Carbs Vs. Fat For Hormonal Acne

Carbs Vs. Fat For Hormonal Acne

The net is full of misinformation about hormonal acne, everything from useless supplements to dubious cleanses. However, science consistently shows that dietary changes can significantly reduce the hormones known to cause acne. Proper dietary changes, that it. One choice that can make a real difference is whether you fill your plate with carbohydrates or fat. In this post I’ll explain how the ratio of carbohydrates to fat in your diet affects hormone levels, and give you simple and easy to follow recommendations.

Carbohydrates vs. fat studies

A very recent paper published in the journal Clinical Endocrinology put women with PCOS on two dietary regimens. The hormonal profile of PCOS is quite similar to that of female adult acne, so it’s a good proxy group to use (many more diet studies are done with PCOS than with acne patients). Here’s the macronutrient composition for the two diet groups.

Standard diet:

  • 55% carbs
  • 27% fat
  • 18% protein

Reduced carb diet:

  • 41% carbs
  • 40% fat
  • 19% protein

The study was so-called crossover design, meaning that the participants started first with one diet and later on switched to the other diet (with a washout period between the two diets). There was no difference in the overall caloric intake between the diets. These graphs show the change in relevant measurements for both groups: The effect of the two dietary regiments to acne-relevant hormones Source: Favourable metabolic effects of a eucaloric lower-carbohydrate diet in women with PCOS.

STD refers to standard diet and lower-CHO refers to the reduced carbohydrate diet group. The stars refer to levels of statistical significance between the two groups, the more stars the higher the statistical significance level. As you can see, moderately reducing carbohydrate intake improved all the acne-relevant hormones. The most notable changes were (I calculated these from the data in the paper):

  • 25% reduction in testosterone in the lower-CHO group vs. 1% increase in the STD group.
  • 23% increase in the 1st phase insulin response (PhiD) in the lower-CHO group vs. 2% increase in the STD group. Poor 1st phase insulin response is one of the first signs of blood sugar problems. As a result of poor 1st phase response post-meal blood sugar levels increase too high and overtime this can cause further insulin resistance damage to pancreas.
  • 26% lower fasting insulin in the lower-CHO group vs. 22% decrease in the STD group.

In a nutshell, reducing carbohydrate intake reduced the levels of many hormones known to affect acne.

One caveat about the study. The lower-CHO group not only ate less carbohydrates, but the glycemic index of those carbohydrates vas also little bit lower (average GI 50 vs. 60). I’m sure this reduction in GI was partly responsible for the beneficial effects in the lower-CHO group. This is of course just one study, and we should never hang our hats on a single study. But I featured this study because I feel it’s fairly representative of the evidence-base as a whole, as a recent systematic review of dietary composition studies for PCOS shows:

There were subtle differences between diets, with greater weight loss for a monounsaturated fat-enriched diet; improved menstrual regularity for low-glycemic index diet; increased free androgen index for a high-carbohydrate diet [bad for acne]; greater reductions in insulin resistance, fibrinogen, total, and high-density lipoprotein cholesterol for a low-carbohydrate or low-glycemic index diet; improved quality of life for a low-glycemic index diet; and improved depression and self-esteem for a high protein diet.

Dietary composition in the treatment of polycystic ovary syndrome: a systematic review to inform evidence-based guidelines

Another systemic review of fat vs. carbohydrates in insulin resistance concludes:

There has been much debate over whether the recent increase in obesity and obesity-related disease is relevant to the current advice that has favored high-carbohydrate diets. The pendulum is now swinging in favor of fat as reflected by current dietary guidelines, in many ways driven by the allure of olive oil and the health attributes of the Mediterranean diet.  Nevertheless, as more emphasis is placed on the nature of the carbohydrates in the diet, its fiber content and glycemic index, the case for certain types of carbohydrates again becomes more compelling.

Fat versus carbohydrate in insulin resistance, obesity, diabetes and cardiovascular disease.

Systemic reviews are papers that look at all the published studies on a given topic and try to derive a conclusion based on looking at all the available evidence. A well-conducted systemic review is considered to be the most compelling form of scientific evidence.

Food quality over macronutrient composition

If that last quote didn’t ring to you as an unconditional endorsement of fat over carbohydrates, well, that’s because it isn’t. While both of these papers mentioned that replacing a portion of carbohydrates with fat usually reduced insulin and androgen levels, both also mention that food quality is far more important than macronutrient composition. So your first order of priority should be to:

  • Replace bad carbs (i.e. high glycemic index, low fiber) with good carbs (low GI, high fiber)
  • Replace bad fats (i.e. trans fats, processed fats and possibly animal-derived saturated fats) with good fats (MUFA and plant-derived, unprocessed fats)

People with insulin resistance or other blood sugar problems, probably also benefit from moderate carbohydrate restriction as it reduces insulin load in your body. However, reducing carbohydrates too much can also cause problems. There’s some degree of competitive inhibition between fat and glucose (sugar) utilization. When your body burns fat it reduces burning of glucose and vice versa. This means that if you reduce carb intake too much, you train your body to burn more fat. So the next time you eat carbohydrates your body “doesn’t know what to do with them”, resulting in abnormally high blood sugar and insulin levels.

