Foods That Fight Cystic Acne From the Inside Out

By BiteBrightly 26 September 2026: This post might contain affiliate links.

Cystic acne — the deep, painful, often scarring form of acne that sits beneath the skin rather than at its surface — is caused by the same four factors as all acne, but with more intensity: excess sebum production, abnormal skin cell proliferation that blocks follicles, Cutibacterium acnes bacterial overgrowth, and inflammation. What makes cystic acne particularly difficult is that it often has a significant hormonal and inflammatory component — and this is precisely where diet enters the picture with genuine, research-supported relevance.

This is not a guide claiming that food can replace dermatological treatment. Cystic acne — particularly severe, scarring cystic acne — often requires prescription treatment (topical retinoids, antibiotics, hormonal therapy, or isotretinoin), and a dermatologist's assessment is important. What diet can do, supported by increasingly strong research, is address the hormonal cascade and inflammatory environment that drives cystic acne — reducing its frequency and severity alongside medical treatment.

Key Takeaways

• The insulin–IGF-1–androgen cascade is the primary mechanism linking diet to cystic acne: high-glycaemic foods spike blood glucose → insulin rises → IGF-1 rises → androgens are amplified → sebaceous glands overproduce sebum → follicles clog → inflammation → cystic lesions; a 2024 clinical trial found statistically significant reduction in acne lesions in patients on a low-glycaemic diet vs controls at 12 weeks

• A 2025 systematic review on adult female acne confirmed that a high-glycaemic diet is a consistent contributing factor alongside hyperandrogenism — placing diet on the same evidence tier as hormonal causes for adult female cystic acne

• Research found omega-3 deficiency in 96% of acne patients; EPA and DHA from oily fish lower IGF-1 levels, reduce leukotriene B4 (a potent pro-inflammatory sebum trigger), and reduce both inflammatory and non-inflammatory lesions; a 2024 study with 60 participants on Mediterranean diet plus algae omega-3 showed significant improvement

• Zinc reduces inflammatory acne lesions by up to 50% in some studies through simultaneous mechanisms — anti-inflammatory, antiandrogenic (5-alpha-reductase inhibition), antibacterial against C. acnes, and sebum-reducing

• Dairy and whey protein specifically worsen acne through leucine-driven IGF-1 stimulation and the hormones present in milk; skim milk shows a stronger association with acne than full-fat milk — the leucine and whey proteins are more concentrated after fat removal

• The gut-skin axis is a genuine research direction — gut microbiome diversity influences systemic inflammation that drives acne; probiotics targeting Lactobacillus and Bifidobacterium strains show promising results for acne reduction in a 2025 systematic review

The Hormonal Cascade — Why Diet Is Mechanistically Relevant to Cystic Acne

Understanding the mechanism makes the food choices make sense, and is what distinguishes evidence-based dietary advice from generic "eat healthy" recommendations:

The insulin-IGF-1 pathway: When blood glucose rises rapidly (from high-GI foods), the pancreas releases insulin. High insulin levels stimulate the liver to produce insulin-like growth factor 1 (IGF-1). IGF-1 then acts on sebaceous glands to increase sebum production, on keratinocytes to increase proliferation (contributing to the follicle blockage that traps sebum and bacteria), and on the adrenal glands and ovaries to increase androgen production. Androgens further stimulate sebaceous glands. The chain: refined carbohydrates → insulin spike → IGF-1 → androgens + sebum + keratinocyte overgrowth = cystic acne preconditions.

The mTORC1 pathway: Ultra-processed foods activate mTORC1 (mechanistic target of rapamycin complex 1) — a cellular growth signalling pathway — through insulin/IGF-1-dependent and independent mechanisms. A 2026 paper in the International Journal of Molecular Sciences confirmed that mTORC1 activation is a key pathway through which ultra-processed dietary patterns drive acne pathogenesis. EGCG from green tea, resveratrol from red grapes, and low-glycaemic dietary patterns all downregulate mTORC1 — reducing the signalling that drives sebum overproduction.

The inflammation pathway: Cystic acne involves significant systemic and local inflammation. Omega-6 fatty acids (dominant in refined vegetable oils and processed foods) promote leukotriene B4 — a potent inflammatory mediator that directly stimulates sebum overproduction. Omega-3 fatty acids compete with omega-6 for the same enzyme pathways, reducing leukotriene B4 production. The Western diet's 15:1–20:1 omega-6:omega-3 ratio creates an inflammatory milieu that worsens acne severity.

