Seppo
This is a guest post by Seppo Puusa from AcneEinstein.com blog, which is a place for rational advice on natural and alternative acne treatments.
When it comes to acne, the web is full of opinions, nonsense and conflicting information. And it’s easy to be left with more questions than answers. That’s why he started AcneEinstein.com; to share evidence-based, rational advice on acne and how to cure it. He explains what works, what doesn’t and does his best to get your questions answered with reliable advice.
There’s no doubt that diet affects acne. Several studies have now shown the connection. But the real question is how to figure out which foods cause acne and which are safe to eat.
To that end I’m happy to introduce you to another possible dietary enemy: FODMAPs.
In this post I want to talk about what FODMAPs are and how they may affect your skin. We’ll also talk about how to figure out whether they are a problem for you and what to do if they are.
FODMAPs Explained
FODMAP is an acronym for Fermentable, Oligo-, Di-, Mono-saccharides and Polyols. They are poorly absorbed sugars found in many plant foods. With sugars I mean short-chain carbohydrates, and that means more than the sweet stuff usually associated with the word sugar.
FODMAPs are linked to many digestive and gut problems. Some people have trouble absorbing FODMAPs from the small intestine. As a result they are rapidly fermented by the harmful bacteria. Fermenting results in gas that bloats up small intestine which then causes abdominal pain. FODMAPs also attract water that further adds to the bloating and discomfort. This condition is called FODMAP intolerance.
I should point out that FODMAPs don’t cause these problems. Nobody absorbs FODMAPs completely, but only some people get these symptoms. The difference comes down to gut health. People who get these symptoms may have small intestine bacterial overgrowth (SIBO) or suffer from other gut abnormalities. Without bacterial overgrowth FODMAPs in the small intestine don’t cause any noticeable symptoms.
FODMAP Sources
Just to give you an idea, here are some common sources:
- Many fruits and vegetables (such as apples and onions)
- Milk and dairy products, both from cows and goats. Lactose-free milks are acceptable.
- Most legumes
- Wheat and some other grains
Can FODMAPs Cause Acne?
There’s a good reason to believe skin health is linked to gut health. For example a few studies have found far higher prevalence of SIBO in acne patients as compared to healthy controls. Similarly other studies have shown clearing of acne when SIBO is treated either with antibiotics or probiotics.
Given that FODMAPs are food for the harmful bacteria residing in the gut, eating them may further aggravate SIBO and lead to leaky gut syndrome. Candida infestations in the gut also occur when the normal bacterial balance is disturbed.
The whole FODMAP concept is still fairly new and we have no studies on how it relates to skin conditions. But anything that causes further disturbance in the gut can plausibly aggravate acne. So I would definitely treat this as a possible cause for acne.
Should You Be Worried About FODMAPs?
So who should be worried about FODMAPs and how do you know if this is a problem for you?
We can’t say for sure, but I would say go with the symptoms. Nothing in the research papers I read indicates that FODMAPs are a problem in absence of digestive symptoms. Let’s keep in mind that it’s normal to have FODMAPs in the gut and everybody malabsorbs them to some degree. It’s only when pathogenic bacteria ferment them that they become a problem.
Common symptoms of FODMAP intolerance include:
- Gas
- Bloating
- Abdominal pain
- Irregular bowel movements
- Loose stools
- Constipation
Again, let’s keep in mind that everybody experiences these to some degree. For example FODMAPs found in legumes are always fermented in the gut. That’s why they are sometimes called the ‘windy vegetables’. So don’t freak out if you get some digestive problems every now and then.
But if you experience those symptoms regularly and they are stronger than normal, then you may have FODMAP intolerance.
What To Do?
OK, so you suspect you may have a problem with FODMAPs. What should you do next?
For this to be more than a temporary fix you need to tackle it from 2 sides.
- You should eliminate most FODMAPs from your diet for a while, and
- Address the underlying problem in the gut.
Low FODMAP Diet
Simply reducing the amount of FODMAPs in your diet is usually enough to get rid of the symptoms. Studies have found that low FODMAP diet is better at reducing symptoms in irritable bowel syndrome (IBS) patients than normal diet recommended for IBS. About 75% of people see good results with the diet.
Before you start with the diet you may want to talk to your doctor. Breath testing can identify problems with fructose and lactose absorption. It’s optional, but if testing shows you have no problems with them then you don’t need to cut them out.
Strict elimination diet for 2 to 4 weeks may be necessary at first. After that you can start introducing the foods back to your diet in small quantities to find the levels you can tolerate.
