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To the bone
To the Bone (2017)

Do anti-acne diets work or cause eating disorders?

Acne is often blamed on sugary diets and fast food, but for some this is the start of a harmful relationship with eating

If you’ve ever suffered from acne or even had a large, noticeable pimple, you’ll know it usually brings people out of the woodworks with recommendations of changes to your diet. Refined sugar and dairy products are often listed as the culprits, along with fast or refined food in general (something that is hard to avoid these days). Despite a collection of small studies suggesting that a low-glycemic diet may reduce acne, genetics more often factor into whether you’re prone to it, as well as hormones and a range of lifestyle factors. So why is the go-to response telling acne sufferers what to eat?

Jenny Adams, a graphic designer and illustrator based in North Carolina, says she developed cystic acne in her t-zone area when she hit puberty, many of which were extremely painful, lasted for months, and became infected. “My friends and family were telling me that it was the food I must be eating – I wasn’t given a meal plan, just anecdotal information that wasn’t based on really anything,” she says. Adams started by cutting out all fast food and, after doing that for a year, started to avoid chocolate, nuts, and sugar “like the plague”. “After eating not a single nut in almost five years, nothing on my face changed at all,” she says.

Adams’ restrictions, born as an attempt to get her acne under control, soon bled over into other areas of her life. Convinced she must be causing her acne, she stopped touching her face, never wore make-up, and changed her bedding fanatically, all to no avail. “I would wash my face twice a day every day and panic if I couldn’t do this. I’d also bring my face cloth and my acne soaps wherever I went,” she says. “Nothing I did to control my environment worked. Food would make me sick sometimes, I was too scared to go out in public, and from trying to control what I ate and drank, my weight was fluctuating.” Adams says she even quit her part-time job because of her skin troubles.

“Nothing I did to control my environment worked. Food would make me sick sometimes” – Jenny Adams

After spending a decade viewing food as “the enemy” and as a cause for her acne, in her thirties Adams looked into other options. After seeing a dermatologist, she started Accutane and an anti-androgen medication called Spironolactone to decrease the oil production from her skin. “My acne was from hormones and genetics – there was really nothing I could do to control it on my own with lotions, soaps, or food,” she says. “This wasn’t my fault.”

Adams’ story rings true for not just acne sufferers, but anyone dealing with issues out of their control under the lens of today’s toxic wellness industry. In fact, people that struggle with their weight are often at increased risk for cardiovascular and metabolic disease not because of the weight itself, but because of weight bias internalisation, studies show.

Licensed esthetician Lily Njoroge says that chronic skin conditions can often result in worsened mental health struggles. “The opposite has been found to be true as well, that depression and anxiety are linked to triggering chronic skin condition flare-ups,” she says. “I have anecdotal evidence of this with my own skin, when I’m extremely stressed, my eczema flares up around my neck like clockwork.”

Njoroge says that while people with food allergies or sensitivities may want to cut back on specific foods to avoid inflammatory responses that can also manifest as acne, the research for those without such sensitivities is still fairly inconclusive. “There hasn’t been a direct correlation between diet and acne [for those without allergies],” she says. In other words, what works for one person won’t necessarily work for another – as with many aspects of health.

“There can be no such thing as acne positivity until we stop viewing acne as a personal or moral failure.”

Under wellness, the tendency to frame issues like weight gain or acne as personal failure is not only misguided, but can fuel eating disorders like orthorexia nervosa (which involves an unhealthy obsession with healthy eating). In what can become a vicious cycle, Njoroge says the negative mental health impacts of this condition can then exacerbate the very skin conditions that fueled the disorder. “We need to stop fear-mongering,” says Nervosa. “We need to stop encouraging people to change their diet without the guidance of a nutrition professional.”

The paradox of (so-called) wellness mentality is that in an attempt to treat an issue society deems as unsavory, many are shamed into disorders that cause more health issues than the concern they started with. While acne is a real issue that impacts an estimated ​​9.4 per cent of the global population, causing pain, discomfort, and self-esteem issues, eating disorders also impact 9 per cent of the US population. The results can be life-threatening.

As a general rule, telling someone what to eat without the advice of a professional should be a no-go, and any acne or weight gain should not be assumed permission to do so. However, stopping this cycle will involve rethinking acne itself. While the “acne positive” movement made some headway in 2018, the condition of acceptance still seems to be fitting into white, thin, able-bodied beauty standards. With that in mind, there can be no such thing as “acne positivity” until we stop viewing acne – and other health issues the wellness industry demonises – as a personal or moral failure and view it for what it is: just a part of the hormonal and genetic lottery.