Does Chocolate Cause Acne?

Does Chocolate Cause Acne?
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What are the effects of dairy products, sugar, and chocolate on pimple formation?

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Acne affects nearly one in ten people in the world, “making it [perhaps] the eighth most prevalent disease worldwide.” What’s the role of nutrition? Well, go back a century, and dermatology textbooks were recommending various dietary restrictions. For example, recommending those with acne avoid foods like “pork, sausage, cheese, pickles, pastries,…sweets, cocoa, and chocolate.”

Yeah, but old-timey medicine was full of crackpot theories. Dr. Kellogg, for example, blamed acne on masturbation. Nothing a few corn flakes couldn’t fix, though!

Population studies have found associations between acne and the consumption of foods like dairy, sweets, and chocolate. But, you don’t know if it’s cause and effect until you put it to the test. There have been high quality reports, like the Harvard Nurses study, that looked at nearly 50,000 women, and found a link between adolescent milk-drinking and acne—particularly skim milk, something that’s been found for teenage boys as well.

They thought it might be the hormones in milk that were responsible. But, it could also be the milk protein, whey—of which they add extra to skim milk to make it less watery—which may play a direct role in acne formation or as hormonal carriers. That would explain cases like this, where whey-protein powders were implicated in precipitating acne flares in teens who had acne that just didn’t seem to want to go away, until they stopped the whey. It doesn’t appear to just be a protein effect, since soy-protein supplements, for example, did not seem to cause the same problem.

But, for dairy, in terms of interventional studies, all we have are these kinds of case series. If you do a systematic review of acne and nutrition, you get results like this for dairy: out of the 20 or so papers on acne and dairy out there, about three-quarters suggest adverse effects, and the remainder report no effect, with no studies suggesting a beneficial effect of dairy on acne. So, you could look at this and conclude a dairy-free diet is worth a try. But, this is based on low-grade evidence, level C and D evidence, where C is like the population studies, and D is like those series of case reports. What we want, ideally, are randomized interventional studies—level A and B evidence, which we don’t have for dairy, but we do have for chocolate.

When it comes to acne, no food is “more universally condemned than chocolate.” So, if you’re the “Chocolate Manufacturers Association,” how are you going to design a study to make your product not look so bad? Well, you can always use the old drug company trick of pitting your product against something even worse. And so, they fed people chocolate bars, versus fake chocolate bars made out of partially hydrogenated vegetable oil: trans fats. So, make it have more sugar, throw in some milk protein, and make it 28% pure trans-fat laden, Crisco-like vegetable shortening. And, surprise, surprise, there were just as many pimples on the fake chocolate bars— allowing them to conclude that eating high amounts of chocolate is A-OK when it comes to acne.

And, the medical community fell for it. “Have we been guilty of taking candy away from babies?” “Too many patients harbor the delusion that their health can somehow be mysteriously harmed by something in their diet.” That original study “finding that chocolate consumption supposedly does not exacerbate acne has continued to remain virtually unchallenged for decades and continues to be cited even in…recent review[s].” For example, this pediatrics journal. Years ago, it was “demonstrated that chocolate consumption had no effect on acne.”

“…[T]his serves as a cautionary example of how ‘research-based evidence’ should be vigorously scrutinized prior to being incorporated into clinical practice.” Just because something is published in the Journal of the American Medical Association doesn’t necessarily mean it’s a good study— especially when industry interests are involved.

Maybe we should be telling acne patients to try cutting down on not only the sweets and the dairy, but also the trans fats found in partially hydrogenated vegetable oils. But, we can’t “be unequivocal in [our] advice to acne sufferers” on foods to include or exclude until they’re put to the test in “well-designed randomized controlled clinical trial[s].” But, there simply weren’t any such trials on acne, until, now—which we’ll cover, next.

Please consider volunteering to help out on the site.

Image credit: congerdesign via Pixabay. Image has been modified.

Motion graphics by Avocado Video.