Gut Healing
Simply removing FODMAPs from your diet is enough to get rid of the symptoms, but it doesn’t address the underlying gut problems. Here are some suggestions for that:
- Probiotics, either as supplements or regularly eating fermented foods (preferable option).
- HCL supplementation. Low stomach acid (HCL) often precedes SIBO and other gut problems. When you don’t produce enough stomach acid food is not digested completely and that encourages the growth of pathogenic bacteria. HCL supplement before a meal can correct the problem.
- Digestive enzymes may also help to correct digestive problems.
- Stress management. Stress has hugely negative effect on gut health and is implicated as one of the causes for SIBO.
- Sufficient sleep – as with stress.
Once the gut issues have been dealt with, it’s likely that FODMAPs aren’t a problem anymore.
FODMAP Resources
I wanted to write this post as an introduction of FODMAPs as possible causes of acne. That’s why I didn’t cover the nuts and bolts of low FODMAP diet. For that purpose, you can check out these resources:
- FODMAP food chart (PDF) – contains high FODMAP foods and suitable substitutes.
- Here’s a comprehensive list of FODMAP foods and substitutes.
- Lowfodmap.com for more information, recipes and cooking inspiration.
There are of course also other resources. Google is your friend here.
Conclusion and Take-Home Messages
- FODMAPs are poorly absorbed sugars and other short-chain carbohydrates found in many plant foods.
- They are rapidly fermented by harmful bacteria in the gut causing abdominal pain, bloating, gas and other digestive problems. This is known as FODMAP intolerance.
- FODMAPs may further aggravate gut issues and open the door for Candida infections.
- FODMAPs don’t cause digestive problems but simply trigger them. The underlying cause is often bacterial overgrowth in the gut.
- While there are no studies to verify this, it’s plausible FODMAPs aggravate acne.
- In absence of abnormal digestive problems this is probably nothing to worry about. There’s no evidence to say that otherwise healthy people will benefit from low FODMAP diet.
- FODMAP intolerance should be treated by reducing dietary intake and addressing the underlying gut problems.
I want to finish this by stressing that you shouldn’t panic about this needlessly. Restricting your diet for no good reason rarely leads to anything good.
Acne has a huge genetic component and there are real abnormalities in acne-prone skin. You can’t fix them with diet. And that’s why diets, no matter how strict or healthy, rarely are enough to get you completely clear. FODMAPs may be an issue for people with recurring digestive problems, but in absence of them there’s no need to put yourself through yet another restrictive diet.
I’d love to hear your thoughts on this. So please voice your questions and comments below.
References:
- Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and nonallergic food intolerance: FODMAPs or food chemicals?
- Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. (PDF)
- Food Choice as a Key Management Strategy for Functional Gastrointestinal Symptoms
Interesting.. I read about another acne cure where all you eat is apples.. I think people just take everything to far. There are so many ways to cure my acne, yet none have worked yet.. oh well.
Annemarie, I don’t really want to get into the ‘3 day apple cure’, other than to say that it’s highly suspicious.
Anyhow, people are different and we have to treat them as individuals. There are situations where one man’s meat is another’s poison. This FODMAP intolerance is a good example. In people with pre-existing gut problems those poorly absorbed sugars from fruits and vegetables can cause real problems. While the next person has no problems with or suffers no ills from them. It’s down to the individual and what they can and cannot handly.
This is why it’s so damn hard to find any universal acne cures. That’s why we have to look at underlying problems (gut issues, inflammation, problems with glucose metabolism, skin irritation) and then figure out individual solutions for those.
Yes i agree with you on that..
I also read that watermelon and apples were supposed to be good for clearing acne!? So ive been eating watermelon in the am for about a week..
Im getting a little confused now, everything I thought was hood like fruits and veggies may not be ok?
The thing with food is that foods affect people completely differently… what causes problems for one person is totally fine for another. In the majority of acne cases, all these fruits and vegetables are completely fine and beneficial to your health and skin.
However, in *some* instances, a person could potentially have a sensitivity to these FODMAP fruits and vegetables. It’s nothing to do with the foods themselves being “bad”, but more with the person’s digestive system. So as Seppo suggests in this article, if you suspect you might have a FODMAPS sensitivity, you would want to cut out these things and see if it makes any difference to you. If you notice a significant improvement in your digestive health and/or skin, then you would leave these foods out of your diet for a while, while at the same time improving your digestive system with probiotics, HCL, digestive enzymes etc.