It therefore appears that an adequate intake of carbohydrate is required for normal glucose tolerance

Fat versus carbohydrate in insulin resistance, obesity, diabetes and cardiovascular disease.

Why fat reduces hormonal acne better than carbohydrates

Other studies shed some light on why fat reduces hormonal acne more than carbohydrates. Studies show that testosterone levels drop shortly after a meal, but also that meal composition affects post-prandial (post-meal) testosterone level as follows:

  • High-fat meals suppress testosterone (T) levels longer than high-carb meals
  • Eating animal fats results in less suppression of T than plant fats, i.e. T levels are higher following a meal of animal fat than a meal of plant-based fats

There’s also the fact that eating fat doesn’t cause an increase in insulin or blood sugar levels. Insulin level is especially important as insulin can stimulate the liver to release androgen hormones (DHEAS, a precursor to T and other androgens) and make your skin more sensitive to androgens.

Take-away and recommendations

Science shows that replacing some carbohydrates with fat can reduces hormones known to cause acne. In women with PCOS moderately restricting carbohydrates resulted in significant reductions in testosterone and insulin levels. That said, food quality triumphs over macronutrient composition, and simply improving the quality of the carbohydrates and fats in your diet affects your hormone levels more than tweaking carbs:fat ratio. Here are some simple science-based recommendations:

  • Replace high GI carbs with low GI and fiber-rich carbohydrates (assuming fiber doesn’t cause gut problems for you).
  • Get rid of trans-fats and other processed fats from your diet. Emphasize unprocessed fats mostly from plant sources (MUFAs in olive oils and nuts and seeds). Data on animal fats is still somewhat unclear; there’s no need to overtly restrict animal fats, but I also wouldn’t gobble them as health food.
  • People with insulin resistance can also benefit from moderately restricting carbohydrates, perhaps to 40 to 45% of total caloric intake with fat bringing in another 40% of your calories. Restricting carbohydrates too much can also cause insulin resistance and cause problems if/when you eat them.

About Me

Hi, I am Acne Einstein(a.k.a. Seppo Puusa). I'm a bit of a science nerd who is also passionate about health. I enjoy digging through medical journals for acne treatment gems I can share here. You can read more about my journey through acne and how I eventually ended up creating this.

60 thoughts on “Carbs Vs. Fat For Hormonal Acne”

  1. I have discovered that eating pork every day does not cause me to break out or gain weight. I don’t think meat is bad. I actually feel bad when I go too many days without meat (and I don’t really like chicken although eat it sometimes) and there’s no way my stomach is full and hunger relieved if I don’t eat meat – since I can’t eat gluten I just need something to fill me up. Legumes also help but they may be too ‘noisy’ if you know what I mean.
    So yes, fats are not bad.

    • I also don’t think meat is bad for the skin. Data is still little conflicting on saturated fats, but that doesn’t mean we should avoid meat.

  2. Did you ever hear of the supplement called estroblock? I was told that it is the miracle cure for hormonal adult acne. I have two bottles coming in the mail this week. I will keep you updated because if this cures my acne after ten years, I’m telling the whole world. I’ve been on numerous diets from straight raw food ism to paleo type diets. Nothing works, food isn’t always the culprit.

    • Agree with you that diet is not always the be-all-end-all solution to acne. Most people can reduce acne with diet, but I wouldn’t say that most people can get completely clear with diet.

      Somebody asked me a few days back about EstroBlock. It’s a DIM/I3C supplement and may be somewhat helpful in improving estrogen balance in the body. It also may inhibit mTor (master regulator protein that regulates all aspects that cause acne). But all of the data is very preliminary, basically test tube studies. A few studies are testing DIM against some cancers.

      DIM/EstroBlock may work for hormonal acne, but I would be MASSIVELY surprised if it turned out to be a miracle cure. I will write about DIM and EstroBlock more in the future.

      Anyway, it would be nice if you would keep up posted about your progress.

