Can keto or low-carb diets improve acne?


If you’re an acne sufferer, you may have wondered whether following a low-carb or keto diet can help clear up your skin.

While medical opinions on the matter have differed over the years, more recent research suggests carbohydrate consumption may just be the reason for pesky facial breakouts.

By avoiding carbohydrates in your diet, you may be able to improve the quality of your skin and prevent future flare-ups.

In this guide, you’ll learn about the connection between diet and acne, plus what you can do to potentially decrease the frequency and severity of your acne through food.


How does acne develop?

Although nearly 90% of adolescents and teens have acne, it’s fairly common in adults, too. In fact, it’s estimated that in Western countries, around 50% of people in their 20s and 30s struggle with acne. Yet, it’s very rare in many cultures that follow traditional diets.1

Acne develops as a result of complex interactions that take place within the skin. Sebaceous glands located in the skin’s outer layer are connected to hair follicles. These glands produce sebum, an oily substance that lubricates the hair and skin cells, which are constantly being shed and replaced.2

acne

In the case of acne, this system is impaired. Elevated levels of androgens (male hormones) cause increased sebum production, leading to oily skin.

Additionally, skin cell production ramps up, and dead skin cells aren’t shed in the normal fashion. Instead, these cells combine with excess sebum, causing blocks or plugs. While this process is occurring, bacteria that feed on sebum also enter the picture.

Similar to the gut microbiome, skin maintains its own bacterial balance. One type of bacteria known as P. Acnes lives deep within the hair follicles and is normally present in the outer skin layer in small amounts.

But in people who have acne, concentrations of P. Acnes increase dramatically, causing inflammation that leads to whiteheads, pustules, and cysts.


The role of sugar and carbs in acne

Up until the 1960s, early studies formed the belief that diets high in sugar and refined carbs worsened acne.3 However, after experimental research failed to show a link between specific foods and acne, diet was no longer considered a major contributor.

But in light of mounting research published within the last 15 years, which suggests refined carbohydrates may be the main dietary culprit in causing acne, due to their negative effects on hormonal regulation, the tide has turned yet again.4

For instance, a 2007 study observing 43 young acne-prone men found that a low-glycemic load (GL) diet led to a greater reduction in acne lesions than a high-GL diet.5

What’s more, the low-GL group experienced a decrease in androgen and insulin levels, improvement in insulin sensitivity, and weight loss. By contrast, the other group had increases in weight, insulin levels, and insulin resistance.

It’s important to point out that this wasn’t really a low-carb diet; the low-glycemic-load carbs accounted for about 44% of the total dietary intake (roughly 220 grams of carbs for someone consuming 2,000 calories a day).

Could there have been an even greater improvement with a low-carb or keto diet providing less than 10% of energy from carbs?


Low-carb and ketogenic diets for acne

Although trials exploring carb restriction and acne haven’t been done yet, many people have reported that their skin has become much clearer as a result of following a low-carb or keto diet.6
Moreover, there are logical reasons why minimizing carb intake would be helpful for acne.

A 2012 article by Italian researchers discusses the potential benefits of ketogenic diets for acne, including the following:7

  • Lower insulin levels: High insulin levels stimulate the increased production of skin cells, sebum, and androgens, thus setting the stage for acne eruptions. Ketogenic diets decrease insulin levels, often dramatically.
  • Anti-inflammatory effects: Inflammation drives acne progression. Very low-carb and ketogenic diets have been shown to reduce inflammation.8
  • Decrease in IGF-1 (insulin-like growth factor 1): Ketogenic diets decrease levels of IGF-1.9 Like insulin, IGF-1 increases sebum production and has been found to play a large role in acne.10

In a 2013 review on therapeutic uses of ketogenic diets for various conditions, these Italian researchers state that although the emerging evidence for the use of keto diets in acne is promising, randomized controlled trials (RCTs) are needed to confirm these benefits.11


Keto or low carb: Which is best for acne?

Since there aren’t any studies on low-carb vs. keto diets for acne yet, it’s difficult to determine what level of carb restriction is needed to achieve the best results.

Similar to losing weight or reducing blood sugar, the necessary carb reduction for potential acne control likely varies from person to person. It’s possible that keto or very low-carb diets might be more effective.


Tips for maximizing the benefits of a keto or low-carb diet for acne

Below are some additional dietary tweaks that may or may not be useful. They are based on preliminary evidence, or small studies that need to be repeated to know for sure whether the suggested effects are real.

