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Acne Vulgaris: A Disease of Western Civilization (2002) (jamanetwork.com)
119 points by surlyadopter 3063 days ago
33 comments

1. When I was a kid, just getting a tan cleared up my acne.

2. Changing my diet helped clean up my acne (not eating junk food)

3. When I was a teenager, I got hurt really bad, and my father found me and had to take me to the hospital. I saw massive acne breakout on his face in less than 15 minutes.

4. When I got older and was less stressed about life, my acne went away. When I got a family/career/house and life stress was severe, acne would come back.

I think there a huge health and stress connection to acne.

When I was a teenager, I saw a dermatologist for my Psoriasis. I somehow wound up with a prescription for tetracycline for my acne. Not only did it not work, but I was constantly sick for a full year after I stopped the medication.

There is no moral to this story.

I was prescribed tetracycline for my acne when I was in my late teens as well. It gave me a terrible sore throat (sharp stabbing kind of pain) so I stopped taking it. I've always told doctors since then that I'm allergic to it, because I'd really rather not repeat that.
Perhaps the moral of your story could be: a second opinion can be invaluable.
The moral of the story is that if a medicine makes your kid sick, you get another opinion. This is on the parents.
> Changing my diet helped clean up my acne (not eating junk food)

This. Actually, for me, it wasn't really the diet in general, but making a switch to drinking water instead of pretty much any other drink (*especially soft drinks!). I went on a hike for a couple of weeks as a teenager, and I think that not having access to anything but water to drink was enough to change my habits.

For me chocolate causes acne (usually on my back). It happens to my father too. When I eliminate that one item from my diet I am fine. Every few years I eat chocolate in hopes that my body's reaction will change. But 30 years later it still causes a reaction.

My high school health teacher insisted that chocolate does not cause acne, according to the research. Her definitive statement made me ignore what my father had been telling me for years. That's the problem with health science, you never know if you are an outlier to which the research does not apply.

It happens quite often, I donno why there is no supportive research on it.
My mother breaks out in acne when she eats chocolate. It's incredibly predictable and she ascribes it to being "allergic".
I had facial acne bad as a kid, and completely went away sometime when I was 18. I stress a lot (just my personality) but it hasn't come back. Anyway, just throwing out another data point.

PS: Acne as an already awkward and hormone supersaturated kid totally sucked.

Everytime I take a plane somewhere I would have huge acnes in the two , three hour duration of the flight. I always suspected it’s the stress of having to be on time and everthing that flying involves.
I've experienced the same, although I don't think I stress out about flights anymore.

My theory is that it's caused by air being dryer in the plane, as my lips are usually chapped on/after flight.

i think there is a connection in there, but not quite sure where.

I myself pretty much only ate junk food, although my diet was very low cal. i avoided the sun because i burned very easy, but I was outside a lot. i was always under a high amount of stress, but i never got acne or anything like that

edit: by junkfood, i mostly ate cereal and lots of cookies/candy bars

I burn easy too, but it still helped. I know people that can eat what ever they want, and it won't affect their skin. And some people that avoid certain foods because it makes them break out.
My daughter had severe acne. She changed her diet from vegetarian to full vegan and it cleared right up, in fact most of the past scaring is also now gone. She still consumes sugar (vegan sugar - yeah that's a thing: https://www.peta.org/living/food/is-sugar-vegan/) and doesn't take vitamin E or D supplements because she hasn't found any that are 'vegan certified.' Given some of the research we've looked at, our going theory is that dairy was the primary cause and there is some support for that: https://www.aad.org/media/news-releases/growing-evidence-sug...
Vitamin D2 is always vegan. Vegan D3 extracted from lichens ( https://www.gardenoflife.com/content/hot-ingredient-first-ve... ) is available now on Amazon ( https://www.amazon.com/Doctor-Formulated-Vitamin-Supplement-... )
My daughter got severe acne after becoming a full vegan. When she introduced eggs, dairy, and fish back into her diet, her acne got much better.
A lot of people report a huge improvement in their acne after cutting out dairy. Drinking cow’s milk in large quantities is something humans have only been doing for a few thousand years and there’s quite a bit of evidence we probably shouldn’t.

https://nutritionfacts.org/video/the-acne-promoting-effects-...

