
Acne Vulgaris: A Disease of Western Civilization (2002) - surlyadopter
https://jamanetwork.com/journals/jamadermatology/fullarticle/479093
======
RobertRoberts
1\. When I was a kid, just getting a tan cleared up my acne.

2\. Changing my diet helped clean up my acne (not eating junk food)

3\. When I was a teenager, I got hurt really bad, and my father found me and
had to take me to the hospital. I saw massive acne breakout on his face in
less than 15 minutes.

4\. When I got older and was less stressed about life, my acne went away. When
I got a family/career/house and life stress was severe, acne would come back.

I think there a huge health and stress connection to acne.

~~~
patcheudor
My daughter had severe acne. She changed her diet from vegetarian to full
vegan and it cleared right up, in fact most of the past scaring is also now
gone. She still consumes sugar (vegan sugar - yeah that's a thing:
[https://www.peta.org/living/food/is-sugar-
vegan/](https://www.peta.org/living/food/is-sugar-vegan/)) and doesn't take
vitamin E or D supplements because she hasn't found any that are 'vegan
certified.' Given some of the research we've looked at, our going theory is
that dairy was the primary cause and there is some support for that:
[https://www.aad.org/media/news-releases/growing-evidence-
sug...](https://www.aad.org/media/news-releases/growing-evidence-suggests-
possible-link-between-diet-and-acne)

~~~
cageface
A lot of people report a huge improvement in their acne after cutting out
dairy. Drinking cow’s milk in large quantities is something humans have only
been doing for a few thousand years and there’s quite a bit of evidence we
probably shouldn’t.

[https://nutritionfacts.org/video/the-acne-promoting-
effects-...](https://nutritionfacts.org/video/the-acne-promoting-effects-of-
milk/)

~~~
simonsarris
What evidence? There's a reason the mutation that kept lactase production "on"
spread so well. Today many of the healthiest cultures on Earth consume lots of
dairy. France with the most butter, Greek with the most cheese, etc.

~~~
cageface
The healthiest populations in the world consume virtually no dairy. Okinawans,
vegans, 7-day adventists etc.

The Mediterrean diet is largely vegetarian:

[http://www.abc.net.au/news/health/2017-02-16/10-commandments...](http://www.abc.net.au/news/health/2017-02-16/10-commandments-
of-the-real-mediterranean-diet/7541786)

75% of the world's population loses their ability to digest lactose after
infancy:

[http://www.pcrm.org/health/diets/vegdiets/what-is-lactose-
in...](http://www.pcrm.org/health/diets/vegdiets/what-is-lactose-intolerance)

Milk is for babies. Cow's milk is for cow babies.

~~~
antgiant
Vegetarian ≠ Vegan. Lots of dairy in the standard Vegetarian diet. The link
you provided to the Mediterranean diet included lots of dairy (cheese, yogurt,
etc.). Also, a lifetime of personal experience says that Seventh-day
Adventists eat quite a lot of dairy.

~~~
cageface
I'm vegan so I know the difference. The Adventists are often cited in
nutrition studies and the vegan subgroup of Adventists is the healthiest.

Quoting directly from the link I provided:

 _If you think the Mediterranean diet looks a little low on dairy foods, you
're right. It's certainly lower in dairy than is currently advised in the
National Dietary Guidelines _

_...But traditional Greek Mediterranean populations got calcium from other
sources: sardines and other small fish which were eaten with their bones, and
from leafy greens (which contain only a little calcium but the large volume of
the greens eaten meant the amount added up)._

------
brucephillips
I grew up with cystic acne that persisted into my early 20s, until two courses
of Accutane cleared it up.

Anecdotally, I tried everything before going on accutane. I cut out sugar to
the point of avoiding fruits with high glycemic indexes. I cut out dairy. I
cut out meat. I tried every supplement you can imagine. If you're thinking
about asking "but did you try X", don't bother, I did.

Only accutane worked.

Reading studies such as this, as well as the internet discussion regarding
acne is a bit frustrating. Yes, there are anecdotes of this and that diet and
lifestyle change reducing acne, but there's very little clinical evidence that
non medical treatment improves cases of cystic acne, and yes, many diet
studies have been performed.

