Acne vulgaris is a common disease amongst adolescents in Western societies. It is an interesting problem because, while it is very common among this particular population, it is very rare in non-Westernized societies. This observation has lead to recent exploration of what factors in Western society may, at least in part, be responsible for this. Recently there have been several epidemiological studies linking certain foods to acne. Of the foods showing a positive correlation, high glycemic load foods have been the most extensively studied. There have been a number of studies examining the possible mechanism of this. To date, there have been no systematic reviews done reviewing the available RCTs on the effect of low glycemic load (LGL) diets on acne in adolescents and young adults.
An exhaustive search of the available medical literature was conducted using Medline-OVID, CINAHL, and Web of Science using the MeSH terms: acne vulgaris, dietary carbohydrates, and glycemic index. Relevant studies were assessed for quality using GRADE.
Three studies met the inclusion criteria and were included in this systematic review. One randomized controlled trial found statistically significant improvement in objective measures of acne as well as BMI and insulin resistance with a 12 week trial of a LGL diet. Another randomized controlled trial of 8 weeks in duration failed to find a statistically significant difference in weight, insulin resistance, and objective measures of acne improvement. The final randomized controlled trial, which lasted 10 weeks, found statistically significant improvement in objective measures of acne but not until 10 weeks (significant improvement seen in inflammatory lesions alone at 5 weeks). This study also found a positive correlation between the level of glycemic load reduction and improved acne severity. In addition this final study found no significant change in BMI.
LGL diets, especially those that replace high glycemic carbohydrates with foods high in fiber and protein, may improve acne vulgaris in adolescent and young adult males. This improvement is likely to be seen in females however the studies examined were in themselves underpowered to make this conclusion. There appears to be a dose response both to time and amount of glycemic load reduction with the greatest improvement in acne occurring in patients who followed a diet which induced at least a 13-point reduction in glycemic load from the control diet and those that completed therapy for at least 10 weeks. It can also be concluded that the greatest effect of this therapy is seen in the reduction of inflammatory lesions as compared to non-inflammatory and total lesion counts.
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