Many women deal with hormonal acne caused by changes in the body's hormonal balance. While common, I know it can be incredibly frustrating and impact your self-esteem and confidence.
There are many treatments for acne, but I've found that a few diet changes can significantly improve symptoms. The food we eat directly impacts our hormones, including those that trigger acne.
In this article, I'll share exactly why hormones can exacerbate acne, how it's connected to our food, and what dietary changes you can make to support clear skin.
What Women Should Know About Hormonal Acne
According to the latest dermatology research, using the term “hormonal acne” to refer to acne in adult women is a misnomer. It's not that your acne isn't caused by hormones — rather, all acne is inherently hormonal!
From acne that occurs during puberty to adult premenstrual acne, all acne patients are sensitive to hormones. In fact, one study also found that women over age 20 are significantly more likely to deal with acne compared to men. The reason? You guessed it — our hormones.
However, hormones aren't the only culprit, either. The primary causes of acne include:
- Excessive sebum production
- Bacteria colonization
- Follicular hyperkeratosis (excessive production of keratin, a protein found in skin and hair, by your follicles)
Hormones Affect Oil Production
Sebum is an oily substance secreted by your sebaceous glands. It's a mix of lipids that protects your skin, but overproduction can clog your pores and lead to breakouts. The sebaceous glands also can produce inflammatory molecules that worsen acne.
Inflammatory cytokines are chemical messengers that increase inflammation in the body. Acne is directly linked to increased expression and activity of cytokines.
Hormones, especially androgens like testosterone, increase the production of sebaceous glands to make more sebum. If you notice your acne flaring at various points in your cycle, like right before your period, during perimenopause, or even if you're pregnant, hormones are a likely culprit.
During puberty, acne can worsen as androgen production increases. Perimenopause also marks a time of increased acne for many women as progesterone drops, leaving estrogen unchallenged and in some cases, androgen levels increase. And excessive androgen production is also why acne is a common symptom of PCOS.
Factors like your genetics also play a role in acne severity, along with habits like not removing your makeup at night or going too long between washing your pillow case. But in recent years, it's also become clear that diet is directly linked to acne because of the influence on hormones and inflammation.
@drjolenebrighten How many did you have? #hightestosterone #hormoneimbalance #hormones #hormonas #latinxcreatives #relationships #pcos #pcosawareness #pcosproblems #periodproblemsbelike #acne #acnetreatment #healthyliving #irregularperiods #amenorrhea #periodtips #periodproblems #hormoneimbalance ♬ In Da Getto – J Balvin & Skrillex
Understanding the Relationship Between Your Diet and Hormonal Acne
For a long time, skin health professionals weren't convinced that diet made any difference for acne, but nutrition science is constantly growing and changing. More evidence solidifies the association between food and skin in the last few years.
In addition to the link between food and inflammation, diet influences acne severity by affecting the levels of various hormones, including:
- Insulin-like growth factor 1 (IGF-1)
- Androgens (like testosterone)
Insulin and Hormonal Acne
Insulin is produced by your pancreas and oversees blood sugar balance. When you eat carbohydrates, blood sugar rises, and insulin is released. This is a normal and healthy response. Insulin signals to move sugar out of the blood and inside the cells.
While we don't want to fear carbohydrates in the diet, too much insulin is inflammatory and is associated with chronic diseases like type 2 diabetes, but it can also impact your skin by boosting androgen production and IGF-1.
IGF-1 is a hormone very similar to insulin that also increases the production of androgens. Research connects higher blood levels of IGF-1 to more severe acne, and it may also increase those inflammatory cytokines linked to breakouts.
In other words, a diet high in foods that spike your blood sugar will increase insulin. Insulin, in turn, stimulates IGF-1 and androgen production, which increases sebum production and inflammation, causing breakouts and worsening acne.
But remember, it doesn't mean that eating sugar automatically causes acne for everyone. We all respond differently to food, but as you'll see below, sugar is only one of the foods that could worsen acne.