Once your digestive system is in better shape, you should be able to eat these foods with no problem. So yes. It’s not that apples and vegetables cause acne in general, but could potentially be a cause for SOME people.
Ok Tracy,
Wow I completely understand now! Well I know dairy breaks me out, bevause every time I eat it, white heads form:( I wish i could enjoy it as some do w/o breaking out..
Do you currently take probiotics?
Yes I am taking some right now 🙂
Some people who breakout from dairy may still be able to tolerate fermented dairy products, such as homemade yogurt and kefir. Have you tried those?
Kim, Tracy explained it well. FODMAPs are far from a universal problem, but they can be a problem for some people. And given that FODMAPs are found in foods generally considered to be healthy, the problem can be hard to pin down. That’s why I wanted to rise awareness of this.
That said, most people probably don’t have to worry about this. The impression I got from the research papers is that in absence of digestive problems (gas, bloating, abdominal pain, etc) FODMAPs are not a problem. Everybody has them in the gut, and they become a problem only when harmful bacteria ferment them causing the aforementioned symptoms.
So if your digestion is working smoothly there’s probably nothing to worry about.
Hey Seppo,
Thanks for the explanation and for researching all of this! I have learned so much from Tracy and have just learned about your site! You have a lot of great info in there, that seems well researched..
I read an article you posted about green tea benefits.. I used to drink it quite regularly, but stopped because I read that caffeine in green tea is bad for acne, but you dont get same benefits from drinking decaffenated i read.. Its puzzling me.. What do you think of this?
Also hiw many cups should you drink? More than 2 or 3 would seem rather harsh on the kidneys to me
Kim, I just replied to your comment on the green tea post. I’m in Malaysia at the moment (normally in Thailand) so because of the time difference it takes me some time to reply to comments.
Anyway, there’s no valid reason to believe caffeine in moderate amounts does anything bad. One reason I’m getting pissed off at alt-med and holistic folk is their constant fear mongering with just about every substance on earth. Real medical research shows no problems from moderate consumption of coffee. In fact it actually reduces the risk of diabetes and may be benefitial for kidneys.
I seriously doubt that caffeine is generally bad for acne. There are always some individuals who react to it badly, but those are the minority. Of course if you get sleep problems from caffeine then that can be a problem. But I wouldn’t otherwise worry about caffeine. Decaffeinated green tea is of lower quality and the decaffeination process also reduces antioxidant levels in green tea.
Very interesting! Thanks
Didnt know there were so many different green teas and etc.. I hope i can find some of those brands here in the U.S.
I used to use stokes brand, but im very curious to try these new ones! It seems very beneficial from what ive learned from you
How many cups do you recommend to start out drinking a day?
I’m sure you can find good quality green tea there. I wouldn’t go too crazy about finding the best possible green tea. Drinking any kind of green tea will give you plenty of antioxidant power. Better quality teas will have more, but I wouldn’t treat that as absolute deal breaker.
How many cups per day? Research consistently shows good resuls from 3 to 5 cups per day. I normally brew about 0.5 liters at a time and drink it as ice green tea. I do that once or twice a day. Go with what’s comfortable and convenient for you.
Ok Seppo,
Thanks.. It is very interesting to me though, that the gree tea is actually supposed to turn green.. The lil packet i usually nrew never has, it usually just turns lk a dark black color.. Im not sure why?
But i hope i can find some that turns green!!
Kim (replying to your comment about tea color). You probably don’t have a very high quality tea there. Green tea is green because the tea leaves are not fermented or oxidized. It can turn brown or towards black when tea leaves oxidize, as is the case with black tea.
Wow Seppo,
Thats very good to know! What kind of diet do you currently follow? Have you ever heard of proper food combining? Thats the diet im currently trying to follow.. Its lk you eat fruits by themselves and dont combine proteins amd complex carbs..
Happy to help Kim 🙂
Diet. To be honest, I’m not too strict with my diet anymore. I’m not sure the benefits of strict diet are worth the effort. When I eat healthy I eat paleo-style diet, meaning I avoid wheat and gluten, processed foods and excess omega 6 fatty acids. I eat a fair amount of meat, but still less than your average paleo person does.
Living in Thailand I eat a fair amount of rice and I usually have a bowl of oatmeal in the morning. But otherwise I prefer sweet potatoes and other tubers for grains. I also eat a lot of salads. Again because of Thailand I’ll have plenty of veggies in most meals. Fruits occasionally.
I make my own yogurt and have a bowl every day. I also just started experimenting with making sauer kraut.