What evidence? There's a reason the mutation that kept lactase production "on" spread so well. Today many of the healthiest cultures on Earth consume lots of dairy. France with the most butter, Greek with the most cheese, etc.
The healthiest populations in the world consume virtually no dairy. Okinawans, vegans, 7-day adventists etc.

The Mediterrean diet is largely vegetarian:

http://www.abc.net.au/news/health/2017-02-16/10-commandments...

75% of the world's population loses their ability to digest lactose after infancy:

http://www.pcrm.org/health/diets/vegdiets/what-is-lactose-in...

Milk is for babies. Cow's milk is for cow babies.

Vegetarian ≠ Vegan. Lots of dairy in the standard Vegetarian diet. The link you provided to the Mediterranean diet included lots of dairy (cheese, yogurt, etc.). Also, a lifetime of personal experience says that Seventh-day Adventists eat quite a lot of dairy.
Every country on the Mediterranean consumes an enormous amount of dairy. Greece consumes more cheese per capita than any nation, and Malta, the island in the middle of the med, comes in third.

http://www.dummies.com/food-drink/special-diets/annual-chees...

I grew up with cystic acne that persisted into my early 20s, until two courses of Accutane cleared it up.

Anecdotally, I tried everything before going on accutane. I cut out sugar to the point of avoiding fruits with high glycemic indexes. I cut out dairy. I cut out meat. I tried every supplement you can imagine. If you're thinking about asking "but did you try X", don't bother, I did.

Only accutane worked.

Reading studies such as this, as well as the internet discussion regarding acne is a bit frustrating. Yes, there are anecdotes of this and that diet and lifestyle change reducing acne, but there's very little clinical evidence that non medical treatment improves cases of cystic acne, and yes, many diet studies have been performed.

Even this study grossly overstates their conclusions. Studying two primitive societies is not nearly enough data to support the conclusion in the title of this article.

Every acne thread has the inevitable comment about Accutane.

And every comment is essentially the same. It’s the only thing that worked for me.

I still love to read them. I’m still amazed by it. It’s literally the only drug I’ve ever encountered that could truly be called a “magic pill” in that it will permanently cure you of what you are taking it for.

The side effects are pretty crazy though. I had to wear sunglasses even when it was cloudy due to photosensitivy for the months I was taking it. Carried Aquaphor in my pocket for the perpetually dry lips and my whole face pretty much flaked off during the first few weeks.

100% worth it. I get a minor pimple every 6 months or so if I don’t wash my face. It used to be completely covered with acne.

Can confirm, Accutane is magical.

A single round of it when I was 16 totally cleared me up. That was over 20 years ago.

Luckily for me, my mom remembered how my dad's acne in high school left his face scarred, so she got me into a dermatologist at the first signs of cystic acne.

The doctor tried everything on me, and Accutane was the last resort.

I implore:

If you have kids with acne, please, take them to a real skin doctor. Don't rely on unproven treatments like cutting carbs or dairy or meat. You have one chance to get it right, and if you don't, they'll have to live with facial scarring forever.

I see adults with acne or scarring and I am so thankful I was put on Accutane.

Totally anecdotal, but I started taking vitamin D supplements at the suggestion of my doctor because of my family history of colon cancer. I noticed that my acne declined significantly. I'm wondering if it has to do with the amount of time one spends outside in the sun.
Here's the discussion and the paper on vitamin D: https://news.ycombinator.com/item?id=15867918 . TL;DR: make sure to always get at least 8000 IU of vitamin D per day (10 times the RDA) if you want to be healthy and have good bones, skin, mood, sleep, immunity and metabolism.

I have also heard a rumor that recent studies suggest solid vitamin D pills are better than oil capsules. Would be nice if somebody knowing what particular study says this could share a link.

https://www.ncbi.nlm.nih.gov/pubmed/26690210 - doses of 1885, 2802 and 6235 IU per day are required for normal weight, overweight and obese individuals respectively to achieve natural 25(OH)D concentrations (defined as 58 to 171 nmol/L)
I think you missed the link to the discussion in your comment.

Would taking 10x the RDA of Vitamin D daily have any side effects? (overdose?)

Sorry. I've updated the comment and added the link. As far as I understand taking 10x the RDA won't have side effects because that's not an overdose, that's the correct dose and the RDA is a mistake.

I haven't tried this myself yet though. I am taking 1000 IU now (and it makes a difference I can feel already as compared to taking nothing or 1 RDA) while waiting for the 10'000 IU pills to get delivered from eBay. I didn't knew I actually need this much before reading the paper by the link.