  3. I have an interesting problem somewhat related to Carbs, Fats, and Acne. I am underweight and have been for many, many years and don’t seem to gain weight at all. My doctor says I could use some extra calories and could use maybe 15 lbs. more but I am healthy. Here’s my problem. I’ve been told that to gain some more weight I should eat a lot more carbs and pasta. If I end up doing that to gain weight I am afraid I could trigger an insulin rush and stimulate androgen hormones and trigger my acne. I don’t know for a fact that I will gain the desired weight but at the cost of more acne or not but I have never heard of anyone else with this problem. Most people desire to be thin but I’m too thin and also have a skin problem. Just thought I’d throw that out there because I seem to be between a rock and a hard place.

    • Robert, I’ve actually heard from many acne patients who complain that they are too thin. It’s a bit of a paradox since insulin resistance and excess androgen levels are usually linked to being overweight. I’ve heard the same thing from many, many people with acne. Too thin and difficult to gain weight. I can’t say I know exactly what the issue is, but I suspect there’s something hormonal going on.

      Do you often feel hot? One possibility I could think of is overactive thyroid. That would speed up your metabolism and there are one or two studies that link overactive thyroid to excessive sebum production.

      To gain weight, you need more calories – not necessarily more carbohydrates. So eating more protein and fat should also work. Though I’m not an expert in weight management, so it’s possible I’m wrong about this.

      • Interesting anecdote – I am also quite thin and have had trouble gaining weight despite various diets that are fairly high in calories. This has been the case on any diet where the majority of my carbohydrates come from fast absorbing sources (I follow the SCD for non-acne health issues and thus generally avoid grains). I have found that I only gain weight when I eat grains, although calorie for calorie and carb for carb my intake is similar to the non-gain diets. My thyroid levels are not too high. Has there been any incremental evidence or evolution in your views over the last year? Thanks Seppo.

        • Has there been evolution in my views regarding what? Grains? Carb/fat ratio? In both cases I’d say no. I still think it makes sense to restrict carbs and focus more on fat. Given what we know about interactions between hormones and acne, this seems like the most sensible recommendation. Of course, there may be people who, for whatever reason, do better when eating more carbs.

          I think grains can be problematic for some people, but probably not for everybody.

  4. Thanks, Seppo. Yes, I think you are correct in saying one needs more Calories, not necessarily more carbs. My doctor actually said Calories and not carbs. I mentioned carbs because plenty of people I know – not doctors – say to eat pasta, etc. to gain weight. One thing I don’t do is eat much meat, except I do eat plenty of chicken. I also don’t consume many fats at all. This could be a big factor why I’m underweight but my reasoning was to avoid acne thinking that eating less of these things would help. I don’t know this for a fact. I think I may up my calories and just see what happens.

    • There’s a lot of misinformation about acne online. Just spend some time online and you’ll quickly ‘discover’ how almost every food causes acne. I think this is one of the reasons many people with acne have borderline eating disorder and severely restrict their diet.

      Of course some foods can cause acne, but that confirmed list is fairly short. Everything else is just unreliable hearsay. So I wouldn’t worry too much.

      Eating too little can also cause problems. Constant semi-starvation, as far as I know, can also mess up your hormone levels. I don’t know your situation, so take this for what it’s worth. In your situation I would try to eat more fat and less carbohydrates. Don’t go low carb, but maybe 40/40/20 (carbs/fat/protein), as % of calories. Balancing fat and carbohydrate intake seems to be helpful in hormonal issues behind acne.

      And please treat those percentages as guidelines rather than strict rules. You don’t have to measure and monitor every bite you eat. Those guidelines are there so you know roughly where to aim for.

  5. “Emphasize unprocessed fats mostly from plant sources (MUFAs in olive oils and nuts and seeds). Data on animal fats is still somewhat unclear; there’s no need to overtly restrict animal fats, but I also wouldn’t gobble them as health food.”

    High fat diet with fat coming mostly from plant sources is going to be high in omega 6, wouldn’t you end up with poor omega3 omega6 ratio and promote inflammation instead as a result? what’s your take on this?

    • High-fat diet even from animal sources will be high in omega-6. High-fat diet based on animal foods will have less omega-6 but there’s no avoiding them. And there are high-fat plant foods that aren’t so high in omega-6. Olive oil for example has far more saturated fats and MUFAs than PUFAs. Coconut and coconut products are another good option.

      I’m not convinced omega-6 fats are the evil they are portrayed to be. I haven’t looked into this in detail, I admit, but I haven’t seen any good quality data to show one should really avoid omega-6 fats and PUFAs. When I looked into fats and insulin resistance most studies showed that replacing SFAs (saturated fats) with PUFAs and MUFAs improved insulin resistance.

      There’s more of a case to be made for balancing omega-3:6 ratio than avoiding omega-6 fats and the data on omega-3:6 ratio is far from conclusive. Some studies show diseases are less prevalent in people with balanced ratio, but you can’t conclude from those that eating more omega-3 and less omega-6 will reduce your risk of disease. It might, but there are other possible explanations for the observed correlation.

