Acne affects parts of the skin where there are hair follicles and active sebaceous glands which produce oils or sebum. It shows up as blackheads, whiteheads and redness due to inflammation. The most common type is acne vulgaris, characterised by inflamed, pus-filled spots which open out on to the skin. Acne conglobata is more severe – when the infection does not actually break through the skin but stays underneath, forming a painful cyst.
What causes acne?
There are various factors which differentiate acne from ordinary spots. The fact that more boys suffer from acne and that people with no male hormones do not suffer at all gives us some insight into its causes. The amount of the male hormone testosteroneTestosterone is a male sex hormone important for sexual and reproductive development…. in the body increases at puberty. This triggers the production of sebum and keratin – an excess of which can block pores. It has also been found that it is not just the increase in testosterone – which happens to all teenagers – but excess conversion to an even more powerful version of the hormone called DHT (dihydrotestosterone) which may bring on acne.(1)
With the increase in keratin, a blockage forms, which in turn creates a build-up of sebum behind it and shows up as a blackhead. As the pores become blocked, it provides an ideal breeding ground for bacteria which normally live harmlessly on our skin, causing them to create an infection in the skin, inflammation and the soreness of a spot. If this inflammation gets out of hand, it can spread through to deeper tissues and if it doesn’t break through to the surface, cause a cyst under the skin.
Avoid dairy for a while
A number of trials have shown a clear link between dairy product intake and acne.(2) Some people are unknowingly allergic to milk, but nevertheless milk promotes a hormone called insulin-like growth factor (IGF-1) in all of us and possibly also oestrogens. IGF-1 levels peak in teenage years, doubly so if you consume a lot of dairy products, and may be a factor in acne if they become too high.
OestrogenOestrogen is one of the main female sex hormones…. dominance is also a common cause for acne in female adults. A diet high in meat and milk can contribute to oestrogen dominance in both men and women. Being overweight has the same effect, because fatThere are many different types of fats; polyunsaturated, monounsaturated, hydrogenated, saturated and trans fat. The body requires good fats (polyunsaturated and monounsaturated) in order to… cells whether in meat, or you because of excess weight, make oestrogenic hormones. I recommend a trial period when you avoid dairy products for up to two weeks as well as reducing meat in favour of fish and vegetarian sources of proteinProteins are large molecules consisting of chains of amino acids. Proteins are essential nutrients for the human body – they are a building block of…, to see if milk and meat are contributory factors for you. Only total avoidance can produce a result if you are allergic.
A high fat diet, especially if you eat damaged fats in processed and fried foods, may also contribute to acne, so reducing meat and dairy products also tends to lessen fats.
Eat more beans and greens
Greens, especially broccoli, contain compounds called indole-3-carbinol (I3C) and di-indolylmethane (DIM) which help the liver to break down excess circulating oestrogens. I3C or DIM can also be supplemented if dietary changes don’t do the trick. These are more relevant to women than men, because women have higher oestrogen levels. Also, beans and lentils contain phytoestrogens that lock onto oestrogen hormone receptors but don’t send a ‘growth’ signal. In this way they lessen oestrogen load, which might help if oestrogen dominance is contributing to your skin condition.
Oestrogen is counteracted by progesteroneProgesterone is one of the main female sex hormones….. Progesterone is only produced during a cycle in which ovulation (the release of an egg) occurs. Some women have anovulatory cycles which leads to relative oestrogen dominance. If your skin is worse at certain times of the month, this is a possibility. A nutritional therapist can arrange a salivary hormone test to see if yours are in balance, and advise you what to do if not.
Cut right back on sugar
High sugar and high glycemic load (GL) diets are strongly linked to bad skin. Too much sugar or fast-releasing carbohydrates in white bread, cereals, white rice, pastries, sweets and sugared drinks, as well as too much fruit juice, creates spikes in your blood sugar level. This, in turn, causes the release of the hormone insulinInsulin is a hormone made by the pancreas. It is responsible for making the body’s cells absorb glucose (sugar) from the blood…. which promotes sebum production. The increased circulating sugar can feed infection in the skin.
Cut right back on sugar and always choose low GL foods, such as wholegrain pasta or brown rice instead of white. This, plus eating protein with carbohydrates, are immediate ways to lower the GL of your diet. Eating fish with brown rice, or an apple with some almonds, will help keep your blood sugar level even. This not only helps your skin in the short-term but it also helps weight loss, reducing the fat cells that increase oestrogen load.
For details on how to follow a low GL diet visit this page.
