Case Report
Dermatology 2012;225:256258
Acne and Whey Protein Supplementation among
Bodybuilders
Thierry Simonart
Private practice, Brussels, Belgium
Key Words
Acne Whey protein Bodybuilding Diet
Abstract
Accumulative evidence supports the role of
nutritional factors in acne. I report here 5
healthy male adult patients developing ac-
ne after the consumption of whey protein, a
favorite supplement of those engaged in
bodybuilding. These observations are in line
with biochemical and epidemiological data
supporting the effects of milk and dairy
products as enhancers of insulin/insulin-like
growth factor 1 signaling and acne aggra-
vation. Further prospective studies are re-
quired to determine the possible role of di-
etary supplements in the fitness and body-
building environment.
Copyright 2012 S. Karger AG, Basel
Introduction
Acne is an androgen-dependent disor-
der of pilosebaceous follicles (or a pilose-
baceous unit). There are four primary
pathogenic factors which interact to pro-
duce acne lesions: (1) increased and al-
tered sebum production under androgen
control (or increased androgen receptor
sensitivity), (2) altered keratinization
leading to comedones, (3) Propionibac-
2012 S. Karger AG, Basel
10188665/12/22530256$38.00/0
Fax +41 61 306 12 34
E-Mail karger@karger.ch Accessible online at:
www.karger.com www.karger.com/drm
Received: September 21, 2012
DOI: 10.1159/000345102
terium acnes follicular colonization and
(4) release of inflammatory mediators in-
to the skin [1, 2]. However, the exact se-
quence of events and how they interact re-
mains unclear. There is a strong genetic
predisposition toward developing acne.
Other factors including cosmetics, envi-
ronment, hormones and stress are also
involved in the development of acne. Al-
though dietary factors have long been
considered unimportant, accumulative
evidence supports the role of nutritional
factors in acne [29]. The apparent ab-
sence of acne in native non-Westernized
populations, e.g. the Kitavan Islanders of
Papua New Guinea and the Ach hunter-
gatherers of Paraguay [6], has led to the
proposal that high glycemic loads in the
Western diet could have a role in acne,
perhaps through hyperinsulinemia lead-
ing to increased androgens, altered reti-
noid signaling and increased insulin-like
growth factor 1 (IGF-1) [68]. IGF-1 stim-
ulates basal keratinocyte proliferation
and sebum production. It also participates
in increasing the effect of circulating
androgens. A variety of clinical studies
showing that a high glycemic load diet
plays a role in acne exacerbation and, in-
versely, that a low glycemic load diet might
improve acne, provide further support for
this theory [49]. There is also histopath-
ological and immunohistochemical evi-
Dr. T. Simonart
av. Gounod 27
BE1070 Brussels (Belgium)
E-Mail tsimonar@ulb.ac.be
Accepted after revision: October 6, 2012
Published online: December 13, 2012
dence that a low glycemic load diet reduc-
es the size of sebaceous glands, decreases
inflammation and diminishes the expres-
sion of proinflammatory interleukin 8
and sterol regulatory element binding
protein 1 which is the key transcription
factor of lipid biosynthesis [9]. Particular
attention has been paid to the role of the
ingestion of products containing refined
sugar and certain dairy products (espe-
cially skim milk, sherbet drinks and cot-
tage cheese) [25]. Risk has been found to
increase with an increased consumption
of milk by individuals consuming more
than 3 portions per week [4]. Milk con-
tains anabolic steroids as well as true
growth hormones and other growth fac-
tors. The presence of 5-pregnanedione,
5-androstanedione and other precursors
of 5-dihydrotestosterone add to the po-
tency of milk as a stimulant of acne [8].
Future studies are required to determine
if dietary modification will reduce long-
term acne burden.
The development or aggravation of
acne after the consumption of whey pro-
tein, a favorite nutritional supplement of
those engaged in bodybuilding, is scarcely
reported in the medical literature. I report
here 5 healthy male adult patients develop-
ing acne after the consumption of whey
protein concentrates.
Table 1. Clinical characteristics of the 5 male patients

Age, years BMI Frequency of whey protein Other supplements Self-reported acne GAGS
consumption/week during adolescence score

26 28 7 egg protein shakes, creatine-amino acids none 25

33 27 7 egg protein shakes, creatine-amino acids, moderate 29
protein bars, multivitamins
35 26 6 none 25
25 24 3 mild 19
19 22 5 multivitamins none 19