But I also eat ice cream and other less than healthy stuff every now and then. And I’m not adverse to occasionally having (gasp!) fast food 🙂
So fairly healthy, but not too strict by any means.
I don’t think there’s much to the food combining theory. I used to believe into it when I was into raw food diet. But I never saw any benefits from it. Even if I violated all the rules I never got any digestive problems. So, I don’t see any point to put additional restrictions on myself.
Thanks for quick reply,
Wow that sounds neat! Making your own yogurt.. Is it hard to do?
I hear you on not wanting to be so strict! I have doing prper combining for about 6 weeks.. So far ive lost nearly 20 ibs.. My reasons for going on it at first were not to lose weight, but just to have more energy and hopefully clear my skin!! Ill have to say it is helpiing keep my skin less inflamed somewhat..
But around werk 4, i started to slip off a little and eat sweets and etc on occasion.. My biggest weakness is chocalote! I love that stuff, but it doesnt love me back!
Its nice to know you have tried the diet before.. Mist ppl i speak to have never heard of it and serm stumned!! I know I was when i first learned about!! H
How long did you do it for and did it help your acne and give you energy?
Making your own yogurt is dead simple. Just get a yogurt maker (around $20 at Amazon). You’ll just mix milk and yogurt and allow it to sit in the yogurt maker for 8 to 12 hours. I don’t bother with organic or any of that stuff. I just get milk and yogurt from 7-11 and be done with it.
Congratulations for losing all that weight 🙂 My guess is that it’s not due to food combining as such. Any diet restrictions leads to lower caloric intake and thus weight loss. Weight loss then has well-documented, positive effect on hormone levels and inflammation – both of which help the skin.
I did food combining when I was on my raw food diet phase, about 1.5 years. The first year I felt really good. Of course we have to keep in mind that feeling good or energizes is highly prone to placebo effect. And when you believe you are doing the right thing the placebo alone makes you feel better.
After the first year problems started creeping up. I almost gave myself diabetes with the high-fruit diet. And in the end I was in serious pain and had absolutely no energy.
Wow, thanks for sharing!
This is the diet i am doing…http://www.alderbrooke.com/images/food-combining-chart-front.jpg
Is this similar to the one you were doing? I also follow fit for life by harvey diamond and his wife.. Thats frightening to know about the diabetes, brcause I do consume a lot of fruit, but i also eat meat lk for supper.. I am hoping that will balnce it out!!
I am sorry to hear about what you encountered with it
The one I did was along the same lines. I didn’t eat too much meat, animal foods or fats at that time though. It was mostly fruits, vegetables and some nuts and seeds.
I ran into problems because of excessive carbohydrate consumption. Live and learn 🙂 It was a good wake up call for me. Burst lot of bubbles for me.
But people are individuals, and other people may be able to tolerate higher carbohydrate loads. I’m from Northern Europe and I guess my ancestors ate more meat, fats and starchy vegetables.
My suggestion is that if you don’t really WANT to follow food combining, just break the rules and see what happens. If you feel fine and don’t get any digestive symptoms then it’s probably all for nothing. You didn’t sound that convinced that it had made much of a difference on your acne.
Ok thanks!
Well my face acne has improved a lot, but im not sure completely if thats because of diet.. I am doing other things as well, such as body brushing etc..
The only frustrating thing is I have back and chest acne, i have been body brushing for about 5 days, i hope that will improve it! Its discouraging, because its lk i tried evrything to cure it.. Even went antibiotics for a year andnit did clear it a lot, but not totally! I stopped the antiboitics thi, because i dont want to be on it forever and its lk when i did, everything came back!?
Do you body brush and do you think it will help back and chest acne
What kind of soap you are using on your body? My scalp acne improved by 90 – 95% when I switched to a shampoo that doesn’t have sodium lauryl sulfate or other irritating ingredients.
I don’t know what to say about body brushing. I’m sure it feels nice 🙂
I react to some FODMAPS foods.. so far I have noticed reactions to garlic and onion, most notably. I also seem to have trouble with apples, although I initially assumed that was to do with the rise in blood sugar after eating them (I seem to have hypoglycemia).
I plan to supplement with HCL and Pepsin soon, as well as pro-biotics. I hope these will help.
Thanks for sharing. Let us know how it works for you.
Hey Seppo,
Wow!! Yeah..That could be it also..the shampoo I use.. I used to use (head and shoulders) which had zinc in it and i felt it wld help clear it! It diesnt seem lk they sell it any more tho:(
Which brand do you recommend that doesnt have sls?