Even this study grossly overstates their conclusions. Studying two primitive
societies is not nearly enough data to support the conclusion in the title of
this article.

~~~
SOLAR_FIELDS
Every acne thread has the inevitable comment about Accutane.

And every comment is essentially the same. It’s the only thing that worked for
me.

I still love to read them. I’m still amazed by it. It’s literally the only
drug I’ve ever encountered that could truly be called a “magic pill” in that
it _will_ permanently cure you of what you are taking it for.

The side effects are pretty crazy though. I had to wear sunglasses even when
it was cloudy due to photosensitivy for the months I was taking it. Carried
Aquaphor in my pocket for the perpetually dry lips and my whole face pretty
much flaked off during the first few weeks.

100% worth it. I get a minor pimple every 6 months or so if I don’t wash my
face. It used to be completely covered with acne.

------
jayess
Totally anecdotal, but I started taking vitamin D supplements at the
suggestion of my doctor because of my family history of colon cancer. I
noticed that my acne declined significantly. I'm wondering if it has to do
with the amount of time one spends outside in the sun.

~~~
qwerty456127
Here's the discussion and the paper on vitamin D:
[https://news.ycombinator.com/item?id=15867918](https://news.ycombinator.com/item?id=15867918)
. TL;DR: make sure to always get at least 8000 IU of vitamin D per day (10
times the RDA) if you want to be healthy and have good bones, skin, mood,
sleep, immunity and metabolism.

I have also heard a rumor that recent studies suggest solid vitamin D pills
are better than oil capsules. Would be nice if somebody knowing what
particular study says this could share a link.

~~~
nhylated
I think you missed the link to the discussion in your comment.

Would taking 10x the RDA of Vitamin D daily have any side effects? (overdose?)

~~~
skosch
Max "official" safe daily limit is 4000 IU currently, but the only studies I'm
aware of where actual toxicity was reported started at something like 40,000
IU daily for months. Vitamin D is likely pretty safe.

~~~
AstralStorm
No, the estimated RDA based on EPIC series of studies is 3000 IU daily and
it's suspected to be on the lower side due to old people being bit
overrepresented. This based on all cause mortality, various European subjects.
Intake estimated by direct multiple blood levels.

Vitamin D intake vs mortality followed a very shallow U curve (almost J) and
minimum was between 2000 and 4000 IU.

~~~
qwerty456127
So the RDAs are about just decreasing mortality rather than improving
life/health, right?

------
cal5k
I'm always amused/horrified by Hacker News comments on anything health-
related. Herein lie a group of incredibly smart individuals sharing anecdotal
evidence and folk remedies without a lick of irony.

~~~
scarecrowbob
The idea of "hey, this strange thing worked for me, and I don't wholly
understand all parts of the system but it seems to have some results" is
pretty much the core of what "hacking" is, right?

~~~
nur0n
I understand hacking to be the opposite: understanding a system so deeply that
you can invoke unintended behavior.

~~~
scarecrowbob
I'm not saying that you don't have a valid idea here, but that doesn't meet
with my understanding of the term. I mean when I say I'm a hack piano player,
I mean that i can get by but am not classically trained. When I say, this fix
for my problem is a hack, I mean that it's not a well engineered solution, but
rather that it's a functioning (albeit perhaps ugly) solution.

I can also say that it's a good thing that I didn't apply that when I started
working with computers or I would never have gotten to the point where I
understood the systems well enough to bend them to my purposes regardless of
the intended behavior.

And that doesn't even touch the question of what "intended behavior" might
mean for a biological entity which isn't "designed" in a way that has an
intended use.

------
_delirium
The HN title should probably say "nonwesternized" (the term used in the
abstract) rather than "non-Western" (although the paper subtitle does use
"Western"). Still an ambiguous term, but "non-Western population" would
usually be understood to include countries like Japan and China, who this
study definitely doesn't mean to include.

~~~
ajhurliman
I was wondering about that; I was just in China and there were tons of people
with acne there.

------
weeksie
Why's everybody talking about vitamin D? (Same thing popped up in a Twitter
thread I saw about this yesterday.)

As far as I can tell the paper only talks about high insulin loads and refined
sugars for etiology? Then again I might have missed something? Seriously, I'm
in no way competent to read these papers but all I could see were mentions of
insulin spikes and such. Could someone ELI5 what I'm missing?

~~~
djsumdog
I immediately thought about sugar/carbs. A lot of people on Keto/Adkins report
that reduced carb intake seems to help control acne.

~~~
weeksie
Sure, but I'm talking about the actual study linked. Or maybe I'm just being
too generous with my assumption people are referring to the linked article.

------
DeusExMachina
I noticed that on myself, high concentrations of sugar or high density carbs
(pasta and bread) make it surge.

