Has it been years since you started treating your acne with everything possible under the sun including over the counter and prescription drugs, antibiotics, skincare products, hormonal therapy, the pill but was never able to achieve any long lasting results?
If this sounds familiar I know exactly how you feel and let me tell you, you are not alone. In fact for most people acne seems to persist way beyond their teenage years and the main reason for this is the fact that the underlying causes of acne are misunderstood and therefore seldomly addressed.
However, thanks to the work of many amazing holistic and functional doctors and a lot of new research we are beginning to understand the causes of acne a lot better and it is far from what your dermatologist ever told you.
First, let’s look at the common definition of acne:
Acne is a chronic inflammatory disease involving the pilosebaceous unit and it primarily affects areas of the skin with a relatively high number of oil glands, including the face, upper part of the chest, and back. There are four main factors leading to the formation of acne lesions:
- Increased sebum production by the sebaceous glands, in which androgens ( a group of hormones) have an important role (explains why acne starts in puberty)
- Hyper keratinization of the follicle, leading to a microcomedo that eventually enlarges into a comedo (blackhead). In a normal skin the keratinocytes shed off and reveal new, beautiful skin cells. In the case of acne the keratinocytes shed but don’t budge. They adhere to the skin and pile up in our hair follicles.
- Colonization of the follicle by the anaerobe Propionibacterium acnes which is a bacteria normally living on the human skin without causing any problems but when presented with the above conditions (access sebum and trapped dead keratinocytes) starts to overgrow causing acne.
- An inflammatory reaction occurs as a result of bacteria proliferation, manifesting as redness, swelling and inflamed breakouts.
This only explains however the mechanism of how acne is formed not the underlying reasons for it.
What we are now learning, and there are more and more new studies confirming it, is that acne is very closely related to our diet, gut health, digestion, liver function and toxicity, and it is not only a result of a hormonal imbalance but for many people acne is caused by food sensitivity or unsuspected food allergies.
The reason for an acne breakout could be everything from yeast overgrowth, blood sugar spikes, SIBO (small intestinal bacterial overgrowth), to chronic stress that could break down the barrier in the gut creating intestinal permeability and ultimately contributing to the development of food allergies and inflammation. Stress also contributes to hormonal imbalance and digestive issues that may lead to food sensitivities and acne.
Another major reason for persisting breakouts is continues use of topical products that mainly focus on anti-bacterial and exfoliating actives. Many of these skin products are very often harsh, stripping, drying and skin barrier disturbing especially if used for a prolonged period of time. Overusing of anti-acne topicals also leads to skin oil overproduction, disturbed skin microbiome and overall inability of the skin to retain vital moisture levels and to protect and heal itself.
Our body is an intelligent and highly complicated ecosystem and all, seemingly separate, functions in it are in fact connected and constantly communicate with each other. The skin is a very important part of our immune system and as such its role is to give us signals that something is wrong or out of balance, similarly to how a runny nose might signal a viral infection telling us we are ill. The skin is also an organ of elimination and it is involved in the detoxification processes in our bodies so it seems logical that when the body is overburdened or experiences a certain imbalance our skin will show signs of it. Conventional medicine puts organ systems in different boxes - the gut and digestion in one box, the brain in another, the skin in another, the immune system in a separate box as well, and they all have separate medical specialists with separate offices that rarely communicate between each other. Well, simply put, this is crazy and no wonder the conventional medical system is failing us on so many levels.
- GUT HEALTH
We never give it much thought or attention, but the gut is one of the most important and hardest working organs in our body and is especially important for skin health. 70% of our immune system is in the gut. The gut lining (or gut barrier) also has incredibly strong ability to extract nutrients from our food and a powerful ability to decipher friends from enemies keeping us safe and protected from the environment and what we consume. The gut lining is however under constant attack trough medications, chronic stress, alcohol use, overuse of antibiotics and certain foods. All this leads to overgrowth of bad bacteria, inflammation, food allergies, SIBO, leaky gut syndrome, impaired immune system and very often acne or other skin conditions as a result of toxins that have been leaking out of the gut lining. Keeping the gut healthy should be our number 1 priority not only when having acne but for overall health and strong immunity. Start by introducing probiotics, prebiotics (the food that the probiotics eat), fermented foods and digestive enzymes.
In a supplement look for these bacteria
- Lactobacillus acidophilus
- Lactobacillus bulgaricus
- Lactobacillus reuteri
- Streptococcus thermophilus
- Saccharomyces boulardii
- Bifidobacterium bifidum
- Bacillus subtilis
Prebiotics are basically what probiotics eat (ferment) that gives them fuel and basically makes the beneficial gut flora a lot more healthy, potent and resistant. Best sources are:
- Raw dandelion greens
- Raw garlic
- Raw leeks
- Under-ripe bananas
- Raw asparagus
- Raw or cooked onions
Introducing fermented foods in your diet will ensure a healthy gut microbiome and it is the easiest way to keep your gut flora healthy. Look for foods like:
- Apple Cider Vinegar
If you are not vegan or vegetarian bone broth is one of the most powerful and healing food sources for the skin, gut, digestion, joints health and immunity. Bone broths contain minerals in forms that your body can easily absorb: calcium, magnesium, phosphorus, silicon, and sulphur, as well as, chondroitin sulfate and glucosamine, compounds sold as pricey supplements to reduce inflammation, arthritis and joint pain. Make sure you know exactly how to make it properly or you can get it as a protein powder supplement made from bone broth.