      My point is not to worry too much about omega-6 fats. Rather eat a balanced diet with both animal and plant foods. I’m by no means advocating avoidance of animal foods, I’m just not convinced beef and pork are the health foods paleo circles portray them to be.

  6. Basically I’m wondering is it really a good idea to add olive oil and increase nuts to reduce acne? Seems kind of counter intuitive. 🙂

    • Olive oil and walnuts sounds like a Mediterranean-style diet to me. Most studies would suggest it’s one of the healthiest mainstream diets out there.

  7. Olive oil and walnuts may be very healthy for most individuals but I think for anyone with a skin problem like acne it would be feeding fuel to the fire in my opinion and from what I have read regarding acne. These foods I think probably are beneficial to the skin of “normal” people but are risky for acne-prone skin.

    • Can you tell me how they would be like feeding fuel to fire? Sebum production has nothing to do with dietary fat. If olive oil and walnuts would be inflammatory then I could agree, but I don’t think they are.

  8. Wanted to ask you, what is your way to add more fat into your diet? I’ve realised that I focus on waaay too much protein and carbs but not so much fat! How do I increase it? I use coconut oil for cooking so that’s one… Anything else?

    • Here’s what I do. I usually make my own bread based on this recipe: But I use less almond flour and more coconut and flaxseeds. I use 1/2 almond flour, 1 cup shredded coconut and 1 cup ground flaxseeds. And I use omega-3 eggs.

      In the morning I’ll eat an omelet with 3 eggs, 1/2 can of tuna, little bit fruit and my own bread. If I’m hungry I might add an avocado to that, and occasionally I’ll fry some veggies to go with scrambled eggs.

      I also make soups and smoothies with coconut milk. Steamed pumpkin blended with coconut milk and some spices creates a nice soup. Occasionally I make green smoothies with coconut milk (2 bananas, 1 cup coconut milk, greens and frozen strawberries).

      If you need more ideas, please search for paleo or low-carb recipes.

  9. Hi seppo! Just wanna clarify something regarding taking apple cider vinegar before eating any carbohydrates. Since we asian cannot live without white rice. And i think it is high in carbo. Is it true that apple cider vinegar helps lowering blood sugar level thus contributing to lower insulin firing into the body to help prevent more sebum.

    • Yes, it’s true that vinegar can reduce blood sugar and insulin levels after carbohydrate meals. You don’t need to use apple cider vinegar for this, it happens with every vinegar.

  10. In the book you say: “Saturated fats, transfats and high GI carbohydrates generate the worst inflammatory responses, whereas healthy fats and low GI carbohydrates generate much smaller inflammatory responses.” — What about things like grass-fed beef and lamb, organic liver, egg yolks, coconut oil, red palm oil, etc…? These are all highly recommended on the Perfect Health Diet.

    • In retrospect, I probably should have left out lot of the nutrition-related stuff from the book. The thing is that even if saturated fats do increase post-prandial inflammatory response, it probably has little to no relevance on acne.

      For the record, I have nothing against saturated fats and eat quite a bit of them myself. For the vast majority of people, they probably have no effect on acne – in the context of whole food based, healthy diet.

  11. Wow, I just read this on page 145:

    “Several studies have found no effect from soy protein, but soy nuts, because of their relatively high polyunsaturated (PUFA) fat content can reduce inflammation.”

    Since when can high PUFA content reduce inflammation, especially n-6 PUFA?

    • I don’t remember now the context of that quote. If you look at post-prandial inflammation PUFAs are indeed anti-inflammatory and SFAs are inflammatory. Still, I’m not sure how relevant post-prandial inflammatory response is to the overall inflammation levels.

      I know paleo proponents like to say PUFAs are dangerous because they oxidize so easily. That implication is that eating a lot of PUFAs is inflammatory. Theoretically that’s true, PUFAs are highly reactive and oxidize without antioxidant protection, but I’ve never seen any good evidence to show eating more PUFAs would increase your risk of heart disease or other diseases linked to inflammation.

      In contrast, most of the reviews and meta-analyses I’ve read show PUFAs protect against cardiovascular disease. For example, here are a couple of interesting quotes from a 2010 systemic review of n-6 fatty acids and cardiovascular disease risk:

      From the conclusions:

      No adverse effect of n-6 PUFA intake on blood pressure, inflammatory markers or haemostatic parameters has been observed, even with intake up to 15 % of total energy.

      Finally, whatever the objective might be (i.e. to limit the risk of developing inflammatory or obesity diseases), recommending n-6 PUFA consumption below the current lowest values (i.e. 4 % of total energy in France) is not supported.

