Q I have a lot of acne. Could anything that I eat or drink be contributing to the breakouts? — D.M., Winterville

A The possible acne-food connection has been of interest to many teens and adults for a long time. The story seems to change. I asked Josh Porter, a third-year medical student, to answer your question. We were pleased to have ECU dermatologist Dr. Bill Burke help us with this column, too. Here is what Josh learned.

Although you suffer from acne, rest assured that you are not alone. Acne is the most common skin disorder in the United States, with approximately 85 percent of teens and numerous adults suffering from the disorder.

The role of diet in acne is currently both controversial and a hot topic in the medical literature. Previously, a wide variety of food items have been thought of as acne triggers. They included milk and dairy products, chocolate, cereal, pork, nuts, bread, eggs, and fatty foods. Mainstream medicine has been hesitant to wholeheartedly embrace the idea that diet plays a role in acne, because case studies have not been able to pinpoint any particular dietary factor that causes acne.

Several studies now suggest a tie between nutrition and acne. Most of the evidence revolves around consumption of milk, high-carbohydrate foods, polyunsaturated fatty acids, and fiber.

You probably have heard the commercial that milk is supposed to "do your body good," but will it give you acne? Two recent studies monitoring dietary dairy intake among high school students found an association between acne and milk consumption among teenagers. The authors suggested that the natural hormones and bioactive chemicals found in milk could worsen acne. Interestingly, the association was highest for skim milk.

Experts reported in a 2007 study of the effects of a high-protein, low-carbohydrate diet versus a regular, high-carbohydrate diet, that a naturally occurring compound in our body called insulin-like growth factor, or IGF-1, may play a role in acne. Insulin and IGF-1 are released when blood sugar is elevated, such as after eating a sugary meal.

We've all heard that fish is good for your heart, right? Well, fish may also be good for your skin. Omega-3 fatty acids, commonly found in fish and fish oil, have anti-inflammatory properties and thus may be valuable in preventing and treating acne. A 2003 study showed that people living in communities with diets high in omega-3 fatty acids had low rates of acne.

Fiber, which is found in whole grains, fruits and vegetables, could also play a role in acne. Although the evidence is anecdotal, some clinicians have noted improvement in acne simply by having patients incorporate high-fiber breakfast cereal into their daily routine.

So, what should you make of all this information? I believe the notion that diet does affect acne, but changing your diet will not be enough to fight your acne alone. The treatment of acne includes a number of topical and systemic therapies, and I encourage you to consult your family doctor about coming up with a treatment plan that is right for you.

Cutting out greasy foods, dairy, and carbohydrates may not cure your acne. However, a low-sugar, low-saturated-fat, high-fiber diet will certainly decrease your risk of cardiovascular disease and will be good for your overall well-being. And who knows ... a few dietary modifications, in conjunction with advice from your doctor, just might lead you down the path toward acne-free skin.