Max "official" safe daily limit is 4000 IU currently, but the only studies I'm aware of where actual toxicity was reported started at something like 40,000 IU daily for months. Vitamin D is likely pretty safe.
No, the estimated RDA based on EPIC series of studies is 3000 IU daily and it's suspected to be on the lower side due to old people being bit overrepresented. This based on all cause mortality, various European subjects. Intake estimated by direct multiple blood levels.

Vitamin D intake vs mortality followed a very shallow U curve (almost J) and minimum was between 2000 and 4000 IU.

So the RDAs are about just decreasing mortality rather than improving life/health, right?
I just wonder how does official data of this kind emerge if not based on any studies.
I love taking vitamin D before bed. It passes me right out.
You must be an outlier; the consensus seems to be that it counteracts fatigue: https://www.gwern.net/zeo/Vitamin-D
Vitamin D deficiency is common in Saudi Arabia, especially among women - factors include traditional clothes, avoidance of sun, and inadequate dietary intake
Do they have more acne then?
No one knows
Oh, I know this is sad but I found this comment hilariously blunt. So true.
Same.
Actually, other women do...

From what I saw in the UAE, Gulf women are naturally beautiful.

Steve Gibson did some research on this topic.

https://www.grc.com/health/vitamin-d.htm

Vitamin D is prescribed for several skin conditions I am on 20k IU a week.

And also Anecdotally I am also on imuno suppressants and touch wood haven't had a cold this winter - yay

I started Vitamin D supplements too, after reading several personal accounts of it being helpful. Still have not come across any good studies proving the effectiveness of taking Vitamin D supplements (TBH I also haven't tried finding any such information either).
It seems to rate pretty high (high=credible) on this list, which I often consult because it is easy to understand and easy to click-through to the actual sources: http://informationisbeautiful.net/visualizations/snake-oil-s...

Snake Oil Supplements?

Scientific evidence for popular health supplements

Showing tangible human health benefits when taken orally by an adult with a healthy diet (Mar 23rd 2017)

"Vitamin D supplementation decreases all-cause mortality in adults and older individuals" http://acpjc.acponline.org/Content/pdf/ACPJC-2008-148-2-030....

(It's a review of randomized control trials of Vitamin D supplementation.)

I'm always amused/horrified by Hacker News comments on anything health-related. Herein lie a group of incredibly smart individuals sharing anecdotal evidence and folk remedies without a lick of irony.
The idea of "hey, this strange thing worked for me, and I don't wholly understand all parts of the system but it seems to have some results" is pretty much the core of what "hacking" is, right?
I understand hacking to be the opposite: understanding a system so deeply that you can invoke unintended behavior.
I'm not saying that you don't have a valid idea here, but that doesn't meet with my understanding of the term. I mean when I say I'm a hack piano player, I mean that i can get by but am not classically trained. When I say, this fix for my problem is a hack, I mean that it's not a well engineered solution, but rather that it's a functioning (albeit perhaps ugly) solution.

I can also say that it's a good thing that I didn't apply that when I started working with computers or I would never have gotten to the point where I understood the systems well enough to bend them to my purposes regardless of the intended behavior.

And that doesn't even touch the question of what "intended behavior" might mean for a biological entity which isn't "designed" in a way that has an intended use.

The parent was talking about hacking in the Javascript sense of the word.
Do you say that people who take spoonfuls of cinnamon to cure their diabetes are hackers?
If by doing so they earn lots of money for early seed investors, yes.
If it helps them, then yes.
More or less, yes. If the fix works, it is a fix. If a fix doesn't work, it's not a fix.
Your analogy is close but flawed in a major way.

The underlying assumption when hacking is that if you don't understand the internals of something that's ok, but you can rely on understanding the interface, and your manipulation of the interface is skilled enough that you can get the results you need.

In this case, we don't even remotely understand the interface or manipulating it.

Consider the case of two kinds of users operating on some kind of interface that is unfamiliar, say, MS Word.

One class of user will consult a manual and try to find the right answer, or perhaps will call an expert.

Another class of user will just start pushing buttons to see what happens, because they have a rough familiarity with the system even if the specific interface is not well understood.

It's that second class that I am thinking about when I think about how "hackers" operate.

In that case, I get that it's dangerous to mess around with a system whose internals you don't know about... but at the same time, there is a kind of fantasy that somehow other folks have a privileged knowledge of what our bodies do.

