Acne: The Role of Dairy in the Nutrition Management for PCOS
Got acne? Don't get milk! This, according to new research published in the Journal of the Academy of Nutrition and Dietetics, showing a positive link between dairy consumption and acne (1). Acne is a common symptom of PCOS that can significantly affect quality of life in women of all ages.
The connection between dairy, androgens and insulin
In their review of 27 studies, researchers conclude frequent dairy intake as well as a high glycemic load diet (GL) contribute to acne. As the figure below shows (1), there are several ways dairy influences acne development:
1. Dairy ingestion can lead to increased insulin levels leading to increased cellular growth and acne.
2. Dairy products are carbohydrates which stimulate insulin growth factor 1 (IGF-1), resulting in high insulin levels. "Both skim and whole milk (but not cheese products) have a 3 to 6 fold higher glycemic-load compared with other carb foods". High insulin levels lead to increased androgens creating more sebum production.
3. Milk contains growth-stimulating hormones, including IGF-1 and dihydrotestosterone (DHT), which increases androgens resulting in higher sebum production and acne.
How much dairy to have
Hate to give up your cheese entirely? You may not need to. No randomized controlled trials have examined the relationship between milk or dairy consumption and acne. Most of the studies conducted have relied on self-reported dairy intake and focus on milk, not cheese or other dairy sources (2-6). There aren't any formal guidelines as to how much dairy consumption to have or if it's necessary to completely avoid dairy if you have acne or PCOS. In one study, the risk of acne increased when 3 or more servings of milk were consumed (6). Because of the direct influence on androgens and insulin, it is advisable for women with PCOS (who have acne or not) to limit their dairy intake to 1 or 2 servings each day. A serving of dairy is:
1 cup milk or yogurt, or
1.5 ounces hard cheese
If you do have acne, you may first want to start with eliminating dairy entirely and slowly reintroduce it in small amounts after 2 weeks.
Non-dairy calcium sources
American women need 1,000mg of calcium daily. There are ways to get calcium other than from dairy. Milk alternatives such as almond, hemp, rice and coconut milk can easily be used in place of cow's milk (but usually lack the protein content of cow's milk). Many vegetables (kale, broccoli, bok choy, for example) provide a good source of calcium as does fish (5 ounces of salmon contain more calcium than a glass of milk), seeds (chia, sesame and flax) and quinoa.
Have you cut back on dairy and seen an improvement in acne or other PCOS symptoms? Let us know!
1. Acne: The Role of Medical Nutrition Therapy," Jennifer Burris, MS, RD, CDE, CNSC, CSSD; William Rietkerk, MD, MBA; Kathleen Woolf, PhD, RD, FACSM. Journal of the Academy of Nutrition and Dietetics, Volume 113/Issue 3 (March 2013).
2. Danby FW . Nutrition and acne . Clin Dermatol . 2010;28(6):598–604
3. Smith TM , Gilliland K , Clawson GA , Thiboutot D . 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;128(5):1286–1293.
4. Abedamowo CA , Spiegelman D , Danby FW , Frazier AL , Willett WC , Holmes MD . High school dietary dairy intake and teenage acne . J Am Acad Dermatol . 2005;52(2):207–214.
5. Abedamowo CA , Spiegelman D , Berkey CS , et al. Milk consumption and acne in adolescent girls . Dermatol Online J . 2006;12(4):1.
6. Di Landro A , Cazzaniga S , Parazzini F , et al. Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults . J Am Acad Dermatol . 2012;67(6):1129–1135.
7. Office of Dietary Supplements: http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/