Food 1: Low-GI Carbohydrates — Interrupting the Insulin-IGF-1 Cascade

Acne mechanism: Low-glycaemic foods prevent the insulin spikes that drive IGF-1 production, androgen amplification, and sebaceous gland overstimulation — the most well-supported single dietary intervention for acne Evidence level: Strong — 2024 RCT: statistically significant reduction in lesions at 12 weeks on low-glycaemic diet; 2025 systematic review: high-glycaemic diet confirmed as consistent adult acne contributor

The transition from high-GI to low-GI carbohydrates is the single most evidence-grounded dietary change for acne — because it directly interrupts the insulin-IGF-1-androgen cascade at its starting point.

A 2024 clinical trial (Morales-Sánchez et al., n=52) randomised male acne patients receiving standard treatment (topical adapalene + doxycycline) to either a low-glycaemic diet or a control diet for 12 weeks. The low-glycaemic diet group showed a statistically significant reduction in acne lesions compared to controls — confirming that diet produces measurable clinical benefit on top of medication. A 2025 systematic review on adult female acne confirmed high-glycaemic diet as a consistent contributing factor alongside hyperandrogenism.

The practical shift — from high-GI to low-GI:

High-GI (insulin-spiking — limit):

• White bread, white rice, white pasta

• Sugary drinks (sodas, fruit juices, energy drinks)

• Breakfast cereals (most commercial varieties)

• Cakes, biscuits, pastries, doughnuts

• Instant noodles, processed snack foods

Low-GI (insulin-stable — choose):

• Oats and porridge (GI 55 — slow glucose release)

• Legumes: lentils, chickpeas, black beans (GI 20–40 — the lowest of any carbohydrate category)

• Sweet potato (GI ~55 — compared to white potato GI ~85)

• Quinoa, barley, brown rice

• Wholegrain bread and pasta (substantially lower GI than refined versions)

• Most non-starchy vegetables (GI well below 55)

Food 2: Oily Fish — Omega-3 to Break the Inflammatory Acne Cycle

Acne mechanism: EPA and DHA lower IGF-1 levels, reduce leukotriene B4 (a pro-inflammatory sebum stimulant), generate pro-resolving mediators (resolvins, protectins) that resolve skin inflammation, and shift the omega-6:omega-3 ratio toward the anti-inflammatory balance Evidence level: Good — 96% of acne patients found omega-3 deficient; 2024 study (60 participants, Mediterranean diet + algae omega-3): significant improvement in both inflammatory and non-inflammatory lesions; 2,000mg EPA+DHA daily for 10 weeks: significant lesion reduction in RCT

The omega-3 deficiency finding — present in 96% of acne patients in one study — is among the most clinically striking nutritional findings in acne research, given that omega-3 deficiency is also common in the general population on a Western diet. The pathways through which omega-3 addresses acne are multiple:

EPA and DHA lower IGF-1 levels directly — counteracting the sebum-stimulating growth factor that high-GI diets elevate. They reduce leukotriene B4 production (by competing with arachidonic acid for LOX enzyme activity) — leukotriene B4 directly stimulates sebaceous gland activity and inflammatory acne lesion formation. They generate specialised pro-resolving mediators (resolvins, protectins, maresins) that actively resolve the deep inflammation characteristic of cystic acne.

Best omega-3 sources for acne:

• Salmon: 2.2g omega-3 per 150g — the highest of low-mercury fish

• Sardines: EPA + DHA + vitamin D + zinc (multiple anti-acne mechanisms in one tin)

• Mackerel: very high omega-3, low mercury

• Walnuts: ALA omega-3 — conversion to EPA/DHA is limited (under 8%) but walnuts also provide zinc and vitamin E with antioxidant relevance for acne

• Ground flaxseed: ALA + fibre; a practical daily addition to oatmeal or yogurt

• Algae-based DHA/EPA: the most effective plant-based source; confirmed beneficial in the 2024 study

The omega-6 side of the equation: Reducing refined vegetable oils (sunflower, corn, soybean oil — heavily used in processed and fried foods) lowers the pro-inflammatory omega-6 load that competes with omega-3 for the enzymes that determine the balance of inflammatory mediators. Replacing with EVOO (high in monounsaturated fat + oleocanthal anti-inflammatory polyphenol) shifts the balance.

