How Blood Sugar Fluctuations Cause Acne


If you are looking for information on whether sugar causes acne, click this link.

This page finally wipes out the ridiculous notion that diet has nothing to do with acne.

It isn’t just me rambling. This is actually backed by credible science. Most of the material here is from Dr. Loren Cordain’s paper ‘Implications for the Role of Diet in Acne‘ (available here).

I’m summarizing the study here and translating it from medical jargon to plain English so that you don’t have to get a PhD just to understand it.

Basically Dr. Cordain is saying that fluctuations in blood sugar level cause acne by:

  • Increasing sebum production
  • Causing skin cells regenerate faster
  • Causing dead skin cells to stick together

Faster regeneration of skin cells means that more dead skin cells have to be pushed through skin pores. By the way, it also means faster aging of skin. When dead skin cells stick together they have to be pushed through skin pores in big lumps instead of single skin cells. It’s like diverting heavy truck traffic through a narrow village road. That can only mean traffic jams.

Throw in a good measure of sticky sebum and I’m sure you understand that it can only mean one thing: clogged skin pores and acne.

This picture summarizes the whole thing.

Click the picture to enlarge (opens in a new window)

Blood sugar and acne

The red line shows what happens to your blood sugar levels when you eat foods with high glycemic load (GL). The green line shows the same for low GL foods. Glycemic load is a measure of how much a particular food increases your blood sugar levels (BL).

Eating high GL foods spikes your BL levels. The pancreas responds by releasing large quantities of insulin to bring down the bloodsugar levels. It has to do this because high BL are dangerous.

Large quantities of insulin cause BL to plummet. Too low blood sugar levels trigger another emergency response. The adrenalin glands release androgens. Androgens are hormones that signal the liver to release some of its glycogen storages to raise the BL. Too low BL levels can lead to unconsciousness.

Incidentally low BL levels also trigger serious sugar cravings. With these cravings hammering the back of your head it’s likely that you’ll grab something sweet (=high GL) and repeat the process.

If this would happen only once in a while it wouldn’t be a problem. Unfortunately our modern diets are full of processed foods filled with refined carbs and sugar. So this becomes a daily cycle.

The more the pancreas releases insulin the less effective it becomes. Cells don’t respond to it anymore so well. This is called insulin resistivity or reduced insulin sensitivity. To counter this effect the pancreas has to release larger quantities of insulin.

Fats further add to the insult. Diet high in fats (like our modern diets are) leads to high levels of fat in the blood stream. Fats literally coats the sugar and insulin molecules and makes it harder for them to connect – further reducing insulin sensitivity.

So now you have this escalating cycle where more and more insulin is circulating your blood stream. If (and when) the blood sugar levels swing you also get a steady supply of androgens.

Insulin never works alone. It’s a precursor to practically all the hormones in your body and always affects other hormones also. In this case we are interested of insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP-3). When insulin levels go up IGF-1 follows the lead but IGFBP-3 levels drop.

So how does this cause acne.

Well insulin, IGF-1 and androgens all increase sebum production. IGF-1 is actually a growth hormone and it increases the rate at which skin cells regenerate. IGFBP-3 facilitates separation of skin cells when they die. So now you have a steady supply of three hormones that all increase sebum production. More of one hormone that makes skin cells grow regenerate and die faster. And less of one hormone that actually causes the skin cells to separate when they die.

As we discussed above, all that means more traffic jams, clogged pores and acne.

As I mentioned in the what causes acne page this is just a part of the equation. Take a look at the following quote:

Despite there being a correlation of acne with elevated IGF-1 and DHEAS (type of androgen), it would be difficult to use these hormones as laboratory markers of adult acne in the clinical setting because levels are usually within the normal range. Undoubtedly, these hormones have important effects in other organ systems in the adult in addition to effects in the skin, and therefore nonspecific inhibition of hormone synthesis could have undesirable effects.Correlation Between Serum Levels of Insulin-like Growth Factor 1, Dehydroepiandrosterone Sulfate, and Dihydrotestosterone and Acne Lesion Counts in Adult Women – Mark Cappel, MD; David Mauger, PhD; Diane Thiboutot, MD ARCH DERMATOL/VOL 141, MAR 2005

In plain English that means that IGF-1 and androgen levels cause acne in acne prone individuals, but the levels are roughly the same both for people with and without acne. Some, yet unknown, factorworks behind the scenes to cause acne.