What you eat has everything to do with your acne, the biggest acne trigger is refined sugar, with wheat and dairy being also on the top of the list for acne prone people. Also, consuming high amounts of processed foods high in fats rich in Omega 6 and not consuming enough Omega 3 results in inflammation and skin conditions. More of now diet plays a role for our skin health bellow.
Consuming high levels of sugar, processed foods and simple carbs leads to high insulin levels which triggers the ovaries to produce excess testosterone and other androgens, as well as, inflammation - all leading to acne breakouts. In fact sugar together with stress are probably the two biggest factors in hormonal imbalance today. Eating fresh, whole foods cooked from scratch and rich in healthy fats, fresh vegetables and foods high in fiber will ensure healthy hormone levels, less inflammation, healthier gut and elimination of acne.
I would recommend trying an elimination diet to figure out which foods are your acne triggers. Start by eliminating refined sugar first, then dairy and finally gluten. You have to do each one for at least 3 weeks in order to see a real difference, doing it for a week or two will not give you accurate results because the body needs time to turn off its inflammatory or allergic receptors. In addition to the sugar, dairy and wheat you may have to add other carbohydrates like white rice, corn, potatoes, beans to your elimination diet but this is only if you don’t see results after eliminating the first 3. Most people however see results right after cutting off sugar and dairy and addressing their gut health.
Balancing our hormones through our diet and lifestyle is actually easier than we think and very effective but it is a process and you have to stick with. Frist step is eliminating the most common hormonal disturbers, these are: sugar, dairy, gluten, caffeine, alcohol, stress, lack of exercise and pesticides.
Eat a whole, real, unprocessed, organic, mostly plant-based diet with organic or sustainably raised animal products, this will minimize your intake of pesticides, hormones, and antibiotics along with restoring your digestion and gut health.
To reset your hormonal balance focus on specific hormone-balancing foods like:
Cruciferous vegetables like broccoli, cauliflower, kale, cabbage and brussels sprouts are the most powerful food source for hormonal balance. Crucifers are rich in sulphur compounds that help to neutralize and eliminate carcinogens, as well as isothiocyanates and indole-3-carbinol (I3C) these are nutrients that prevent estrogen related cancers. These vegetables are also high in fibre, which helps the body eliminate excess estrogen. Cruciferous also help the liver detoxify and eliminate excess hormones, the liver, as well as, the skin are organs of elimination so if you have a sluggish liver that is overloaded with eliminating toxins the skin will pick up some of the slack and start breaking out in acne, redness and inflammation.
Flax seeds contain a series of chemicals called lignans that help lower the estrogenic effect when you have too much or raise it when you have too little. Also very rich on fiber and essential fatty acids, both very important for hormonal balance. Flax should be freshly ground to be effective or if you buy pre-grounded one keep it in the fridge.
Fiber – recommended daily dose of at least 30 grams, fiber is very important for balancing our hormones by lowering the levels of excess estrogen. Avocado, chia, strawberries, green leafy vegetables, nuts and seeds, frozen peas and beans are all high in fiber.
Antioxidants – help prevent inflammation and lower levels of stress, which can help improve cortisol levels. Look for bright colored fruits and vegetables and eat them raw. Oranges, pomegranate, peppers, tomatoes, most berries, eggplant, kale, artichokes, red cabbage, dark chocolate, green tea and goji berry.
Healthy fats – the body needs a sufficient amount of healthy fats to function properly, keep inflammation down and maintain a hormonal equilibrium. Good sources of fat are avocados, wild salmon, and grass fed butter. There are 2 Essential Fatty Acids that the body must obtain from food as it cannot synthesize on its own. These are Omega 6 (Linoleic acid) and Omega 3 (Alpha-Linolenic acid) they build all of the lipid compounds the body needs, regulate inflammation response, enable tissue to stay fluid and flexible, regulate cell division and structure, help produce steroids and hormones, regulate nerve transition, and act as a primary energy source for the heart muscle. Deficiencies and imbalance in the essential fatty acids play a significant role in the development of degenerative diseases, like heart disease, cancer, stroke, autoimmune disease and skin conditions. Omega 6 and Omega 3 are best consumed in close to equal proportions 1 : 1 or 3 : 1 being ideal. However, in today’s typical diet we consume way too much Omega 6 and are deficient on Omega 3 which creates real health dangers. Omega 6 rich oils like canola, soybean, peanut, safflower, corn and cottonseed are everywhere and in everything, they are cheap and relatively stable so the food industry really favors them. This is another reason to stop consuming packaged foods and opt for a wholesome diet made of home cooked meals and rich in raw fruits, vegetables and healthy oils in the right ratio. Sources of Omega 3 are fatty fish like salmon, mackerel and sardines, walnuts, flaxseed, chia seeds, hemp oil (has the perfect ratio between the two), flax oils (very high in Omega 3 and also good ratio between the two omegas), I would recommend cooking mainly with grass fed butter, olive oil or coconut oil and use flaxseed oil or hemp oil for salad dressings, while supplementing with a good Omega 3 supplement.