Personally, I quit wheat and dairy (and reduced my alcohol consumption) because it's a specific tree allergy season here. I have a couple possible accounts of why this is working (because I believe that it is) but I don't really understand the interface or even what I am manipulating when I alter my diet like that... I just know that I can breath, whereas historically I have terrible allergies at this time of year. Feel kind of like a hacky solutions... it's not an engineered solution, that's for sure.

> Herein lie a group of incredibly smart individuals

Citation needed.

GP said it, so it must be true.
Its not anecdotes, its a multi year study of 1200 people. Also people often forget that there are many things science doesn't know, many health problems we have no good answers for, and that anecdotes & intuition are the only way we can generate hypotheses to validate scientifically in the first place.
I suspect the parent comment is referring to the comment section (which is indeed full of anecdotes).
There have been many, many studies discrediting the folk remedies proferred in this thread.
I think this happens often around here on anything non-tech related. Surprise, being smart doesn't mean you know everything ;-)
But I appreciate the high quality of discussion that intelligence can bring to a topic many of us don't understand.

Who really understands how meltdown and spectre work without asking? Smart people ask questions, and like answers. Add wisdom, and you can appreciate answers that challenge your own biases.

[edit: clarification]

It doesn’t of course, but it seems reasonable to hope that people (particularly “smart” people) would try and support arguments/suggestions with data.
Nutrition science is, in general, a massive joke. It's more frustrating that the scientific/medical community will stand by the status quo because proving something to be true of humans is so incredibly difficult.

Edit: IMO, "hacking" is simply recognizing that the scientific community moves at a glacial pace and not waiting around for "experts" to arrive at a consensus 30 years from now to change something about your lifestyle/diet today that has been shown to be true of animals/smaller scale human studies many times over.

I find the opposite to be true. I think it's terrible that really smart people will often times blindly trust a certain sect of society on health issues, even when there's evidence that says they shouldn't.

And then publicly shame others for finding ways to heal themselves.

It's a useful reminder that incredibly smart people with amazing technical literacy don't necessarily have the same scientific literacy.
I'm actually horrified at the opposite. The lack of knowledge around health issues scares me. When users comment they did not know tumeric is anti inflammatory it makes me wonder.
You're frightened by people not knowing turmeric is anti inflammory?
Since the error is being propagated- it’s turmeric.
Obligatory xkcd: https://xkcd.com/1053/
Yeah, me too. It's more than just the comments in this case though.

> Here's a 15yo uncontrolled epidemiological study of acne, that blames everything on diet, go forth and treat your own skin conditions!

The paper is more restrained than that, but that's not how people interpret it. Problem solved. Eat like a Bantu.

Science would use this as bearing for a hypothesis to do an single-factor studies.

> group of incredibly smart individuals

It's not because you are smart that you can't be ignorant of certain things at the same time. Even smart people can be fooled about stuff they are not familiar with. It's like trusting blindly the stories on your newspaper.

Also anything science related.
Imagine that you could aggregate all the anecdotes shared on the internet. It would be fascinating to compare the statistical conclusions you could draw against accepted science.
https://nequalsmany.com/

Check it out, this is happening. They are doing many crowdsourced analysis, the most prominent being a 30-day carnivore diet protocol: eat meat, drink water.

I’d be lying if I said I didn’t expect HN to tell me that it’s already being done. I am impressed and amused that it happened this fast and it’s pretty much exactly what I posited. Slow clap.
It would be damn near impossible to conclude anything from such research without a control. “Randomized double-blind, placebo-controlled trial” is the critical sentence - at best you’d get a correlation which probably has been influenced by the availability of research. Finding truth is freaking hard.
Do you think that qualitative data is useless?

'It would be damn near impossible to conclude anything from such research without a control. “Randomized double-blind, placebo-controlled trial” is the critical sentence'

Since the advent of randomized double-blind, placebo-controlled trial has our public health improved or declined?

I'm resisting the urge to respond flippantly, since I think that's a question that could be answered rigorously and is certainly worth asking.

With that said, since the advent of the RCT, life expectancy has gone up dramatically in the Western world. It would be hard to imagine testing the efficacy of, say, antibiotics or vaccines without testing them against a control in a placebo-controlled, double-blinded way.