Related articles:

Blood sugar worries (blog post).
Acne and candida.
Candida and acne – Misinformation strikes again (blog post).

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Comments on How Blood Sugar Fluctuations Cause Acne Leave a Comment

Curious @ 1:50 am #

I just had a question about IGF – 1. Since it increases cell proliferation, doesn’t it increase aging, because a cell can only divide so many times?
I’ve been googling this hormone and I’ve been reading about its benefits which can be very contradicting with the dangers. What do you think? I know this is not very related to acne, but I am reducing my carbohydrate intake because of my acne, but I wanted to see if it will also help me in the long run with wrinkles too? Since I know acne causes free radicals which really sucks for us having to deal with early skin aging too.

Also, a low protein diet helps decrease IGF – 1, so maybe that’s also something we need to look into in order to help with acne??


Jackson @ 5:56 am #

It’s funny how there’s an advertisement for Tim Horton’s Fruit Smoothies on this page.

Hammer @ 3:43 pm #

Your pdf link doesnt seem to work.

macy @ 2:04 pm #

Hi Seppo. Was wondering if you have any suggestions on how to get rid of the dark spots that pimples sometimes leave?

Jo @ 12:41 pm #

I’ve finally cleared my acne (after 20 years of cystic acne and 2 bouts of accutane) by lowering my IGF-1 levels. I did it by cutting out grains 90% of the time, particularly any corn derivatives as a blood test showed food sensitivities to corn (and also rice and buckwheat). I also now eat very little sugar compared to the average American. In addition I cut out as many sources of fluoride as possible since I believe I also had fluoroderma… and I recently found that fluoride increases IGF-1. Fluoride is not only in our water (carbon filters don’t get rid of it) but concentrated in teas, soup stocks/broths, some medicines, and many processed foods like juices. When I stick to a good diet my skin completely clears up very quickly, with the exception of all my blackheads. (Oh and I also don’t smoke or drink.)

I decided to avoid the grains/carbs instead of the fats since I believe grains are not necessary to the diet but fats are, and animal protein is very beneficial in countless other ways. So I actually consume a very high protein diet and don’t try to avoid healthy fats (to me they are coconut oil, butter, ghee, olive oil, flaxseed, avocados, whole fat yogurt — not straight milk as it contains IGF-1). I have animal protein at every meal, and with this I still have clear skin. If I ate like a normal American I’d have deep cysts all over my face, neck, and shoulders.

Thank you for the explanations!

Alexis @ 9:39 pm #

I am 30 years old and have had acne on and off for approximately 10 years. It has always been isolated to my face. It did not start until I was in college (around age 19 or 20). When I first went to a dermatologist, he had me use topicals and antibiotics, which seemed to helped significantly. I only needed the antibiotic for a couple months. Shortly after I went off these (about 6 months), I was on birth control, so I think that kept the acne at bay for a while. I had a baby a year ago, and during pregnancy and postpartum my skin was pretty good… however, a month or so after my cycle returned I started getting more breakouts, that have gradually worsened over the last 6 months. In the meantime, my fasting blood sugar was slightly elevated (98), and my thyroid was low. I was put back on thyroid meds (I had been off for about 3 years). I just recently saw a dermatologist, and she prescribed antibiotic, birth control, and topicals. She said there was no correlation to diet, blood sugar, and makeup regarding, and that what she prescribed would be the only thing that would work. I am very frustrated, because I do not want to be on multiple pills and creams for the rest of my life. I feel like there has to be something I can do. My parents and sisters do not have skin problems like I do, so I truly believe I must be sensitive to something in my diet. I eat relatively healthy, I have been vegetarian for the past three years, workout 30 minutes 4-5x a week, and am not overweight. I also am active during my job as a physical therapist throughout the day. Any tips you can give me would be greatly appreciated. Sorry so long winded… just thought a detailed history would better help you to understand my condition better.