A couple of friends of mine also cured a candida infection by avoiding carbs.
So our diet might play a role.

~~~
t3rmi
If you are in the Bay Area check out Acneology or the US Face reality clinics.
They basically have the whole science of acne treatment down to almost
perfection. Dermatology didn't help me at all but their treatments worked
wonders. I'll give out more info if anyone is interested. Source - I've had
acne for a decade :( more or less cleared up now.

~~~
brucephillips
I just checked this out. It's a dermatologist. They offer benzoyl peroxide and
salicylic acid, which are standard solutions. This is nothing special.

~~~
t3rmi
Read my reply below. The prescriptions are standard the pore
unclogging/extractions and peels are the real differentiator. Oh yeah and the
Diet restrictions.

~~~
brucephillips
This very little evidence that diet affects acne. I'm glad you found a
solution, but food probably had little to do with it. Especially "greasy"
food, which is one of the items they list on their website.

They also say that antibiotic solutions are a "myth", which is patently false.

~~~
t3rmi
There are several kinds of acne. The kind that you get when you hit puberty is
not related to diet. Adult acne in most cases is however.

The thing is food does not directly cause acne. The logic is pretty simple
actually. Acne causing bacteria grow in blocked pores and greasy food and
dairy makes me super oily . More sebum more blocked pores aaand more acne.

~~~
brucephillips
> Adult acne in most cases is however.

Source? Because no, it's not.

There's also no evidence that greasy food increases sebum production.

You're buying into a bunch of snake oil.

~~~
t3rmi
Sorry I guess I generalized too much. I definitely get super oily after eating
dairy It might be that some people have my skin type. I've noticed some of my
friends dont get oily at all after eating a ton of pizza. Depends on the
person I guess. As for the snake oil thing their treatment has already worked
for me so if you have acne I would advise giving it a try.

------
perardi
"As in the Kitava sample, skin infections and intramuscular abscesses were
common and responded well to treatment with antibiotics such as erythromycin
and tetracycline."

I'll take the occasional zit and cover it up with concealer, thank you very
much.

~~~
sevensor
It doesn't have to be a package deal -- their low glycemic load diet isn't
causing the abscesses.

------
intro-b
taking a course of antidepressants and making some lifestyle changes during
university for depression had the side effect of almost completely clearing up
my acne that normal dermatological treatments were unable to deal with. given
that there's some kind of biological link between chronic inflammation and
depression, i wouldn't be surprised if some acne cases manifested the same way

------
stochastic_monk
This should be marked [2002].

------
mtgx
Hyperinsulinemia caused by a high-carb diet seems to result in many of our
health issues:

[https://www.youtube.com/watch?v=wiVFtRlObZk](https://www.youtube.com/watch?v=wiVFtRlObZk)

~~~
buckthundaz
Yes. Great share on your link. Here's another good one:
[https://www.youtube.com/watch?v=SzcOz38FjaU](https://www.youtube.com/watch?v=SzcOz38FjaU)

“There are a thousand hacking at the branches of evil to one who is striking
at the root.”

― Henry David Thoreau,

------
reillyse
The double negatives here make this heading really hard to parse (I actually
read the abstract thinking something totally different and had to come back to
check), maybe something along the lines of

"Acne vulgaris exists predominately in Western populations" or "Acne vulgaris
mostly exists in Western Populations" would make it clearer.

------
JumpCrisscross
TL; DR A 2002 study believes we should explore “dietary interventions using
low–glycemic load carbohydrates may have therapeutic potential in the
treatment of acne because of the beneficial endocrine effects of these diets.”

------
ggm
Given that all humans share a remarkably high % of genome, and race is a
social construct, I'm struggling with the 'this is not genetic' part. Either
its a truism, or its backed by strong evidence of no genetic linkage. Because
this 'its not your race' thing, applies to almost anything. For instance the
supposed Asian intolerance to unmodified milk proteins which has been changing
as diet shifts. Is that also now not actually genetically determined?

~~~
CryoLogic
Human and pig genomics are also very similar. It's not the 98% that make or
break these things. Lactose intolerance is inherited and as a result of LCT
gene not expressing due to downregulation by another gene MCM6.

------
cageface
There's a strong link between acne and consumption of dairy products.

[https://nutritionfacts.org/video/the-acne-promoting-
effects-...](https://nutritionfacts.org/video/the-acne-promoting-effects-of-
milk/)

[https://nutritionfacts.org/video/saving-lives-by-treating-
ac...](https://nutritionfacts.org/video/saving-lives-by-treating-acne-with-
diet/)

------
janwh
As per my personal anecdotal evidence: diet is always key to Acne. I have been
suffering from Acne vulgaris, Acne conglobata, and—worst of all—Acne inversa
for all my life (26yo), and whenever I fell into bad eating habits with lots
of (saturated) fats and carbohydrates, my skin issues are worsening. Western
food is just poor quality in general, being heavily processed and “enhanced”
and all.