Same goes for simple things like washing your hands and administering prophylactic antibiotics during a C-Section, which dramatically improves the odds that a mother will live through complications during child birth. There would be no way to actually know that these were important without studying them vs. the status quo at the time.

This can be partly explained by different subsets of the overall user base.

I have the same reaction to some of the posts on longevity research.

Smart people often fall prey to "I'm smart and an expert in 'X', how hard could 'Y' be?"
I get the same feeling listening to physicists talk about neurology, which is just to say that intelligence and expertise don’t imply anything beyond the limits of one’s speciality. Besides, the quest for improved health leads to a desperate mindset, which is easily exploited.
The HN title should probably say "nonwesternized" (the term used in the abstract) rather than "non-Western" (although the paper subtitle does use "Western"). Still an ambiguous term, but "non-Western population" would usually be understood to include countries like Japan and China, who this study definitely doesn't mean to include.
I was wondering about that; I was just in China and there were tons of people with acne there.
The title of the paper is "Acne Vulgaris - A Disease of Western Civilization."
Why's everybody talking about vitamin D? (Same thing popped up in a Twitter thread I saw about this yesterday.)

As far as I can tell the paper only talks about high insulin loads and refined sugars for etiology? Then again I might have missed something? Seriously, I'm in no way competent to read these papers but all I could see were mentions of insulin spikes and such. Could someone ELI5 what I'm missing?

I immediately thought about sugar/carbs. A lot of people on Keto/Adkins report that reduced carb intake seems to help control acne.
Sure, but I'm talking about the actual study linked. Or maybe I'm just being too generous with my assumption people are referring to the linked article.
I noticed that on myself, high concentrations of sugar or high density carbs (pasta and bread) make it surge.

A couple of friends of mine also cured a candida infection by avoiding carbs. So our diet might play a role.

Try cutting out dairy. That made a dramatic effect for the better in me. Milk chocolate is probably the worst for me.
Totally anecdotal, but too much chocolate is what makes me erupt. And I prefer dark chocolate, so it might be the chocolate rather than the dairy.

Eating a large bar of dark chocolate should differentiate, purely in the interests of science of course.

Chocolate is the culprit for me as well. Sometimes sugar too, but, not as frequently or as much as chocolate (but the acne seems subtly different from the chocolate one).

Out of curiosity, does chocolate have any other effects on you besides the acne? Like easier bleeding/blood thinning? Or other inflammation besides acne? It has more than one effect on me and I surely can't be the only one observing it.

I haven't noticed any anticoagulant effect.

I consume chocolate in the evening and do sometimes clear walking tracks before breakfast, which often involves scratches. So I would expect to have noticed wounds bleeding for longer than usual.

Try comparing British to American process chocolate. Makes a huge difference for my wife. American chocolate triggers a bad outbreak. Different chemical process, different quality of ingredients.
Its the dairy
I would add possibly polluted or adulterated dairy. Raw milk (anecdote) may not cause the same issues as processed dairy.

Also, I would add that most processed dairy (besides just plain old milk) is mixed with many other detrimental ingredients. So there may be a cause/effect relationship overlap with other foods.

I can't speak for other people's cases but in my case it's definitely not the dairy. The only time dairy ever had an effect on me was pre-elementary school when eating too many egg started giving me pimples, so I cut down on that and that fixed it. Never had a problem with it again.
Yes. We as a culture do not move around enough to utilize the sugar we ask our body's to digest ( fast + dirty fuel )

The surplus sugar serves as a substrate to allow candida to thrive, not to mention a myriad of other maladies.

If you are in the Bay Area check out Acneology or the US Face reality clinics. They basically have the whole science of acne treatment down to almost perfection. Dermatology didn't help me at all but their treatments worked wonders. I'll give out more info if anyone is interested. Source - I've had acne for a decade :( more or less cleared up now.
I just checked this out. It's a dermatologist. They offer benzoyl peroxide and salicylic acid, which are standard solutions. This is nothing special.
Read my reply below. The prescriptions are standard the pore unclogging/extractions and peels are the real differentiator. Oh yeah and the Diet restrictions.
This very little evidence that diet affects acne. I'm glad you found a solution, but food probably had little to do with it. Especially "greasy" food, which is one of the items they list on their website.

They also say that antibiotic solutions are a "myth", which is patently false.

There are several kinds of acne. The kind that you get when you hit puberty is not related to diet. Adult acne in most cases is however.

