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Acne: Is Chocolate a Culprit?
By: Maggie Hawk
In a world full of self-help magazines which portray models with beautifully flawless skin and perfect bodies, it’s no wonder that teenagers enduring acne break outs feel insecure and embarrassed. They are constantly bombarded with images of impossible standards and are desperate for any solution to their problem of acne. Just walk by any cash register in a grocery store, and you are sure to see on the covers “10 ways to Alleviate your Acne” or “5 Easy Steps to a Clearer Complexion.” Although there is little concrete evidence that diet plays a part in the disorders of the skin, you might be surprised how often it is suggested to “avoid chocolate” and other oily foods in order to have a clearer skin.
Who Tells Us to Avoid Chocolate?
Why do individuals believe that eating chocolate will make them break out? Is it just something that our mothers tell us to keep us away from the candy dish?
The Canadian Medical Associate Journal published in September of 1938 is evidence that this idea of chocolate as an aggravator of chocolate has been pondered for years. From their observation of a mixed, unselected, dietary-un-controlled and locally untreated group for a five month period, they determined that the fat radicle found in whole dairy products such as cheese, chocolate, cocoa, nuts and fried foods helped fuel the developing demands of the sexual development at puberty, but also stimulated bacterial invasion. A direct quote shows the strong belief that chocolate was indeed a culprit for acne: “Derivatives of the cocoa bean, being of a fatty nature, must still be forbidden.” (Ereaux 1938)
More currently, the warnings against eating chocolate can be found in self-help magazines or websites such as the Natural Acne Remedy Website. (http://www.naturalacneremedy.com/btf/food-that-causes-acne.html)
However, it’s not just the non-educated and easily manipulative individuals in society who believe this myth about chocolate’s effect on acne. In a 2001 study of sixth year medical students, who all subsequently graduated from The University of Melbourne, Green and Sinclair asked 215 students to answer a short-answer question on acne management and exacerbating factors in one of their final year examination papers. Diet was stated to be an important factor by 41% of students, of whom 12% specifically mentioned chocolate. Persistence of these misconceptions among medical graduates is likely to perpetuate misinformation in the community. (12)
People have been trying to point the blame for acne for many years. Often acne is viewed as a mark of uncleanliness or a lifestyle disease-something that is completely under the personal control of the individual. Acne is almost seen as a punishment for something the individual did wrong. One of the early myths about the arousal and prevalence of acne was associated with sexual misbehavior. People noticed that acne generally began to flare during the time of sexual maturation and development, and so some people began to associate acne with a sign of a loss of innocence or sexual purity. A second myth was the idea that people got acne because their skin was dirty and those that broke out were simply paying the price for being “unclean.” Other popular ideas included the idea that since oily skin usually accompanied acne break outs, the more rich or greasy food you ate, the oilier you made your skin, and thus the higher chance of acne break out. Extending that logic, people began to believe that the more richly delicious the food, the more likely it would cause breakouts. This made chocolate a prime suspect for acne break outs. Not only was it richly delicious, but this finger pointing was also influenced by the coincidental fact that many women crave mood-elevating chocolate when under stress or before a menstrual period (both of which flare acne.) (Preston 2004)
In fact, it is ironic that acne can cause so much embarrassment and insecurity when it is NOT a lifestyle disease or anything an individual can have personal control over. It is a medical condition that must be treated medically, not behaviorally.
What is Acne?
Acne is a chronic disease of the sebaceous follicles. (Fulton 2002) Acne is largely genetic and it is inherited as an autosomal dominant gene. It is believed to have come from a Mediterranean pool and was spread through the world by the early Spanish adventurers. (Fulton 2002) People often experience a flare up of acne during the adolescence years, because during these years the bodies of teenagers produce and release an increased amount of androgens. This increase of androgens causing the sebaceous glands under the surface of the skin to enlarge. The sebaceous glands respond by producing excess oil. This excess oil mixes with bacteria and dead skin on the skin’s surface and blocks pores. Inside these pores, the bacteria multiplies and causes inflammation. (http://www.articleset.com/Kids-and-Teens_articles_en_Acne-And-Teenage-Girls.htm)
The basic lesion can be defined as an obstruction of the follicular orifice, the blocking of the flow of sebaceous material and the formation of a comedo. (Cahn, 1960) It can also be defined as the hyperkeratotic plugging of vellus hair follicles into which the glands empty or bacterial conversion of sebum to irritating fatty acids.
How Prevalent is Acne?
In a comprehensive epidemiological study of skin disease in the United States in 1978, Johnson and Roberts found that some 30% of the population was found to have “diseases of the sebaceous glands (acne) at the age of 20. (Marks 1985) and other studies show that 85% of people have acne at some time during adolescence. (Truswell 1985) Although often associated with adolescents, the disease of acne is not uncommon in infants or individuals over the age of 50.
What Makes People Break Out?
“Acne is more complex than simply the fatty acids or the bacteria populations.” (Fulton 2002) In contrast to the popular myths mentioned earlier, the factors that that can cause people to prone to acne include but aren’t limited to: stress, hormones, cosmetics with irritating oils, heat and humidity, sunlight, and certain drugs. Other factors include: nervous tension, fatigue, genetics, secondary bacterial infection, and excessive iodides present in the diet. (Fulton 2002)
According to R LI Myerick, a general practitioner in London, the best way to approach the treatment of a patient with acne is to listen to the patient first and foremost and explain that the condition will finally clear even without treatment. The patient should be supervised and seen for a minimum of six months. For slight conditions, a local benzoyl-containing cream often helps. For moderate or severe, the cream is combined with an antibiotic. For older women with established menstrual cycles, sex steroid therapy is usually very helpful. (Meyrick 1985)
Yudkin in 1953 showed that there are three criteria by which one tests the hypothesis that a dietary component is implicated in the causation of a disease.