------
wst_
They decided to choose a closed, often tribal cultures for comparison. We can
assume they behave as most of us do, mate within the group mostly. So the
genes pool/variation differences must be huge between them and Western
population (whatever Western means in this context - let's say United States.)
On what premises they excluded genetic factor, then?

------
snarfy
I'v read a few studies about demodex mites causing chalazion[1]. Demodex mites
are something humans picked up from having dogs and cats as pets. Do non-
western countries have these animals as pets?

[1]
][https://www.ncbi.nlm.nih.gov/pubmed/26408604](https://www.ncbi.nlm.nih.gov/pubmed/26408604)

------
cmrdporcupine
For my wife, it's lots of sugar that causes outbreaks. Or worse, cheap
American chocolate (British chocolate doesn't trigger it as bad).

But all the dermatologists she saw as a teen and young adult... always
ridiculed this and insisted it had nothing to do with diet.

------
markhall
I always love when obscure (but interesting) topics surface to the top of HN.
Great community.

------
grondilu
Only tangentially related, but recently I watched a documentary about the
epidemic spread of myopia. Apparently the main culprit was the lack of time
spent outside, which was interpreted as a lack of exposure to sunlight.

I wonder if acne can't have the same cause.

------
m3kw9
I mean you don’t need to be Sherlock to know sugar is bad for you, I’ve heard
over and over again from all sorts of different publications and talks on the
effects. You talk sugar out, you give yourself a better chance

~~~
nashequilibrium
I grew up in a non-western country and at the age of 19 I sporadically got
Acne and I ate meat once a week and hardly any sugar. It lasted a 1 1/2yrs,
fast forward 5yrs I got Acne at age 26 again but worst, this time it wasn't
going away, finally I decided to just use natural ingredients. I got tea tree
oil and jojoba oil mixed them and would put it on my face and 3 months later
it went away forever.

I still don't get any pimples even after going back to normal lotion but
around Halloween I always get a pimple or two because of all the candy.

------
rland12
Given the link between diet and the microbiome, and the possible link between
diet and acne, I wonder if the microbiome has something to do with it.

Really, I'd be very surprised if the microbiome wasn't involved somehow.

------
colordrops
I know this is anecdotal, but I lived in Beijing for 8 years, and it was VERY
existent amongst the population there. Perhaps it's a function of the
"western" cosmopolitan lifestyle of urbanites.

------
buckthundaz
Sugar and carbs.

Read Weston A. Price's, 'Nutrition and Physical Degeneration'

------
dgregd
I have always wondered why evolution has allowed such a defect. Maybe this is
the effect of crossing with Neanderthals.

------
jcroll
How much time are those "non western" people spending outside shirtless
soaking in the sun?

------
ccc111
*anecdotal

started shaving with a safety razor, helped quite a bit.

vs 5 blade massacre

------
proee
Coffee is the source of my acne - but I'm not able/willing to give it up.

~~~
elliotec
Do you put milk and/or sugar in it? I betcha anything it’s not the actual
coffee.

~~~
proee
I put a "tiny, tiny, tiny" amount of sugar, and maybe a few tablespoons of
milk. Going off coffee for a week clears up my skins, while I continue to
consume dairy and sugar products.

So I do believe it's the coffee. Also for some reason, Kona Coffee make my
acne even 2x worse than say columbia, etc.

------
ars
This title "Acne vulgaris is virtually nonexistent in non-Western populations"
is not supported by the article.

HN policy is not to change the title which is "Acne Vulgaris - A Disease of
Western Civilization"

~~~
huac
The paper also only observes two groups: "the Kitavan Islanders of Papua New
Guinea and the Aché hunter-gatherers of Paraguay."

That's not anywhere close to all non-Western populations!

~~~
peterburkimsher
I guess that those two groups haven't had genetic contact with "Western"
races.

It's highly misleading, because my Taiwanese girlfriend has acne (worse than
mine, and she's over age 30).

She probably has some Dutch blood in her from 400 years ago (her mum is from
Tainan, and the light brown hair, double eyelids, and larger cleavage are
probably a result of that too).

What the article is suggesting is that if that contact hadn't happened 400
years ago, she wouldn't have acne. Malicious propagandists could easily
exaggerate that to blame Western civilisation for their ills, which I think is
divisive.

The real research has shown a statistical correlation within a small sample
size. That doesn't imply causation, or give any guidance on how to manage or
mitigate the effects.

If future children getting acne is really your major worry about choosing a
partner, the research might be of interest to you, but it fails to emphasise
that even connections in the distant past can have an effect, and rejecting
Westerners is not a suitable solution.

