Acne is complex because there is no single cause for it. It can be triggered by hormonal changes, like those brought on by puberty or the menstrual cycle, but also when there is an excess of androgens (e.g. testosterone) such as in adult men with acne and women with polycystic ovarian syndrome (PCOS). Diets high in sugars and refined carbs also trigger acne by increasing insulin which in turn increases androgens and insulin like growth factor-1 (IGF-1), both of which promote acne.³ Fried foods and damaged fats like refined and partially-hydrogenated vegetable oils are also problematic because these oils are easily oxidized and set off an inflammatory cascade in the skin and elsewhere in the body. The health of the gut is also strongly connected to the health of the skin. Researchers have long noted a strong correlation between people with intestinal issues (like constipation, heart burn, halitosis and bloating) and acne.^{4 5} We are just beginning to understand exactly how the bacteria in our intestines influence the condition of our skin, but to put it simply, healthy intestinal bacteria help to keep our skin smooth and clear.⁶ Finally, stress has been show to trigger and exacerbate acne by altering blood sugar balance, increasing inflammation and triggering the release of substances that increase breakouts.⁷ For most people with acne, the cause is likely to be a complicated interplay of two or more triggers, but at the root, acne is an inflammatory condition. So as you begin to correct the different underlying causes and bring balance to the body, you are also helping to reduce the underlying inflammation.

Start With Diet

Cleaning up the diet is absolutely the first step in clearing up the skin. Several studies have connected a high intake of sweets, fried foods and refined carbohydrates with an increased risk of acne.^{8 9} Getting rid of these foods is a great place to start. Beyond simply cleaning up the diet, many acne sufferers should consider eliminating foods that commonly cause reactions, especially gluten and dairy. A higher intake of dairy, especially low and no-fat dairy and sweetened dairy, like ice cream, has been connected to acne, possibly because it is more likely to cause a blood sugar spike and subsequent insulin spike.^{10 11} Fermented full-fat dairy, like plain yogurt and kefir, appear to be better tolerated for many acne sufferers.¹² Try building your diet around simple real foods like grass-fed meats, wild fish, pastured eggs, vegetables, unrefined olive and coconut oil, nuts, seeds and fruits.  And don’t forget plenty of clean water to assist in flushing toxins from the skin. Not only will this diet help to keep the blood sugar stable, keeping insulin in the normal range, but it also supplies abundant vitamins, minerals and phytonutrients that act as antioxidants to help fight inflammation.

Extra Internal Support

A simple supplement routine can do wonders to correct deficiencies, bring balance back to the body and clear the skin.

• Cod Liver Oil not only supplies omega-3s to modulate inflammation, but also supplies naturally occurring vitamins A and D, which support the health of the skin and inhibit its inflammatory response.¹³
• Probiotics are the beneficial bacteria that help to restore balance to the intestinal microflora, support healthy elimination, modulate inflammation and promote skin health.
• Antioxidants scavenge free-radicals to help reduce inflammation in the skin and support its healthy regeneration. Some especially good choices for skin health include vitamins A, C and E, zinc, green tea and turmeric.
• Herbal Infusions (a.k.a. a strong cup of tea) with any combination of the following herbs helps to support detoxification and to flush impurities from the skin: burdock root, red clover, milk thistle, nettle, dandelion, echinacea and green tea. Or look for premade blends specifically for the skin.
• Pantothenic Acid (B5) is important for maintaining a healthy oil balance in the skin. It is also easily depleted when the body is under stress, leaving little to perform its skin health roles.¹⁴
• Alpha Lipoic Acid helps to support healthy blood sugar levels and insulin function but also works as an antioxidant to fight free-radical damage, inhibit inflammation and possibly even prevent scarring.
• Vitex (a.k.a. Chaste Berry) helps to balance hormonal fluctuations and has long been used by herbalist to help clear the skin. Best for young women and women who suffer from premenstrual breakouts.

From the Outside In

Once you clean up the diet and start supporting skin health with some targeted supplements, you’ll likely want to add a supportive topical routine as well. As tempting as it may be to try to scrub or dry blemishes off your body, this approach can lead to more breakouts in the long run. Remember that at the heart of each blemish is inflammation, so a more gentle approach is a better option. Begin by cleansing the skin both day and night with a gentle, non-drying cleanser. The herbs neem or tea tree help fight the bacteria that can contribute to acne and are good ingredient choices either in your cleanser or as a spot treatment. After cleansing look for serums and light creams with the same antioxidants you might be taking internally such as vitamins A, C, E, alpha lipoic acid or green tea. Aside from when you are actively cleansing or applying product, resist the urge to touch your face and definitely avoid picking or popping, which spreads acne-causing bacteria and leads to more inflammation.

Acne is often the body’s cry for help. Answer its call by correcting the imbalances that cause it from the inside out and you’ll be thanked with better health in general and clear, blemish-free skin to prove it!

References

1. n.a. Acne. The American Academy of Dermatology website. Available at: https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/a---d/acne. Accessed June 10, 2015.
2. Collier CN, Harper JC, Cafardi Ja, et al. The prevalence of acne in adults 20 years and older. J Am Acad Dermatol. 2008;58(1):56-59.
3. Cordain L, Eades, MR, Eades MD. Hyperinsulinemic diseases of civilization: more than just Syndrome X. Comparative Biochemistry and Physiology. 2003; 136:95-112.
4. Zhang H, Liao W, Chao W, et al. Risk factors for sebeaceous gland diseases and their relationship to gastrointestinal dysfunction in Han adolescents. J Dermatol. 2008;35(9):555-561.
5. Bowe WP, Logan AC. Acne vulgaris, probiotics and the gut-brain-skin axis – back to the future? Gut Pathog. 2011;3:1.
6. Kresser C. The gut-skin connection: how altered gut function affects the skin. ChrisKresser.com website. October 19, 2012. Available at: http://chriskresser.com/the-gut-skin-connection-how-altered-gut-function-affects-the-skin/
7. Perricone N. The Acne Prescription. New York, NY: HarperCollins Publishers; 2003.
8. Bowe WP, Logan AC. Clinical implications of lipid peroxidation in acne vulgaris: old wine in new bottles. Lipids in Health and Disease. 2010;9:141.
9. Ismail NH, Manaf ZA, Azizan NZ. High glycemic load diet, milk and ice cream consumption are related to acne vulgaris in Malaysian young adults: a case control study. BMC. 2012;12:13.
10. Adebamowo CA, Spiegelman D, Berkey CS, et al. Milk consumption and acne in teenaged boys. J Am Acad Dermatol. May 2008;58(5):787-793.
11. Ismail NH, Manaf ZA, Azizan NZ. High glycemic load diet, milk and ice cream consumption are related to acne vulgaris in Malaysian young adults: a case control study. BMC. 2012;12:13.
12. Bowe WP, Logan AC. Acne vulgaris, probiotics and the gut-brain-skin axis – back to the future? Gut Pathog. 2011;3:1.
13. Agak GW, Qin M, Nobe J, et al. Propionibacterium acnes induces an interleukin-17 response in acne vulgaris that is regulated by vitamin A and vitamin D. J Invest Dermatol. 2014. 134(2):366-373.
14. Leung LH. A Stone that kills two birds: How pantothenic acid unveils the mysteries of acne vulgaris and obesity. Journal of Orthomolecular Medicine. 1997;12(2^nd Quarter)