The thing is food does not directly cause acne. The logic is pretty simple actually. Acne causing bacteria grow in blocked pores and greasy food and dairy makes me super oily . More sebum more blocked pores aaand more acne.

im interested!
Their treatment regimen goes something like this, You have a session with an esthetician who will assess your acne severity. They will give you a list of food to avoid and to no one's surprise it contains dairy and greasy foods http://www.thefacialroom.com/upload/FOODS%20AND%20LIFESTYLE%...

After that you'll have monthly sessions where they unclog all your pores(called extractions) and remove white heads afte that Peels for the hyper pigmentation.

You'll be prescribed benzoyl perioxide and mandelic serum for acne and hyperpigmentation.

After a few sessions all your pores are clean and tight and bam almost no more acne.

The peels and mandelic serum worked wonders for my hyper pigmentation.

If you are in the bay area I can give you the address of the clinic I go to.

I'm in the same boat.
"As in the Kitava sample, skin infections and intramuscular abscesses were common and responded well to treatment with antibiotics such as erythromycin and tetracycline."

I'll take the occasional zit and cover it up with concealer, thank you very much.

It doesn't have to be a package deal -- their low glycemic load diet isn't causing the abscesses.
taking a course of antidepressants and making some lifestyle changes during university for depression had the side effect of almost completely clearing up my acne that normal dermatological treatments were unable to deal with. given that there's some kind of biological link between chronic inflammation and depression, i wouldn't be surprised if some acne cases manifested the same way
This should be marked [2002].
Hyperinsulinemia caused by a high-carb diet seems to result in many of our health issues:

https://www.youtube.com/watch?v=wiVFtRlObZk

Yes. Great share on your link. Here's another good one: https://www.youtube.com/watch?v=SzcOz38FjaU

“There are a thousand hacking at the branches of evil to one who is striking at the root.”

― Henry David Thoreau,

The double negatives here make this heading really hard to parse (I actually read the abstract thinking something totally different and had to come back to check), maybe something along the lines of

"Acne vulgaris exists predominately in Western populations" or "Acne vulgaris mostly exists in Western Populations" would make it clearer.

TL; DR A 2002 study believes we should explore “dietary interventions using low–glycemic load carbohydrates may have therapeutic potential in the treatment of acne because of the beneficial endocrine effects of these diets.”
Given that all humans share a remarkably high % of genome, and race is a social construct, I'm struggling with the 'this is not genetic' part. Either its a truism, or its backed by strong evidence of no genetic linkage. Because this 'its not your race' thing, applies to almost anything. For instance the supposed Asian intolerance to unmodified milk proteins which has been changing as diet shifts. Is that also now not actually genetically determined?
Human and pig genomics are also very similar. It's not the 98% that make or break these things. Lactose intolerance is inherited and as a result of LCT gene not expressing due to downregulation by another gene MCM6.
As per my personal anecdotal evidence: diet is always key to Acne. I have been suffering from Acne vulgaris, Acne conglobata, and—worst of all—Acne inversa for all my life (26yo), and whenever I fell into bad eating habits with lots of (saturated) fats and carbohydrates, my skin issues are worsening. Western food is just poor quality in general, being heavily processed and “enhanced” and all.
They decided to choose a closed, often tribal cultures for comparison. We can assume they behave as most of us do, mate within the group mostly. So the genes pool/variation differences must be huge between them and Western population (whatever Western means in this context - let's say United States.) On what premises they excluded genetic factor, then?
I'v read a few studies about demodex mites causing chalazion[1]. Demodex mites are something humans picked up from having dogs and cats as pets. Do non-western countries have these animals as pets?

[1] ]https://www.ncbi.nlm.nih.gov/pubmed/26408604

For my wife, it's lots of sugar that causes outbreaks. Or worse, cheap American chocolate (British chocolate doesn't trigger it as bad).

But all the dermatologists she saw as a teen and young adult... always ridiculed this and insisted it had nothing to do with diet.

I always love when obscure (but interesting) topics surface to the top of HN. Great community.
Only tangentially related, but recently I watched a documentary about the epidemic spread of myopia. Apparently the main culprit was the lack of time spent outside, which was interpreted as a lack of exposure to sunlight.

I wonder if acne can't have the same cause.

