 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, a substance known to increase signs of inflammation. Compared to that, no wonder the 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. Our 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 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 they 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 bakers 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 Giordelli baking chocolate, and they broke out within days, a significant increase in the total average number of acne lesions within four 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 two weeks, as 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 nutrition facts 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. 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 four days like in the Giardelli 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 like burp up some cocoa taste, and no, 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 up on chocolate to see if your symptoms improve.