizing the Benefits of Keto for Acne and Other Skin Problems
Now that you know the blood-sugar regulating and insulin-reducing benefits of keto for acne, below are some ways to get the most out of this diet that’s supported by research.
1. Avoid highly processed foods.
In other words, keep your keto diet clean. Many processed items, even though they’re marketed as keto-friendly, contain hidden sugar and carbs that could spike your insulin and cause skin problems.
Common items include barbecue sauces, salad dressings, hamburger patties, chicken nuggets, and other fast-food items.
If you can’t avoid them completely, protect yourself by making a habit of reading food labels, including the ingredients list. Don’t settle for the claims on front labels, which can sometimes be false and misleading. Here’s a helpful guide that teaches you how to check labels on keto diet foods.
The best way to avoid unnecessary sugar, carbs, and other ingredients that aren’t good for your body is to focus on whole foods.
2. Get quality sleep at night.
Sleep affects your skin. Quality sleep allows your skin to rebuild and repair, while poor sleep does the opposite.
Research has shown that poor sleep quality doesn’t only increase your risk of overall all-cause mortality, but at a superficial level, it may also worsen acne (*). Furthermore, fatigue upon waking is strongly associated with acne (*).
If you’re not making sleep a priority, now is the time to consider your sleep hygiene. Aim to get at least 7 hours at night (*).
Doing whatever makes you feel relaxed before bed, such as taking a warm bath, meditating, listening to soothing music, and reading a good book promote restful sleep.
3. Incorporate physical activity into your keto lifestyle.
Exercise can help with acne by regulating blood sugar, reducing insulin resistance, and flushing toxins out of your system. In addition, it allows you to get better sleep and lower your stress levels (*).
There are plenty of exercises you can do while in ketosis. Try running, biking, weight lifting, and yoga. The key is to engage in any physical activity.
As an additional tip, be sure to remove makeup prior to your workout and avoid touching your face with your hands during exercise.
4. Consider cutting out dairy.
If dairy seems to be causing keto acne, it may be best to remove it from your diet. The growth hormones and extra carbs in dairy products might be the reason why your skin isn’t clearing up yet.
Giving up dairy might be difficult for some people. If you’re one of them, consider almond milk as a dairy-free replacement and other keto-friendly vegan options.
5. Try intermittent fasting.
Intermittent fasting (IF), which entails cycling between periods of fasting and eating, is used to boost results while on keto such as weight loss.
For those who are struggling with acne, IF reduces facial breakouts by mitigating inflammatory pathways and inhibiting mTOR activation (which increases androgen hormones) (* , *).
Common intermittent fasting practices include alternate-day fasting, the 16/8 method, a 24-hour fast, and skipping breakfast. It may be optimal to begin with shorter fasting periods if you’ve never tried IF before.
Important: Consult a healthcare professional if you’re considering fasting while on glucose-lowering medications.
6. Consume omega-3 fatty acids.
The Western diet is known to be highly inflammatory, with loads of processed foods, low-quality meat, and cheap oils. One of the primary drivers behind inflammation is an imbalance between omega-3 fatty acids and omega-6 fatty acids (*).
Omega-6 fats are associated with inflammation, while omega-3 is highly anti-inflammatory.
Adding sources of omega-3 fats to your diet will help to balance out the naturally occurring omega-6 and support your inflammatory pathways. Omega-3s are found in fatty fish like salmon, tuna, mackerel, and sardines. Supplementing with fish oil or krill oil also helps.
A study done on healthy males with mild to severe acne revealed that after 12 weeks of taking fish oil capsules daily, 8 out of 13 participants received a lower grade acne, which indicated improvement (*).
Acne can be treated effectively and one of the best ways to make it less severe is by following a diet that prevents blood sugar and insulin spikes (which increase androgen and sebum production).
There’s a high possibility of seeing improvements with skin health on keto, especially when you implement strategies to maximize your diet — such as eating mostly whole foods, removing dairy, fasting, and consuming omega-3 fats.
On top of this lifestyle change, consider talking to a dermatologist to explore topical treatments to clear acne further or make scars less noticeable.
Goulden V et al. The familial risk of adult acne: a comparison between first-degree relatives of affected and unaffected individuals. 1999 August
Cappel M et al. Correlation Between Serum Levels of Insulin-like Growth Factor 1, Dehydroepiandrosterone Sulfate, and Dihydrotestosterone and Acne Lesion Counts in Adult Women. 2005 March
Nestler J et al. Insulin Stimulates Testosterone Biosynthesis by Human Thecal Cells from Women with Polycystic Ovary Syndrome by Activating Its Own Receptor and Using Inositolglycan Mediators as the Signal Transduction System. 1998 June 1
Smith R et al. A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. 2007 July 1
Smith R et al. A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. 2007 July 1
Juhl C et al. Dairy Intake and Acne Vulgaris: A Systematic Review and Meta-Analysis of 78,529 Children, Adolescents, and Young Adults. 2018 August 9
Misery L et al. Consequences of acne on stress, fatigue, sleep disorders and sexual activity: a population-based study. 2015 April
Tulsian R et al. Caloric restriction effects on liver mTOR signaling are time-of-day dependent. 2018 July 16