Increase your intake of zinc
The need for zincWhat it does: Component of over 200 enzymes in the body, essential for growth, important for healing, controls hormones, aids ability to cope with stress… is especially high during the teenage years, because it is involved in growth and sexual maturation, but most people consume only about half the basic amount needed of 15mg a day.
A number of topical treatments including zinc have proven effective against acne. It is certainly worth making sure you are taking in at least 15mg, and preferably 20mg a day, especially if you are a teenager. A good quality multivitamin-mineral should provide 10mg which is enough if your diet is rich in fish, eggs, lean meat, nuts, seeds, beans and lentils.
Zinc, especially combined with vitamin CWhat it does: Strengthens immune system – fights infections. Makes collagen, keeping bones, skin and joints firm and strong. Antioxidant, detoxifying pollutants and protecting against…, is an antimicrobial agent that helps to kill infections in the skin. A good supplement programme should include both zinc and at least 1,000mg of vitamin C. Some skin creams also contain zinc which can act locally. The use of zinc ascorbate, which combines both zinc and vitamin C (ascorbate), would be particularly effective.
The conventional approach to clear acne includes using anti-microbial skin cleansers and antibiotics. Although effective, the latter is quite a drastic approach and fails to address the key question as to why a person is getting spots. Although the antibiotics may work in the short-term, they wipe out healthy bacteria in the gut, which is a primary means by which the gut is protected. Their use should therefore be a last resort.
Localised cleansing with an anti-microbrial cleanser helps to break down the obstructions stopping normal sebum drainage and reduces skin infections.
Use vitamin A and C based skin creams
Among the most commonly prescribed treatments for acne are retinoids, which are vitamin A like drugs, sufficiently different from natural retinol, and hence patentable. Many of these retinoids are also considerably more toxic than natural vitamin A and hence there is a need for real caution regarding their use, especially in pregnancy. Retinoids are often given in capsule form, one of the most commonly prescribed being isotretinoin, but increasingly common is the use of skin gels and creams containing retinoids. The reason they are thought to work is by decreasing the production of sebum.
The natural alternative is to use creams or gels that contain natural retinol, which comes in various forms that can penetrate the skin. These are extremely effective. Some skin-care products also contain Vitamin C as ascorbyl palmitate, although ascorbyl tetraiso-palmitate is more absorbent. These are extremely effective. Vitamin A creams also help to prevent flaky skin blocking the drainage of sebum.
The issue with vitamin A creams is that if they are too concentrated they can irritate the skin. By increasing the amount of vitamin A gradually, the skin produces more receptors for vitamin A. For this reason it is best to find skin creams, such as Environ, that contain graded amounts of vitamin A and, ideally, be guided by a skin care therapist or dermatologist.
Vitamin A can also be supplemented internally. It is far less toxic than the synthetic retinoids and while the general advice is not to exceed 3,000mcg (10,000iu) in pregnancy, I have seen no convincing evidence that this extreme caution is necessary. However, for the sake of caution, do not exceed 3,000mcg (10,000iu) if you are a woman of child-bearing age. If you are male or extremely unlikely to get pregnant, I recommend 3,000mcg twice a day for at least a month to help reduce sebum production. A good multivitamin should provide at least 1,500mcg(5,000iu) so you’ll need to supplement extra vitamin A, which is available in small capsules.
Vitamin C, at an intake of at least 1,000mg, taking either 500mg or 1,000mg twice a day, often helps reduce acne for reasons that are not completely clear. It may prevent the oxidation of sebum and oils in the skin, or act as a natural antibiotic.
Other culprits
It is also important to note that acne like spots can be caused by exposure to industrial materials such as mineral oil and coal tar derivatives, sensitivity to certain cosmetics and certain drugs including steroids. So if you are getting spots which seem to be acne, you should first check that they are not being caused by a chemical you are exposed to.
Cautions
- Limit your intake of vitamin A to 3,000mcg (10,000iu) if pregnant.
- Increase the dose of vitamin A in skin creams gradually to avoid irritation, as advised by a skin-care therapist.
- If you have had a course of antibiotics, always follow with two weeks of probiotics, which are beneficial bacteria (Lactobacillus acidophilus and bifidobacteria) in order to recolonise the gut.
References
- Takayasu, S. et al., ‘Activity of testosterone 5-alpha-reductase in various tissues of the human skin’, J Invest Dermatol, vol 74, pp187-91 (1980)
- Spencer, E et al., International Journal of Dermatology, Apr. 2009; 48(4):339-47
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