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应对皮肤问题:调整饮食习惯是否必选项

更新时间:2018-11-21 20:20:12 来源:纽约时报中文网 作者:佚名

Is it time to stop blaming your diet for acne?
应对皮肤问题:调整饮食习惯是否必选项

As a consultant dermatologist based in London, I have been seeing patients with skin conditions for well over a decade. Acne is one of my main areas of interest. Over the past few years, there are some observations I have made which are causing me concern: with the rise of 'wellness' and its stubborn persistence, my increasing worry is how it is affecting our relationship with food in the context of managing skin problems.

作为伦敦的皮肤科顾问,十多年来,我见过无数皮肤病的病人。痤疮是我最感兴趣的领域之一。在过去的几年中,我的一些观察引起了我的思考:随着“健康”观念的兴起和对追求健康的锲而不舍,我越来越担心这种观念在处理皮肤问题上,将如何影响我们和食物的关系。

Let me give you a bit of background. I am aware that I see a self-selecting group of patients in my private clinics. Many suffer with a longstanding history of acne, most are female and from an affluent background – that is the nature of working in exclusive areas of London. Like many of us, they are intelligent, clued-up women who care not only about their skin health, but also their general health.

让我给你一些背景知识。在我的私人诊所里,我看到一些自我选择的患者。很多患者有长期的痤疮病史,其中大多数是女性并且家境富裕,这是在伦敦的高级地区行医才会遇到的情况。像我们很多人一样,她们即聪明又有知识,不仅关心皮肤健康,还关心自己的整体健康状况。

By the time many of them are sitting opposite me in clinic for their acne, they have already exhausted numerous avenues of treatment. This includes changing their skincare, often having spent thousands trying to find the right product, as well as manipulating their diet.

当她们因受痤疮烦恼来到我的诊所求珍时,她们往往已经穷尽了无数的治疗方法,包括不断更换护肤品。她们往往为了找到合适的护肤产品,已经花了数千英镑,还同时节制自己的饮食。

The nutrition aspect is a trend that I am finding hard to ignore. Patients are telling me how they are cutting out dairy, gluten and sugar in an attempt to clear their spots. Many are actively restricting food to the point where it is clear to me it has become an unhealthy obsession: finding excuses not to go to dinner with friends, refusing to eat a slice of birthday cake that has been lovingly made by a family member, skipping meals when out and about as there is no 'clean' café that can provide 'acceptable' or 'allowed' food. What I am dealing with is not just the acne itself, but also a very real fear of certain foods.

我发现,患者在饮食营养方面着手是一个不容忽视的趋势。患者们告诉我,她们为了消除脸上的痤疮(即除痘)是如何禁绝乳制品,麸质和糖类食品。其中许多人正在费尽心机地节制饮食,在我看来已经是完全不健康的强迫症。她们找借口避免和朋友共进晚餐,拒绝吃一块家人精心制作的生日蛋糕,外出时避免就餐,而借口是因为没有能提供“可接受”或“被允许”食物的“干净”咖啡馆,诸如此类。所以我治疗的不仅仅是痤疮本身,还包括患者对某些食物的一种真实的恐惧。

But let’s look at the evidence. What is the relationship with acne and diet?

但是让我们来看看证据。痤疮和食物之间究竟是什么关系?

The link has been discussed for decades and remains controversial. Doing good quality dietary studies is difficult and many rely on people's memory of what they ate in the past. Can you accurately recall what you ate last week, let alone 10 years ago?

这二者的关系已经被讨论了几十年,但是仍然存在争议。做高质量的饮食习惯研究很困难,因为要依赖于人们对过去所吃东西的记忆。你能准确的回忆起你上周吃过什么吗?更不用说十年前的了。

What we do know is that there is a growing relationship between acne development and food that has a high glycaemic index (GI) – so, potentially, sugar has some part to play. The way I would translate this, however, is not to cut out sugar altogether but be mindful of consumption. This isn’t just good for your skin, but also for your general wellbeing.

我们知道的是,痤疮的产生与具有高血糖生成指数(GI)的食物之间是有关系的,所以脸生痤疮,糖有可能起了一些作用。对此我的见解是,不是要完全杜绝所有含糖食物,而是要控制糖的消耗量。这不仅有益于你的皮肤,也有益于你的整体健康。

The link with dairy is actually much weaker. Still, it may have a role in acne in a small, select group of people – not everyone! For reasons that are not fully understood, low fat dairy seems to be worse than full fat. There is no acne guideline in the UK or the US which recommends cutting out dairy for the treatment of acne. There are plenty of people I see following a vegan diet who still have spots.

但与乳制品的关系实际上是相当微弱。虽然乳制品可能对特定的一小群人有影响,但并不是所有人!由于尚未完全了解的原因,低脂乳制品似乎比全脂乳制品更糟糕。在英国或美国的治疗痤疮的指引中,没有一条建议用禁绝乳制品来治疗痤疮。我见过很多遵循纯素饮食的人也仍然长青春痘。

Likewise, I have lots of patients who have cut out whole food groups, but their spots persist. Labelling food as the problem is too simplistic and fails to take account of the multi-factorial nature of acne, which includes variations in hormones and genetics.

