What is Acne?
Let’s take a trip back in time.
Way back in the early 20th century, some dermatologists actually believed diet could have a significant influence on the development of acne. Unfortunately, later that century, in 1969 and 1971, two studies authored by prominent dermatologists stated the opposite, and since that time the major textbooks of dermatology have denied that diet affects acne by citing those two papers.
Since then, this has been the belief that has persisted. In 2012, the American Academy of Dermatology’s website links to a patient information site stating, “There’s no need to worry about food affecting the acne.”
However, there have been other studies that have gone relatively unnoticed and unpublicized claiming that nutrition actually could play a major role.
A study of 800 Koreans correlated a high-glycemic load diet, processed cheese, a high-fat diet, and iodine with the exacerbation of acne. Another Norwegian study found that low raw vegetable intake correlated with increased acne in females. Observational and epidemiological studies following the Inuit for over 30 years found that acne, which was once absent, became prevalent as they moved from a fish-based diet to one rich in processed foods, like bread, sweets, pastries, and soft drinks.
So what gives here?
In terms of pathophysiology, it can be broken up into 4 steps:
1. Abnormal hyperkeratinization in the hair follicle lumen.
2. Increased sebum production by the sebaceous glands.
3. Overgrowth of Propionobacterium acnes within the follicle.
4. Inflammatory processes are triggered, leading to swelling, redness, and pustule formation.
P. acnes activates Toll-Like Receptor 2 (TLR2) in the innate immune system, triggering an inflammatory cascade.
This inflammation can be caused by a variety of triggers, including increased testosterone levels, high levels of omega 6 fatty acids (which are pro-inflammatory), increased adiposity, insulin resistance, and increased oxidative stress, among others.
Common Causes of Acne
In addition to poor nutrition (consuming a Standard American Diet, full of refined grains, poor-quality fats, and/or sugar, for example), there are a variety of other common causes for acne.
Clogged pores, either from dead skin cells or excess oil production, can contribute to acne. Similarly, constant skin irritation, from sports equipment, backpacks, and hats, can lead to breakouts in common areas, like the forehead, back, and chin.
Poor sleep hygiene and high amounts of stress can play a role as well.
Bacteria and hormone imbalances are important to address. When androgen hormone production increases, so does oil production, for example. This is much more common in teenagers and young adults. Sometimes, people can “outgrow” this phase, and do not struggle with acne long-term. However, those who suffer from conditions characterized by hormone imbalances, like PMS, PCOS (polycystic ovarian syndrome), irregular periods, menopause, and pregnancy, could experience acne more frequently.
Certain medications, like corticosteroids, lithium, androgens, and birth control pills, can make acne worse as well.
So what are some things you can do about it?
Therapeutic Strategies for Acne
Omega-3 Fatty Acids
The fats we consume ultimately end up in our skin. If you consume the Standard American Diet (SAD), then you likely have high levels of arachidonic acid (AA), a pro-inflammatory omega-6 fatty acid.
Increasing your omega-3 fatty acid intake will incorporate more EPA and DHA in cell membranes while decreasing AA. Omega-3s block TLR2, the immune trigger that is activated by P. acnes. If this is not triggered, then the immune cascade will not follow. Additionally, omega-3s have anti-inflammatory effects, and reducing inflammation is key when treating acne.
Address Insulin Resistance and Dairy Intake
Those who have had acne for long periods of time likely have increased IGF-1 (Insulin-like Growth Factor 1) levels. Increased levels of insulin and IGF-1 increase sebum production in pores. Insulin levels are driven by what we eat. Consuming the SAD, with a majority of foods being inflammatory in the form processed sugars, packaged foods, candy, soda, sweets, chips, and the like, will increase serum IGF-1 levels.
Casein and whey are two proteins found in dairy products, and play a role in increasing IGF-1 and insulin levels, respectively. Casein supplementation increases IGF-1 levels by 15%, while whey supplementation increases insulin levels by 20%. Therefore, limiting or (ideally) eliminated your dairy intake can help improve acne going forward.
Use this list below as a baseline to get you started going forward.
- Eat real foods, with at least 50% of each plate being vegetables.
- Eat a diet primarily of vegetables, fruits, nuts, seeds, lean proteins, and healthy fats.
- Choose pasture-raised, organic, grass-fed, and/or wild animal meats and fish a few times per week at most.
- Eat an assortment of different-colored vegetables and fruits (eat the rainbow).
- Drink clean water.
- Eat fermented foods to balance your gut flora, like kimchi and sauerkraut.
- Cut out inflammatory foods, like simple carbohydrates, sugars, processed foods, and candies.
- 80% of the time eat right, allowing yourself 20% “wiggle room.”
- Drink lemon water in the morning, it helps boost metabolism and liver function.
- Look for foods that are high in fiber (whole foods) and low in sugar.
- Eliminate all packaged foods, if possible.
- Be sure to read ALL ingredient labels.
- Never eat out of a box or bag.
- Eat greens at least twice per day.
- Choose organic foods as often as possible.
- Listen to your body!
