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troversy, yet it is discouraging that this study is widely reported as indicating a positive relationship between chocolate and acne (12).
Rasmussen (7) criticized the work of Fulton et al. (13) as not employing sufficiently specific means to evaluate a shift in severity from equal numbers of comedones to pustules. Nevertheless, the work of Fulton et al. is generally recognized as disproving any link between chocolate and acne and is cited positively in a letter to the editor of the Journal of the American Medical Association (14). This letter also pointed out that many erroneous assumptions have been made in relation to chocolate and allergy. It also speaks to the discrepancy between patients' perceptions and clinical symptoms. A study is described in which 500 allergic individuals, of whom 33% have been told to avoid chocolate, were tested. Of the 500, 16% thought that chocolate caused allergic symptoms. In fact, only 10 of the 500 manifested specific allergic symptoms within a predictable time after consuming chocolate. Eight of these ten were further tested using the double-blind technique, finding that only three of the eight reproduced any effects with the sample, but not with the placebo. Interestingly, only one of these three tested positively in a skin test.
Anderson (15) conducted a study over 6 years in what is described as 'the unusually favorable situation of the (Missouri) University Health Service'. Student patients with acne, most of whom believed certain foods substantially exacerbated their acne (within 36 hours), were initially questioned about these foods. Of these patients, 810% believed chocolate was a cause, and 34% blamed nuts, cola or milk. These subjects were provided with and consumed large daily amounts of chocolate, milk, nuts or cola under supervision. The author concluded, 'to the constant amazement of both the patients and medical students, absolutely no major flares of acne were produced by the foods'.
There are two other papers seeking to draw a correlation between chocolate consumption and acne (as well as, in one case, dental caries). The first describes Eskimos leaving their native habitat to thereafter enjoy chocolate consumption and at the same time suffer acne vulgaris (6, 12); the second attempts to connect the availability of dietary fats in certain regions to acne prevalence (12). Both are papers relying upon inductive reasoning without providing evidence and without adding new data to the presumed controversy.
There are many examples of authors eloquently describing their beliefs along with anecdotal support of the connection between chocolate consumption and acne. Hard evaluation of the data and their sources provide little, if any, real correlation. Three previous major reviews on the subject (3, 7, 12) concluded no effects of chocolate on the production of acne. The American Dietetic Association in its consumer publication Complete Food and Nutrition Guide, described the view that chocolate causes acne as a myth: 'That misconception has captured the attention of teens for years. However hormonal changes during adolescence are the usual causes of acne, not chocolate' (16).
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