Acne isn’t something that’s supposed to happen once you’ve past your teenage years, right? If you’re like me, you’ve been dealing with acne for a large part of your life. You’ve probably tried every acne-fighting product on the market by now and even taken antibiotics before. Perhaps it worked for some time, but yet here you are years later as an adult, still struggling to have clear skin and unable to imagine leaving the house without some makeup on.
You’re not alone. Research shows that 40-54% of the adult population over 25 still struggles with some degree of acne, and 12% of these people are women who have more severe, clinical facial acne. The more interesting part of this research? It turns out the incidence of acne is much higher in Westernized countries. (1)
Our skin is a window to our health, so if you’re struggling with acne, inflammation or redness on your face, it is a sign that there is something out of balance inside your body. Over the years, I have found that it is the food we eat and the lifestyles we follow as a Western society that are largely to blame for this imbalance; no amount of prescription medication or topical treatments will help if these root causes aren’t addressed first.
This article will help you understand how acne actually forms, what the root causes are, and how to reverse it from the inside. If you follow these guidelines for a few months, you should start to see the quality of your skin improve and your acne fade away.
What Is Acne?
Let’s first understand the beast we’re dealing with, shall we?
There are two major forms of acne, acne vulgaris and acne conglobata. For the purposes of this article we will discuss acne vulgaris, this is the more common form. The latter is extremely severe and also known as cystic acne, where a person’s face and body can be covered in painful lesions and fluid-filled cysts.
Acne vulgaris essentially refers to blackheads, whiteheads and pimples, as a result of a hair follicle getting clogged with excess oil or dead skin cells.
How Does A Pimple Form?
Every hair follicle is accompanied by a sebaceous gland, which produces sebum, a mixture of oils and waxes that lubricate the skin and prevent loss of water. When there is an overproduction of either sebum or keratin (a type of skin protein), it can block the hair canal.
This blockage leads to a whitehead or blackhead. Eventually if bacteria starts to overgrow in this area it promotes inflammation, redness, and will also lead to a pimple.
Causes of Acne
Now that you understand that acne is caused by excess sebum and keratin production, it’s a matter of figuring out what causes sebum overproduction. Note: genetics is a factor, but I’m not listing it as a cause below because it’s not exactly very actionable!
Here’s what research has found:
Testosterone can stimulates the cells that line the follicular canal to produce keratin, and it also causes too much sebum to be released. Testosterone can also convert into a more potent (and often harmful) form known as DHT. People who had too much 5-DHT (the enzyme that covers testosterone to DHT) were found to have more acne. (2)
Trans-fats found in shortening, margarine, dairy products, vegetable oils, processed foods and fried food can aggravate acne by increasing inflammation in the sebaceous glands.
I know, we all love ice-cream and a cold bowl of cereal. But this is probably the single biggest dietary factor that causes acne and makes it worse. I want you to consider the function of cow’s milk – it is to grow a baby calf naturally through growth hormones present in the milk, namely insulin-like growth factor (IGF-1).
Receptors for IGF-1 are present in the sebaceous gland so when it binds to those receptors, it stimulates more sebum production. If the presence of IGF-1 wasn’t bad enough, dairy also contains precursors to DHT (potent form of testosterone) as well. Essentially, the growth hormones in milk are what cause your acne to grow as well. Research strongly recommends removing dairy from your diet. (3) (4)
Sugary foods and high carb diet
When you eat too many simple carbs (i.e. white bread, pasta, potatoes) or consume too much sugar (i.e. soda, chocolate, fruit juice, granola bars), it sends your blood sugar skyrocketing and floods your body with glucose. In order to get that glucose out of your blood and into your cells, you need the hormone insulin. Unfortunately, a high-carb diet or constant insulin secretion increases the conversion of testosterone to DHT in skin, which increases sebum production. In fact, one researcher has even termed acne as skin diabetes (5)
Outside of dairy and sugar, there are certain foods which can trigger inflammation for people who are sensitive to them e.g. wheat, soy, corn and peanuts. Wheat is a very common one, so try to avoid these foods for a few weeks and see what happens to your skin.