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Acne affects nearly one in ten people in the world, “making it [perhaps] the eighth most prevalent disease worldwide.” What’s the role of nutrition? Well, go back a century, and dermatology textbooks were recommending various dietary restrictions. For example, recommending those with acne avoid foods like “pork, sausage, cheese, pickles, pastries,…sweets, cocoa, and chocolate.”

Yeah, but old-timey medicine was full of crackpot theories. Dr. Kellogg, for example, blamed acne on masturbation. Nothing a few corn flakes couldn’t fix, though!

Population studies have found associations between acne and the consumption of foods like dairy, sweets, and chocolate. But, you don’t know if it’s cause and effect until you put it to the test. There have been high quality reports, like the Harvard Nurses study, that looked at nearly 50,000 women, and found a link between adolescent milk-drinking and acne—particularly skim milk, something that’s been found for teenage boys as well.

They thought it might be the hormones in milk that were responsible. But, it could also be the milk protein, whey—of which they add extra to skim milk to make it less watery—which may play a direct role in acne formation or as hormonal carriers. That would explain cases like this, where whey-protein powders were implicated in precipitating acne flares in teens who had acne that just didn’t seem to want to go away, until they stopped the whey. It doesn’t appear to just be a protein effect, since soy-protein supplements, for example, did not seem to cause the same problem.

But, for dairy, in terms of interventional studies, all we have are these kinds of case series. If you do a systematic review of acne and nutrition, you get results like this for dairy: out of the 20 or so papers on acne and dairy out there, about three-quarters suggest adverse effects, and the remainder report no effect, with no studies suggesting a beneficial effect of dairy on acne. So, you could look at this and conclude a dairy-free diet is worth a try. But, this is based on low-grade evidence, level C and D evidence, where C is like the population studies, and D is like those series of case reports. What we want, ideally, are randomized interventional studies—level A and B evidence, which we don’t have for dairy, but we do have for chocolate.

When it comes to acne, no food is “more universally condemned than chocolate.” So, if you’re the “Chocolate Manufacturers Association,” how are you going to design a study to make your product not look so bad? Well, you can always use the old drug company trick of pitting your product against something even worse. And so, they fed people chocolate bars, versus fake chocolate bars made out of partially hydrogenated vegetable oil: trans fats. So, make it have more sugar, throw in some milk protein, and make it 28% pure trans-fat laden, Crisco-like vegetable shortening. And, surprise, surprise, there were just as many pimples on the fake chocolate bars— allowing them to conclude that eating high amounts of chocolate is A-OK when it comes to acne.

And, the medical community fell for it. “Have we been guilty of taking candy away from babies?” “Too many patients harbor the delusion that their health can somehow be mysteriously harmed by something in their diet.” That original study “finding that chocolate consumption supposedly does not exacerbate acne has continued to remain virtually unchallenged for decades and continues to be cited even in…recent review[s].” For example, this pediatrics journal. Years ago, it was “demonstrated that chocolate consumption had no effect on acne.”

“…[T]his serves as a cautionary example of how ‘research-based evidence’ should be vigorously scrutinized prior to being incorporated into clinical practice.” Just because something is published in the Journal of the American Medical Association doesn’t necessarily mean it’s a good study— especially when industry interests are involved.

Maybe we should be telling acne patients to try cutting down on not only the sweets and the dairy, but also the trans fats found in partially hydrogenated vegetable oils. But, we can’t “be unequivocal in [our] advice to acne sufferers” on foods to include or exclude until they’re put to the test in “well-designed randomized controlled clinical trial[s].” But, there simply weren’t any such trials on acne, until, now—which we’ll cover, next.

Please consider volunteering to help out on the site.

Image credit: congerdesign via Pixabay. Image has been modified.

Motion graphics by Avocado Video.

Doctor's Note

Even if chocolate were a problem, is it just the sugar or milk in chocolate? What about dark chocolate? What about cocoa? Stay tuned for my next video: Does Cocoa Powder Cause Acne? In the meantime, feel free to check out some of my other acne videos:

If you haven’t yet, you can subscribe to my videos for free by clicking here.