Keith @ 6:59 pm #

I am 53 and have had acne since I was 12. It cleared up briefly in my 20s then at 30 I moved to NY and developed a very severe case of cystic acne. I tried the usual antibiotics and topicals etc with no help. I did the accurane for 3 months and was acne free for about 10 years. It was like a miracle for me.
However , for the past 3 years I’ve been breaking out again. The newer topicals really helped , but as time has moved on the breakouts are more often and getting more cystic . My new dermatologist has tried me on many retinoids which work for a while then it comes back. I was almost at the point of trying accurane despite the fact very little research is available on people in their 50s ,but I just discovered that I am pre diabetic. Then I just read your article. Now I am really hoping that these principals will work for me too. I’ve always believed diet must work somehow . My dermatologist already said it is hormonally caused, so now I hope to get my blood sugar levels down and get acne out of my life. At 53 I should be worrying about wrinkles not zits!

I will keep you posted on how things work out. You may well be saving an old man the headache of a life time.

Jo @ 7:11 am #

@Alexis, I also agree your doctor’s wrong to say diet has nothing to do with it. Since you’re vegetarian, you could have low zinc levels, which play into bad skin. You also probably consume lots of bread and rice or other carbs, which can definitely cause a problem, not just for your skin but also your blood sugar. For low thyroid, consider looking into a connection with low iodine (‘they’ say we get enough from milk, bread, and eggs, but this isn’t true — iodine was once added to these foods but not anymore, they substitute with bromine which actually depletes us of iodine, and fluoride does as well). Iodizes salt isn’t the best solution — you should see an alternative doctor (like an osteopath), but seaweed and sometimes Lugol’s iodine can support a healthy thyroid. You might also have a candida connection if you do eat many carbs. Candida can definitely cause bad skin. Finally, if you had a very stressful time before/after your pregnancy, you might want to get your adrenals checked for adrenal fatigue, which often goes hand-in-hand with low thyroid. Some supporting factors for it are vit D, vit C, iodine vit B group (you might be low in B12 being vegetarian), and lowering blood sugar (often by eating more protein and healthy fat).

Keith @ 12:53 pm #

@Seppo: Seppo
Thank you for all your helpful information.
I visited a nutritionist about my pre diabetes and being slightly underweight. Her recommendations are very similar to your 50/30/20 advise. I’ve been following the low sugar routine and I am seeing a great improvement in my acne. In fact I’ve only had two breakouts since the change and they were smaller and much less inflamed than before. Even the texture and overall tone has evened out. You can imagine how much better I feel !
It’s such a shame that there is so little recognisation of these important facts you bring to your website . You are doing such a great service to people like myself who thought it impossible to break the cycle of acne.
I will keep you updated.
Keep up the great work Seppo !


joy @ 2:00 am #

I am just so confused I have had acne since I was 13 and most recently now in my twenties got cystic acne. After taking antibiotics which didn’t seem to help much I decided to take a healthy approach and I am now on a healthy diet, I only drink water no sodas or fruit juices i don’t drink milk i eat alot of fruits and vegetables and take probiotics as well as B vitamins and until recently I decided to go gluten free since I feel like it might be a huge factor in my acne.My skin has improved alot but I still break out. I went to the doctor and they told me i have low blood sugar so now i am thinking that this might be the cause of my acne but I don’t understand, I though it was high blood sugar that causes acne. I eat a healthy diet,but I do notice that when I eat alot of carbs I break out so should I stop my gluten free diet and go back to eating whole wheat breads and pasta as this could help with my blood sugar levels or what do I do?Could it be simple carbs that are making me break out or is it the gluten? What are my best options if I have low blood sugar?

Laura @ 4:05 am #

I’m 40 years old and I’ve known my acne to be hormonally based since I went on birth control for the first time in my twenties. The antibiotics didn’t work, Accutane did for a little while but it came back. Birth control consistently worked. I’m not wanting to be on birth control medication for other concerns so I’ve been looking at other ways to control my acne. Looking at diet, all this on your site makes a lot of sense. I eat fish and seafood but no other meats, how does one get enough protein? If you look at “plant” proteins they are all grain and legume that I’ve read to stay away from! I’m stumped. Suggestions?

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