Why avoid milk products?
The reason that milk products cause acne is because milk contains hormones that "turn on" oil glands. The cows that give the milk are pregnant and milking most of their lives. These hormones are not injected into the cows - they are natural hormones that cows make during every "menstrual" cycle, but during pregnancy these hormones are produced continuously at high levels and so are found in all cows' milk. See below for more details.
What about hormone-free milk?
There is no such thing as "hormone-free" milk. A company that sells a hormone for injection into cows to make them produce more milk caused this problem. It is called either bovine somatotropin - BST or recombinant bovine growth hormone - rBGH. Some milk producers have made the point that they do not use this injection by advertising that the milk is "hormone-free". It obviously does not contain the injected hormone but all the cows' natural hormones are still in the milk. We do not know yet what the injected hormones do to the levels of natural hormones in milk. Fortunately, this injection is being used on cows less and less.
Is lactose-free milk okay?
No. Lactose intolerance has nothing to do with acne. But if you have acne and are found to be lactose intolerant and you stop your milk, your acne will often improve or clear. The real cause for the improvement is the lack of the hormones and growth factors in the milk. If you try instead to use milk with 'Lactaid', that may help the lactose intolerance but it does nothing to eliminate the hormones in the milk.
Is "organic" milk okay?
No, because "organic" simply means that the pesticides and insecticides the cows are exposed to in their food are less toxic than usual. This makes the cows generally healthier and we now know that these healthier cows' milk contains even more hormones.
What are the options?
There are two ways to handle dairy restriction.
The first (and simplest) is to just stop consuming all milk, cream, cheese, ice cream, butter, sour cream, cheeseburgers, pizza - anything that contains or is made from milk. That includes the body-building 'protein supplements' that contain casein and whey.
It is best to avoid "anything that comes from the south end of the cow".
The second way is to find dairy-like substitutes for whatever you are missing. Soy products are the most convenient and include substitutes for milk, creamer, chocolate milk, ice cream, cheeses of various types and even butter substitutes. Other protein supplements are available made from egg, pea, rice, hemp or other vegetables.
Goat milk and goat cheese are suggested by some as alternatives, but also contain hormones (the same ones in your own mother's milk and the milk from all mammals) and should be avoided.
How do the cow hormones make acne?
Oil gland pores are plugged by the overproduction of the cells that line the pore - basically a "traffic jam" happens in the pore. There are several sources of hormones that cause this overproduction. The first is ovaries or testicles, the second is the adrenal (stress) glands and the third is dairy products. In addition, some birth control methods (some pills and some IUDs and some implants) also cause trouble, but others can be very useful in controlling acne.
These three "stack up" on each other, and when the amount of hormone present is enough to plug up the pore, acne is started.
Everybody has a different level of hormone where this happens (this is the acne threshold). Many young women pass this threshold just before their period every month; others stay above the threshold for years because of milk and milk products; others cross the threshold with stress (first-year college is the most common stressor in late teens). By removing dairy from your diet, you will usually be able to get down below your personal threshold, making your acne much less with time. This threshold is also influenced by your family history so if one or both of your parents had acne, your threshold will be lower, making acne risk higher.
Over the past 6 years we have learned much more about how milk turns on the acne. The casein in milk raises the amount of insulin-like growth factor - 1 (IGF-1) and the whey in milk raises the amount of insulin in your blood. These two hormones open up the male hormone receptor site so male hormones can do their job, and one of those jobs is to make your oil glands work harder. The same mechanism is what plugs the pores.
Once the male (androgen) receptor is open, the male hormones in the milk, from the ovaries and testicles, from the stress (adrenal) glands, and from male-type birth control pills - all can get to the androgen recptor and turn on acne.
How long do I need to do this?
The "No Milk" diet has three phases.
First is the total restriction phase. You need to stop making new plugs in the pores. This is slow and usually lasts at least six months. This will give you (and your dermatologist) six moths and a fighting chance to get the acne under control.
Second is the maintenance phase, and it lasts through all the teen years into the early 20s. During this phase, zero dairy intake is best. While you may be able to have a little bit of dairy from time to time, it is really difficult to tell how much you can get away with. The problem is that it takes months for the plugs in the pores to build back up again, so it takes months to find out if you have exceeded your threshold again. And everyone is different.
Third is the cautious reintroduction phase, usually possible in the early 20s. But, depending on individual thresholds, some acne patients can never return to dairy. One of my original patients with dairy acne was 61 years old and he had eaten a pint of ice cream a day for the past 50 years. It took over a year to cool down his back acne in the days before isotretinoin.
What else can I do for my hormones?
For males there is no generally accepted anti-hormone therapy. Young men can be told that there is almost nothing to be done about their stress hormones, but that they have a choice on the other two sources of hormones: "We can cut off your dairy or cut off your testicles." It's a joke, but it helps them understand.
Young women have the option of controlling their hormones with birth-control pills (BCPs). We prefer to call these "hormone control" or "acne control" pills, but they are all the same as birth control pills, really, and are given for medical reasons. The product we prefer is not only the least likely of all "birth-control" pills to make new acne, but it also blocks acne - making hormones from other sources (like the adrenal "stress" glands). Most young women with previous acne have almost no acne after six to 12 months on this "pill", especially if they stop dairy intake.
The best anti-acne BCPs contain the progestin called drospirenone. It blocks the androgen receptor but there is a concern about increasing the risk of blood clots by taking this. ALL birth control pills increase this risk; some studies show a higher risk with drospirenone; but the risk drops the longer you take it so if you are already taking drospirenone and are being carefully monitored by your physician you may choose to continue. To reduce the risk we often switch to norgestimate as the next best progestin.
Women can also take advantage of another way of blocking the androgen (male) receptor, by using oral spironolactone tablets. A prescription is required and most dermatologists use this drug regularly, either with or without BCPs.
What about my calcium intake?
Remember first of all that there are hundreds of thousands of growing teens in this country and millions in the world, who are either lactose intolerant or allergic to milk. They grow up just fine. It also helps to realize that cows have big strong bones, healthy teeth, produce milk containing calcium during most of their lives, and also produce a calf every year with its own new set of bones - yet they drink no milk and take no calcium supplements in nature (although when they are being 'factory-milked' they do get supplements).
It is far more important for maintenance of bone health to make sure you have an adequate intake of vitamin D - 2000 IU per day taken with food is usually sufficient. This is a minimum dose according to Vitamin D experts - but a maximum dose if you listen to others. You also need regular bone-stressing exercise, a healthy diet containing sources of calcium, and a normal amount of estrogen in your body if you are female.
What else do dairy hormones do?
There are studies that suggest that consuming dairy products may be associated with breast cancer and prostate cancer and even lung cancer. Further studies are necessary, but if you have a family history of these kinds of cancer you should consider avoiding dairy intake.