(Photo: Joel Louzado)
Throughout high school, I was one of the lucky few among my fellow students who didn’t struggle with acne—but when I turned 21, I started to break out *badly.* Within a couple of months, I was struggling with cystic acne covering my cheeks, forehead and chin. Since this type of acne is “deeply embedded” under the surface of the skin, my breakouts were not only incredibly painful, but they also lasted up to a month. My original skincare routine was limited to a simple oil-free cleanser, so when my skin changed, I went straight to my drugstore to try every acne treatment on offer and spent a fortune on natural oils and masks.
Initially, I avoided going to a dermatologist because I was so embarrassed. At the time, sitting in a doctor’s office with fluorescent lights highlighting my blemishes and having someone get up close to examine my skin seemed humiliating—so I opted to self-treat.
However, my skin resisted all of my efforts, which prompted a desperate “how to get rid of acne” Google search. That led me down a rabbit hole of bloggers swearing that after trying harsh treatments for their acne, changing their diet was what rid them of their blemishes for good. Fixated on the promising before-and-after photos, I cut out foods I thought were triggering my skin (including dairy, gluten and sugar) to the point that I was only eating quinoa and vegetables and drinking close to four litres of water per day—which resulted in noticeable weight loss. At the time, I thought it would clear up my skin, but instead it introduced a problematic relationship with food and disordered eating habits that lasted well after my acne scars faded.
The “acne diet” can lead to disordered eating
According a 2012 Italian study published in the American Journal of Clinical Dermatology, acne is often a dermatological symptom of anorexia nervosa and bulimia nervosa—two of the most common eating disorders. But in some cases, the relationship between acne and eating disorders is flipped, with acne potentially leading to the development of an eating disorder. Dr. Tobey Mandel, a psychologist specializing in eating disorders at Connecte Psychology in Quebec, explains that if individuals are on an “acne diet,” a way of eating that claims to improve acne by eliminating foods linked to it, they could be suffering from disordered eating.
“In general, attempting to control our food intake for any reason can lead to an unhealthy relationship with food,” she says.
According to Dr. Mandel, disordered eating isn’t just limited to anorexia and bulimia nervosa. “[Disordered eating] can include less severe but still problematic behaviours, such as developing rigid rules around food—including what to eat, when to eat, how much to eat, cutting out certain types of foods, obsessive calorie counting and regular skipping of meals,” she explains. “It can be categorized as any time someone’s relationship with food is significantly affecting their well-being, including energy levels, if it’s isolating them in any way, or is causing physical harm.”
Sam, a 21-year-old Toronto student whose name has been changed to protect her privacy, started struggling with cystic acne on her cheeks and lower jawline in her mid-teens—something she figures was likely due to hormones. She was able to get her skin under control by developing a thorough skin routine that involved using a medicated topical treatment suggested by her dermatologist. She was eventually prescribed the birth control pill to clear her skin—something she says made a *huge* difference.
These days, Sam keeps her acne at bay with a strict skincare routine and continues to take the pill—but notes that her acne-fighting ritual is not the only thing that changed when she started breaking out. “When I started getting acne, I became a lot more insecure,” she says. “I can remember not wanting to go out with friends and being stressed out all the time because I was embarrassed and anxious that people were looking at how bad my skin looked.”
Being “grossed out” and self-conscious about your skin when you have acne is something that many acne-sufferers experience in one form or another—it’s why we attempt to hide our spots via concealer and other methods. (I even got bangs out of desperation to hide the acne on my forehead.) Because of her insecurities, Sam also changed her her diet. “I started avoiding dairy products because I found research online about how dairy can affect your skin,” she says. After researching, she began seeing possible links between dairy and her own breakouts. “I noticed that there were times that I’d eat ice cream or yogurt and start breaking out the next day,” she explains. While cutting out ice cream isn’t necessarily an *unhealthy* choice, Sam quickly began restricting the majority of her diet because she was so scared of triggering a breakout, something that she recognizes negatively affected her relationship with food.
Changing your diet isn’t an uncommon response to skin issues. Cameron Diaz blamed burritos for her past struggle with acne, and far too many people struggling with breakouts have been told that their skin would clear up if they just stopped eating chocolate and greasy food, neither of which has been proven to cause acne.
The Canadian Dermatology Association says that one of the biggest myths surrounding acne is that certain foods, such as the occasional Kit Kat bar or McDonald’s combo, aggravate it. That’s simply not the case. “Scientifically, there’s insufficient evidence to link the consumption of ‘enemy foods’ [to acne],” says Toronto-based dermatologist Dr. Elena Poulos. While she acknowledges that some studies indicate the consumption of skim milk and diets with a high glycemic index may aggravate acne, there is still debate. “The research is compelling, but not definitive,” she explains. “I warn patients [who want to] eliminate skim milk to reduce acne, because it’s probably one of the easiest ways for adolescents and young adults to get calcium in their diet. I don’t tell them not to try it, but you have to be sure you’re still getting nutrients from other sources.”