      And here’s from a section talking about inflammation.

      In human subjects, higher intakes of n-6 fatty acids do not appear to be associated with elevated levels of inflammatory markers. A study in a large US adult population reported that n-6 fatty acids did not inhibit the anti-inflammatory effects of n-3 fatty acids.

      In addition, combination of both types of fatty acids (higher percentile of EPA þ DHA intake of 1·12 % of energy among men and 0·471 % among women; a-linolenic acid ranging from 0·46 to 0·52 % and LA ranging from 4·3 to 5·4 %) was associated with the lowest levels of inflammation, assessed by C-reactive protein, IL 6 and soluble TNF receptors 1 and 2 plasma levels(59). In the In CHIANTI (Invecchiare in Chianti, ageing in the Chianti area) study, in the context of a mean PUFA intake of 7 g/d, higher plasma levels of n-6 PUFA (mainly AA) and n-3 PUFA (mainly DHA) were independently associated with lower levels of serum pro-inflammatory markers.

      Source: n-6 Fatty acids and cardiovascular health: a review of the evidence for dietary intake recommendations.

      That said, another paper about fatty acids and CVD makes the point that if you look at studies that increase just the amount of n-6 fats, there’s evidence that n-6 fats may increase CVD disease and mortality.

      To answer your question, outside of paleo and saturated fat loving circles, PUFAs have been always considered anti-inflammatory. I don’t claim to be an expert on this, and perhaps in the end someone shows me I’m wrong, but I have yet to see good evidence to show eating PUFAs from whole foods would be dangerous.

      • Yeah I’ve never heard of anyone in the Ancestral Health community recommending PUFAs.

        “These polyunsaturated fatty acids
        (PUFAs) may be likened to ‘double-edged swords’: on one
        hand they are considered essential for membrane function
        and eicosanoid formation necessary for vascular, immune
        and inflammatory cell function, while on the other they lead
        to increased susceptibility to lipid oxidation, stimulating
        neoplastic cell growth in culture and impairing insulin

        • Yes, that’s what I eluded at the end of my earlier comment when I mentioned that studies that increase only n-6 fats show slight increase in CVD risk and mortality. That said, there are only a few of those studies, and knowing how unreliable dietary studies can be, it’s by no means a given conclusion.

          But let’s say we take the conclusion at face value. The post at the PaleoGuy blog referred to a 2010 study that on the face value showed that increasing n-6 fats without increasing n-3 fats increases CVD risk and mortality. However, the increase in risk was only 13%. Nothing to snuff at but certainly not the certain death sentence the ancestral health community makes n-6 fats out to be. I mean, if PUFAs, and n-6 in particular, would be sooo bad, then why we see only 13% increase in risk?

          Furthermore, the conclusions of that meta-analysis have been called into questions (, so it’s not at all clear that the conclusions are valid.

          Yes, I agree that PUFAs are more susceptible to lipid oxidation. This has been shown many time in test tube studies, and the paleo proponents are very eager to show you these studies. The problem is that those studies don’t tell anything what happens inside of a living human. In the body there are compensatory mechanisms that protect PUFAs, and, it seems to me, these make irrelevant the fact that PUFAs oxidize easily.

          The other paper you linked to, and PaleoGuy fondly refers to, doesn’t actually give any compelling human data to support the idea that PUFAs, or even n-6 fats, would be dangerous. The paper talks a lot about various proxy measures but doesn’t give any compelling human data that would link increased PUFA intake into increase in human disease risk.

          People in the paleo and natural health often criticize mainstream doctors for prescribing statins to lower cholesterol, arguing that cholesterol doesn’t lead to heart disease. It’s the same thing here. As far as I can tell, the whole case against PUFAs rests on test tube studies and proxy measures (like cholesterol). In contrast, there’s a lot of data to show increasing PUFA intake (especially mixed n-3 and n-6) reduces the risk of many diseases. Again, if PUFAs were so dangerous, then why there’s consistent evidence from studies they reduce risk?

          Just so we are clear. I don’t actually advocate people to go and eat large quantities of n-6 fats or vegetable oils. My point is that I just don’t see any compelling reason to avoid whole foods that have a lot of n-6 fats (like nuts and seeds) just because they are rich in n-6 fats, especially since most of them also contain n-3 fats.

  12. Maybe part of the problem is that many studies replace SFAs and TFAs with n-6 and n-3 PUFA and find benefits. Certainly replacing trans fats with omega 3 will produce many benefits. If they compared SFAs from coconut oil with n-6 PUFAs from canola oil I think there would be no contest.

