Someone asked me at one of my talks recently if dairy really makes acne worse.
This is a great question, because the research that looks at the relationship between acne and dairy intake has been mixed, and it has therefore become a somewhat controversial subject.
Since I'm an acne nerd and I enjoy an occasional trip down the rabbit hole to get to the truth, I did some digging.
Here are some of the studies that examine the correlation between high milk intake and acne:
In this large retrospective study of severe teenage acne, skim milk was clearly associated with acne, while whole milk was not significantly associated with acne.
This small study came to practically the exact same conclusion, showing low-fat or skim milk was correlated with acne, while full-fat milk was not.
Similar results were found in this prospective cohort study of teenage boys, showing significantly higher levels of acne in those having two or more servings of skim milk per day, when compared with those having less than one serving per week.
In a prospective study of teenage girls, total milk consumption as well as whole, low-fat, and skim milk were all associated with acne.
This study of male teenagers in Brazil found a slight association between yogurt and inflammatory acne, while there was not a clear correlation between whole milk and inflammatory acne, or any form of dairy and non-inflammatory acne.
In this small case-control study that looked at patients aged 18-30, those with acne consumed significantly greater amounts of milk, calories, and high-glycemic foods.
But this may be the clincher for milk:
A 2018 meta-analysis sought to settle the matter, and concluded that there is "a positive association between milk consumption and acne risk,"specifically tying milk intake to moderate-to-severe acne, and showing that skim milk is more strongly associated with acne than milk with higher fat content.
Now, these outcomes don't say much about cheese or yogurt, which are arguably more enticing forms of dairy... so, what about these? Well, there are fewer studies on this, but here's what I found:
A case-control study looked at various dietary factors and concluded that high consumption of milk (especially skim milk, again), and consuming cheese or yogurt more than 3 days per week was associated with moderate-to-severe acne.
Another 2018 meta-analysis looked at dairy consumption and acne in people aged 7-30, this time including yogurt and cheese. It found that increased acne risk was associated with higher intake of any dairy, and again highest with skim milk intake. Cheese on its own was not significantly associated with acne (though barely), while yogurt was associated with increased risk.
A freshly-published 2019 meta-analysis found "a positive relationship between dairy, total milk, whole milk, low-fat and skim milk consumption and acne occurrence. In contrary, no significant association between yogurt/cheese and acne development was observed."
So, does dairy intake increase the risk of acne?
In regard to milk (especially skim milk), it seems like the answer is yes, with the association for yogurt and cheese being less clear and requiring more investigation. Several of these studies indicate that quantity matters, with high intake of milk and overall dairy increasing the risk of acne compared with low intake. Perhaps many people can handle small amounts of dairy without any issue with their skin.
That being said, it's likely also going to depend on your particular physiology. Clearly not everyone who eats a lot of dairy ends up with breakouts all the time. And some people who eat no dairy whatsoever have severe acne. There are so many other factors to take into account, that cutting out dairy is unlikely to be a silver bullet.
Anecdotally however, I've had many patients notice their acne improve when they reduce or remove dairy products from their diet. Does everyone with acne need to avoid dairy? Probably not. But for many, it's worth a try as part of a comprehensive acne strategy.
I'll keep an eye out for new research on cheese and yogurt, since I think most of us love cheese and would be happy to know if we can include it in our diets without worrying about breaking out.
Do you include dairy in your diet?
If you've tried eliminating dairy, what have you noticed?
Dr. Alexa
A note on this research:
These studies involve self-reported dietary information, which inherently hold the risk of inaccurate reporting because they rely on memory and perception. Most observational studies on dietary patterns have this same issue. Just something to keep in mind whenever we're looking at nutrition research.