I read with great interest the recent article by Cordain et al.¹ This group makes a strong argument for the involvement of diet-induced hyperinsulinemia in the pathogenesis of acne vulgaris. In addition to the glycemic load of the typical western refined-food diet, it is also important to note that the western diet typically includes a much lower intake of omega-3 fatty acids, an excess of proinflammatory omega-6 and trans fatty acids, and a reduced intake of dietary antioxidant vitamins. The current ratio of omega-6 to omega-3 fatty acids in the western diet reaches 20:1, while through evolution and in a traditional hunter-gatherer diet it is closer to 1:1.² Fish, wild game, and wild plants have much higher levels of omega-3 fatty acids than do refined western foods.