Lifestyle & Environmental factors
While internal factors are largely responsible for chronic acne, there are certain things on the outside that can clog pores and make the situation worse:
- Air pollution e.g. dirt, dust, oils, grime which can clog pores. If your cleansing routine is ineffective, this can lead to breakouts
- Repetitive rubbing and touching your face
- Excessive washing – the top two layers of your skin comprise of a hydro-lipid barrier (helps the skin retain water) and an acid mantle (natural layer of acidic oils that fight acne causing-bacteria). If you over wash your face, you are leaving it vulnerable to acne-causing bacteria and stripping it of its naturally protective oils. The skin in turn will react by producing more oil to compensate and this leads to more acne.
- Wearing too much makeup
Research has shown that 50% of patients with severe acne had increased blood level of toxins absorbed from the intestines. (6) Basically, if you are chronically constipated, not eating enough fibre or not drinking enough water to aid regular bowel movements, it is likely you have an overgrowth of bad bacteria in your gut and it will show in your face. Plus, if you’re also overburdening your liver and kidneys with more toxins than they can effectively discharge, your skin will take over and discharge excess toxins for you.
Do you have more breakouts right around the time of their period? Here’s the thing: all hormones have to work together and in a certain ratios with other partner hormones; when one is out of balance, it affects the rest. If you have a low progesterone to estrogen ratio, you will get that one big pimple or two before your period. Often, the cause for this imbalance is due to estrogen dominance. You can learn more here about how to bring estrogen back into the normal range.
Is stressing about your pimple causing pimples? AHH!! Yep, I know it’s a little twisted but being in a state of chronic stress or anxiety influences your blood sugar and overall hormonal balance.
Conventional Treatment of Acne
I understand that severe acne can take a serious toll on someone’s emotional health, and this is why people turn to antibiotics or other strong pharmaceutical drugs. However, these drugs do not address the root cause, but simply suppress symptoms.
If I had truly understood what caused acne when I was younger, I wouldn’t have taken tetracycline and probably would have been better off just not drinking a big glass of milk everyday. Below are just some of the side effects of the most common drugs:
- Antibiotics e.g. minocycline, tetracycline
- Headaches, muscle pain, drying of skin, candidiasis
- Accutane (a derivative of Vitamin A)
- Nosebleeds, depression, suicidal thoughts
These other topical treatments are also simply suppressing symptoms, but they’re effective and don’t come with as many side-effects: (9)
- Benzoyl peroxide
- This is an antiseptic that keeps the growth of bacteria down and needs to be applied on a daily basis. While it’s good for superficial pimples, it can also dry out the skin, cause redness and peeling
- Retin-A (tretinoin)
- This treatment improves acne by chemically burning the skin so it results in a lot of peeling and drying
- Blue Light therapy
- You can typically get this service at a skin clinic or spa that provides skin treatments.
- Here are the steps: a mild microdermabrasion is given to remove the surface layer of dead skin, then a product called Levulan is applied to make acne bacteria more sensitive to light. Once it is washed a high intensity blue light is used to kill bacteria.
- Side-effects include redness, swelling, scaling and crusting
Natural Acne Treatment – Diet
Swap out dairy
There’s no reason you can’t enjoy a cold glass or milk or ice-cream again, you just have to educate yourself about the alternatives. Choose from a nut-milk such as almond, cashew, pumpkin seed or hazelnut milk, rice milk or even coconut milk (my personal favourite). The list is endless, and there are yogurts, smoothies, gelato, and ice-creams all made with these plant-based options.
Minimize processed grains (simple carbs)
Processed grains are the biggest culprit in a high-carb diet that not only damage the skin, but provide the least nutritional value and cause weight gain. This means avoiding bagels, pastries, muffins, croissants, store-bought granola bars, breakfast cereal, paninis, wraps and sliced bread. If that sounds like insanity to you, remember that there are better and similar options available.
You can eat steel cut oats instead of breakfast cereal, indulge in grain-free (paleo) baked goods that taste the same if not better, and still eat organic, sprouted bread in moderation. Here’s an article I recently wrote about how to choose a healthier bread option.
This one is a no-brainer. The less sugar you eat (whether natural or refined), the better it will be for your skin. Natural sugars such as raw honey, maple syrup and coconut sugar are definitely a healthier option, however if you’re looking for a lower glycemic load, purchase stevia or monk fruit sugar. Both of these options do not spike blood sugar at all.
