"Does Cocoa Powder Cause Acne?"
A century ago, diet was commonly used
as part of the treatment for acne.
During the 1960s, however, the diet–acne connection
fell out of favor.
Why?
Because of a study purported to “prove”
that chocolate had no influence on acne
by comparing a chocolate bar to a pseudo-chocolate bar
composed of 28% pure trans fat
laden partially hydrogenated vegetable oil,
a substance known to increase signs of inflammation.
Compared to that, no wonder
that chocolate didn’t come out looking so bad.
And then, there was this other study
where small groups of medical students
ate a variety of purported culprits
and only about a third broke out,
but there was no control group to compare to,
yet 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 been relegated to the category of myth”
are commonplace in both the past
and current medical literature,
yet the major dermatology textbooks promulgating this notion
that diet and acne are unrelated,
rely only on those two flawed studies.
So, this current thought within the dermatology community
that diet and acne are unrelated
has little or no factual support.
And, there’s reason to suspect
chocolate consumption may be an issue.
If you take blood from people before and after eating
a couple of bars of milk chocolate,
it appears to prime some of your pus cells
to release extra inflammatory chemicals,
when you expose them to acne-causing
bacteria in a petri dish.
So, maybe this is 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?
Yes, if you survey teens
on their acne severity and eating habits,
there appears to be a link
to chocolate consumption,
but is that people sprinkling
cocoa powder in their smoothies,
or eating dark chocolate or,
is it because of the added sugar and milk?
Just cutting down on sugary foods
and refined grains can cut pimple counts
in half in a few months,
significantly better than the control group,
complete with compelling before and after pictures.
To tease out if it was the sugar,
researchers gave people milk chocolate
versus jelly beans.
If it was just the sugar,
then acne would presumably
get equally worse in both groups,
but instead, the chocolate group
got worse—a doubling of acne lesions,
whereas no change in the jelly bean group.
So, it’s apparently not just the sugar,
maybe there is something in chocolate,
or is it only in milk chocolate?
So far, there have been no studies
assessing the effects of pure
100% chocolate on acne,
that is, until...
there were!
57 volunteers with mild-to-moderate acne
were randomized into three groups,
receiving white chocolate bars,
dark chocolate bars, or no chocolate bars
every day for a month.
And, this wasn’t just dark chocolate,
but 100% chocolate,
meaning like baker’s chocolate.
Unlike pure dark chocolate,
white chocolate is packed
with sugar and milk.
And, indeed, acne lesions worsened
in the white chocolate group,
but not in the dark chocolate or control groups.
So, in this study, white, but not dark,
chocolate consumption was associated
with an exacerbation of acne lesions.
But, other studies did show acne
worsening on dark chocolate.
Give research subjects a single big load
of Ghirardelli baking chocolate,
and they broke out within days.
A significant increase in the total average number
of acne lesions within 4 days.
And, same thing with more chronic
dark chocolate consumption:
a half a small chocolate bar a day for a month,
and increased acne severity
was reported within 2 weeks,
with before-and-after pictures looking like this.
OK, but what was lacking in these two studies?
Give people chocolate every day
and their acne gets worse,
or one big load of chocolate
and their acne gets worse.
What didn’t these studies include?
Long-time NutritionFacts followers
should know this by now.
Right, they’re missing a control group.
If you look at surveys,
most people believe chocolate causes acne;
so, if you give people a big load of chocolate,
maybe just the stress and expectation
that they’re going to have an outbreak
contributes to the actual outbreak.
To really get to the bottom of this,
you’d have to design a study
where you give people disguised chocolate.
You expose people to chocolate
without them knowing it
and see if they still break out.
Like you could put cocoa powder
into opaque capsules, so they don’t know
if they’re getting cocoa or placebo,
and that 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 placebo,
but there's never been such a study until...
NOW.
A double-blind, placebo-controlled study assessing the effects of
chocolate consumption,
actually cocoa powder consumption,
in subjects with a history of acne –
assigned to swallow capsules
filled with either unsweetened 100% cocoa,
or a placebo of like an unflavored, unsweetened jello powder.
Just a one-time binge requiring the swallowing
of up to 240 capsules to try to
secretly expose people to a few ounces
of cocoa powder and…
the same significant increase,
the same doubling of acne lesions
within 4 days,
like in the Ghirardelli study.
So, sadly, it really does appear
that in acne-prone individuals,
the consumption of cocoa
may cause an increase in acne.
Now, the study did just include men;
so, they didn’t have to deal
with cyclical hormonal changes,
and it’s hard to imagine that the real cocoa group,
after swallowing hundreds of capsules,
didn’t burp up some cocoa taste
and know they were not just 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.