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Protein shakes and acne « Supplement Reality
Eating dairy products has long been associated with acne, though a cause-effect relationship has never been proven beyond a shadow of a doubt, at least not to my knowledge. Recently Bill Danby, MD, an adjunct professor at Dartmouth Medical School in New Hampshire, reviewed this topic (1). He suggests that dairy products, including whey and/or casein-containing protein supplements, can cause acne by doing one or both of the following:
- Dairy products contain androgens, including precursors to dihydrotestosterone (DHT). DHT is an androgen implicated in acne as well as hair loss.
- Dairy products increase insulin and insulin-like growth factor 1 (IGF-1) levels. Insulin and IGF-1, in turn, promote the actions of androgens.
Danby states,
???In men, we used to see acne caused by anabolic steroid use in weight lifters and body builders fairly regularly. Over time, the level of sophistication in this population has increased, so that the risks of ???stacking??? various combinations of anabolic steroids is now recognized and steps are taken to make less acnegenic choices. Nevertheless, a new problem has begun to appear in the gym: acne onset and exacerbation in teenaged boys and in mature 40ish men who are consuming casein- and whey-containing protein powder ???shakes??? based on cow milk-derived proteins in an attempt to ???bulk up??? and ???put on some muscle.??? This has not occurred when soy-based protein shakes are used (author???s unpublished observations).???
Talking about the effects of milk on insulin and IGF-I levels, he notes,
???A glass of milk added to a low glycemic index meal can boost the insulin response 300%, to the level produced by a high glycemic index meal [45] and cow milk formula does this even better than human breast milk.[46] It appears from differentiating studies that insulin rises in response to the whey component (20% of milk protein), whereas casein is responsible for the IGF-1 increase.[47] Because whey and casein are both involved in stimulating androgen production, there is little point in further differentiating them in dietary restriction. Both should be avoided.???
Danby continues,
??????The typical Western diet, consisting of numerous dairy sources and foods with high glycemic indices, appears to have solidly-documented potentiating effects on serum insulin and IGF-1 levels, thereby promoting the androgens that are at the basis of the intraductal changes that lead to the development of acne vulgaris. More recent work, in progress, seems to implicate the same mechanism in the worst folliculopathy we treat, hidradenitis suppurativa.???
Bodo Melnik, MD, is a professor in the Department of Dermatology, Enviromental Medicine and Health Theory at the University of Osnabrück in Germany. Here he summarizes the complex biochemistry by which the intake of milk and whey-protein-based products may lead to acne (2):
???Acne vulgaris, the most common skin disease of western civilization, has evolved to an epidemic affecting more than 85% of adolescents. Acne can be regarded as an indicator disease of exaggerated insulinotropic western nutrition. Especially milk and whey protein-based products contribute to elevations of postprandial insulin and basal insulin-like growth factor-I (IGF-I) plasma levels. It is the evolutional principle of mammalian milk to promote growth and support anabolic conditions for the neonate during the nursing period. Whey proteins are most potent inducers of glucose-dependent insulinotropic polypeptide secreted by enteroendocrine K cells which in concert with hydrolyzed whey protein-derived essential amino acids stimulate insulin secretion of pancreatic β-cells. Increased insulin/IGF-I signaling activates the phosphoinositide-3 kinase/Akt pathway, thereby reducing the nuclear content of the transcription factor FoxO1, the key nutrigenomic regulator of acne target genes. Nuclear FoxO1 deficiency has been linked to all major factors of acne pathogenesis, i.e. androgen receptor transactivation, comedogenesis, increased sebaceous lipogenesis, and follicular inflammation. The elimination of the whey protein-based insulinotropic mechanisms of milk will be the most important future challenge for nutrition research. Both, restriction of milk consumption or generation of less insulinotropic milk will have an enormous impact on the prevention of epidemic western diseases like obesity, diabetes mellitus, cancer, neurodegenerative diseases and acne. Proving a causal link between intake of dairy products and acne or other androgen-dependent conditions will be very difficult.???
Danby, too, feels that it won???t be easy to prove a causal link between intake of dairy products and acne or other androgen-dependent conditions. This is partly because it isn???t as simple as measuring, say, testosterone or DHT levels after drinking a protein shake. For instance, any testosterone or DHT produced may immediately be metabolized, resulting in no measurable increase in the level of either hormone.After receiving his paper, I reached out to Danby with a few more questions. During our conversations he told me that he saw 6 male patients over the course of a 6-month period in 2008 who had recently turned 40 and decided to get into shape by joining a gym. He explained,
???Gym guys are now salespeople for [whey- and casein-containing protein supplements] and all four of these gentlemen had been heavily into it. After about 3-4 months they started getting into trouble with acne. All stopped it and I???ve seen none of them back. I did initially worry that the protein powders may have been adulterated with anabolic steroids, but now that we know more about whey and casein, I don???t think we need my suspicious theory. I was giving an evening seminar to physicians in Mumbai a little over 2 years ago, and during the question and answer session an Indian lady dermatologist reported that she had seen the same thing in young boys going to the gym. But I had not discussed it during my talk. She volunteered the observation and so I told her [what I told you above about the protein supplements.]???
I then asked Danby if he thought eating dairy products might promote male pattern baldness, another condition associated with androgens, particularly DHT. He told me,
???I suspect but cannot prove that there is cause and effect. Nobody to my knowledge has collected or sorted any data. So that is pure suspicion/speculation.???