The only way to know for sure if what you're eating is causing acne is to follow an elimination diet. In an elimination diet, you remove all potentially problematic foods and see if your skin improves. For many women, diet makes a significant difference.
My free hormone starter kit includes a 7 Day Meal Plan and Recipe Guide designed to help women take control of their hormones and address the underlying causes of acne and similar issues.
Foods to Avoid That May Trigger Hormonal Acne
Here's a list of the foods most likely to trigger your acne. If you're at your wits' end and want to know with certainty which foods are a problem for your skin, try eliminating all these foods for at least two weeks, then gradually add them back slowly (one to two foods each week) to learn their individual effects.
High Glycemic Index (GI) Foods
The glycemic index (GI) is a scale that ranks carbohydrates based on how fast they raise your blood sugar (glucose). High GI foods spike glucose quickly, while lower scores mean the food is digested slowly — and generally healthier for your metabolism.
High-glycemic foods include:
- Candy and baked goods
- Soda and juice
- White and whole wheat bread
- Sweetened cereals and bars
- Chips and crackers
- White rice
- French fries
Since chocolate is usually categorized as a sweet treat, it seems appropriate to address the big question — does chocolate cause acne? It likely depends on the type.
Pure, unsweetened cocoa is not a high GI food. While one small study did find a significant increase in acne after participants were given unsweetened cocoa, other studies specifically found an association between milk chocolate and acne.
Milk chocolate is sweet and contains dairy (which we will look at next), so it may be more about the added ingredients.
Dairy is complex because not all types are linked to acne. Yogurt and cheese don't seem to be a problem for most people, but milk and acne are connected, mainly due to the milk proteins.
Casein and whey, the two primary proteins found in milk, could exacerbate acne because, like high GI foods, they increase IGF-1. This also helps explain why some people break out after using whey protein supplements.
Milk also stimulates insulin production even though it's not considered a high-GI food, but yogurt and cheese don't appear have the same effect. While yogurt and cheese don't appear as problematic as milk in the research, I can tell you that clinically I have see patients who absolutely have their acne triggered by eating their favorite cheese.
A review of studies that included more than 70,000 participants concluded that drinking milk increases acne risk. And when milk is combined with a diet high in sugar and inflammatory fat, IGF-1 levels jump and make acne even worse. As always, nutrition is nuanced and quite personal.
Inflammatory Fats and Oils
The link between acne and fats is linked to omega-6 fatty acids, which increase inflammation in your body. Foods highest in omega-6 fatty acids include refined vegetable oils like:
- Canola oil
- Soybean oil
- Corn oil
- Safflower oil
- Peanut oil
Since these oils are used in so many packaged and processed foods, they can sneak into your diet even if you aren't using these oils for cooking. Fried foods are also usually cooked in these oils.
Omega-6 fatty acids are essential for your body, but they need to be balanced with omega-3 fatty acids, which reduces inflammation. If omega-6 is too high (which is very common given these fats are found everywhere in modern Western diets), it can throw off the fatty acid balance and increase inflammation that exacerbates acne.
Ultra-processed foods are packaged, refined foods that combine all of the above risk factors. They are usually made with refined, simple carbohydrates and processed vegetable oils, and as a result, they can make acne much worse (and just aren't great for us in general).
Ultra-processed foods include:
- Fast food
- Ice cream
- Some frozen packed foods
Interestingly, research suggests that groups of people who followed traditional diets without access to the ultra-processed Western diet didn't have acne until these foods were introduced.
Alcohol is less talked about with acne, but since it directly impacts hormones, I've seen it as a problem for some women, and it's been noted as a risk factor in research.
Both estrogen and testosterone levels can rise following drinking which impacts hormone balance and worsens acne. There are several ways in which alcohol can affect your hormones and it may show up first as acne or as period problems.