Eat more protein and good fat
While everyone is different in their requirement for macronutrients, a good starting point is to aim for a diet of 45% protein, 35% carbs, and 20% fat. (7) Both protein and fat help balance blood sugar and keep it stable, and also prevent carb cravings. In particular, aim to eat more good fats such as avocado, olive oil, wild-caught fish, sunflower seeds, walnuts, chia seeds and hemp seeds to improve your skin.
Eat fermented food
A healthy gut leads to healthy skin; aim to eat a serving of fermented, probiotic-rich foods daily such as tempeh, miso, sauerkraut, and kimchi. These foods help crowd out bad bacteria and yeast, prevent damage to the intestinal lining and toxicity from building up.
Whole food vs. processed food
If it comes in a package, box or a wrapper, you should probably avoid it. Real, whole food is nutrient-dense, full of fibre and rich in antioxidants that protect your skin. Start making more meals from scratch and packing your snacks to take to work.
A simple starting point is simply buying: fruits, vegetables, legumes, raw nuts and seeds, cold-pressed organic oils, wild-caught fish, grass-fed meat and organic eggs and poultry. Processed food on the other hand (think granola bars, crackers, chips) are high in salt and sugar, contain little nutritional value and are often high in iodine which is also known to worsen acne.
Minimize alcohol and caffeine
Both alcohol and caffeine are stimulants that trigger stress hormones, therefore leading to hormonal imbalances and blood sugar spikes. Caffeine disrupts normal digestion and alcohol also adds onto the burden of internal toxicity that I had mentioned earlier in this article.
Natural Acne Treatment – Lifestyle
Cut back on make-up
I know, I know, easier said than done! If you love wearing make-up everyday, at the minimum you can try to instil some healthier habits: 1) take if off as soon as you get home; 2) avoid make-up with harsh dyes and chemicals; 3) wash and dip your makeup brushes and sponges in alcohol after each use; 4) use natural, water-based products instead of oil-based formulas as much as possible. Large health food stores typically have a make-up section, so top by and educate yourself on some new brands.
The simplest and most effective stress busters that will simultaneously improve your skin are 1) regular exercise; 2) sufficient sleep each night; 3) 15 minutes of sunshine at the minimum each day. For more ideas you can read this article.
Clean your face once per day
While this tip is more anecdotal, it has been passed around and I’ve witnessed the benefits myself. Try washing your face once at night, instead of both morning and night. You can wash your face with water in the morning, but don’t scrub and make it squeaky clean. This will allow your skin’s natural oils and bacteria more time to restore balance.
Natural Acne Treatment – Supplements
Zinc – 30mg daily (elemental)
Studies have shown that people with the most severe forms of acne have the lowest levels of zinc. Supplementing with zinc helps reduce the buildup of DHT, kill bacteria (similar to antibiotics), reduce keratin production and reduce inflammation. (8) (9)
Vitamin E – 400IU daily
Research has shown that Vitamin E can regulate retinol levels in human; retinoids help your skin slough off dead skin cells at a more normal rate so the dead skin cells don’t bind together and clog your pores. (10)
Probiotics – 10 billion CFU + daily
Research confirms that the link between healthy gut flora and acne can no longer be ignored.
(11). In addition to adding fermented foods to your diet, consider taking a daily probiotic supplement. Start within a minimum of 10 billion and work your way up (if it suits you and you don’t feel bloated) to 70-100 billion CFU daily with a meal.
Vitamin C – 1000mg daily
Not only is Vitamin C crucial for collagen production (for skin cell repair and regeneration, firmness and elasticity) but as an anti-inflammatory it helps reduce the redness associated with acne.
Essential Fatty Acids – 1-3 grams daily
Whether you’re consuming this as fish oil, flax oil or another plant-based oil, EFAs help supply GLA to keep the skin smooth and soft, repair tissues, and dissolve fatty acids that block pores.
Burdock Root & Red Clover – as directed on bottle
Known as alteratives, or blood purifiers, in herbal medicine, these two herbs are powerful blood cleansers that help remove toxins from the blood. (12) I have personally taken these two herbs before and never been disappointed with the results; you’ll often find them in many clear skin formulas at the health food store.