    • Yes, that’s certainly part of the reason. Dietary studies to get to the bottom of this are notoriously difficult to conduct – it’s hard to get people to stick to a highly artificial diet for a long time.

      The person who asked the question at PaleoHacks put it well. Paleo proponents argue very strongly against PUFAs, claiming they are dangerous, yet the evidence to support that statement is remarkably weak – or doesn’t even exist.

      My personal view is that it probably doesn’t matter that much what kind of what you eat, especially when it comes to acne. Assuming of course that we are talking about a diet that’s mainly based on whole foods.

  13. What would you recommend to people who have gut problems and can’t eat fiber-rich foods?

    • If people have gut problems, they most likely can still tolerate some types of fruits, veggies and fibre-rich foods. So you would have to figure out what you can and cannot tolerate, and in what quantities. Other than that, plenty of fat and protein rich foods out there.

      • In my experience, eating fat alongside something with high Gi like White Rice hasn’t done any difference than eating Brown rice alone. I guess it is true that adding fat to foods like potatoes or white rice, lowers their GI.

        • I don’t thing this question is fully settled yet. I’ve seen some research that shows eating fat with high GI carbs reduces the overall meal GI and some research that shows no effect.

          • At this point, there’s enough evidence to prove ( at least for me) that it has some effect, I mean it would explain why certain foods have a lower GI in mixed meals than being eaten alone. But who knows, you said it yourself. Science is messy, at this point I haven’t detected a difference between eating brown rice or white rice. At this point my skin’s at its peak and I eat white rice daily. So there you go.

  14. Wait the fact that the percentage for fat were higher than protein.. Does that mean that they ate more fat than protein? ..

    • The percentage of fat or carbs is almost always higher than % of protein. If you stick to eating whole foods it’s almost impossible to eat more protein than carbs or fat.

      • Really? Because I’ve been following a protocol made by a bodybuilder where I eat

        320 grams of Carbs
        160 grams of Protein
        57 grams of Fat

        and uh.. Well clearly I eat more Carbs than protein but I can’t imagine I would eat more fat than protein though.

        • Well, yes, if you build your diet from lean chicken breast, tuna and egg whites it’s possible to eat more protein than fat, but as a general rule most protein-rich foods contain more fat than protein.

          • Hmm.. I’ve actually been thinking about it lately, and I do want to try this out. Berberine actually gave me a weird reaction as I broke out in about 5 pimples or so after I started taking it. I’m not sure what it caused but I do want to focus on the hormonal side of acne to see if it’ll do something.

            Anyways I wrote early the amount of grams per macronutrients I eat. I’m a bit unsure how much I would have to reduce carbs in favor of fat really.. Can you help maybe?

          • You can find plenty of low and moderate carb recipes online. If I were you, I would find a few that look interesting and then replace some meals where you eat more carbs with some low/medium-carb meal.

  15. I have seen a video of two girls called “nina and randa” and they got clear by following a extreme low far diet and i have heard of manypeople that it will help so i got intressted in the while thing. Isnt it true that insulin resistance can be reversed by low fat high fiber diet?
    I have ordered today the book “the clear skin diet” hipe that this bring me a way out about all the conflicting info information..
    Have u heard about that book and if yes what do you think about it?

    • It means nothing when someone says they have gotten clear by doing X and Y. Let me give you an example to illustrate my point. My acne is linked to gut issues and I get breakouts when I eat onions and certain other foods that irritate my gut. That being the case I could probably eat nothing but Twinkies and get clear skin. Does this mean Twinkies are good for acne? Or that other people should start eating more Twinkies to get rid of acne?

      Of course not. Truth is that we don’t know the reason these 2 girls got acne. Perhaps it’s hormones or perhaps it’s something else. Perhaps, by switching to a low fat diet, they also eliminated some dietary irritants that caused their skin problems.

      Yes, it’s true that some people can reverse insulin resistance by going on a low fat, high fiber diet. The key would be to focus on eating low glycemic index carbohydrates.

      That said, when you look at things on population level; i.e. what happens on average when a large number of people try low fat or low carb diets. As I explained in this post, studies show that eating more fat is a better way to stabilize blood sugar levels than eating more carbs and less fat.

      That said, the macronutrient ratio is not that important. Both low-fat and reduced carb diets can work when you avoid ‘bad foods’ (sugar and high GI carbs, unhealthy fats). I do think that reducing carbohydrates to about 30% of total calories is much easier than going on a low-fat diet, and studies show it seems to work somewhat better. That’s why I recommend moderating carbohydrates and eating more fat.