50 responses to “Does Chocolate Cause Acne?

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  1. I had terrible acne as a teenager. I was coerced into drinking milk since my parents, like most other parents, were brainwashed by the propaganda back then that cow’s milk is a super food for humans … wrong! I noticed as an adult, when I stopped drinking milk, the acne went away. Finally, I cut out all milk and cheese altogether and I have felt great ever since with no acne. I do eat a little whole cacao powder, so I’m looking forward to the next video.




    30
    1. Ditto, WFPB-Hal. I went through dry-ice treatments from a dermatologist for years, nothing really worked – in addition to enough penicillin to cure the entire U.S. population of everything! (Who knows how that affected my gut!) I wish I had known about dairy. The rosacea I had for years after acne is also gone, now that I’m dairy-free. Sigh…




      18
      1. And ditto again. I had acne as a teenager and rosacea (and gum disease, despite scrupulous cleaning) for decades. As soon as I adopted the WFPB diet, the rosacea and gum disease disappeared. Sadly, my dentist remains sceptical that diet has reversed the gum disease, though he remains amazed at the turn-around. If he knew about this site, he wouldn’t find the dietary cause such a stretch.




        9
    2. I am in my 40ies and still get ACNE if I just consume tiny amounts of sugar in most shapes and forms. I only consume raw fresh fruit and steamed vegetables with little whole grains. This keeps my skin super clean. I think pure coco powder might not be the problem, unless the process to create the powder also creates sugar like molecules.




      2
  2. I would suspect that if chocolate DOES cause acne, that it would be because much chocolate is *milk* chocolate. I also thought of cute jingle in response to teenage athletes getting acne from whey. No way, no whey!




    7
    1. That’s what I thought too, but if you don’t want to wait until the next video is posted Monday then you can click through the linked study mentioned at the end of the video. Lo and behold, they tested cocoa powder (no milk) and mere cocoa powder caused a statistically significant increase in acne in their tiny sample. It’s not the best study, but it certainly suggests that acne suffers should avoid all types of chocolate, even dairy free.




      13
      1. What about Dr. Gregor’s video on the ‘Kuna Indian Secret’?
        He says the secret to their good health is that they drink cup after cup of cocoa. (September 2009)




        2
      2. With my own experience as a younger person, seems like every time I ate chocolate I got a few pimples/acne. I was not prone to acne. When I was in my late 20s, and could understand what the “medical community and/or industry-backed” studies were saying~~ that their studies did not show chocolate causing acne…none of it made sense to me, because my personal experience showed the opposite. Basically, I did not believe the studies…and thanks to your report, I now know.




        5
        1. Anne, what report? He didn’t give a conclusion yet just pointed out how the studies were skewed. But when you say chocolate, what kind of chocolate were you eating? Pure cocoa powder is different than consuming a candy bar with a variety of ingredients (a very large variety most of the time), for example. Also people tend to drink milk with chocolatey desserts and for that matter, when one is eating candy and other desserts regularly, more than likely they’re consuming other junk foods regularly as well. A lot of stuff to consider.




          2
      3. I’ve never had acne per say, just random pimples and I get them when I eat chocolate. Cocoa powder with cocoa butter and stevia. That’s it. No dairy or sugar.




        1
  3. I liked this video in part because of it’s comments on how to look critically at published research reports (e.g., “follow the money, honey” and actually look at the study design, not just the conclusions). I sent a link to my daughter, a nurse who is thinking about going to grad school. She’s already heard these suggestions from me, but I think they may have more lasting influence coming from a third party. So, thank you, Dr. Greger.




    14
  4. “Too many patients harbor the delusion that their health can somehow be mysteriously harmed by something in their diet. ” Gotta love that line–I think nutriitonfacts does an awesome job of dispelling that myth.




    15
  5. I always thought the problem with chocolate candy and acne had more to do with the wax in the candy. A wise old nurse told me in l975, when she saw me eating chocolate candy, “You do not want to put wax into your blood stream!” I believed her of course. She was old and wise and I was neither.




