The keto diet has gained a lot of popularity in recent years because of its weight-losing and alleged anti-aging benefits.1 Celebrities and social media influencers are endorsing the ketogenic diet while citing its numerous health benefits.
This is a special form of diet which is low in carbohydrates but has a moderate protein and high-fat content.2 Eating this way forces the body into “ketosis” which is similar to what the body experiences during starvation.3
While keto is very helpful for weight loss, there is a concern that it might lead to acne and inflammation of the skin (also called the epidermis or the cutis).
Acne is a very common skin condition, especially during adolescence. It presents as pustules or pimples on the face, upper back, or chest.4 Acne occurs when hair follicles become clogged with sebum and dead skin cells. Bacterial proliferation in the plugged follicle occurs which results in inflammation and pimples.5 Other possible causes include hormonal imbalances.6
Recent evidence suggests that there might be a link between diet and acne.7
When it comes to the ketogenic diet, there is some evidence that it might help reduce the severity of skin inflammation.8 However, by the same token, there is anecdotal evidence that it might also cause pimples and rashes. This can be explained by the fact that dietary fat intake might exacerbate acne in prone individuals.9
This article explores the effect of keto on the skin and its possible association with acne.
Even though there isn’t any reliable research that examines the relationship between the keto diet and acne, the diet has been linked with skin eruptions in some individuals. The inflammatory skin condition is called “prurigo pigmentosa.”10
It is a rare epidermis condition that manifests as a recurrent itchy rash with inflamed spots that form a netlike pattern. It is associated with ketosis and is now referred to as the “keto rash.”11 It affects the upper back, chest, and sometimes the abdomen.
The exact mechanism of prurigo pigmentosa is not yet known. Apart from the ketogenic diet, other conditions that have been linked with the development of “prurigo pigmentosa” include diabetes, sweating, and contact dermatitis.
One hypothesis suggests that ketone bodies may induce inflammation which leads to “prurigo pigmentosa-”12 This is supported by the fact that anti-inflammatory medications improve the condition. Skin darkening or hyperpigmentation develops later in the course of the disease which might be difficult to treat.13
Despite the concerns that ketosis may initially trigger acne in prone individuals, it may also help it clear over time.
Recent research indicates that foods with a high glycemic index might contribute to acne development through “insulin resistance”.14 Insulin resistance describes the condition in which the cells of the body are not responsive to insulin, a hormone essential for the utilization of glucose by the cells. As a result, more insulin is released.
High levels of insulin in the body stimulate the release of insulin-like growth factors by skin cells which results in the proliferation of sebaceous glands.15 In addition, insulin also increases the levels of androgens in the body which are linked with acne.
The ketogenic diet is known to improve insulin sensitivity over time and also reduce inflammation. By reducing the production of insulin-like growth factor-1, theoretically, ketosis can reduce the severity and progression of acne.
However, more research is needed to study the effect of keto on acne. If a ketogenic diet is triggering pimples, discontinuing the diet might be recommended. Always consult a certified dermatologist if you have concerns about the effect of keto on your skin.
Keto has become popular in several beauty and wellness blogs because of its alleged anti-aging property. It is often claimed that following a keto diet will bless one with a youthful, vibrant cutis.
Perhaps you've heard of the keto glow, or have seen people posting keto before and after photos of acne?
While there is no scientific research that studies the link between keto and skin aging, there is a growing idea that ketosis might be beneficial in age-related conditions.16
In addition, keto has been found to reduce oxidative stress, which is assumed to contribute to epidermis aging and other skin disorders.17,18 Oxidative stress results in the production of free radicals that cause damage to cells and tissues.
Keto diets are linked with reduced production of free radicals and also induce antioxidative properties in cells. This can account for the proposed anti-aging effect of the ketogenic diet.