Milk thistle – as directed on bottle
This herb is well known as a tonic and overall support for the liver; if the liver cannot break down and clear excess hormones from the body, it will worsen acne
Chaste tree berry (Vitex) – as directed on bottle
If you suffer from pre-menstrual breakouts, have menstrual irregularities or strong PMS symptoms, consider taking Vitex. This herb is ideal for regulating hormones, in particular if you suffer from estrogen dominance.
Natural Treatment of Acne – Topical Remedies
Tea Tree Oil – 5-15% solution
This essential oil has antiseptic properties and is an ideal skin disinfectant. One study showed that a 5% tea tree oil solution had effects similar to those of 5% benzoyl peroxide for mild acne, but with far less side effects. You can use stronger solutions up to 15% for moderate to severe acne. (13)
Azelaic Acid – 20%, 2x daily
This is a compound extracted from grains which has antibiotic properties. Clinical studies have shown 20% azelaic acid cream to produce results equal to tetracycline, Retin-A, and benzoyl peroxide (that’s no joke!) (14)
These two have the strongest research behind them, but of course there are many other natural remedies that have been known to help. Some of these home remedies for acne are listed on the right.
Where Do I Start?
The best place to start is with your diet – everything you eat forms the raw materials for your cells and has a direct impact on them. If there’s two things I would do immediately it is to switch over to a whole foods diet and eliminate processed foods as much as possible. Next, I would recommend cutting out dairy and sugar 100% and seeing what impact that makes on your skin over the course of the next few months.
This is the biggest and hardest step to take, but once you’ve achieved this you can then add on other supplements or natural remedies. Lay the foundation first and the rest will come much more easily!
(1) Cordain L, Lindeberg S, Hurtado M, et al. Acne vulgaris: a disease of Western civilization. Archives of Dermatology 2002;138:1584-1590
(2) Takayasu S, Wakimoto H, Itami S, Sano S. Activity of testosterone 5-alpha-reductase in various tissues of human skin. Journal of Investigative Dermatology 1980;74:187-191.
(3) Spencer EH, Ferdowsian HR, Barnard ND. Diet and acne: a revise of the evidence. International Journal of Dermatology 2009 Apr;48)4):339-347
(4) Melnik BC, Schmitz G. Role of insulin, insulin-like growth factor-1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris. Experimental Dermatology 2009 Oct;18(10):833-841.
(5) Kader MM, El-Mofty AM, Ismail AA, Bassili F. Glucose tolerance in blood and skin of patients with acne vulgaris. Indian Journal of Dermatology 1977;22:139-149.
(6) Juhlin L, Michaelsson G. Fibrin microclot formation in patients with acne. Acta Dermato-Venereologica 1983;63:538-540.
(7) Kappas A, Anderson K, Conney A, et al. Nutrition-endocrine interactions: induction of reciprocal changes in the delta 4-5 alpha-reduction of testosterone and the cytochrome P-450-dependent oxidation of estradiol by dietary macronutrients in man. Proceedings of the National Academy of Sciences of the United States of America 1983;80:7646-7649.
(8) Dreno B, Amblard P, Agache P, Litoux P. Low doses of zinc gluconate for inflammatory acne. Acta Dermato-Venereologica 1989;69:541-543.
(9) Leake A, Chisholm GD, Habib FK. The effect of zinc on the 5-alpha-reduction of testosterone by the hyperplastic human prostate gland. Journal of Steroid Biochemistry 1984;20:651-655.
(10) Murray, M., & Pizzorno, J. (2012). The encyclopedia of natural medicine (3rd ed., p. 250). New York: Simon & Schuster, Inc.
(11) Bowe, W., & Logan, A. (2011). Acne vulgaris, probiotics and the gut-brain-skin axis – back to the future?. Gut Pathogens, 3(1), 1. http://dx.doi.org/10.1186/1757-4749-3-1
(12) Balch, P. (2010). Prescription for Nutritional Healing (1st ed., p. 150). New York: Penguin Group.
(13) Bassett IB, Pannowitz DL, Barnetson RS. A comparative study of tea-tree oil versus benzoyl peroxide in the treatment of acne. The Medical Journal of Australia 1990;153:455-458.
(14) Nazzaro-Porro M. Azelaic acid. Pharmacokinetic and pharmacodynamic properties and its therapeutic role in hyperpigmentary disorders and acne. International Journal of Dermatology 1995;34:75-84.