Case Reports Discussion inflammatory and/or cystic flares of their

I identified 5 healthy adult men (age
1935 years, mean 27.6 years) who devel-
oped moderate to severe facial and truncal
acne after the consumption of whey pro-
tein for increasing muscle bulk. Acne se-
verity was determined by the Global Acne
Grading System (GAGS) (table1). The es-
timated delay between the introduction of
whey and acne development was 5.6 8 1.8
months. Two patients had acne during ad-
olescence but 3 reported no past history of
acne (table1).
None of them reported the use of ana-
bolic steroids for increasing muscle bulk.
None of them was taking drugs or smoking.
All reported healthy dietary habits. Mean
body mass index (BMI) was 25.4 8 2.4 kg/
m2. Two reported moderate alcohol con-
sumption (12 beers/day). Standard labo-
ratory tests were performed in 3 patients
and these were within the normal ranges.
The patients were advised to stop using
whey protein concentrates. The lesions
had cleared completely in 1 patient 6 weeks
after discontinuation of whey protein sup-
plementation along with the use of a fixed-
combination product of topical retinoid
and benzoyl peroxide. One patient was lost
to follow-up. The 3 remaining patients
preferred to not discontinue their whey
protein supplementation. One received
isotretinoin 0.5 mg/kg daily, per os, for
9 months. Most of the lesions regressed
and there was no significant recurrence of
acne after an additional follow-up of 3
months. The 2 other patients were given a
fixed-combination product of topical reti-
noid and benzoyl peroxide which led to a
partial regression of their lesions. Isotreti-
noin was best avoided for these patients
because of intense physical activity.
Along with casein, whey protein is the
predominant protein found in milk. It is
the liquid remaining after milk has been
curdled and strained to remove the caseins
(curds). It is a mixture of globular proteins
that are water-soluble byproducts of the
production of cheese, containing five ma-
jor proteins, namely -lactoglobulin, -
lactalbumin, glycomacropeptide (depend-
ing on the method of whey manufacture),
proteose peptone 3, immunoglobulins and
serum albumin, which together make up
approximately 85% of whey protein [10
12]. Whey protein concentrates are very
popular nutritional supplements among
athletes, especially those involved in the
bodybuilding and fitness environment.
The concentrates seem to have positive ef-
fects on muscle size, strength and athletic
performance without major adverse ef-
fects or high costs. There is also increasing
interest in whey, as a potentially rich natu-
ral source of bioactive compounds to re-
duce the risk of disease and/or to prevent
its development [10]. Whey proteins are
being commercialized or marketed to aug-
ment cancer treatments, fight inflamma-
tory disease, heal wounds, promote bone
repair and lower blood pressure and cho-
lesterol [10].
I report here 5 healthy male adult pa-
tients developing acne after the consump-
tion of whey protein concentrates. Al-
though some discussion forums on the in-
ternet point to the possible link between
acne and nutritional supplements for ath-
letes, the development of acne after the use
of whey protein shakes has been scarcely
reported in the medical literature. Very re-
cently, Silverberg [11] reported 5 male pa-
tients aged 1418 years who experienced
acne shortly after the initiation of whey
protein supplementation; 3 teenagers used
the supplement for muscle building in
football training and the other 2 were at-
tempting to gain weight. All 5 patients had
a poor response to acne treatment regi-
mens of oral antibiotics, topical retinoids
and benzoyl peroxide. In 4 of the patients,
the lesions cleared completely after the
discontinuation of whey protein supple-
mentation, but 1 patients acne flared after
the reinitiation of the whey protein supple-
ment [11]. The description of 5 patients, 3
of whom reported no acne during adoles-
cence, developing acne flare-ups during
adulthood after the consumption of whey
protein shakes strengthens the link be-
tween whey protein concentrates and acne.
The patient with the best therapeutic re-
sponse was the one who discontinued the
consumption of whey shakes. Interesting-
ly, most patients preferred not to discon-
tinue their whey protein supplementation,
despite the persistence of acne lesions.
There is strong physiopathological evi-
dence that whey protein may favor acne
development. Whey protein-based prod-
ucts contribute to elevations of postpran-
dial insulin and basal IGF-1 plasma levels,
potentiating the signaling effects of hyper-
glycemic carbohydrates [13]. Increased in-
sulin/IGF-1 signaling activates the phos-
phoinositide-3 kinase/Akt pathway, there-
by reducing the nuclear content of the
transcription factor FoxO1, the key nutri-
genomic regulator of acne target genes
[13]. Nuclear FoxO1 deficiency has been
linked to all major factors of acne patho-
genesis, i.e. androgen receptor transacti-
vation, comedogenesis, increased seba-
ceous lipogenesis and follicular inflam-
mation [13]. Another putative mechanism

Whey Protein and Acne Dermatology 2012;225:256258 257

is the stimulation of the nutrient-sensitive
kinase mammalian target of rapamycin
complex 1 (mTORC1), which plays a role in
lipogenesis, androgen hormone secretion
and keratinocyte proliferation and may be
involved in the proinflammatory signal-
ing of keratinocyte [14].
Although IGF-1 plasma levels were not
determined in our patients, these observa-
tions are also in line with biochemical and
epidemiological data supporting the ef-
fects of milk and dairy products as en-
hancers of insulin/IGF-1 signaling and
acne aggravation [35, 8, 13]. In terms of
dairy products being involved in acne ag-
gravation, whey-rich types, i.e. skim milk,
sherbet drinks and cottage cheese seem to
be more of an issue [5]. The daily intake of
4080 g of concentrated whey protein is a
usual procedure during muscle training
periods in the bodybuilding and fitness
environment [13]. As 1 liter of milk con-
tains approximately 6.6 g of whey proteins,
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in some studies [18]. However, an elevated
BMI is rather common among bodybuild-
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ume than fat does. The use of anabolic-an-
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among members of fitness centers [1719],
could represent another confounder. How-
ever, none of these patients reported the
use of anabolic steroids.
In conclusion, these data suggest that
whey protein supplementation may induce
or aggravate acne. Further prospective
studies are required to determine the inci-
dence of acne and the possible role of di-
etary supplements in bodybuilders.
Disclosure Statement
The author has no conflict of interest
to disclose.
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Simonart
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