  • Consume fatty fish often: Long-chain omega-3 fatty acids found in fish are potentially anti-inflammatory and have been credited with possibly improving acne.12 The best sources include salmon, mackerel, sardines, herring, and anchovies.
  • Eat low-carb vegetables: Leafy green and cruciferous vegetables may help promote hormonal regulation and improve skin health. Dermatology researcher Bodo Melnik recommends a Paleo diet rich in vegetables for acne management.13
  • Avoid or limit dairy: Dairy has been shown to increase levels of insulin and IGF-1.14 Although skim milk seems to have the the strongest link to acne, cheese may also be problematic for some people.15
  • Drink green tea: Green tea is an excellent source of the antioxidant EGCG (Epigallocatechin gallate). A 2016 study found that green tea extract seemed to significantly reduce acne lesions in adult women with moderate to severe acne.16
  • Avoid or limit dark chocolate: Although earlier studies showed no difference in acne when chocolate was compared to other sweets, a 2016 study found that even virtually sugar-free, 99% dark chocolate might worsen breakouts in acne-prone men.17 For this reason, you may want to minimize intake of dark chocolate, just to be safe.
  • Focus on fresh low-carb foods: Even if you don’t eat sugary and starchy foods, you may still be consuming ingredients that can cause skin issues. Processed meats often contain sugar, corn syrup, fillers, or other additives that can raise insulin levels and possibly provoke inflammation. Stick to fresh food whenever possible and be sure to read nutrition labels.
  • Give the diet some time: Paradoxically, some people report a worsening of acne shortly after starting a keto or low-carb diet. However, this appears to be short-lived and may be part of the keto-adaptation process.18 Overall, breakouts seem to improve with carb restriction long term in most people.

Meal plan for clearer skin

The meal plan below is available through Diet Doctor Plus. Not a member? Sign up for a FREE 30-day trial to get our meal plan for clearer skin and many other membership benefits. After the free trial ends, it’s only $9.99/month or $99/year.

Keto: 7-day clear-skin diet #1

This meal plan includes nourishing, minimally processed keto foods that might help improve acne (fatty fish, vegetables). In addition, it’s low in foods that may increase skin breakouts (dairy). What’s more, the recipes are delicious, easy, and provide 20 grams of net carbs, or less, for the day.

Keep in mind that you’ll likely need to continue eating like this for several weeks to see results. However, this first week of meals can help you get started on your journey to clear skin.

Enjoy!

Full meal plan →

Summary

While the evidence is still preliminary, there are many reasons to believe that low-carb and keto diets may improve acne. Feel free to keep reading for several stories from people who have tried it and use our free guides below to get started.

By choosing nutrient-dense, minimally processed low-carb foods, you may be giving yourself the best shot at clearer, healthier skin.

Eating low carb is safe, and besides the cost of food, it’s also free. So, go ahead and try it out for a few weeks, and see what happens to your skin!


Franziska Spritzler, RD

Did you enjoy this guide?

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Stories

  • Keto and intermittent fasting: "I am completely blown away by the changes"
  • "For the first time in 15 years I'm free of acne"
  • Acne (and IBS) vanished with a diet change
  • "Within three months of starting a well-formulated ketogenic diet, all flares were gone!"

All acne success stories

 

Low-carb basics

 
 

  1. JAMA Dermatology 2002: Acne vulgaris
    A disease of Western civilization
    [observational study; very weak evidence]

  2. American Family Physician 2012: Diagnosis and Treatment of Acne [overview article; ungraded]

  3. Journal of the American Academy of Dermatology Directors Association 2010: Diet and acne [overview article; ungraded]

  4. Journal of Drugs in Dermatology 2014: Diet and acne update: carbohydrates emerge as the main culprit [overview article; ungraded]

  5. The American Journal of the Clinical Nutrition 2007: A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial [randomized trial; moderate evidence]

  6. Anecdotal reports; [very weak evidence]

  7. Skin Pharmacology and Applied Skin Physiology 2012: Nutrition and acne: therapeutic potential of ketogenic diets [overview article; ungraded]

  8. Lipids 2008: Comparison of low fat and low carbohydrate diets on circulating fatty acid composition and markers of inflammation [non-controlled study; weak evidence]

  9. Clinical and Experimental Rheumatology 2000: Reduction in serum leptin and IGF-1 but preserved
    T-lymphocyte numbers and activation after a ketogenic diet
    in rheumatoid arthritis patients
    [non-controlled study; weak evidence]

  10. Clinical, Cosmetic and Investigational Dermatology 2015: Linking diet to acne metabolomics, inflammation, and comedogenesis: an update [overview article; ungraded]

  11. European Journal of Clinical Nutrition 2013: Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets [overview article; ungraded]

  12. Acta Dermato-venereologica 2014: Effect of dietary supplementation with omega-3 fatty acid and gamma-linolenic acid on acne vulgaris: a randomised, double-blind, controlled trial [randomized trial; moderate evidence]

  13. Hautarzt 2013: Acne and diet [overview article; ungraded]


  14. Nestlé Nutrition workshop series. Paediatric programme 2011: Evidence for acne-promoting effects of milk and other insulinotropic dairy products
    [overview article; ungraded]


  15. Journal of the European Academy of Dermatology and Venereology 2016: The constellation of dietary factors in adolescent acne: a semantic connectivity map approach
    [case-control study; very weak evidence]

    Nutrients 2018: Dairy Intake and acne vulgaris: a systematic review and meta-analysis of 78,529 children, adolescents, and young adults [systematic review of observational studies; very weak evidence]

  16. Complementary Therapies in Medicine 2016: Does supplementation with green tea extract improve acne in post-adolescent women? A randomized, double-blind, and placebo-controlled clinical trial [randomized trial; moderate evidence]

  17. International Journal of Dermatology 2016: Dark chocolate exacerbates acne [non-controlled study; weak evidence]

  18. This is based on anecdotal experience. [very weak evidence]