Instead, Poulos suggests that while maintaining a healthy, balanced diet helps reduce acne, the biggest factor contributing to flare-ups is actually genetics. “When somebody has moderate or severe acne, there’s usually a family history.” Poulos further explains that women of all ages may struggle with cystic acne around their lower face and upper neck even into adulthood because of hormonal patterns (which can be associated with menopause, pregnancy or PCOS). Though hormones are known to flare up in the teenage years, a hormonal imbalance could also explain why my skin took a hit at 21.
The after effects of the “acne diet” last long after the blemishes fade
Despite food having relatively insignificant impact on acne, my “acne diet” persisted. I thought the only lasting reminder of my acne would be the scars, which can take months to clear. What I didn’t expect was the fear that lingered in regard to eating foods outside of my “safe” zone. After navigating my acne on my own for four months with no improvement to my skin, I finally decided to book an appointment with my doctor, who referred me to a dermatologist. Within one hour-long appointment, my derm attributed my acne to a combination of genetics (both of my parents struggled with acne in their mid-to-late teens) and hormones. To begin treatment, she prescribed a topical cream to see how my skin would respond before exploring further treatment options. During the first month of using the topical prescription, I didn’t have any new breakouts and my existing blemishes started clearing up. Within two months, we decided that I was safe to wean off the prescription and I was sent home with a gentle cleanser. Ever since then, my cystic acne has stayed under control (save for the occasional, very normal blemish).
But despite my breakouts fading, I maintained my “acne diet”—which involved eliminating my morning coffee, creamy butternut squash soup (my go-to lunch), acidic fruits and vegetables such as berries and tomatoes—for almost a year after my skin cleared. I continued to lose weight and wouldn’t eat for days because I was convinced that eating the “wrong” food would bring my acne back. I still can’t bring myself to drink caramel macchiatos.
Sam reports similar diet-restricting behaviour because she was “grossed out” by her skin. “At times I wouldn’t want to eat because I didn’t want to break out,” she says. When her skin was at its worst, she was anxious going to social events that involved food. “I didn’t want to seem rude for not taking any of the food, but I didn’t want to eat the food there because I didn’t want to break out,” she says. “I deprived myself of a lot of foods.”
Aside from eliminating certain foods in the hopes of alleviating acne symptoms, Mandel notes that many people do so because it’s a way of gaining control during a time that they feel out of control of their appearance. “Whenever anything in our lives feels like it’s out of our control, individuals with certain personality structures tend to look for something, whether consciously or not, to feel as if they’re back in control,” Dr. Mandel says. “So if you do feel as though your acne has changed suddenly because of something you can control in any way, it is possible that some individual could turn to controlling their food.”
What to do to minimize breakouts before you start restricting your diet
Before believing the acne-fighting tips you read on the internet—which are likely largely unfounded—Poulos recommends talking to a dermatologist, especially for individuals who may be susceptible to developing unhealthy eating habits. After months of trying to self-treat by drastically changing my diet and using harsh acne-fighting cleansers with no improvement, my dermatologist helped me understand my acne and find a treatment that worked well for my skin. Not only did she help me clear my acne, she was crucial in repairing my relationship with food by helping me understand the real root of my blemishes and showing me that there were treatment options that didn’t involve cutting out foods that were good for my nutrition (and my tastebuds).
I also noticed how my restrictive eating was negatively affecting my concentration at school and affecting my mood, and I realized this diet needed to stop. I started slow, reintroducing foods with low sugar content, drinking very small amounts of coffee in the morning and adding a few berries to my breakfast. While at first, I was nervous to eat these foods, adding them back into my diet in small quantities and at a gradual pace helped me deal with the anxiety. Once I proved to myself that eating these foods didn’t result in a catastrophic breakout, I was able to incorporate my favourite foods back into my regular meals.
“Rather than start avoiding foods that really might cause nutritional deficiencies or cause other emotional problems with diet, you’re much better off trusting an expert,” says Poulos, noting that if you’re having anxiety around food in addition to acne issues you should seek treatment for that as well. “You don’t need to have a full-blown eating disorder to see a psychologist on the topic,” she says. “In fact, it’s way easier to make changes if you see a professional before it turns into a full-blown eating disorder to make get an evaluation to check-in with what’s going on your eating, what you can do differently and work through the fear of re-introducing foods.”
Two years after I first started breaking out, I am back to eating creamy butternut squash soup and have a much clearer understanding of what will, and more importantly will not, impact my skin. And I’m growing out my bangs.
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