Acne and Dairy – The Chronology – Prepared at David Collins’s request – February 2005

By way of introduction, I am a dermatologist. After training in Toronto, I practiced in Canada for 24 years and then moved to the United States. My credentials include my Canadian specialist certificate, my American specialty ‘boards’, a few scientific papers, the conduct of 23 clinical trials (several of them on acne medications), well over 2000 personal cases of acne treated with isotretinoin, 23 years as Chair of a division of dermatology and teaching medical students in a Canadian university and now two years teaching about acne at an American medical school.

I have had an active interest in the interaction of hormones and the skin and when I saw David Collins’s web site I sent him along a copy of a presentation that I’ve been developing and presenting intermittently to various groups of dermatologists and other doctors for over ten years. David asked me for a summary in layman’s language, and so here it is.

Basically, almost all dermatologists agree that hormones are the driving force behind acne. Everybody pretty much agrees that the male hormone 5 alpha dihydrotestosterone (DHT) is the final molecule that turns on the oil making cells, even in women. The problem is that there are multiple sources of hormones that turn into DHT – some of them are accepted by almost all dermatologists and some are not, at least yet.

Generally, the male hormones that come from the testicles and from the ovaries and from the adrenal (stress) glands are accepted, but there is another source that has been investigated incompletely but that clinically appears quite important.

The story goes back to the mid 1960s when Dr. Jerome K. Fisher, a dermatologist in Pasadena, California, collected dietary histories on over 1000 consecutive acne patients. He found acne to be related to the amount of milk consumed and was able to compare his patients to a much larger group of 5227 teenagers whose diets were studied in New York City. The acne patients in Pasadena consumed 50 to 300% more milk than the teenagers in NewYork.

Other scientists, working in Wisconsin USA, Germany, and Scotland (Edinburgh and Glasgow) showed in the early 1970s that milk contains progesterone; that is a product of the cows’ pregnancy; and that there are other hormones in the milk of pregnant cows, particularly in the butterfat fraction. Also, it was shown that the enzymes necessary to convert these hormones to DHT are present right in the oil glands themselves.

So there is a chain of events that leads from the cow getting pregnant; to her being milked; to getting pregnant for her second calf while she is still being milked; to you taking the hormones into your diet as milk, cream, ice cream, butter, cheese, yogurt, pizza, lasagna, cheeseburgers and the rest; to the hormones being absorbed into your body, going to the oil gland receptors, converting to DHT and turning on the cellular activity that creates acne.

So why is this not common knowledge?

Well, first of all, Dr. Fisher’s paper was never published. It was presented as his admission paper to the prestigious American Dermatology Association but we do not know if he ever got it ready for publication .We do know that his research on pregnant cows’ hormones came to a halt because the cow he was using to test the milk during her pregnancy miscarried and the testing was incomplete. The researchers who did the work on hormones in milk were not interested in acne and never took their work further. The researcher who did the work on the enzymes shifted his career interest to other things. And nobody seemed to see the thread linking these findings until I noted the relationships about 15 years ago.

But I am not a research scientist and, despite attempts to interest others, it is apparent that, quite naturally, researchers want to follow their own ideas and not other folks’, unless of course there is money involved to pay for some rather expensive testing of a fairly large number or people, cows and dairy products. I have so far been unable to put together the ideas, the team and the financing required to properly investigate and scientifically prove what I have outlined above.

This must therefore be considered a personal, incompletely proven theory of mine until properly constructed experiments provide the data needed to verify the chain of reactions linking pregnant cows and acne sufferers.

But in my practice, and in the practice of many noted dermatologists prior to Dr. Fisher’s work, there have been many examples of patients whose acne improved when the dairy fat in their diet was eliminated. I recently mentioned this theory on an Internet chat group of several hundred dermatologists and heard a few more stories of patients whose acne didn’t respond until they stopped their dairy intake. I also heard some skepticism, which is normal when proof is lacking.

As I see it, the problem is that, like when one is fighting forest fires, just stopping the cause of the fire doesn’t put the fire out. David’s web site points out that the only medication that really shuts down oil glands is isotretinoin. I could not agree more. There is a tremendous amount of money, time and worry wasted in trying to treat acne with other medications. Only isotretinoin puts the fire out. And only isotretinoin shrinks the oil gland back down close its pre-pubertal size. That is what really needs to happen.

Then, when the fire is out, is the time to stop making more fire. You must stop lighting any more matches.

  • Then is the time to stop all dairy fat intake.
  • Then is the only time that long-term topical retinoids will pay off as preventive medications.
  • Then is the time that birth control pills (that most female patients should have been on anyway during the isotretinoin) have the best chance of stopping further period hormone-related flares.

So the best way to see the effect of dairy restriction is somewhat after the fact, preventing recurrences. Nevertheless, it also works to help reduce acne activity in general, even when the acne isn’t quite bad enough for isotretinoin. Indeed, I use dairy restriction whenever my patients (and their parents) will listen and try it.

But, it doesn’t always work – it is, after all, only one of several source of hormone. The testicles, ovaries and adrenal glands may be producing enough hormones on their own to keep the acne going. Again, isotretinoin is the treatment of choice.

For women, the Birth Control Pill (BCP) Dianette or Diane 35 is a highly potent ally to reduce ovarian output, but there is no equivalent for males. And there is no safe way to suppress adrenal hormone output in either sex.

So give it a try – for at least six months. Remember that you were intended to be weaned some time in the first year or so of your life. Recall that milk from a pregnant cow is not really a ‘natural’ food for a growing human – any more than milk from a pregnant human would be natural to feed to a growing calf.

F. W. Danby, MD FRCPC

Footnote: This was written almost 10 years ago. We now know that Dr. Fisher’s paper was submitted to a dermatology journal but the reviewers gave no credibility to the theory that the body could absorb the hormones in milk from the stomach without destruction, so the paper (which was also probably too long for any journal at the time) was rejected.

We now know that these steroid hormones are absorbed and that it is not just the hormones in the fat part of the milk but the whey and casein in the watery part, all of them acting together, to stimulate the growth of the comedo, in exactly the same way that this amazing growth-signaling system we call milk does its original job, to stimulate the growth of the baby (human or other).

Diane® and Dianette® (based on the progestin cyproterone acetate) never made it to market in the USA, but the arrival of drospirenone and later norgestimate made up for that deficit.

Accutane®, the original isotretinoin, was removed from the market in the USA because of concerns (later demonstrated to be unfounded) that isotretinoin caused depression and inflammatory bowel disease. Isotretinoin is still the best drug in the world for acne vulgaris, it is available worldwide with few exceptions under several generic names, but is used with care.