There also have been studies that suggest that keto might stop or even reverse the progression of tumors.19 The anti-inflammatory property of keto might also help reduce the severity of acne. In addition, Keto might help or prevent diabetic skin conditions by lowering insulin levels in the body.20,21
Keto eliminates high-glycemic foods (carbohydrates and sugars) which are a known trigger for acne in some people.22
Foods with a higher glycemic index induce the release of insulin, which is considered to be the culprit behind the pathogenesis of acne. This hypothesis is supported by the fact that there is an observed correlation between acne severity and carbohydrate consumption. A study published in 2007 demonstrated a reduction in the severity of acne in young males on low glycemic index foods.23
Even though there are no consensus guidelines that recommend the use of a specific keto diet for acne or other skin conditions, there are certain food items in the keto diet that may improve or exacerbate acne.
There is emerging evidence for the potential beneficial application of the keto diet in dermatology.
A ketogenic diet improves insulin sensitivity, which can help reduce the incidence and severity of acne. Skin conditions like psoriasis might also benefit from a very low-carb keto diet.28
While some individuals might experience an initial triggering of facial flush or acne on keto, the long-term benefits of the diet have promising potential for skin health.
In addition, there is an alleged role of ketogenesis in anti-aging which makes it an attractive choice for beauty bloggers.
However, it should be kept in mind that the effect of the ketogenic diet can vary depending on the individual. If you experience any unpleasant side effects, always consult your doctor and a registered dermatologist.
The ketogenic diet is high in fat content. Omega-3 fatty acids, which are present in fatty fish, can be a great source of fats for your cutis.
A study published in 2018 demonstrated the beneficial effects of omega-3 fatty acids in improving the severity of acne and in the treatment of side effects resulting from isotretinoin.29 A dry cutis is often reported as a side-effect of isotretinoin which is used for the treatment of acne. Omega-3 fatty acid supplementation was found to significantly reduce skin dryness.
While certain fat groups present in keto might be beneficial for dry skin, it should be noted that ketosis can result in dehydration.30 Therefore, try to drink plenty of fluids when on this diet.
Rosacea is a skin disorder that is characterized by the presence of spots, redness, and facial flushing. Even though it might mimic acne in the early stages, it is a different condition. Some common triggers for rosacea include spicy food, alcohol, sun exposure, and strong emotions.31
While there is no reported evidence of ketosis triggering rosacea in patients, the fatty component of the ketogenic diet might be a risk factor for some people. Eating a high-fat diet has been reported as a trigger factor for rosacea in certain individuals. Therefore, avoiding fatty food might be better if you suffer from rosacea. Fatty food might also contribute to chronic inflammation which can worsen symptoms of rosacea.32
Starting a ketogenic diet might result in a flushed or red face. This is because the ketone bodies can activate the niacin receptor which results in vasodilation.33 Vasodilation allows for increased blood flow to the skin capillaries which can give the skin a flushed or reddened appearance.
The skin appears warm, itchy, and red. While the symptoms can be uncomfortable, it’s important to remember that the keto flush or “niacin flush” is generally harmless. If you’re experiencing a flushed face or skin, consult a dermatologist for expert advice.
Consumption of high dietary fat or carbohydrates is linked with increased sebum production.34 Sebum is produced by the sebaceous glands of the skin and its excessive production can result in oily, greasy skin. As a ketogenic diet is high in fat content, it can potentially lead to oily skin in some individuals.
One way you can reduce your risk of developing oily skin is to limit your dairy intake. Milk and other dairy products have been linked with increased sebum production which can exacerbate oily skin.35
There is compelling evidence to suggest that keto can improve acne through its effect on insulin sensitivity. However, the change in dietary patterns can also trigger skin rashes in susceptible individuals.
Given the contradictory nature of available research, it might be best to consider getting an expert opinion of a certified dermatologist. Everybody's skin is different and the individual responses to keto can vary.
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7. Dall’Oglio, F., Nasca, M. R., Fiorentini, F., & Micali, G. (2021). Diet and acne: review of the evidence from 2009 to 2020. International Journal of Dermatology, 60(6), 672–685. https://doi.org/10.1111/ijd.15390 ↑
8. Zinn, C., Wood, M., Williden, M., Chatterton, S., & Maunder, E. (2017). Ketogenic diet benefits body composition and well-being but not performance in a pilot case study of New Zealand endurance athletes. Journal of the International Society of Sports Nutrition, 14(1). https://doi.org/10.1186/s12970-017-0180-0 ↑
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