The Role of Diet in Acne May Also Play a Role in Rosacea

Please note: In my book, Rosacea 101, I wrote an appendix with the title, Diet and Acne and it appears on page page 225. Rosacea 101 is a comprehensive, 373 page book, covering the conventional and alternative treatments for rosacea and covers basic rosacea 101 knowledge for rosacea newbies. It is a must have book for those who need in one book what they need to know about rosacea. Below is some information which helped formed the basis for my discussion on diet and rosacea. The Rosacea Diet is included in this book.

Loren Cordain, Ph.D., says, "I believe that like acne vulgaris, rosacea results from interactions between genetic and environmental factors, and that diet plays a key role in the etiology of this disease via its modulating influence upon cytokine and hormonal homeostasis.  In support of this notion are recent studies showing that EGF receptor blockers elicit non-comedo acne symptoms similar to rosacea.  We now have preliminary evidence to show that a substance found in whole wheat, wheat germ agglutinin (WGA) competitively binds the EGFR in gut (thereby displacing the endogenous ligand) and enters plasma via this pathway.  Because WGA displaces the endogenous ligand, it will upregulate the EGFR in a manner similar to pharmaceutical EGFR blockers.  We believe that diet also elicits a number of other endocrine responses that are intimately linked to the pathophysiology of rosacea."

In an email to me on this subject, Dr. Cordain said, "My colleague Neil Mann at RMIT has just completed a dietary intervention showing that a high protein low glycemic load diet ameliorates acne symptoms.  See attached abstracts.  I believe a similar study could be easily conducted with rosacea patients.  Neil failed to control for at least 2 dietary factors which I believe are also crucial in not only ameliorating acne symptoms but also rosacea symptoms.  I have outlined these mechanisms in my book, "The Dietary Cure for Acne".  Our research group is currently in the middle of a clinical trial testing the hypothesis that dietary WGA enters plasma via the EGFR I spoke of earlier.  We believe that WGA adversely influences hormonal and cytokine function that underlie a number of skin diseases and other health problems."

Dr. Cordain further states, "In regards to sugar (sucrose) being a trigger for rosacea, I believe this phenomenon occurs because the fructose moiety of sucrose elicits a transient and/or chronic hypertriglyceridemia which upregulates keratinocyte EGF receptors.  Additionally, high glycemic load carbohydrates like sucrose simultaneously may increase a number of pro-inflammatory cytokines such as  IL-1a which is associated with opthalmic rosacea symptoms."

Dr. Cordain wrote the book, The Dietary Cure for Acne. as well as The Paleo Diet.

Here are the abstracts mentioned in paragraph above:

Smith R, Mann N, Braue A, Varigos G. Low glycemic load, high protein diet lessens facial acne severity. Asia Pac J Clin Nutr. 2005;14 Suppl:S97.

Background - Acne vulgaris is a multi-factorial skin disorder which affects the 85-100% of the adolescent population in Western civilizations. Despite its high prevalence in the West, acne prevalence is extremely low or rare in non-westernized societies. It has been proposed that refined, high glycemic foods common in Western societies may accentuate underlying causal factors responsible for its proliferation. Objective - To determine whether a low glycemic load diet, comprised of high levels of protein and low GI foods, can alleviate the severity of acne symptoms in young males. Design - Male acne sufferers [n=43, age=18.3 +/- 0.4 (mean +/- SEM)] were randomly assigned to either the dietary intervention (n=23) or control groups (n=20). The intervention diet consisted of 25% energy from protein and 45% energy from low glycemic index carbohydrates. The control group received no information about diet nor were they given dietary instruction. The efficacy of dietary treatment versus control was clinically assessed by a dermatologist using a modified Cunliffe-Leeds acne scale. The dermatologist assessed facial acne by means of lesion counts and was blinded to the subject's group. Outcomes - Dietary intervention resulted in a reduction in total lesion counts (-23.1 +/- 4.0 lesions, P <0.001) and inflammatory counts (-16.2 +/- 3.0 lesions, P <0.001). The control group also showed a reduction in total lesion counts (-12.0 +/- 3.5 lesions, P <0.01) and inflammatory counts (-7.4 +/- 2.5 lesions, P <0.05). However, between group analyses showed that the reduction was significantly greater in the intervention group for total counts (P <0.05) and inflammatory counts (P <0.05). Conclusion - These data indicate that a low glycemic load diet, comprised of high levels of protein and low GI foods, significantly decreased the mean number of facial acne lesions, therefore alleviating the severity of acne symptoms. However, the multi-factorial nature of this condition is reflected in the fact that the control group also showed a decrease over time, thereby suggesting that other factors are at play. 

Smith R, Mann N, Braue A, Varigos G. The effect of a low glycemic load, high protein diet on hormonal markers of acne. Asia Pac J Clin Nutr. 2005;14 Suppl:S43.

Background - Acne vulgaris is a common endocrine condition affecting adolescents in Western civilizations. Acne typically manifests during puberty when there is a transient decrease in insulin sensitivity. It has been suggested that high glycemic nutrition during puberty induces hyperinsulinemia which increases the bioavailability of androgens and certain growth factors. These changes may induce follicular epithelial growth and increased sebum production - two factors responsible for acne proliferation. Objective - To determine the effect of a low glycemic load diet, comprised of high levels of protein and low glycemic index (GI) foods, on hormonal makers of acne vulgaris. Design - Male acne sufferers [n=43, age=18.3+/-0.4 (mean +/- SEM)] were randomly assigned to either the dietary intervention (n=23) or control groups (n=20). The intervention diet consisted of 25% energy from protein and 45% energy from low glycemic index carbohydrates. The control group received no information about diet nor were they given dietary instruction. Venous blood was collected at baseline and 12-weeks for an assessment of testosterone, sex hormone binding globulin (SHBG), free androgen index (FAI), dehydroepiandrosterone - sulfate (DHEA-S), insulin-like growth factor (IGF)-I and IGF-binding proteins -I and -3. Outcomes - Dietary intervention resulted in a significant reduction in FAI (-9.1 +/- 4.5, P<0.05) and DHEA-S (-0.72 +/- 0.33 umol/L, P<0.05) and an increase in IGFBP-1 (5.3 +/- 1.6 ng/mL, P<0.01). No significant changes were observed in levels of IGF-I, IGFBP-3, testosterone or SHBG following dietary intervention. The control group showed no change in any of the blood parameters measured. Conclusion - These data suggest that a low glycemic load diet may reduce androgenic activity (as indicated by a reduction in FAI and DHEA-S) and may oppose the growth promoting effects of IGF-I by increasing levels of its binding protein, IGFBP-I. This implies that a low glycemic load diet may reduce hormonal influences involved in acne pathogenesis.

Dr. Cordain is a member of the RRDi MAC.

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