Food 3: Zinc-Rich Foods — The Multi-Mechanism Anti-Acne Mineral

Acne mechanism: Zinc inhibits 5-alpha-reductase (reducing conversion of testosterone to the more potent DHT that drives sebum production); reduces C. acnes bacterial activity; reduces inflammatory cytokines; antioxidant protection of sebaceous gland tissue; reduces sebum production Evidence level: Good — zinc reduces inflammatory lesions by up to 50% in some studies; multiple mechanisms confirmed; 2024 AAD guidelines note insufficient evidence for topical zinc but oral zinc RCTs consistently show benefit for inflammatory acne

Zinc is the most multi-mechanism dietary mineral for acne — simultaneously addressing the hormonal, inflammatory, and bacterial components:

Zinc inhibits 5-alpha-reductase — the enzyme that converts testosterone to dihydrotestosterone (DHT), the more potent androgen that drives sebaceous gland activity. This gives zinc an anti-androgenic mechanism that is particularly relevant for hormonal and cystic acne. Zinc reduces Cutibacterium acnes (formerly P. acnes) colonisation in follicles — the bacteria that drives the inflammatory cascade of cystic acne. Zinc reduces the production of inflammatory cytokines (IL-1β, TNF-α) that contribute to the inflammation severity of cystic lesions. Zinc's antioxidant properties reduce oxidative stress in sebaceous tissue. Research has found low selenium levels in acne patients, and the selenium-dependent glutathione peroxidase enzyme activity is reduced — zinc and selenium from food together support the antioxidant system most relevant to acne.

Best dietary zinc sources for acne:

• Oysters: the highest zinc food source by a significant margin (up to 74mg per 100g)

• Pumpkin seeds: 2.2mg per 30g — highest plant zinc per gram; can be added to oatmeal or salads

• Beef (lean): significant zinc alongside complete protein; choose lean cuts

• Cashew nuts: 1.6mg per 30g — practical daily snack

• Chickpeas and lentils: meaningful zinc alongside the low-GI carbohydrate benefit

• Hemp seeds: high zinc + omega-3 ALA — an anti-acne combination seed

• Eggs: moderate zinc + selenium + complete protein

Food 4: Colourful Vegetables and Antioxidant-Rich Foods — Reducing Skin Oxidative Stress

Acne mechanism: Antioxidants (vitamin A/beta-carotene, vitamin C, vitamin E, polyphenols) reduce oxidative stress in sebaceous tissue; vitamin A regulates keratinocyte proliferation (the same pathway targeted by retinoid acne medications); vitamin C supports collagen synthesis relevant to post-acne scar healing Evidence level: Good — lower levels of vitamins A and E found in acne patients vs controls; antioxidant mechanisms well-established; vitamin A's role in keratinocyte regulation the basis for retinoid treatments

Lower levels of vitamins A and E were found in 200 acne patients compared to age-matched controls — suggesting that antioxidant status is meaningful in acne pathogenesis. The connection to vitamin A is particularly notable: isotretinoin and topical retinoids — the most powerful acne medications — are vitamin A derivatives, working through the same keratinocyte regulation pathway that adequate dietary vitamin A supports at lower intensity.

Best antioxidant foods for acne:

Beta-carotene (converts to vitamin A) — sebaceous gland regulation, keratinocyte control:

• Sweet potato: one of the highest beta-carotene foods available

• Carrots: vivid orange = high beta-carotene

• Dark leafy greens: kale, spinach — beta-carotene + folate + antioxidants

Vitamin C — collagen synthesis for scar healing, antioxidant protection:

• Red and yellow peppers (190mg per pepper — highest of any food)

• Kiwi fruit (93mg per fruit)

• Strawberries, broccoli, citrus

Polyphenols for mTORC1 downregulation and anti-inflammatory activity:

• Blueberries, pomegranate, strawberries — anthocyanins with anti-inflammatory properties

• Red grapes: resveratrol inhibits mTORC1 signalling relevant to acne

• Dark chocolate (70%+): flavanols; but portion size matters (large amounts of processed chocolate = sugar + dairy)