同时,我也有很多病人已经停止食用所有未经加工的全天然食物,但是他们的痘痘仍在脸上。标签食物之所以是问题,是因为将食物与痤疮的关系过于简单化,没有考虑到造成痤疮的多种因素,比如荷尔蒙和基因上的差异等。

If food restrictions weren’t bad enough, the second thing I can’t ignore is food shaming. This is where people think it is socially acceptable to pass unsolicited advice or judgement on someone’s eating habits, blaming them for their skin disease. This has happened to me, too. The stranger in the street who tells you that you have acne because you’re eating ice cream on a hot summer’s day. The concerned relative who tells you to put the chocolate down as it’s obviously giving you spots. The troll on social media who tells you that it’s not surprising you have bad skin because you posted a picture of a slice of pizza.

如果对食物的节制还不够严重,那还有我不能视而不见的对他人饮食选择的横加指责。人们认为自作主张对他人的饮食习惯提出意见或加以评论,将皮肤病归咎于此人的饮食习惯,是社会可以接受的行为。这类事在我身上也发生过。街上的陌生人告诉你,你生痤疮是因为在大热夏天里吃了冰淇淋。一个关心你的亲戚让你放下巧克力,因为显然是巧克力给你带来了痘痘。社交媒体上挑衅的帖子也会告诉你,难怪你皮肤不好,因为你上贴了一片披萨的图片。

We are living in a world of information overload. Everyone has a voice and a platform and social media allows us to reach a wider audience that would not have been possible 20 years ago. But how does one sort out the scientifically credible voices from the charlatans?

我们生活在一个信息超载的世界。每个人都有自己的声音或者平台和社交媒体,让我们能覆盖到广泛的受众,这在20年前是不可能的。但是如何区别江湖郎中的告诫和可信的科学声音呢?

If you’re feeling desperate because of your spots and your self-esteem is in your boots, it is totally understandable why you would turn to the internet for advice. The difficulty is that not all advice is created equal, and there is a lot of conflicting information – sometimes even coming from health professionals themselves. And just because something works for one person doesn't mean it will work for you. We are all individuals, with our unique DNA, environment and gut and skin microbiome.

你因为痘痘而感到绝望,自尊心极低,而转向互联网寻求意见,这是完全可以理解的。困难的是并不是所有的建议都应该一视同仁,甚至即使是来自卫生专业人士,其中也有很多相互冲突的信息。因为某样东西对某个人凑效,并不代表对你也有用。我们都是一个个独立个体,拥有我们各自独特的DNA,环境,肠道和皮肤微生物组织。

Acne has already been linked to a number of mental health concerns such as anxiety, depression, social isolation and poor body image. Telling people who are already vulnerable to developing mental health issues to then restrict their diet is a worry. But it is happening all over social media, where people – bloggers, via naturopaths and functional medicine – promise to get to the 'root of the problem'.

已知痤疮和许多精神健康问题有关,例如焦虑,抑郁,社交孤立和身体形象欠佳等。让容易产生心理问题的人去节制饮食令人担忧。但这样的事正在所有的社交媒体上出现,网友和博主们介绍自然疗法和特效药,并担保一定能“治本断根”。

No one is denying that good nutrition is important for your skin. Food has multiple roles in skin health and disease. But this is not the same as making people feel bad about their dietary choices by offering uninvited advice that is not rooted in science. This creates an unfair blame culture, criticising people who are already struggling. Patients are telling me that comments like this are affecting their mental health or creating disordered eating patterns. Many worry much more about what they eat, or think twice about eating that sugary food in public. Friends who work in nutrition and psychology tell me that I’m not alone, and that they are seeing the same thing in their clinics.

没有人会否认营养好对皮肤很重要。食物在皮肤健康和疾病中起到多重作用。但是这与提一些没有科学依据的建议,让人对自己的饮食选择感到不舒服还是有所不同。批评那些已经在苦苦挣扎的患者,这已造成了一种指手画脚干涉他人的责怪文化。向我求诊的病人告诉我,他人这样的评论影响到他们的心理健康并导致他们饮食模式混乱。结果许多患者对于自己要吃什么显得忧心忡忡,或者他们在公共场合吃含糖食物时都要再三思量。在营养和心理学领域工作的朋友们告诉我,并非只有我会有这样的患者,他们在诊所也遇到同样的情况。

So what is the solution? If you are suffering with acne and any of this resonates, then it is important to seek medical help. Likewise, if you are noticing a loved one becoming wary around food because of their spots, please encourage them to talk to someone. Be open with your GP or dermatologist about your concerns around food. It can be really helpful to work with a team of people such as a dietitian and psychologist alongside having your skin treated.

那么解决方案是什么呢?如果你患有痤疮并且对上述任何一种境遇深有同感,那么寻求医疗帮助是很重要的。同样的,如果你注意到你所爱的人因为长痘对饮食变得顾虑重重,请鼓励他们与人交谈。对你的全科医生或者皮肤科医生坦诚说明你对饮食有顾虑。在治疗你的皮肤时,也寻求诸如营养师和心理学家这样的专业人士的意见,会对你非常有帮助。

Food does not have to be 'good' or 'bad' – the labels are too binary. Eating well for your skin is about sustained eating patterns over time, not just that packet of sweets you ate today.

食物不一定非“好”即“坏”——这种标签太二元论。为你的皮肤好好吃,是长期持续的饮食模式,而不仅仅在于你今天吃的那包糖果。

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