I mean you don’t need to be Sherlock to know sugar is bad for you, I’ve heard over and over again from all sorts of different publications and talks on the effects. You talk sugar out, you give yourself a better chance
I grew up in a non-western country and at the age of 19 I sporadically got Acne and I ate meat once a week and hardly any sugar. It lasted a 1 1/2yrs, fast forward 5yrs I got Acne at age 26 again but worst, this time it wasn't going away, finally I decided to just use natural ingredients. I got tea tree oil and jojoba oil mixed them and would put it on my face and 3 months later it went away forever.

I still don't get any pimples even after going back to normal lotion but around Halloween I always get a pimple or two because of all the candy.

Given the link between diet and the microbiome, and the possible link between diet and acne, I wonder if the microbiome has something to do with it.

Really, I'd be very surprised if the microbiome wasn't involved somehow.

I know this is anecdotal, but I lived in Beijing for 8 years, and it was VERY existent amongst the population there. Perhaps it's a function of the "western" cosmopolitan lifestyle of urbanites.
Sugar and carbs.

Read Weston A. Price's, 'Nutrition and Physical Degeneration'

I have always wondered why evolution has allowed such a defect. Maybe this is the effect of crossing with Neanderthals.
How much time are those "non western" people spending outside shirtless soaking in the sun?
*anecdotal

started shaving with a safety razor, helped quite a bit.

vs 5 blade massacre

Coffee is the source of my acne - but I'm not able/willing to give it up.
Do you put milk and/or sugar in it? I betcha anything it’s not the actual coffee.
I put a "tiny, tiny, tiny" amount of sugar, and maybe a few tablespoons of milk. Going off coffee for a week clears up my skins, while I continue to consume dairy and sugar products.

So I do believe it's the coffee. Also for some reason, Kona Coffee make my acne even 2x worse than say columbia, etc.

Black no sugar, as it comes?
This title "Acne vulgaris is virtually nonexistent in non-Western populations" is not supported by the article.

HN policy is not to change the title which is "Acne Vulgaris - A Disease of Western Civilization"

Thanks, we've reverted the title.
Agreed. The HN title is misleading and inaccurate, but even the original title obscures the presence of acne in non-Western countries.

For example, many Japanese suffer very bad acne through adolescence and young adulthood. In one study, nearly 60% of the teenagers had acne and many "had seborrhea and a family history of acne." [0] Indeed, even the most basic web search for "acne vulgaris in Japan" yields plenty of results to studies and treatments. (The study linked in the OP does mention Okinawa, whose relationship to Japan is complicated, as having practically zero incidence of acne vulgaris.)

In any case, given the current and historical prevalence of acne in Japan and the assertions of the study in the OP, would Japan be considered Western or is it a condition of urbanization and the health effects due to environment and diet?

Perhaps the word "Western" confounds easy interpretation of this study because it's actually a proxy for "outside Papua New Guinea".

[0] https://www.jstage.jst.go.jp/article/dermatol/111/9/111_1347...

EDIT: clarify source of reference to Okinawa.

The paper also only observes two groups: "the Kitavan Islanders of Papua New Guinea and the Aché hunter-gatherers of Paraguay."

That's not anywhere close to all non-Western populations!

I guess that those two groups haven't had genetic contact with "Western" races.

It's highly misleading, because my Taiwanese girlfriend has acne (worse than mine, and she's over age 30).

She probably has some Dutch blood in her from 400 years ago (her mum is from Tainan, and the light brown hair, double eyelids, and larger cleavage are probably a result of that too).

What the article is suggesting is that if that contact hadn't happened 400 years ago, she wouldn't have acne. Malicious propagandists could easily exaggerate that to blame Western civilisation for their ills, which I think is divisive.

The real research has shown a statistical correlation within a small sample size. That doesn't imply causation, or give any guidance on how to manage or mitigate the effects.

If future children getting acne is really your major worry about choosing a partner, the research might be of interest to you, but it fails to emphasise that even connections in the distant past can have an effect, and rejecting Westerners is not a suitable solution.

Does your girlfriend eat a Western diet?

My wife is a registered dietitian and has a PhD in nutrition and in her experience acne is incredibly influenced by diet.

She eats a meat bun for breakfast, a Taiwanese-style biandang 便當 lunchbox, and noodles or dumplings in the evening. She's seen doctors about her acne, and still sometimes visits when there's particularly big or painful zits.

It got much better when she was in Australia on Working Holiday, when she worked outside on a farm and was eating a more Western diet, she was less stressed, and the air was less polluted. Our agreed plan is to try to move to another country (probably New Zealand or Australia, perhaps Canada) anyway, which should solve my nationality issues and her health issues.