In a study published in the British Medical Journal in 1967, scientists measured the sugar intake of patients with seborrhoeic dermatitis or acne and control subjects in order to test their hypothesis that those patients with seborrhoeic dermatitis consume significantly more sugar than persons without the disease. Their findings included a significantly higher intake of sugar in patients with seborrhoeic dermatitis than in control subjects, but no real sugar difference for those subjects with acne. In their discussion they concluded that sugar had no affect on acne, but that that didn’t necessarily rule out the idea that diet could be involved in the medical disease of acne-further investigation was required to test this possibility. (Yudkin 1967)
In 1969, a study was conducted at the University of Pennsylvania by Fulton in which 65 subjects suffering from acne were tested. Subjects in a control group ate chocolate bars with no chocolate (but the bars resembled an actual chocolate bar and contained 28% vegetable fat, in order to imitate the fat content of cocoa butter and chocolate liquor in a real chocolate bar.) A group of test subjects, similar in make up to the control group, were given chocolate bars with nearly 10 times as much cholocate liquor as a typical 1.4 ounce chocolate bar. The results showed no significant difference in acne in the test group compared with the controls. (Fulton 1969)
Another study was done at the Naval Acadamy in Annapolis, Maryland compared 80 midshipmen who all shared similar living conditions. One group avoided chocolate for four weeks while a matched group consumed at least 3 chocolate bars each day. After four weeks, the groups switched eating patterns. Results of the experiment were based on clinical observations and showed no significant difference in the acne of either group. (http://www.wholehealthmd.com/ME2/dirmod.asp?sid=D4934726D9D54C3F94550D9284CA1307&nm=Expert+Opinions&type=AWHN_ExpertOpinions&mod=Today&tier=3&id=F191413F5AB245208F48FF42B2E3C9AB)
Critiques of studies: A primary critique of these studies is the acknowledgement that it is hard to produce a truly double blind conditions and impractical to think that you can take a group of young people, keep them in cages on controlled diets. True, you can control some aspects of their diets but can’t accurately dictate everything they eat. Also, another valid critique of these studies was made by Gustave H. Hoehn from San Gabriel, California. He argues that once a follicle is impacted and distended, it will not function perfectly even on a good diet. Thus any dietary control involves two to six months at least so some of these studies might not accurately measure whether or not chocolate really is a factor in the prevalence and aggravation of acne because the studies didn’t last long enough. (Hoehn 1980) A final critique of these studies is just the difficulty in finding the actual reports that came with each study. It is easy to find summaries of their findings, but I could not locate a copy of the actual primary source document reporting the findings of the study done at the Naval Academy in Maryland.
Can Chocolate actually be Good for Our Skin?
After reviewing the scientific literature and data that is available today, it is easy to say with confidence that the idea that “chocolate will make you break out” is truly just a popular myth that has no scientific evidence. Ironically there are now products coming on to the market that are taking that exact opposite approach than those of our predecessors. Companies like Sensation Chocolat Pari and Borbora Chocolate Bar are just a couple of the many cosmetic companies now producing chocolate based skin products. The products are said to be effective in the prevention of wrinkles because cocoa might actually prevent damage by free radicals to collage, elastin and other proteins in the skin because of its antioxidants. Consumers rave about the “healing” properties of these products and the ability of the cocoa to soften and lubricate the skin. Of course medical science has yet to either prove or disprove the claims of cocoa in these products.
Interested in learning more? Check out these websites!
Sensation Chocolat Pari
A major challenge and problem in the treatment of acne today is the poor dissemination of information concerning the availability and effectiveness of treatment. Individuals should be informed of facts about the disease and realize that it is indeed a medical condition that needs to be treated. Acne has important social and economic consequences for individuals and better knowledge about the nature of the disease and its treatment could and would greatly benefit the community. (Marks 1985)
Cahn, Milton M. (1960). The Skin from Infancy to Old Age. The American Journal of
Nursing, 60, 993-996.
Ereaux, L.P. (1938). Facts, Fads and Fancies in the Treatment of Acne Vulgaris. The
Canadian Medical Association Journal, 257-261.
Fulton, James E. (2002). Acne: Its Causes and Treatments. Int J Cosm Surg Aesth Derm,
Fulton JE Jr, Plewig G, Kligman AM (1969). Effect of chocolate on acne vulgaris.
Journal of the American Medical Association 210, 2071-2074.
Green & Sinclair. (2001). Australian Journal of Dermatology, 42, 98-101.
Hoehn, Gustave H. (1980). Acne and Teenager’s Diets. The Western Journal of
Medicine, 132, 3-4.
Marks, R. (1985). Acne-Social Impact and Health Education. Journal of the Royal
Society of Medicine Supplement, 78, 21-24.
Meyrick, R LI. (1985). The Management of Acne in General Practice. General
Practitioner, 78, 7-9.
Preston, Lydia. (2004). Breaking Out: A Woman’s Guide to Coping with Acne at Any
Age. New York: Simon and Schuster.
Truswell, A Steward. (1985). ABC of Nutrion: Children and Adolescents. British
Medical Journal, 291, 397-399.
Yudkin, John. (1967). Sugar Consumption in Acne Vulgaris and Seborrhoeic Dermatitis.
British Medical Journal, 3, 153-155.
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