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Ep 18: Dairy and Acne- How Does Diet Affect The Skin?
Dr. TWL: Hi everyone and welcome to another episode of Dermatologist Talks: Science of Beauty. I’m Dr Teo Wan Lin and today we’re going to kickstart a series under Science and Sustainability, touching on the relationship between dairy and acne.
This topic is particularly close to my heart because my training as a medical doctor is based on science. And at the same time, I am also personally very enthusiastic about sustainable practices. However, I also critically evaluate these practices on my own based on my scientific knowledge. It may seem intuitive that science and sustainable practices go hand in hand. But there seems to be a few issues that have arisen over the last few years which have gotten my attention. One of these topics relates to the consumption of animal-based products – we’re going to talk about dairy in this episode.
Chelsea: This is a topic I’m excited to hear more about! I’ve always wondered about the link between dairy products and acne. It’ll be interesting to hear more about the science behind that!
You’ve recently had a pretty major change to your diet! Can you tell us more about the philosophy behind that?
Dr. TWL: Since the start of the COVID-19 pandemic, I personally made the decision to eliminate animal-based products from my diet. I still consume seafood and fish in small amounts, but I subscribe to a predominantly plant-based diet. Animal products, dairy, meats – I have completely eliminated it. The reason for my decision was primarily because seeing the way the COVID-19 pandemic started and panned out. From a scientific perspective, I feel very strongly that as long as we continue to farm animals, invade the habitats of other creatures, and continue to consume meat, we are fuelling an industry that will no doubt produce more pandemics.
Nature herself is an ecosystem. An ecosystem is one that is sustainable on its own, and that’s the beauty of it. Science isn’t a philosophy, neither is it a concept that is a derivative from someone’s ideas. It is truly the study of what is around us – making observations, logical deductions, analysis. These findings are then applied to the development of new interventions that are beneficial for the ecosystem, mankind, and other species.
An ethical perspective
I feel that from an ethical perspective, there are a lot of advantages in us subscribing to a plant-based diet. There is clear evidence that mammals feel pain and emotions. It should not be our goal as mankind to merely treat our fellow creatures on this earth as commodities. We certainly don’t own any species. Simply because we are the dominant civilization on earth, doesn’t mean we ought to act in an authoritarian manner. But rather, be seen as guardians of what nature has bestowed us with. At the same time, I am fully aware that my recommendations are to be solidly grounded in science. Additionally, I feel that there is indeed a meeting point between these two.
Chelsea: That’s so insightful… I agree, I think the pandemic really should be a wake up call. We should be more conscious about our actions and practices on this earth. Moving on, can you introduce us to some of the topics you’re going to cover today?
What is the relationship between diet and acne?
Dr.TWL: To begin with, as a dermatologist, I want to talk about dairy products. It is established from various studies that generally, individuals who consume dairy are more acne-prone than those who don’t. In the latest systematic review in the journal Nutrients in 2018, dairy intake and acne vulgaris was systematically reviewed of 78,000 individuals across various age groups. Children, adolescents, and young adults were included in this meta analysis. The findings were that there was an increase in the incidence of acne in individuals ages 7 to 30 years when they consumed dairy products, including milk, yoghurt and cheese.
The underlying mechanism of action has to do with how acne develops. Acne itself is a chronic inflammatory disease of the oil glands. It is predominantly genetically influenced. The inflammation leads to what we call follicular retention, or hyperkeratosis. This is where microcomedones from under the skin rise to the surface. These form the open and closed comedones – whiteheads and blackheads. Oil production is also a factor in the development of acne. It is influenced by male hormones. How that links to dairy consumption is related to the induction of insulin-like growth factor and androgens. This directly increases sebum production.
Can you explain more on the science behind how dairy products affect our skin?
More on that, milk-derived amino acid proteins promote insulin secretion and cause the insulin-like growth factor (IGF-1) synthesis by the liver. This itself is regarded as the driver of acne as it stimulates the growth of the skin follicles – the epithelium. Also keratinization, the retention of the dead skin cells on the surface of the skin. In the study of genetics about IGF-1, the differences, known as polymorphism, have also been shown to increase one’s tendency to develop acne. There have been several observational studies internationally published about dairy intake and children in adolescents and young adults.
The main concern is because of the different ways these studies are done, there could be what we call methodological flaws. These include biase, inappropriate weighing of results, and skewed estimates. In this latest journal meta analysis, the overall conclusoin from all this information being taken in totality, does suggest the role that dairy consumption has on acne is a significant one.
There is a definite link between dairy and acne
For all the proponents of the controversy that dairy may or may not worsen acne, I think the bulk of the evidence now based on the meta-analysis, actually points towards the fact that regardless of how you analyze it. Taking into consideration inter-study variances including statistical uncertainty that has been built into the model, it is conclusive that all this data points towards a definite link between dairy consumption and acne development.
Chelsea: Well there you have it. From the science, we can see that dairy does play a role in acne development.