    3
    1. Sara, that’s a really interesting topic in its own right… What are the effects of consuming wax? Considering they not only add it to candy but even wax produce (depending on the company and/or store), seems like that would be some pretty relevant information. I’m not sure if it’s been looked into or not but I’ve never actually heard anything on it.




      0
  6. I love Dr. Greger. I listen to him every day, but I don’t think there was anything substantial in today’s video. I sometimes wish he would get to the point and not tease us. Does eating chocolate cause acne or not? Is dark chocolate different in its effects than milk chocolate? Does amount of chocolate matter? Does the age of the person eating it? Should we be eating chocolate at all if we want to eat an ideal diet?




    5
    1. Hi Brian Anthony Kraemer, thank you for your comments and questions. Until we get the further videos on this topic of Acne, Dr Greger had covered another video on Acne that indicated that Westernized diet were one of the reason behind increasing excessiveTOR enzyme production which contributes to acne and obesity. For example, “Cow’s milk is not just food but appears to represent a most sophisticated [hormone-] signaling system activating” TOR. It has three times higher Leucine amino acid which is the primary activator of TOR. So what helps to inhabit the TOR activity, I hear you ask? It is Fruits and vegetables which have natural plant derived inhibitor in treatment of acne. I hope this helps with some of the questions until we see the new videos.
      Saving Lives by Treating Acne with Diet




      5
    2. Brian, he has lots of videos on cocoa and its health benefits, check out the one about the Kuna Indians (again, hope I’m getting the name right!). This is simply specific to acne and probably specific to person if it IS linked because I don’t get a reaction and I don’t hear fellow cacao lovers complaining.
      Cacao/cocoa is very healthy though, I wouldn’t worry.
      Kind of agree about the teasers though, would prefer it summed up in one video but sometimes it’s obvious why there needs to be a series on things e.g the gluten/casein free diet for autism.




      1
  7. Another cliffhanger! LOL. It used to be the daily or weekly tv shows that would leave me waiting impatiently for the next episode. Now NutritionFacts.org is nearly the only place in my life where I have to experience the dreaded wait.




    2
  8. I can only imagine the conversations between Dr. Kellogg and the teenagers, which caused him to draw that conclusion.

    I never had a doctor even ask one question.




    2
  9. I thought phytochemicals in cacao are known to benefit the skin and help improve a variety of skin conditions including acne?

    Also, I thought dairy and sugar are know to increase the production of p. acnes?

    If the above are true, wouldn’t it follow that very dark chocolate would not be a culprit in acne and that milk chocolate could possibly contribute to one’s acne?




    1
  10. Nooo! Not “next!” I want want my beloved cacao exempt immediately! Oh well, I’m any case, I don’t seem to get any negative reaction from it on my skin personally. I was having a slight issue when I was overly obsessive about 3-6 ratios so I was consuming way too much flax and chia (crazy amounts) and was extremely low in omega 6. After reading something about not getting enough omega 6 being linked to stickier sebum (to simplify), I paid attention to what happened after I kept up the flax and possible chia in more normal amounts and allowed myself to eat omega-6 rich foods w/o trying to sway the ratio and my skin went back to normal!




    7
    1. Yes, very high. Cacao is just the least processed form, cocoa is more processed so there are less antioxidants but still good. Dr. Greger has a video on here about the Kuna Indians (I hope I’m getting their name right) and their cacao consumption.




      1
  11. There seems to be a universal desire to villanize chocolate. What’s clear to me is that it’s not chocolate, per se, it’s the animal-based and processed and refined ingredients that are the culprits. I would love to see how pure dark chocolate and cacao stacks up. Next video, please!




    3
  12. There is an invisible side this story. Some molds in cacao beans produce mycotoxins. This has to do with processing (sun drying, storage, etc) and not with the cacao beans. Thus, studies could in theory go all over running in circles thinking they finally nail it. And different brands, different locations, etc., have different processes. The way it would work is that mycotoxins, at different concentrations and types, would over stimulate the immune system which in turn can cause collateral damage (acne?). Cooking kills the living mold but does not get rid of the mycotoxins (the product).




