Please stop, don’t read this page until:

1. You’ve implemented the diet changes outlined in the diet page of this chapter.
2. You went through the gut healing program.
3. You have ruled out histamine as a cause for your acne.
4. You have ruled out other possible acne types, for example, you are fairly confident that your skin problems aren’t related to stress.

The reason I’m asking you to rule out all of the above is that we are going to talk about very restrictive diets. In general, I’m not in favor of strict diets. Mainly because:

• In most cases, they are unnecessary and started on for wrong reasons (such as detox or unscientific food sensitivity tests) and thus are unlikely to help.
• They often cause stress and limit your social life, which can lead to dangerous social isolation.
• They can result in a destructive cycle. You start by eliminating “harmful” foods from your diet, but your acne doesn’t get better. So you think you have to do more, cut out more bad foods, be better with your diet. In some people, this road leads to eating disorders.
• Related to the above, many of these restrictive diets are recommended and promoted by alternative health practitioners. They often push the idea that people have more control over their health than they in reality do. For acne, they often promote the idea of detoxification. That you can get rid of acne by eliminating (unnamed and undefined) toxins from your body. This empowering message has a dark flip-side; Your acne is your fault for not doing enough. It’s easy to see how this idea feeds the destructive cycle above.

With all that being said, more restrictive elimination diets can be an option for people for whom the other things discussed in this chapter have not worked.

It’s possible you have developed a food sensitivity that’s causing your acne. From time to time, posts pop up on acne forums where a person says sensitivity to citrus fruits caused his/her acne. A friend of mine always breaks out from eating chicken. There’s nothing inherently bad about chicken or citrus fruits that would cause acne, and I believe food sensitivities are the most likely explanation.

Before we go on, I need to make a disclaimer. Most of what you read on this page is not based on good evidence (like the other parts of this course are). Simply because food sensitivities and elimination diets are a controversial area, and we don’t have a lot of solid evidence to draw from.

I don’t want to claim, or even give the impression, that I’m an expert on this area. If at all possible, I suggest you work with a doctor who is familiar with food sensitivities.

With those disclaimers out of the way, let’s talk about how to know which foods, if any, you are sensitive to.

Food sensitivity tests are not reliable

Many companies sell blood tests that claim to pinpoint your food sensitivities. They check your blood against a battery of common foods (from 40 to 250 different foods). Most of these tests measure immunoglobulin G (IgG) antibodies. The theory is that these antibodies are the result of a delayed immune response (in contrast to the immediate response that happens with food allergies) and that this delayed immune response means you are sensitive to that particular food.

The problem is that these tests are not validated. Many scientists specializing in food allergies believe that food-specific IgG antibodies indicate exposure to food. There’s even some evidence to suggest IgG antibodies are protective against food allergies.

I’m not saying that IgG-based food sensitivity testing is obviously wrong and cannot work. Contrary to what the laboratories selling these tests say, they haven’t been validated. There are no good quality studies that show implementing dietary changes based on these tests works any better than eliminating common food allergens. Until such studies are done, selling these tests seems ethically dubious.

Given that these tests are expensive (most cost several hundred dollars per test) and aren’t usually covered by insurance, I can’t recommend them.

Elimination diet and rechallenge

Food elimination diet and rechallenge is the only reliable way to identify food sensitivities. Dr. Alexis Shields wrote a guest post on AcneEinstein.com about this topic, please check it out here.

Here are the basics:

1. Eliminate the foods from your diet that you would like to test for at least three weeks.
2. Reintroduce only one food at a time per 3-day period.
3. Eat a normal serving size of the food you are testing each day for three days in a row.
4. Keep a food diary of the type of food you are testing, serving size, the number of days eating the food, energy level, mood, sleep, skin health, and digestive function.

It is important to remember– reactions to foods can happen immediately to 48 hours after eating the food.

In her clinical experience, the most common food intolerances or sensitivities are:

• Dairy
• Gluten-containing grains
• All grains
• Soy
• Eggs
• Nightshades
• Legumes
• Alcohol
• Sugar & sweeteners
• Caffeine
• Chocolate
• Nuts & seeds

What to test and how to start

If you suspect food sensitivities cause your acne, here’s how I would start testing.

• Think back to times when your skin was ‘better than normal,’ can you think of foods you didn’t eat (or ate less than normally) during that period? Do you suspect certain foods cause acne for you?
• Start by doing the food elimination and rechallenge protocol for your suspect foods.
• If the above didn’t work, or you don’t have any suspect foods in mind, do the lectin elimination diet and rechallenge outlined on the lectins page in the diet chapter. The lectin protocol also tests for gluten and grains.
• If that doesn’t help, try a more generalized elimination diet. PrecisionNutrition.com has a good article that outlines what foods you can and cannot eat during the elimination phase. I would start testing foods from the Dr. Alexis Shields’ list above.

Before you start eliminating and testing, it’s important that you set the success and failure criteria beforehand; such as “I will eliminate foods X and Y for 4 weeks, and if during that time I haven’t noticed any improvements, I can conclude that foods X and Y have nothing to do with my acne.” Setting the guidelines in advance helps you to avoid the destructive cycle of eliminating more and more foods. It’s important to keep in mind that even negative results are results – just not the kind you wanted. A negative result (no improvement) tells you which foods do not cause your acne, and therefore you are free to eat them.

If none of the above helps, it’s reasonably safe to conclude your acne cannot be fixed with diet. It might be due to genetics, or there might be some abnormality (such as overgrowth or tumor in androgen-producing tissues) that leads to acne.

I highly recommend that you seek the help of a qualified healthcare professional, such as a doctor specializing in functional medicine.