In the meantime, I don't mind spending romantic moments popping her zits, haha. I think it's kind of cute.

Meat bun for breakfast, biandang for lunch and dumplings for dinner sounds like a hell of lot of red meat -- aka the Western diet.

If I were her I'd try to cut out the animal products for a month and see what that does. It might not work and then you've at least eliminated a variable.

Also remember that the average medical doctor never had to take a single human nutrition course. Some doctors have done quite a bit of additional studying and are up-to-date on nutrition research and findings but most probably just see the same flawed headlines most Americans do.

Many Chinese that I knew in Beijing had bad bouts with acne with little western food in their diets. I bet it has more to do with pollution than diet in their cases.
i recently went on a little exploratory mission to see what the working explanation is for how the pores actually get blocked, and then swell. it sounds like the process, in super detail, is not well understood. from what i could gather, sebaceous glands get blocked, and the sebum they secrete starts to pool in the duct around the follicle, under the skin. the sebum creates an ideal environment for a bacteria called p acnes to flourish, which causes inflammation and redness. it seems that the rate of sebum production, and the composition of the sebum itself might have some effect on how likely the pore is to clog. and, of course, skin cleanliness is but one of many factors that seem to affect how often people get acne. as other people have noted, it sounds like "inflammation", a topic i know nothing about, seems to be at the root- basic idea seems to be that diet can cause inflammation which can then result in acne. im more curious about the actual point at which the pore becomes blocked, and why it happens, from a more mechanical way. i feel like a satisfactory answer to this question would address why some pores on someones face get clogged and others do not. im curious if anyone ever did a very detailed microscopic timelapse somehow. since i havent studied this field at all, its likely im not really asking the right questions, but if anyone reading this has anything interesting about this topic, id love to hear it.
I do not know why you're being downvoted. I feel your comment added to the discussion of the article

I also learned recently that sebum production -- and inflammation -- are both complex mechanisms. As with most regulatory systems I wouldn't be surprised if they were linked in some way. But obviously I don't want to claim this in some hand-wavy way. Can you share any reading material you found when exploring the topic?

I have recently started Spironolactone for various PCOS symptoms, including acne vulgaris, so it's of interest to me

Probably the formatting. I didn't downvote and found it interesting but had a bit of trouble reading the blob of text. I find that capitalization is really helpful when reading longer paragraphs, especially if many of the sentences themselves are compound.
thanks. i was honestly surprised to be down-voted, maybe that explains it a bit.
I haven't read the paper but do they define what they mean by "westernized"? China is very much the east, does acne vulgaris have the same prevelance in countries in Asia and the middle east?
"Herein we report the prevalence of acne in 2 nonwesternized populations: the Kitavan Islanders of Papua New Guinea and the Aché hunter-gatherers of Paraguay." They also mention reports from an Inuit community as it transitioned from a traditional diet/lifestyle to a more industrialized one, and the concomitant rise of acne.

The speculation is that low-glycemic load diets are related, possibly through insulin sensitivity/resistance. So probably an industrialized Chinese diet with a relatively high proportion of refined rice (or other grains) is also prone to acne.

The traditional Chinese diet is mostly rice and vegetables. Modernization brings a large increase of refined sugars and animal fats.
From a quick skimming of The Fine Article, it seems to mean people living in "modern" environments — like, e.g., plumbing. If I had to guess, diet is probably among the most salient characteristics, with lessened sun exposure from spending time indoors also being material.
Diet, time inside/outside, exercise, environmental pollutants, stress, water supply (drinking and bathing), consumer products with (often untested) chemicals...

I'd say there are plenty of western/Western attributes that could have a cumulative (?) impact.

I'm Chinese and my Acne problem is pretty bad.
yep - anecdotally, my family members living in both China and Japan experienced some bad bouts of acne during their adolescence and up through young adulthood. given that the paper's study population were hunter-gatherers and islanders, it would probably make more sense to frame it as "modern industrialized society" versus "hunter-gatherer" rather than "western" against "non-western
The study is about enviromental factors, not genetic
Acne vulgaris is the same as the one adolscents get, right?

How is the claim possibly true? Do they mean something other than what "non-Westerners" means literally? It happens e.g. in the middle-east too and I don't imagine that's an exception. I thought it was a pretty common human phenomenon.