Updated: Jun 5, 2020
Acne is a condition which can greatly affect one's self esteem, especially when located on the face and other visible areas of skin. Most common in the teenage years, if the conditions of the body and skin are not corrected, acne can persist into adulthood.
Our skin contains pores (openings) and follicles, which contain hair. Around each one of these openings are glands called sebaceous glands which produce sebum to help keep the skin lubricated and healthy. The outer layer of the skin (epidermis) is protected by keratin, which is also what your hair and nails are made out of.
For acne to develop, a few things need to occur.
The skin pores become clogged with excess shed keratin
Excess sebum production builds up under the clog
Bacteria, (most commonly, proprionum bacterium acnes, or p. acnes for short, proliferate and a small infected pustule or comedone forms with resulting inflammation.
It's important to remember that all 3 of these steps must occur in order for a pimple to show. It's also very normal for bacteria to be on our skin, many of these species are actually helpful. They protect us from severe infections from other, pathogenic, bacteria. Your skin is actually a complex ecosystem of bacteria and fungi which play important roles in maintaining that healthy beautiful glow (1). Antibiotics are often a first-line treatment of acne, but this doesn't address the first two steps of acne production, and may have undesired effects on this normal ecosystem - both in and on our bodies.
So what causes these steps to occur? Imbalances of nutrition and/or hormones are most commonly the problem.
Nutrient deficiencies, such as vitamin A or vitamin D, can change how keratin forms and increase sebum production (2). Retinoids, Retinoic acid, Isotretinoin/Accutane are often used because these drugs are highly concentrated vitamin A, and both vitamins A and D help decrease excess sebum production, excess keratin proliferation, and support a healthy immune response to the bacterial inflammation. Zinc is also necessary for healthy skin and skin healing, the more deficient you are, the worse the acne (3). Vitamin E is high in the sebaceous glands, and as an antioxidant it may help decrease lipid oxidation which contributes to the inflammation seen with acne (4). Furthermore, the relationship between the skin and essential fats such as omega-3 and omega-6 have been studied to show a relationship, deficiency or imbalance of these fatty acids contributes to acne production and dry, itchy, scaly skin (5, 6). Studies have even looked at the amount of carbohydrates in the diet and found correlations with acne and higher carbohydrate consumption (breads, pastas, tortillas, rices, cereals and sweets are all examples of heavy carbohydrate foods) (7). It's quite clear that diet and nutrient balance plays a role in our skin's health, and these are only a few studies on the subject.
Food intolerances or sensitivites play a role as well. Why is the body deficient in these nutrients if the diet seems balanced? If we have poor digestion of certain foods, that can certainly reduce the absorption and metabolism of the key nutrients listed above. Ingestion of food intolerances, in particular, contribute to increased systemic inflammation and reduced immune system function through the GI tract, where 70-80% of the immune system lives. The most common food intolerances we see include dairy, eggs, potatoes and refined sugars. Dairy has even been noted in the literature as a possible trigger for teenage acne (8). Remember that hormone metabolism has a role in the gut, and with imbalance of digestion, hormone imbalances can result. Chronic constipation creates re-circulation of many hormones that should be eliminated from the system.
Acne tends to show it's ugly head in pre-puberty and puberty as the body begins to produce more sex hormones in preparation for adulthood and sexual maturity, but this is not normal! Acne in puberty should be minimal to none in a teen with healthy skin and nutrition. Sex hormones include estrogen, progesterone and testosterone, as well as their derivatives and precursors. The study noted above on dietary dairy intake and teenage acne concluded that it may be the hormones heavily found in dairy products contributing to the positive correlation between dairy intake and acne (8). The other clue that hormones may be involved is the simple fact that in women, birth control is one treatment commonly used to control break-outs. Decreasing androgens (such as testosterone) and changing hormone mediatiors such as sex hormone binding globulin (SHBG) and insulin-like growth factor-1 (IGF-1) can help reduce sebum production and then acne (2). Remember that hormone production can be influenced by the diet, nutrition and digestive function, as hormones must be metabolized through the liver and eliminated through the gut. Hmmm...seems there's a common denominator here...
When we see a patient concerned about acne, the first step is to look at the digestion. Correcting this will help remove a major obstacle to healthy nutrition, inflammation and hormone metabolism. Supportive nutrients often consist of omega-3 essential fats, vitamins A, D and zinc. Please remember, vitamins A and D can be overdosed and become toxic, and some sources of vitamin A are not safe long term or in anyone who could be pregnant - please consult your physician before beginning vitamin A supplementation.
If you'd like to stop managing your acne through antibiotics (topical or oral), retinoids, birth control and endless topical treatments, consider having someone look deeper than your skin - your gut! Taking a more comprehensive approach such as this has made almost every acne case we've seen improve substantially.
Skin Bacteria are your Friends - Scientific American Article
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