Further, acne is associated with histamine intolerance. Histamine is produced by your immune system as a response to allergies, but people with histamine intolerance tend to make too much histamine or don't break it down properly. It's also important to note, alcohol is high in histamines, so it could worsen acne for histamine-sensitive people.
And finally, some alcohol, especially mixed drinks, can be high in sugar, which increases insulin production.
Anti-inflammatory and Nutrient-dense Foods That Help Hormonal Acne
A dietary strategy to support acne isn't just about what foods you remove but also what nutrient-rich foods you can add to support radiant skin.
@drjolenebrighten These are a handful of ways to address high testosterone #hormones #hormonas #testosterone #hightestosterone #latinxcreatives #hormoneimbalance #hormonehealth #pcos #pcosawareness #pcosproblems #hairloss #healthyliving #acnetreatment #acne #relationships ♬ Levitating – Dua Lipa
Foods High in Omega-3 Fatty Acids
Foods high in omega-3 fatty acids offset inflammatory omega-6 fatty acids and turn down the production of inflammatory cytokines that contribute to acne. Not only can omega-3's turn down the inflammatory response, but they could also lower the production of IGF-1.
You can find omega-3 in the following foods:
- Fatty fish like salmon, sardines, or mackerel
- Chia seed
- Flax seeds
Supplements are also used, especially since many people don't eat fish regularly. When selecting an omega-3 supplement, be sure to look for ones that filter their oil to remove any contaminants like heavy metals.
Probiotics may help with acne by influencing the inflammatory response and lowering IGF-1 and androgens. A small study found that adults who took a Lactobacillus rhamnosus GG probiotics for 12 weeks improved acne symptoms compared to the placebo group. The participants also had lower IGF-1 levels on their skin.
People with acne may also have distinctly different gut bacteria than those without acne. One study found that acne was associated with gut dysbiosis, or an imbalance of gut bacteria, so balancing the gut flora could directly impact your skin.
Examples of foods that contain probiotics include:
- Coconut Yogurt
Brightly Colored Fruits and Vegetables
Polyphenols are the chemicals found in produce that give fruits and veggies gorgeous hues. They have antioxidant activity that lowers inflammation in the body and contain skin-promoting nutrients like vitamin C, and vitamin A. Vegetables and many fruits are also low on the GI scale to support a healthy blood sugar balance.
Including a wide variety of the following fruits and veggies can brighten your skin and benefit your entire body, including hormone balance:
- Bell pepper
- Brussels sprouts
Since we know that high GI foods can increase the risk of acne, adding fiber-rich foods with a much steadier blood sugar response is a vital acne-fighting dietary strategy. Research shows that a diet low in GI foods decreases IGF-1 levels in the blood and reduces acne. Fiber is also essential for a healthy gut and balanced microbiome.
High-fiber, lower GI foods include:
- Vegetables and fruit (as listed above)
One way to incorporate high fiber foods, get more omega-3s into your diet, and increase zinc levels is through seed cycling.
You can take zinc supplements, but they can cause stomach upset and throw off the balance of other minerals like copper.
Foods that contain zinc include:
- Oysters (by far the top source)
- Pumpkin seeds
Tea contains polyphenols (a natural plant-based antioxidant) that could support inflammation and benefit hormone balance.
- Green tea is exceptionally high in polyphenols and antioxidants to support inflammation. Research suggests that taking green tea extract could improve acne and calm inflammation.
- Rooibos tea is also high in polyphenols that combat oxidative damage and inflammation.
- Spearmint tea can lower androgens to improve acne (and can be really supportive for PCOS).
Frequently Asked Questions (FAQs) About Hormonal Acne and Diet
Here are some of your most common questions about hormonal acne and diet answered.
What Foods Trigger Acne?
Foods that trigger acne include milk, whey protein, refined carbohydrates, high GI foods, sugar, alcohol, and inflammatory fats. These foods impact your skin by increasing the production of hormones that worsen acne. Not everyone will react to all these foods, but consider eliminating them if you deal with stubborn acne.
