In reply
In his letter, Dr Logan proposes that a lower dietary omega-6鈥搊mega-3 ratio in the Kitavan and Ach茅 people may play a synergistic role along with a lower glycemic load in preventing the development of acne via reductions of proinflammatory eicosanoids. This hypothesis is certainly reasonable given recent evidence showing that an LTB4 blocker led to a 70% reduction in inflammatory acne lesions after 3 months.1 We have previously reported that the Kitavans indeed maintain a significantly lower dietary omega-6鈥搊mega-3 ratio than do western populations2 and that a lower dietary omega-6鈥搊mega-3 ratio is characteristic of virtually all hunter-gatherer diets.3 Another feature that distinguishes Kitavan and Ach茅 diets from western diets is the absence of milk, which exhibits a low glycemic index but paradoxically is highly insulinotropic.4 As with high-glycemic-load carbohydrates, dietary interventions will be required to assess the effectiveness of any nutritional treatment on the development of acne.