It’s worth to try sulfate free shampoos. Sodium lauryl sulfate (SLS) is a common skin irritant. Many researchers use it as go-to irritant when they want to study rashes or skin care products. That said, the exposure time is usually so short that it doesn’t cause problems for most people. But some, like me, are more sensitive.
I can’t recommend any brands in the US. I’m using some local brand here in Thailand. But there should be plenty of choices available in the US.
Ok thanks,
I actually find some! Yay
..http://www.miraclesoap.com/soap.htm
Used it last night to wash my hair, it left it a little oily tho..but my hair prolly just neefs adjustment to it..
Btw are you originally from Thailand, or does work bring you there?
Glad to hear you found something. I looked at the ingredients and I found ‘foaming agent’. I don’t know what they use for that, but that’s one of the uses of SLS. But there are plenty of other foaming agents also. Let us know how it works for you. I noticed a difference quite quickly, like in a matter of week or two.
I’m from Finland. I came Thailand to do a scuba diving instructor course and have since found myself stuck here. Now I have a Thai wife so I guess that means there’s no going back anymore 🙂
I have always wanted a clear skin. I have decided to eat apples everyday just for the sake of my skin. I thought it would help. I guess not. I had a breakout after a month that I’ve started eating apples. Maybe I should consideration to stop eating apples and go for oranges. Recently today, I’ve ate 2 apples and suddenly, my stomach felt so bloated and it hurts a lot.
For a while I was eating an apple every morning, a apple a day keeps the doctor away right? well i was hoping to help clear my skin with an apple’s lovely skin benefits. I remember I was also breaking out bad & more then never at that time. I read a brief comment online that said apples and onions can cuase acne becuase of digestion and i didnt do further research but cut down on apples. I stopped eating them altogether becuase my mother stopped buying and i tried to test the theory out and now my acne has been at bay ever since and it has been a little over 6 months. i never exactly noticed the connection between apples and my acne till recently pondering on why my acne was so bad and reading this article. Im not 100% sure the apples are to BLAME becuase i was having alot of stress&anxiety and using a harsh harsh soap.. but i had used that same soap months before and i was fine so it was either annxiety and stress adding onto digestive issues WITH APPLES.My acne was bad at that time and now it has calmed down noticeably, i dont wanna risk it by eating APPLES (EVEN IF THEY COULD BE OKAY FOR ME) lol however i still eat onions with food, I wonder if i cut onions down entirely it would diminish my remaining acne… though im not sure if i eat enough for it to make a difference. Thank you for this article tracy, interesting!! all these thoughts in my head lol
I can’t say about you, but for me even small quantities of onions cause gut problems, usually followed by skin problems a day or two later. It depends how sensitive you are to the FODMAPs in them.
AHHHHH!!!! I am so lost haha…
I feel like anything I eat aggravates my acne. I stopped eating so much dairy and that helped. Also, I am starting to realize that I may have a gluten problem as well. But also, if I eat veggies and fruits I get sick to my stomach. My digestive system is really messed up. So how am I supposed to fix my acne if everything I eat aggravates my stomach? If can’t eat gluten, dairy, veggies and fruits, what am I supposed to eat?
I am so ready for my acne to just go away. I have had it since I was 12 and now I am almost 20. I used to try and treat it externally through natural methods and store-bought/prescribed methods. I even went to a dermatologist who prescribed me antibiotics, which I regret the most because I feel like even though this was a long time ago, it has made things worse. I also tried doing nothing at all. Now I am all about treating it internally.
All my younger brothers and sisters also developed acne at around the same age as me and they never actually tried to do anything about it and they have already outgrown it. But here I am, the oldest, and I am still struggling with this curse.
It seems like throughout different periods in my life I have had “different types of acne”. It started off with me having smooth skin but me having huge red bumps all over my face. Now I have black/heads everywhere, including my back, chest, face, etc. It’s just tiny little bumps but they are everywhere! My pores are so big and visible! I also break out on my cheeks really bad with hard, under the skin bumps.
I have learned to be more confident with it having acne, and I have learned to live with it, but I refuse to accept that I have to live with it all my life. I already have acne scarring also. I really really need answers.
Hi
I had terrible acne around my jaw and also a lot of itching in various ‘sensitive ‘ areas.
After being on the low FODMAPS for nearly a month, my skin is clear, and I am no longer itchy.
I am not 100% strict but try to be about 90% low FODMAPS. Seems to be working for me!