What Foods Help with Hormonal Acne?
The best foods for hormonal acne are foods high in omega-3s (fatty fish and shellfish), high-fiber fruits and vegetables that control blood sugar, fermented foods like kimchi, kraut, and kefir to balance your microbiome, and mineral-rich foods like oysters, which reduce inflammation and support skin health.
How Do I Clear Hormonal Acne?
Acne takes a multi-faceted approach, but you can start with diet. Consider a hormone-supporting diet that eliminates offenders like high GI and inflammatory foods, sugar, alcohol, and dairy. Try adding nutrient-rich foods like colorful produce, whole grains, nuts, and legumes to nourish you from the inside out.
What Vitamins Help Clear Skin?
Skin supportive vitamins include vitamin A, vitamin C, and vitamin E. Vitamin C and vitamin E acts as antioxidants to bring down inflammation in the body that could contribute to acne. Vitamin A is usually used topically but is also helpful for skin health as part of your diet.
How Does Zinc Clear Acne?
Zinc helps with acne by lowering inflammation associated with breakouts. It can reduce the redness associated with acne and help with scarring. People with low zinc levels in their blood are more likely to experience breakouts, especially those with severe acne.
- Acne is caused by several factors that can relate to women's hormones (especially puberty, menstrual cycles, and menopause), including inflammation and excessive sebum production.
- In turn, your diet also affects your hormones, so dietary changes are an essential aspect to address hormonal acne.
- Foods that trigger acne include high GI foods, milk, inflammatory oils, ultra-processed foods, and alcohol.
- Nutrient-dense, anti-inflammatory foods like fruits, vegetables, fish, oysters, and tea can your body clear acne by lowering inflammation and insulin production.
- Collier CN, Harper JC, Cafardi JA, Cantrell WC, Wang W, Foster KW, Elewski BE. The prevalence of acne in adults 20 years and older. J Am Acad Dermatol. 2008 Jan. 58(1). 56-9.
- Hyojin K, et al.. Insulin-Like Growth Factor-1 Increases the Expression of Inflammatory Biomarkers and Sebum Production in Cultured Sebocytes. Annals of Dermatology. 2017 Feb. 29(1). 20-25.
- Tanghetti EA. The Role of Inflammation in the Pathology of Acne. J Clin Aesthet Dermatol. 2013 Sep. 6(9). 27-35.
- Baldwin H, Tan J. Effects of Diet on Acne and Its Response to Treatment. Am J Clin Dermatol. 2021. 22. 55-65.
- Perkins AC, Maglione J, Hillebrand GG, Miyamoto K, Kimball AB.. Acne vulgaris in women: prevalence across the life span. J Womens Health (Larchmt). 2012 Feb. 21(2). 223-30.
- Sutaria AH, Masood S, Schlessinger J.. Acne Vulgaris. StatPearls. 2021 Aug 9.
- Thomas DD, et al.. Hyperinsulinemia: An Early Indicator of Metabolic Dysfunction. J Endocr Soc. 2019 Sep 1. 3(9). 1727-1747.
- Bagatin E, et al.. Adult female acne: a guide to clinical practice. Anais Brisileiros de Dermatologia. 2019 Jan-Feb. 94(1). 62-75.
- Rahaman SMA, De D, Handa S, Pal A, Sachdeva N, Ghosh T, Kamboj P. Association of insulin-like growth factor (IGF)-1 gene polymorphisms with plasma levels of IGF-1 and acne severity. J Am Acad Dermatol. 2016 Oct. 75(4). 768-773.
- Smith TM, Gilliland K, Clawson GA, Thiboutot D. IGF-1 induces SREBP-1 expression and lipogenesis in SEB-1 sebocytes via activation of the phosphoinositide 3-kinase/Akt pathway. J Invest Dermatol. 2008 May. 128(5). 1286-93.