~~~
teach
Does your girlfriend eat a Western diet?

My wife is a registered dietitian and has a PhD in nutrition and in her
experience acne is _incredibly_ influenced by diet.

~~~
peterburkimsher
She eats a meat bun for breakfast, a Taiwanese-style biandang 便當 lunchbox, and
noodles or dumplings in the evening. She's seen doctors about her acne, and
still sometimes visits when there's particularly big or painful zits.

It got much better when she was in Australia on Working Holiday, when she
worked outside on a farm and was eating a more Western diet, she was less
stressed, and the air was less polluted. Our agreed plan is to try to move to
another country (probably New Zealand or Australia, perhaps Canada) anyway,
which should solve my nationality issues and her health issues.

In the meantime, I don't mind spending romantic moments popping her zits,
haha. I think it's kind of cute.

~~~
teach
Meat bun for breakfast, biandang for lunch and dumplings for dinner sounds
like a hell of lot of red meat -- aka the Western diet.

If I were her I'd try to cut out the animal products for a month and see what
that does. It might not work and then you've at least eliminated a variable.

Also remember that the average medical doctor never had to take a single human
nutrition course. Some doctors have done quite a bit of additional studying
and are up-to-date on nutrition research and findings but most probably just
see the same flawed headlines most Americans do.

------
the_cat_kittles
i recently went on a little exploratory mission to see what the working
explanation is for how the pores actually get blocked, and then swell. it
sounds like the process, in super detail, is not well understood. from what i
could gather, sebaceous glands get blocked, and the sebum they secrete starts
to pool in the duct around the follicle, under the skin. the sebum creates an
ideal environment for a bacteria called p acnes to flourish, which causes
inflammation and redness. it seems that the rate of sebum production, and the
composition of the sebum itself might have some effect on how likely the pore
is to clog. and, of course, skin cleanliness is but one of many factors that
seem to affect how often people get acne. as other people have noted, it
sounds like "inflammation", a topic i know nothing about, seems to be at the
root- basic idea seems to be that diet can cause inflammation which can then
result in acne. im more curious about the actual point at which the pore
becomes blocked, and why it happens, from a more mechanical way. i feel like a
satisfactory answer to this question would address why some pores on someones
face get clogged and others do not. im curious if anyone ever did a very
detailed microscopic timelapse somehow. since i havent studied this field at
all, its likely im not really asking the right questions, but if anyone
reading this has anything interesting about this topic, id love to hear it.

~~~
keyboardhitter
I do not know why you're being downvoted. I feel your comment added to the
discussion of the article

I also learned recently that sebum production -- and inflammation -- are both
complex mechanisms. As with most regulatory systems I wouldn't be surprised if
they were linked in some way. But obviously I don't want to claim this in some
hand-wavy way. Can you share any reading material you found when exploring the
topic?

I have recently started Spironolactone for various PCOS symptoms, including
acne vulgaris, so it's of interest to me

~~~
platinumrad
Probably the formatting. I didn't downvote and found it interesting but had a
bit of trouble reading the blob of text. I find that capitalization is really
helpful when reading longer paragraphs, especially if many of the sentences
themselves are compound.

~~~
the_cat_kittles
thanks. i was honestly surprised to be down-voted, maybe that explains it a
bit.

------
wasx
I haven't read the paper but do they define what they mean by "westernized"?
China is very much the east, does acne vulgaris have the same prevelance in
countries in Asia and the middle east?

~~~
billconan
I'm Chinese and my Acne problem is pretty bad.

~~~
intro-b
yep - anecdotally, my family members living in both China and Japan
experienced some bad bouts of acne during their adolescence and up through
young adulthood. given that the paper's study population were hunter-gatherers
and islanders, it would probably make more sense to frame it as "modern
industrialized society" versus "hunter-gatherer" rather than "western" against
"non-western

------
throwaway863601
Acne vulgaris is the same as the one adolscents get, right?

How is the claim possibly true? Do they mean something other than what "non-
Westerners" means literally? It happens e.g. in the middle-east too and I
don't imagine that's an exception. I thought it was a pretty common human
phenomenon.