Food 5: Green Tea — EGCG Against Multiple Acne Pathways

Acne mechanism: EGCG (epigallocatechin gallate) is anti-inflammatory, antiandrogenic (inhibits 5-alpha-reductase), downregulates mTORC1 signalling, reduces sebum production, and provides antioxidant protection to sebaceous tissue Evidence level: Good mechanistic evidence; 2–3 cups daily recommended in clinical commentary; 2% topical EGCG shows benefit in small trials; EGCG listed among compounds with acne-relevant activity in Life Extension protocol review

Green tea's EGCG polyphenol addresses acne through more pathways than any other single dietary compound:

Anti-inflammatory: EGCG inhibits the pro-inflammatory cytokines (IL-1β, TNF-α, IL-6) that drive the deep inflammation of cystic lesions. Antiandrogenic: EGCG inhibits 5-alpha-reductase (reducing DHT production from testosterone) — relevant to the hormonal component of cystic acne, particularly in adult women. mTORC1 inhibition: EGCG downregulates mTORC1 signalling — the same cellular growth pathway activated by ultra-processed foods and high-GI diets that drives sebum overproduction. Antibacterial: EGCG has demonstrated activity against C. acnes in laboratory studies. Sebum reduction: EGCG reduces lipid synthesis in sebocytes (sebum-producing cells) — directly reducing the excess sebum that clogs follicles.

This multi-pathway activity makes replacing one or two daily coffees or sugary drinks with green tea one of the most practically achievable and mechanistically relevant dietary changes for acne — simultaneously reducing caffeine (which raises cortisol, indirectly stimulating sebum) and adding EGCG.

Practical use: 2–3 cups daily. Cooled green tea can be used as a face rinse (the anti-inflammatory and antibacterial properties apply topically). Matcha (powdered green tea) provides a higher EGCG concentration per cup.

Food 6: Fermented Foods — The Gut-Skin Axis

Acne mechanism: Gut microbiome diversity influences systemic inflammation and immune regulation; dysbiosis (gut microbiome imbalance) is associated with increased systemic inflammation that worsens acne; Lactobacillus strains reduce inflammatory cytokines systemically; 2025 systematic review found oral probiotics improve acne outcomes Evidence level: Emerging-to-good — gut-skin axis well-established mechanistically; 2025 systematic review and meta-analysis of double-blind RCTs (Tjiu and Lu, Medicina, 2025) found oral probiotics significantly improved acne; clinical confirmation ongoing

The gut-skin axis — the bidirectional communication between the gut microbiome and skin health — is among the more compelling emerging areas in acne research. A 2026 paper in Applied Sciences reviewed the gut-skin axis as a central mechanism in acne vulgaris, and a 2025 systematic review and meta-analysis of double-blind randomised clinical trials (Tjiu and Lu, Medicina, 2025) found that oral probiotics significantly improved acne outcomes — particularly inflammatory lesion counts.

The mechanism: gut dysbiosis (imbalanced microbiome) increases intestinal permeability, allowing bacterial endotoxins (lipopolysaccharides) to enter systemic circulation where they trigger systemic inflammatory responses. This systemic inflammation exacerbates the local skin inflammation of acne. Lactobacillus and Bifidobacterium strains reduce intestinal permeability and reduce systemic inflammatory cytokines — lowering the inflammatory baseline from which acne lesions develop.

Best probiotic-rich foods for acne:

• Kefir (unsweetened): 10–15 bacterial and yeast strains; the most comprehensive fermented dairy food — though some people with dairy-sensitive acne may react; monitor individual response

• Plain unsweetened yogurt with live cultures: widely available; avoid added-sugar versions (sugar worsens acne)

• Kimchi: probiotic + antioxidant; note sodium content

• Miso: anti-inflammatory compounds alongside probiotics

• Sauerkraut: Lactobacillus strains; watch sodium

The prebiotic fibre link: The Lactobacillus and Bifidobacterium strains that benefit acne need dietary fibre to thrive. Foods rich in prebiotic fibre (garlic, onion, oats, leeks, bananas, asparagus, lentils) feed the microbiome that dietary probiotics establish.