  16. Hello!
    Great article- I have PCOS and acne is an issue. My diet is as clean as a whistle but I still suffer from acne. I avoid carbs and stick to vegetables. However, after reading this article, perhaps my problem IS that I avoid all carbs. That being said, what are your macronutrient ratios you’d advise if someone would like to include more protein? (I bodybuild);usually taking in around 35% or so of protein. If I were to raise carbs to around to 40%, is it ok to add more protein versus having 40% fat?
    Is higher protein advisable for pcos and acne?

    • I don’t think macros matter that much. I recommend people eating fewer carbs and more fat and protein because the average diet in Western countries is quite high in carbs. And there’s some research to show moderating carb intake works better than lowering fat. That said, as long as you eat healthy foods and avoid sugar, tweaking your macro ratios doesn’t mater that much.

      From everything I’ve read, I would say that the best diet for acne and PCOS follows these guidelines:

      – Relatively high in fat
      – Moderate amount of carbs and protein. If you need more protein for athletic reasons, I would substitute carbs for protein. Both protein and carbs are somewhat acnegenic.
      – Eat most of your calories early in the day and stick to a light dinner
      – Cook foods in low temperatures to avoid creating dietary AGEs

      In your case, it’s probably a good idea to eat most carbs in the morning and before/after exercise.

  17. The relationship diet( plus a bonus )- acne with me goes like this :
    1) If I eat sugary stuff often, in small or big ammounts, within 4 days I get acne, on my eyebrows.If I eat a ton, but just up to 1-2 times in a row, the acne is just small, hard to notice bumps. After working out, then eating all that, nothing happens. Conclusion came from milk chocolate, snickers bars,nutella,table sugar. ( So it might be the milk ? Or the chocolate ? Or a combination ? )
    2) If I eat keto style for a week, especially after eating lots of saturated fat ( like pork cooked in butter, bacon, fatty cheeses etc ) I can feel my face after meals smell like butter/cheese. Soon I get acne high on my cheeks. Never went ketodiet more than a week, so I don’t know what happens after that.
    3) If I masturbate,especially if I climax ( yeah cmon, no shame ) I get acne around/on my nose or on left eyebrow.
    Low GI starchy carbs,wheat etc cause flatulence, I take it as a sign they dont work well with me. So, I cant eat many ( saturated ) fats. I cant eat many sugar/low GI carbs often.
    Just throwing some info/experience out there, maybe people have similar stories. In this case, I think a slightly low fat, high carb, moderate-high protein diet with the above foods 80% of the time excluded,would work well for people, especially when paired with often weight training.
    Just my two cents, please keep this up Seppo !

    • Thanks for sharing your experience, Joseph!

      Fats should usually be fairly safe for the skin. If you get acne after eating bacon, etc. I would suggest trying to cook them in low temperatures. Cooking in high temperatures creates advanced glycation end products (AGEs), which could be harmful to the skin. This is by far not proven, but I think it’s worth testing.

      You might also have some gut issues’ going by what you said about flatulence. They could also affect your skin. I know they are the main reason I get skin problems.

      • Hey Seppo, thanks for the reply and forgive me for the long posts.
        1) About cooking in high temperatures,are the tiny amount of sugars in the meat really enough to glycate the fat in the meat so much that it can cause inflammation ? In any case, its worth testing like you say.
        2) ”Fats should be safe for the skin”. All fats ? I cant certainly say saturated fats suck, but in my experience they did. During the next weeks I’ll be eating more Mono-USFs and less SFs. Will test.
        2 ) About the gut issue thing. I can most certanly say I have been a chronic constipation sufferer.From what I read, probiotcs should help ?
        -I just noticed the above comment by Kaya. Having to face both acne and bodybuilding-theme needs is a trouble indeed.

        • 1) I don’t know how or why AGEs form in meat during cooking, but it’s an established fact that they do. Dry, high-heat cooking can increase AGE content in meats and fatty foods by 10 times. See the table 1 in this paper for AGE content of 500 something foods:

          2) Aside from trans fats and other processed oils, in general yes, fats are quite safe for the skin. They don’t trigger any cascading hormonal reactions that would mess the skin. Both carbs and proteins trigger signaling chains increase sebum production and skin cell growth, carbs more than proteins. That said, I’ve heard occasional reports that fats cause problems for some people. Aside from AGEs, it’s hard to say why some people react badly to fats.

          3) This is a bit tricky as it depends on what causes your constipation. SIBO (small intestine bacterial overgrowth) sometimes involves probiotic bacteria, and in such cases taking probiotics actually makes things worse. Any time I’ve taken probiotics they’ve made a mess of my gut, caused constipation and made acne worse. I had to take herbal antimicrobials (olive leaf extract, etc.) and supplements that heal the gut lining (butyrate and turmeric) to fix my gut. It’s still not 100% but I no longer get any constipation and skin is doing better.