Additionally, antioxidant levels seem to be lower in those who suffer from acne. Research indicate that acne severity can be correlated to oxidative stress. Swedish researchers noted that men with severe acne have significantly less RBC levels of glutathione (considered the “master antioxidant”). They also tend to have increased p-Hydroxyphenyllactate (HPLA) and 8-Hydroxy-2-deoxyguanosine (8OHdG) levels, two markers of increased oxidative stress and DNA damage.
Therefore, it is important to load up on foods high in your antioxidant nutrients: vitamins A, C, E, selenium, and zinc.
You can focus on antioxidant rich foods (high in vitamins A, C, and E), like carrots, berries, beets, spinach, kale, and other leafy greens. Focus on foods high in zinc as well, like oysters, red meat, seeds, ginger, fish, nuts, kidney beans, and turkey. Foods high in selenium include Brazil nuts, butter, seafood, and grains grown in selenium-rich soil.
Oxidative stress plays a crucial role in the formation of acne, as well as the rise of cortisol levels. Cortisol levels rise in response to sleep deprivation and prolonged exposure to stress of all kinds. Excessive cortisol causes central obesity, peripheral muscle wasting, hyperglycemia, and acne. Sleep deprivation is also associated with increased insulin resistance.
The following recommendations can be greatly beneficial to those suffering from acne because they can help improve the release of cortisol:
- Eliminate dairy and other common food sensitivity sources (gluten, soy, shellfish, corn, added sugars).
- Eat 5-8 servings of vegetables and 2 servings of fruit per day.
- Eat 2.5 to 3 palm-sized servings of protein-rich foods (meat, poultry, eggs, fish) daily; include fish one to two times weekly.
- Avoid processed foods, high-fructose corn syrup, soda, sports drinks, juice, and hydrogenated vegetable oils (safflower, sunflower, peanut, soy, and cottonseed oils).
- Eat vegetable carbohydrates, such as squash, sweet potatoes, root vegetables and, if you tolerate them, legumes and whole, unprocessed grains.
- Drink filtered water, teas, and juiced vegetables.
- Limit alcohol intake.
- Sleep 7-8 uninterrupted hours nightly.
- Relaxation techniques (meditation, yoga, tai chi, self-hypnosis, biofeedback, or progressive muscle relaxation).
- Exercise at least 3x a week (strength, aerobic, flexibility, etc.).
Maintain Proper Facial Hygiene
You don’t have to buy all the latest and most expensive topical cleaning agents, but maintaining proper hygiene can go a long way in managing acne. Below are some home remedies you can try yourself:
- Essential oils, like tea tree oil and lavender, have antibacterial properties. Simply mix a few drops of the oil with 1 tablespoon of coconut oil (make sure you use a carrier oil, like coconut oil, in combination). You can then apply the mixture to the affected areas.
- Make sure to clean brushes, phones, hats, and other objects that regularly are in contact with your face.
- Consider a homemade exfoliating mask (can be made of coffee grounds and lemon or sea salt and honey). Mix the dry ingredient and the wet base, and apply. Once finished, remove mask with a damp cloth.
- In addition to exfoliating regularly, make sure you are gentle on your skin.
- Clean your face only once or twice per day, as more frequent cleanings can irritate your skin. Additionally, more frequent cleanings can cause an overproduction of oils.
Maintain Proper Hygiene
Water is a vital to proper nutrition. Consider this: the average human body contains roughly 10 gallons of water at any given time. It is recommended at least 48 fluid ounces of water per day is needed to replace the water lost through the daily routine in sweat, urination, and breathing. However, this is the low end of what is even adequate.
Dehydration has been shown to impair physiologic function and performance values during exercise. Water is necessary for proper nutrient absorption and adequate water levels allow for nutrients and minerals to cross cell membranes more easily. Water is a chief component of blood, and each cell in our bodies is suspended in a watery solution. Water can absorb and transfer heat within and out of the body. Water is also needed to carry waste materials through the kidneys to be excreted.
Water helps keep skin moisturized properly, and chronic dehydration can lead to an accumulation of bacteria and toxins below the skin’s surface.
I recommend the amount of water needed per day is equal to half your body weight in fluid ounces. In other words, if you weigh 150 pounds, you should drink at least 75 fluid ounces of water daily. This is the goal you should be shooting for.
In most cases, acne tends to clear up with time. If you are going through a particularly stressful period in your life or are a teenager, this is especially true. Other common causes include clogged pores, bacterial infections, poor nutrition, hormonal imbalances, high-stress environments, and poor sleeping habits.
However, if you are suffering from persistent acne for prolonged periods of time, then it might be worth it to visit a doctor and try to identify the underlying cause. These can include thyroid problems, PCOS, or another hormone disorder, just to name a few. Every situation is unique, so work with your doctor to find the best holistic solution for you.
Though based in research, personal, and clinical experience, the opinions in this article should not be taken as medical advice. The information is designed for educational purposes only and is not designed to diagnose, treat, or cure disease. Botanical medicine and nutraceuticals should be treated with the same caution and care as pharmaceuticals, as both have the potential for strong, potentially adverse effects and allergic reactions. Please consult a trained, licensed health care practitioner before proceeding. Neither the publisher nor the author takes responsibility for possible health consequences of any person reading or following the information in this book. All readers, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition or supplement program.