As a woman in her mid to late 30s that is interested in healthy living, like many others, I do my best to eat, sleep and exercise well. I have always been slight and building muscle has always been a challenge. Over the years, I have had friends, (who also happen to be personal trainers) tell me repeatedly that it is down to my diet and not enough protein.
So over the years, I've done what I'm sure a lot of other women do too, and gone out one afternoon and come home with a box of whey protein powder and a various array of protein bars and snacks. Just the process of shopping for these items and seeing drawers full of them at home made me feel smugly virtuous and "healthy".
Obviously, I did my research. I spent countless hours on the Internet reading about protein powders before I decided which one I should buy. For a newbie to supplements (I've always believed that if I eat and drink a balanced diet I shouldn't need anything extra) I was amazed there was a choice: whey, casein, pea, rice, hemp. I decided that whey protein was the way forward, it seemed to have the highest protein content gram for gram as well as being easy to find and relatively cheap.
Whey protein powder and bars quickly became a staple if I was in a rush and missed a meal, before and after training, and generally as my "healthy" go-to snack in the middle of the day. So much for my life-long thoughts on eating and drinking everything in moderation; I was in a mind-set that protein was all I needed. (As an aside, my muscles still weren't anywhere near the proportions I've always desired).
I'll come back to the whey protein in a moment.
I also happen to be a dermatologist for a living. I am interested in everything skincare and beauty related. To top it off, I've had troublesome acne that I have failed to grow out of for at least 25 years. I would actually dare say, that my skin has been more resistant than any patient I have ever treated - and I am aware what a bold statement that is to make. Treatments work, it gets better, and 6 to 12 months later, the dreaded red giants are back. Whilst spots are never a good look for anyone, they definitely aren't a good look for the doctor that's meant to be treating them!
Female adult acne is common and consultations for this have been increasing over the past decade. I am certainly seeing more adult women with acne now in my clinics than ever before. We all know that acne makes you feel bad and the emotional and psychological effects such as low self-esteem are well-recognised. There is an idea that adult women with acne may be more conscious of their skin problems because it is still considered a "teenage disease". Grown women end up feeling unsupported and distressed wondering why they are still having breakouts when that part of their life has passed.
The other thing we know about adult women with acne is that there is a higher failure rate of the usual conventional treatments that we use. So, basically, there is a higher chance the treatment either won't work OR that it will work but your spots will come back or relapse again further down the line. It becomes much more about trying to "control" acne rather than "cure" it for once and for all.
And, let's face it, we all lead busy lives - we work long hours and we want a balance so we probably also play long hours too. Families, friends, exercise, work, down-time - it all has to fit in somewhere. Having a skin condition that you cannot control is incredibly frustrating and provokes anxiety. Anyone with bad acne will relate to waking up first thing in the morning and touching their face to see if any new monsters have appeared on their face overnight and that sickening feeling of dread when your worst fears are confirmed. Lack of control is frightening. So we desperately look to find something we can control that might make our skin disease better.
This comes to a question that is often raised with me in consultations about whether controlling diet will help spots. I have lost count of the times I have been asked whether going dairy-free will help. As a doctor and fellow acne sufferer, to answer this question honestly meant going back and reviewing all the scientific literature for myself. It's not that I don't trust anyone else's opinion, but there's nothing more important than reading and making decisions for yourself. So I sat down one weekend some weeks ago to find the answer. I had agreed to do a talk entitled "Diet and Acne" in May for a medical meeting, so effectively I was killing lots of birds with one stone, so to speak.
And what I found was extremely interesting. The relationship between the two has been highly controversial, but before the 1960s, dietary advice was a standard part of acne therapy. Dermatologists actively discouraged foods such as chocolate, fats, sweets, and fizzy drinks. Then in the late 60s and 70s two pivotal scientific studies came along suggesting the link did not exist. Diet was forgotten about for quite a long period of time, and certainly when I was training, I was taught that the whole diet-acne connection was a myth. But having read the studies and the research that came afterwards, those studies had major methodological errors.
What's even more interesting is that certain population groups that follow "hunter-gatherer" diets, such as native populations in Papua New Guinea and Paraguay don't suffer with acne. Other groups such as the Canadian Inuits and Zulus did not have acne until their diet became Westernised. Ok, so it's not a hard and fast robust clinical trial, but nonetheless, an interesting observation.
There is no doubt that there is emerging evidence that diets that are high in processed carbohydrates (high glycaemic index) and dairy can be linked to the development of acne. At present, the link seems to be stronger with high GI foods than dairy itself but it's there. Both types of food are thought to increase raised circulating blood sugar or glucose levels. Raised sugar in the blood stream causes your body to produce the hormone insulin and insulin-like growth factor (IGF-1). Both of these agents increase oil or sebum production and also encourage release of male hormones known as androgens (both men and women have these). A combination of these factors can drive acne production.
So let's go back to where I started. What does this have to do with protein bars? Well, as I was tucking into my protein bar doing my research, the penny suddenly dropped that I was munching on whey protein.
Whey protein - clearly a dairy product. Cow's milk is made of two major proteins, and whey is one of them. Proteins, such as whey are made up of smaller sub-units known as amino-acids. Whey proteins contain a high level of an amino-acid known as leucine. Leucine (along with another few aminoacids in milk - isoleucine and valine - if you're interested!) has been shown to promote insulin and IGF-1 release - which as mentioned before may be associated with acne development.
So this got my brain ticking. Do groups that consume large amounts of whey protein get acne? Body-builders sprung to mind. Surprisingly, there are next to no studies out there investigating this. I found a handful of case reports on Pubmed about milk protein abuse and acne onset and aggravation. Unfortunately, a handful of case reports don't make a clinical trial so there isn't much information out there.
But put simply, we are recognizing a link between acne and dairy, albeit a weak link. Whey is a major component of cow's milk and found in many protein powders and health snacks. So should we be asking ourselves if over-indulging in these can contribute to the acne process? The honest answer is, I don't know, but it literally is food for thought.
Personally, I think what I've learnt is that maybe going back to my original school of thought of everything in moderation wasn't that wrong after all. I will limit my whey protein intake to see if it makes a difference. Anything that can potentially help my acne! Whilst I don't think dermatologists should be treating acne with diet alone, I think the time for us to be closed-minded has gone, and it may prove to be a useful adjunct in the future in addition to the tried and tested acne therapies that we know work.
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