          That said, there are also cases where they could help. I wish I could give you a simple answer but these issues are often anything but simple.

          4) BB can indeed hinder your efforts to get over acne, but it really depends on the type of acne you have. My acne is linked to gut issues and I can take whey protein and go to gym as much as I want without any skin issues. But if you have hormonal-type acne then lifting and taking protein could indeed cause problems.

          • Alright, I see. I guess, with the limited info we have, experimentation/trial and error is probably the simplest way to go about setting this mess right. Thanks for the answers Seppo !

  18. I think the problem with this study (just flipped through it) is that both groups were fed a high fat diet. Sugar is not the culprit, the fat is. Take out fat of a diet and high carb diet will not cause any acne. That is because it seems like fat is causing insulin resistance… the combo of carbs and fats cause acne. Now most people fall really sick on those low carb high in animal products diet.. and eventually develop all kind of problems (been there done that). High carb diet work and the majority of the population on our Earth prove it. If you eat a high fat diet, than eliminate all sugars (carbs). If you want to eat your carbs (they are healthy for you!) then go easy on fats. Of course there are always people who are exception to the rule.

    They should do a study with high carb very very low fat diet and see how it goes.

    • This is simply not true. It’s common in the raw food movement, especially 80/10/10, to say fat causes insulin resistance. The problem is that it’s just not true. Not only is there no evidence for that, but there is evidence to show reducing carbs and eating more fat is better for insulin resistance.

      • Ah i am so fed up with all this BS the lowcarbpaleo argue that vegans do cherry pick and other way round vegans argue that you have to limit fat and thay all paleo people are obese and fat..
        I have read the books of campell graham dougall barnard and i ve read all the books eat fat loose fat,..
        I just dont get it ?!

        • Because diet is the new religion and everyone must ‘prove’ that their religion is the correct one. To be honest, macroratio doesn’t matter that much. There’s some data to show that reducing carbohydrates works better than reducing fat but we aren’t talking about massive effects. I do recommend that people moderate carbohydrates but I usually don’t make a big fuss about it – there are other, way more effective, dietary strategies available, such as not really giving a s**t and eating healthy to enjoy life.

          • I also read on the blog “sciencsbasedmedicine” i dont know if this site is legit that the study of neal barnard who wrote the book “reverse diabetes” is a really bad one and some people went off the diet.. and really all vegans link up to these people like mcdougall, caldwell esselstyn, neal barnard, t colin campell.. but on the other side.. really whats the profit of doing this studies which really can cause harm in my opinion? is it really “just” to save animals?

          • Science-Based Medicine is a good site. Written by people who understand both science and medicine. That said, they apply perhaps excessively high standards of evidence. So just because they point out flaws in some study and say more evidence is needed doesn’t mean the treatment in question wouldn’t work. It just means that more evidence is needed to know with certainty, but you can still experiment yourself (assuming the treatment in question is suitable for self-experimentation).

            really whats the profit of doing this studies which really can cause harm in my opinion? is it really “just” to save animals?

            My view? Because diets and health regimens are the new religion. People feel the need to say that their view is the one true view and they want to ‘prove’ it with sciene.

  19. Hey seppo what do you think about high frequency machines? I might buy one, a good spa grade high quality one to try it out. Normally I’d think things like this are just junk but actually this looks promising, if used often! I have moderate-severe hormonal acne that won’t budge. I figured this might help? Have you heard of it?

    • What high frequency machines you are talking about?

      EDIT, sorry your other comment went to the spam folder because of the link. I haven’t seen (or looked for) any research on such machines. The ‘how it works’ section on the site looked very dubious and as such I would be skeptical. There’s no need to ‘detoxify’ or ‘purify’ the skin, and introducing oxygen molecules to the skin is likely to cause more harm than help – as oxygen is a free radical that causes oxidative damage.

  20. Hi,

    You’re website is proving an interesting read – as ever:)

    Just one point on this article, my skin has always felt more closely correlated to fat intake instead of carbs – concentrated ‘healthy fats’ like ghee and, especially, coconut oil agreed with me in anything approaching low to moderate amounts. I’ve read that increased fat intake is associated with increased serum testosterone levels (see the linear relationships for saturated and monounsaturated fats here:

    Given this relationship, doesn’t it make sense that high fat (saturated and monounsaturated) could significantly exacerbate issues by upping testosterone and, in turn, DHT?

    • Hi Matt,

      Thanks for the great comment and link. I have not considered the effect dietary fat has on androgen levels. If such a link exists, then it could be that high-fat diets can aggravate acne. Though I’m a little skeptical of that because most anecdotes suggest that paleo-style, carb-limited diets clear acne better. But anecdotes are just that, anecdotes and not real data.

      I have to look into this.


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