Food 7: Seeds and Nuts — Zinc, Vitamin E, and Selenium Together

Acne mechanism: Zinc inhibits 5-alpha-reductase and reduces C. acnes activity; vitamin E protects sebaceous tissue from oxidative damage; selenium supports glutathione peroxidase antioxidant activity shown to be deficient in acne patients; the combination provides the antioxidant trifecta most relevant to inflammatory acne Evidence level: Good — selenium-dependent glutathione peroxidase activity low in acne patients; selenium + vitamin E combination showed improvement in clinical study; zinc antioxidant + anti-androgenic properties well-established

Low selenium and low glutathione peroxidase activity are consistently documented in acne patients — and selenium, vitamin E, and zinc together support the antioxidant system most specifically relevant to sebaceous tissue health. A clinical study found that selenium (400mcg) and vitamin E (20mg) daily for 12 weeks improved acne, particularly in those with the lowest baseline glutathione peroxidase activity.

Seed and nut sources providing the anti-acne antioxidant trifecta:

• Pumpkin seeds: zinc (highest plant source per gram) + vitamin E + magnesium

• Sunflower seeds: vitamin E (highest of any common seed per gram) + zinc + selenium

• Brazil nuts: the most concentrated selenium food (one to two daily provides the full daily requirement) — include in moderation (excess selenium is harmful above 400mcg daily)

• Almonds: vitamin E + zinc + magnesium

• Hemp seeds: zinc + omega-3 ALA + complete plant protein

• Walnuts: ALA omega-3 + zinc + vitamin E — the most comprehensive nut for acne

Food 8: Spearmint Tea and Anti-Androgenic Foods — Hormonal Acne Support

Acne mechanism: Spearmint has demonstrated anti-androgenic properties in clinical research — a small RCT found twice-daily spearmint tea significantly reduced free and total testosterone and improved hormonal acne scores in women with PCOS; particularly relevant for adult female cystic acne along the jawline Evidence level: Moderate — small RCT evidence for spearmint's anti-androgenic effect; most consistent evidence in women with PCOS and elevated androgens; mechanistically relevant to hormonal cystic acne

For adult women with hormonal cystic acne — particularly the pattern of deep cysts along the jawline that worsen before menstruation — anti-androgenic dietary strategies are specifically relevant. Spearmint tea has the most direct clinical evidence in this category.

A small but well-designed randomised controlled trial found that women with PCOS who drank two cups of spearmint tea daily for 30 days showed significantly reduced free and total testosterone levels compared to controls, alongside improvements in hormonal acne scores. The mechanism: spearmint contains compounds that inhibit 5-alpha-reductase and reduce luteinising hormone (LH) — two androgenic pathways relevant to cystic acne.

Other anti-androgenic dietary strategies:

• Flaxseed (ground): lignans in flaxseed bind to oestrogen receptors and inhibit 5-alpha-reductase; one tablespoon daily in oatmeal is the most practical format

• Spearmint tea: two cups daily for anti-androgenic effects (note: peppermint tea does not carry the same evidence as spearmint specifically)

• Reducing refined carbohydrates: lowers insulin → lowers IGF-1 → reduces androgen stimulation (the most fundamental anti-androgenic dietary intervention)

• Green tea (EGCG): 5-alpha-reductase inhibition (as discussed above)

What to Avoid — Foods That Worsen Cystic Acne

Dairy products and whey protein: Dairy — particularly skim milk and whey protein — consistently appears in acne research as a worsening factor. A systematic review in the Journal of the Academy of Nutrition and Dietetics found a positive association between dairy intake and acne, particularly in adolescents and young adults. Skim milk shows a stronger link than full-fat milk — because removing fat concentrates the whey proteins and growth hormones relative to the remaining composition. Whey protein supplements spike IGF-1 through the leucine-mTORC1 pathway — potentially more significantly than regular dairy. For people whose acne does not respond to other dietary changes, a 4–6 week dairy elimination trial is a reasonable and evidence-supported strategy.

High-GI foods and refined carbohydrates: The most evidence-supported single dietary change for acne. White bread, white rice, sugary drinks, pastries, breakfast cereals, instant noodles, and processed snack foods all spike the insulin-IGF-1 cascade that drives sebum overproduction.

Ultra-processed foods: Beyond glycaemic impact, ultra-processed foods activate mTORC1 signalling through multiple pathways — their high omega-6 content, refined carbohydrates, trans fats, and food additives all contribute to the inflammatory environment that drives cystic acne.

