Is It the Sugar, the Milk, or the Cocoa in Chocolate Causing Acne?

Michael Greger M.D. FACLM via Nutrition Facts – Is the link between chocolate and acne due to the sugar, the milk, or the cocoa in chocolate? Researchers put white chocolate, dark chocolate, baking chocolate, and cocoa powder to the test to find out.

A century ago, “diet was commonly used as an adjunct treatment for acne. During the 1960s, however, the diet–acne connection fell out of favor.” Why? Because of a study that purportedly “‘proved’ that chocolate had no influence on acne by comparing a chocolate bar to a pseudo chocolate bar composed of 28% hydrogenated vegetable oil, a food known to increase inflammatory markers.” It’s no wonder real chocolate didn’t come out looking so bad when compared to that pure trans-fat-laden fake chocolate. 

As well, in another study, small groups of medical students ate a variety of purported acne-causing culprits, and only about a third broke out. However, there was no control group for comparison. Nevertheless, these two studies, despite their “major design flaws, were sufficient to dissociate diet from acne in the minds of most dermatologists. Textbooks were revised to reflect this new academic consensus, and dermatologists took the stance that any mumblings about the association between diet and acne were unscientific and one of the many myths surrounding this ubiquitous disease.”

“Comments such as ‘The association of diet with acne has traditionally been relegated to the category of myth’ are commonplace in both the past and current [medical] literature…[however] the major textbooks of dermatology promulgate the notion that diet and acne are unrelated, yet rely only on 2 primary references”—those two flawed studies. So, this “present consensus within the dermatology community that diet and acne are unrelated has little or no factual support.” 

But there is reason to suspect chocolate consumption may be an issue, as I discuss in my video Does Cocoa Powder Cause Acne?. Blood was taken from subjects before and after they ate a couple bars of milk chocolate. It appears the milk chocolate “primes” some of their pus cells to release extra inflammatory chemicals when you expose them to acne-causing bacteria in a petri dish. “This may indeed represent one of the mechanisms that could explain the effects of chocolate on acne,” but how do we know it’s the chocolate and not the added sugar or milk?

If you survey teens on their acne severity and eating habits, there does appear to be a link to chocolate consumption, as you can see at 2:18 in my video, but is this association from people sprinkling cocoa powder in their smoothie or eating dark chocolate, or is it because of the added sugar and milk?

As you can see at 2:32 in my video, simply cutting down on sugary foods and refined grains can halve pimple counts in a few months, which was significantly better than the control group. You can view compelling before-and-after pictures at 2:38.

To tease out whether or not it was the sugar, researchers gave subjects milk chocolate or jelly beans. If it was just the sugar, then, presumably, acne would get worse equally in both groups. Instead, the chocolate group got worse, experiencing a doubling of acne lesions, whereas there was no change in the jelly bean group, as you can see at 2:52 in my video. So, apparently, it’s not just the sugar. Maybe there is something in chocolate, or is it only in milk chocolate? 

“There have been no studies assessing the effects of pure chocolate (made of 100% cocoa) on acne”…until researchers randomized 57 volunteers with “mild-to-moderate acne” into three groups, receiving white chocolate bars, dark chocolate bars, or no chocolate bars every day for a month. The dark chocolate wasn’t just any dark chocolate; it was 100 percent chocolate, like Baker’s chocolate. Unlike pure dark chocolate, white chocolate is packed with sugar and milk. What happened? Indeed, acne lesions worsened in the white chocolate group, but not in the dark chocolate or control groups. “According to this study, white but not dark chocolate consumption is associated with exacerbation of acne lesions.” 

Other studies, however, did show acne worsening on dark chocolate. As you can see at 3:55 in my video, when research subjects were given a single, large quantity of Ghirardelli baking chocolate, they broke out within days. “Significant increases were found” in the total average number of acne lesions within only four days. The same was found with more chronic consumption of dark chocolate. Subjects ate half a small chocolate bar a day for a month, and increased acne severity was reported within two weeks, as you can see, along with before-and-after pictures, at 4:11 in my video.

Was anything lacking in these two studies? Subjects were either given chocolate every day or one big load of chocolate, and their acne got worse. What didn’t these studies include? Long-time NutritionFacts followers should know the answer by now. The studies were missing a control group.

If you look at surveys, you’ll find that most people believe chocolate can cause acne. So, if you give people a big load of chocolate, it’s possible the stress and expectation of breaking out contributes to actually breaking out. To really get to the bottom of this, you’d have to design a study where people were given disguised chocolate so you could expose them to chocolate without their knowledge and see if they still break out. For example, you could put cocoa powder into opaque capsules, so the participants don’t know if they were getting cocoa or placebo. This would have the additional benefit of eliminating the cocoa butter fat factor. No milk, no sugar, no fat—just pure cocoa powder in capsules versus a placebo. There had never been such a study…until now.

A double-blind, placebo-controlled study assessed the effect of chocolate consumption—actually, cocoa powder consumption—in subjects with a history of acne. Participants were assigned to swallow capsules filled either with unsweetened, 100-percent cocoa or a placebo of an unflavored, unsweetened gelatin powder. Interestingly, “240 capsules were required for 6 oz of [cocoa] powder.” So, what happened? As you can see at 5:50 in my video, researchers found the same significant increase, the same doubling of acne lesions within four days, just like in the Ghirardelli study. So, sadly, it really “appears that in acne-prone…individuals, the consumption of chocolate correlates to an increase in the exacerbation of acne.” 

Now, the study included only men, who don’t have to deal with cyclical hormonal changes like women do, and it’s hard to imagine that after swallowing hundreds of capsules, the real cocoa group didn’t burp up some cocoa taste and realize they were not in the placebo group. But, the best available balance of evidence does suggest that if you’re bothered by acne, you may want to try backing off on chocolate to see if your symptoms improve. 

What about the effects of chocolate, dairy products, and sugar on acne risk? See my video Does Chocolate Cause Acne?.

KEY TAKEAWAYS

• Although diet was a common adjunct treatment for acne a century ago, studies have been published, purporting to prove that chocolate was not associated with acne. The first was designed misleadingly, pitting a chocolate bar against a fake one composed of 28 percent hydrogenated vegetable oil, a food known to increase inflammatory markers, and another had no control group for comparison. Nevertheless, these two studies, despite major design flaws, effectively dissociated diet from acne in the minds of most dermatologists.
• Milk chocolate, however, appears to “prime” some pus cells to release extra inflammatory chemicals when exposed to acne-causing bacteria in a petri dish.
• To investigate whether the chocolate itself is the culprit and not the added sugar or milk, researchers gave subjects milk chocolate or jelly beans. The chocolate group got worse, doubling their acne lesions, while the jelly bean group had no change. So, sugar doesn’t appear to be the culprit.
• Researchers randomized acne patients to receive white chocolate bars (packed with sugar and milk), dark (100 percent) chocolate bars, or no chocolate bars, and found that acne lesions worsened in the white chocolate group, but not in the dark chocolate or control groups.
• Other studies did show dark chocolate exacerbating acne, but they lacked a control group, so simply the expectation of experiencing a worsening of acne from consuming chocolate cannot be discounted.
• In a double-blind, placebo-controlled study, subjects were given capsules filled either with unsweetened, 100-percent cocoa or a placebo of an unflavored, unsweetened gelatin powder. Researchers found the same significant increase in acne lesions, so it appears consumption of chocolate correlates to greater exacerbation of pimples and lesions in those prone to acne.

To read the original article click here.