Can you tell us a little about how your recent experiences with the COVIID-19 pandemic has changed your outlook on life and work?
Dr.TWL: I think it is very important for us at this point of time in mankind’s history when we are coming to grips with the fact that we’re not alone in this world. We shouldn’t be monopolizing every single thing on earth just because we are the dominant species. The COVID pandemic has caused many, if not all of the industries to grind to a stop, with lockdowns imposed worldwide. Undoubtedly, when you go into the science of how pandemic starts, you first have to consider that it’s across species and it’s coming from the animal kingdom.
But the way nature works is that we shouldn’t be in close contact with creatures carrying these microorganisms. Therefore, something is clearly wrong when a species, like the bat- that hosts viruses that they are able to tolerate in their immune system – crosses over to mankind.
If we were to predict where the next deadly pandemic will arise from, it will be again from the animal kingdom. Even with the current COVID situation, we know that mutations will continue to occur when they cross-infect other species. So the logical thing to do is to consider if we are able to eliminate inappropriate farming practices, or even our consumption of animal meat and animal-based products.
Can you tell us more about the science behind heading towards more plant-based foods?
I feel that the increasing body of evidence in scientific literature points towards plant-derived antioxidant nutraceutical-rich foods. As opposed to animal-based products. The need for vitamin B12 for protein can be taken via supplements. This is as vitamin B12 is actually synthesized by the animal itself. It can be obtained in fortified cereal, and in almond milk for example. There is much evidence that plant sources of protein such as beans, chickpeas, are a lot more nutritious calorie for calorie in terms of its nutrient density when comparing to animal protein.
The case for eliminating dairy
The case for eliminating dairy and animal products stems firstly from the scientific realization that we do not see benefits for the skin when you are consuming dairy. Secondly, it is the great cruelty that the dairy industry subjects the animals to. I think COVID-19 has caused a lot of us to reflect on how sustainable our lifestyles are. When we were in lockdown, a lot of people started growing food if they had access to a garden, or through vertical gardening. It gives people a little bit more confidence when they are growing it themselves.
But when you think about how sustainable milk products are, or even milk, in order for a cow to produce milk, many people including myself, seem to overlook the science behind it. The cow has to first get pregnant. Additionally, milk from lactating cows is not meant for humans, but for the baby calf. Artificial insemination occurs on dairy farms, clearly in a brutal way. If you want to think about mankind undergoing this kind of procedure, it’s actually assault. Not just that, when the cow is lactating, in order for dairy farms to harvest that milk, they need to forcibly remove the baby calf from their mothers. This is so the milk can be reserved for milk production and sale.
Dairy products are not sustainable
I feel that if we were to confront ourselves with this reality, then it becomes extremely painful to support such a brutal process. Are there ethical dairy farms? I think there are various organizations looking into the welfare of animals that have done lots of research. This research is also available publicly.
The reality is, with the COVID pandemic, a lot of these things become unnecessary. If we want to talk about the nutritional value of milk, I feel that we have long advocated for babies, children and toddlers – the milk consuming age group, to take breast milk. We now know that cow’s milk itself contains a lot of fat, and is also full of proteins that trigger IGF-1. IGF-1 is a pro-inflammatory mediator that stimulates and worsens acne formation. In short, there is a lot of science that drives us to make this ethical decision of turning away from dairy.
I have to say that I was a big dairy fan all the way until mid 2020 in the midst of the pandemic. This is when I did my personal research into the ethics of animal farming and our relationship with animals. I realized that this was something that I could not forsee myself continuing to do. Naturally, I turned to alternative sources of milk – soya milk, almond milk. Looking into the literature for the nutritional benefits of these plant-based milks, you’ll realize that there are a lot more nutraceutical bioactive compounds than in animal-based milk.
What are some superfoods that we can include more of in our diet?
Polyunsaturated fatty acids, for one, contrasts directly with the saturated fats present in animal-based products. The good thing about polyunsaturated fats is that number one, it helps us to retain a healthy skin barrier. Number two, it also helps to increase our source of good cholesterol and lower our source of bad cholesterol. All these play a huge role in prevention of metabolic diseases like diabetes, hypertension, cardiac disease. That aside, I think it is important to understand the inherent value of incorporating plant-based products as opposed to animal-based products in one’s diet.
The importance of antioxidants
The main thing is that every single plant I know of contains some level of antioxidants. Antioxidants, as we know, are the key to preventing the aging processes from accelerating. I wouldn’t say it prevents aging, but having a high exposure to antioxidants in your diet will protect you in many ways from inflammaging processes. It can also intervene in the process of carcinogenesis. This is cancer formation that develops as a result of the body being unable to repair damaged DNA, causing mutated cells to proliferate.
Well that’s it for this week’s episode on Dermatologist Talks: Science of Beauty. You can follow Dr. Teo on instagram @drteowanlin where she posts updates on the latest podcast episodes. Remember to subscribe for the latest podcast updates.