Refined vegetable oils: Sunflower, corn, and soybean oils — dominant in processed and fried foods — are very high in omega-6 linoleic acid. In excess, these shift the omega-6:omega-3 ratio toward the inflammatory range that promotes leukotriene B4 and prostaglandin E2 — direct sebum stimulants.

Alcohol: Increases systemic inflammation, disrupts sleep (a significant acne aggravator through cortisol elevation), impairs the liver's ability to metabolise hormones — including the androgens that drive sebaceous gland activity.

Frequently Asked Questions

How long before dietary changes improve cystic acne?

Skin cell turnover takes approximately 28 days — so dietary changes generally take 6–12 weeks to produce visible improvements in acne. The 2024 clinical trial showed statistically significant results at 12 weeks. This is important context: if you have not noticed a difference after two or three weeks, the dietary changes may still be working. Four to six weeks of consistent low-GI eating, omega-3 increase, and dairy reduction is the minimum period for assessing dietary response. Cystic acne in particular may require dermatological treatment alongside dietary changes — dermatologist assessment is recommended for severe or scarring acne.

Is dairy the main dietary acne trigger?

Dairy is one of the most consistent dietary acne triggers in research — but individual response varies significantly. Some people clear dramatically on a dairy-free diet; others see no difference. The most evidence-supported approach is a 4–6 week elimination trial: remove all dairy (milk, cheese, yogurt, butter, whey protein) completely for 4–6 weeks and assess whether acne improves. If it does, dairy is a meaningful trigger. If it does not, focus dietary effort on the glycaemic load and omega-3 changes instead. For more on gut-supportive and anti-inflammatory foods see our Anti-Inflammatory Foods guide at bitebrightly.com.

Can food alone clear cystic acne?

For mild to moderate acne with a clear dietary trigger (dairy, high-GI diet), dietary changes alone can produce meaningful improvement. For severe or cystic acne — particularly scarring cystic acne — dietary changes are a valuable complement to dermatological treatment, not a replacement for it. Isotretinoin, hormonal therapy (combined oral contraceptive pill, spironolactone), and prescription topical treatments address the acne pathways that diet reaches less effectively. The most effective approach for cystic acne combines dermatological care with dietary support. For more on foods that reduce systemic inflammation see our Anti-Inflammatory Foods guide at bitebrightly.com.

References and Further Reading

1. Precision and Future Medicine / ScienceDirect (2024) — The Role of Diet in the Management of Acne. 2024 RCT (Morales-Sánchez et al., n=52): statistically significant acne lesion reduction on low-glycaemic diet at 12 weeks.

2. Health Science Reports / Wiley (2025) — Etiology of Adult Female Acne — Systematic Review. 2025 systematic review: high-glycaemic diet confirmed as consistent adult female acne contributor alongside hyperandrogenism.

3. International Journal of Molecular Sciences (2026) — Ultra-Processed Diets and Pediatric Acne: Insulin–mTOR Activation. mTORC1 pathway in acne pathogenesis; ultra-processed food mechanisms.

4. Banish / Oana Health (2026) — The Anti-Acne Diet in 2026 / New Studies on Supplements for Acne. Omega-3 deficiency in 96% of acne patients; 2024 Mediterranean diet + algae omega-3 study; zinc reducing inflammatory lesions by up to 50%.

5. Life Extension / Dermatology NYC — Acne Overview / Supplements in Acne: What Actually Works. EGCG mechanisms; resveratrol mTORC1 inhibition; green tea 2–3 cups daily recommendation.

About the Author

Judith Tsanga is an Applied Biosciences & Biotechnology graduate with an Advanced Level qualification in Food Science, and the founder of BiteBrightly. Her passion for food as medicine began with her own experience: after making targeted dietary changes, she noticed a meaningful improvement in her eyesight — a personal transformation that inspired her mission to share evidence-based nutrition insights that help others eat well and heal boldly. Content on BiteBrightly is for educational purposes and isn't a substitute for advice from your doctor or dietitian.

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Important Notice: This article is for educational purposes only and is not intended as medical advice. I am not a medical doctor, dermatologist, or registered dietitian. Cystic acne — particularly severe or scarring cystic acne — should be assessed by a dermatologist. Dietary changes are a meaningful complement to dermatological treatment, not a replacement for it. If you are considering a dairy elimination diet, discuss with your GP to ensure calcium and protein needs are met through alternatives. These statements have not been evaluated by the FDA.

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