    0
    1. This is a way to wash away mytotoxins/lectins in whole beans assuming they are on the surface:

      1 Place beans in a bowl overnight or longer covered with water

      2 Stir beans with an utensil to mechanically rub away the surface

      3 Change water before cooking

      If you experience a gain in energy (immune system has priority on glucose) when compared to not doing anything, then you made an improvement.

      PS: If you happen to have a mixer (like Kitchen Aid), you could use its paddle to do the work on the bowl for like 5 minutes rubbing the beans on water instead of using a utensil with your hand.




      1
        1. That could be true depending on the pressure cooker model. Different models operate at different pressures.

          Stove top pressure cookers = 13 to 15 psi
          Electric pressure cookers = 6 to 12 psi

          Therefore, if you use an electric pressure cooker, some lectins could still be present. But if you soak-wash, it would help a lot and it may be enough.




          0
  13. Not everyone has acne but for people who are acne-prone it really helps to avoid certain foods, including chocolate, if you want clear skin. I suffered with severe adolescent and adult acne (up into middle-age) that was virtually impossible to treat even with antibiotics (…it scares me to think how many antibiotics I took…). I finally had a doctor who advocated drastic changes in my diet, specifically no dairy, no chocolate, no sugars, etc. And I eventually became a whole foods vegan. After making these changes my skin finally cleared up and I now have beautiful skin that glows with health. I also have few wrinkles compared to others my age. When I was in my early 20’s, a woman I knew recommended I give up dairy, sugars, flesh foods, etc. and become vegan. I thought her advice was really stupid and cited the study mentioned above that foods have no effect on acne. Now I wish I had followed her advice then…I could have avoided much suffering!!!




    4
    1. “Chocolate” isn’t really a food, it’s a flavor that comes in a package with a variety of foods and additives, a far cry from pure cacao/cocoa. Will be interested to see what the science has to say on pure cocoa/cacao!




      1
  14. What’s the point of the video? No conclusion at all. On top of this the term chocolate could mean anything. It’s universally acknowledged that the higher the cacao content, the better it is for you.




    2
    1. Really good information, thanks for sharing this! I don’t drink bottled water from plastic for multiple reasons but still good to know and this should definitely be shared. A bit concerned about my occasional Harmless Harvest coconut water consumption. I hate plastic… Stupid Garden of Life started putting their B12 spray in plastic bottles instead of glass as they previously had, I like that their spray is all natural and organic but due to this I’d prefer to switch to a different B12 supplement (I take a high dose once a week), anyone know of any good, natural brands?




      1
      1. S, just order some b-12 drops in a glass bottle and pour that into a glass spray bottle you have saved from when your brand came in glass.

        … you DO save your glass spray bottles don’t you?… Everyone does this…. right???




        1
        1. haha, I do actually! though I wish I had saved more now that they don’t make them. I’ll have to shop around but am hoping someone might have a suggestion for good pure form so I don’t have to search, I’ve really only ever used Garden of Life’s since I started supplementing with it so I never had to worry about unnatural additives or a less natural form, etc. I honestly don’t care if it’s a tablet or liquid, I just want it as natural as possible.




          0
  15. Never had acne as a teenager. Now that I’m well beyond that age, and for the past 8-9 years, I’ve had 3 squares of 72%-plus dark chocolate bar as my only dessert every evening. (No milk in it, of course.) My complexion is as smooth as a baby’s butt. :-)




    2
  16. Are there any studies of acne and chocolate that separate out the pure organic cacao with organic dates, vs chocolate that has sugar, milk vs dark…most curious about organic cacao and dates vs the other chocolates
    Organic tempered chocolate from cacao paste, cacao butter, and maple syrup or date syrup, at varying % sweetness, and fat compared to typical chocolate.




    0

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