How Do Diet and Blood Zonulin Levels Impact Acne Severity?

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New literature has compared dietary habits and blood zonulin levels between patients with and without acne to confirm the relationship between diet and acne.¹ It was found that foods such as red meat, chocolate, milk, and foods with a high glycemic index may impact the severity of the disease.

The signaling protein of zonulin in the blood reversibly opens the tight junctions between intestinal epithelial cells.² This increased intestinal permeability may have an effect on acne.

A total of 150 patients were included in the study, 75 with acne and 75 without. About 57.3% of the participants in both groups were female. The average age was approximately 23 years and many were university students. Participants with hyperandrogenism or systemic diseases like celiac disease, Type 1 diabetes, autoimmune thyroid disease, and inflammatory bowel disease were excluded.

Both groups had their blood zonulin levels analyzed using the sandwich ELISA (enzyme-linked immunosorbent assay) method. After fasting for 12 hours, 10 mL were collected from each patient. Participants with acne were assessed for disease severity via the Global Acne Grading Scale (GAGS). Clinicians recorded the type of acne, disease duration, and any past treatments. The mean disease duration was 68.16 months. Almost 90% of patients had adolescent acne. There were 11 patients with mild acne, 41 patients with moderate acne, and 23 patients with severe acne (p = 0.001).

Investigators also evaluated the height, weight, body mass index (BMI), sleep and exercise habits, dietary preferences, and other demographics of the participants. The dietary questionnaire focused on foods such as milk, dairy products, lactose-containing foods, eggs, red meat, white meat, fish, vegetables, fruits, cereals, legumes, olive oil, solid oils, nuts, fast foods, ready-to-eat desserts, soft drinks, and chocolate.

The mean blood zonulin level was much higher in the acne group than in the control group (195.54 ± 49.05 ng/mL vs. 158.45 ± 85.07 ng/mL, p = 0.001). There was no correlation between blood zonulin levels and the severity of acne (p = 0.191). However, there were significant correlations between BMI and blood zonulin levels in the acne group (r = 0.309, p = 0.007). This cohort also had higher blood zonulin levels in those who used alcohol versus those who didn’t (p = 0.026). Additionally, men with acne had higher mean zonulin levels than women with acne (p = 0.009).

Overall, those with acne had higher levels of milk (especially semi-skimmed milk) and high glycemic index food consumption. More specifically, those with acne consumed more servings of fast food, ready-to-eat desserts, sugary soft drinks, and refined cereals. Because of this, they had significantly higher mean blood zonulin levels than those in the control group who ate the same foods.

“The association between acne and milk, but not fermented milk products, may be attributed to the ability of probiotic bacteria, particularly lactobacilli, to reduce the levels of IGF-1 during fermentation when they are added to milk,” the authors wrote.

There was also a positive correlation between blood zonulin levels and red meat consumption in the acne group (r = 0.273, p = 0.018). The mean blood zonulin level was also elevated because of this. Chocolate consumption, especially milk chocolate, was higher in individuals with acne, thus equating to a greater mean zonulin level. No relationships between the onset age of acne, disease duration, sleep patterns, quality of life, and zonulin levels were observed.

Since the nutrition questionnaire was long and comprehensive, only a small sample size was utilized in the study. Future large-scale research can address this and further identify the impact of foods on the pathogenesis of acne through intestinal permeability. Based on these results, researchers currently recommend foods like fish, olive oil, vegetables, fruits, eggs, and nuts in an acne-protective diet.

References

1. Gürel RC, Yıldırım M, Erturan İ, Korkmaz S, KumbulDoğuç D. Measurement of Acne Severity, Dietary Habits, and Blood Zonulin Levels in Acne Patients. J Cosmet Dermatol. 2025;24(3):e70083. doi:10.1111/jocd.70083

2. Jaquez-Durán G, Arellano-Ortiz AL. Western diet components that increase intestinal permeability with implications on health. Int J Vitam Nutr Res. 2024;94(5-6):405-421. doi:10.1024/0300-9831/a000801