Water - The human body is composed of 75 percent water and 25 percent solid matter. To provide nourishment, eliminate waste and regulate all the functions in the body, we need water. If we do not hydrate enough our body starts having difficult time detoxifying itself and eliminating waste, which often results in acne since the skin is an organ of elimination as well. In today’s modern world however most people are chronically dehydrated, we are substituting water with tea, coffee, alcohol and soft drinks not realizing that they are actually very dehydrating. Aim for 8 glasses of pure water a day, start the day with a large glass of pure water with some lemon in it, this will re-hydrate your body after the night, will help maintain the pH of your body, will contribute to your digestive health, also helping the body with its natural detoxifying processes. Lemons possess anti-bacterial and anti-fungal properties as well. If you are not used to drinking water adding lemon in your water for the whole day will make it easier for you to reach your daily goal as it makes the water taste better. Another trick is to get a fruit infuser water bottle where you can add all sorts of fruits to your water, this will make drinking water a lot more fun and it has added health benefits.
Stress, very simply put, increases our stress hormones and when this happens, adrenaline works to increase your heart rate and blood pressure, while cortisol increases the sugar in our bloodstream, lowers the immune system, and suppresses digestion processes. This all stresses our body out and undermines our health.
Meditate - Meditating daily or doing breathing exercises will lower stress hormones levels and keep everything in check. Meditating also increases our melatonin levels, helping us to sleep better and balances our sex hormones.
Our body need to eliminate toxins from food and the environment as well as excess hormones and other pathogens daily. If for some reason the body (mainly the liver) can’t do this properly other systems of elimination like the skin will pick up the burden – this is a major cause for skin problems.
Sleep – There is a tremendous amount of vital body processes that take place during the time we sleep with the 2 most important ones being detoxification and cellular renewal. The main organ responsible for detoxification is the liver which needs all the energy it can get to do its job properly. If we don’t get enough deep, quality sleep that is long enough for all processes to take place we risk a chronic state of toxicity. The liver is most active in its quest to purification between 10pm and 12am, if we are not sleeping at that time the liver wouldn’t get enough energy to cleanse the blood sufficiently. This results in the accumulation of toxic material in the liver and blood stream. If toxins keep circulating in the blood, they will settle in the interstitial fluid (connective tissues) of organs and systems, thereby raising acidity and damaging them, including the liver itself.
Growth factors, commonly known as growth hormones, are secreted profusely during the hour of deep sleep (between 11pm and 12am). These powerful hormones are responsible for cellular growth, repair and rejuvenation. People age faster if they don’t produce enough growth hormones. Missing on deep sleep before 12am also increases your stress hormones production, ultimately disturbing your hormonal balance.
The second important sleep cycle is between 2am and 6am and is responsible for moving the body’s waste products from the liver, the cells, the intestines and all other areas of the body towards the organs and systems of detoxification and elimination. The entire body is geared towards excretion of useless waste material, about 70% of the body’s waste is eliminated through the lungs, 20% through the skin, 7% through urine, and 3% through feces.
Exercise - By increasing blood flow, exercise helps nourish skin cells and keep them vital. Blood carries oxygen and nutrients to working cells throughout the body, including the skin. In addition to providing oxygen, blood flow also helps carry away waste products, including free radicals, from working cells and helps decrease stress which is very closely linked to hormonal imbalance causing acne. Exercising will also help you sleep better at night and will lower stress levels.
- SKINCARE AND ANTI-ACNE PRODUCTS
Last, but certainly not least, there is a very big chance that your persisting acne is due to your skincare routine and the products your use.
The truth is, most products commonly recommended for acne or acne prone skin are actually disrupting the skin barrier and messing up with the healthy microbiome balance which ultimately leads to weakened skin's defense systems. This creates a perfect viscous cycle.
We have been told to cleanse, strip, rub and exfoliate a lot and avoid all oils and moisturizers because they will clog your pores leading to more acne. For most acne sufferers doing all this will actually worsen their acne.
Here is why:
The 3 most important factors to consider when taking care of our skin and choosing face products are:
- Skin barrier
- Skin pH
- Skin microbiome
When we constantly wash and exfoliate our skin (especially with soap or surfactant based washes) hoping to clear our acne and lower our sebum production but don’t moisturize after that we create perfect conditions for damaging our skin barrier. The skin barrier is what protects the skin from the outside world and it is basically our skin’s immune system, it is responsible for maintenance of water content, reduction of the effects of UV light, and mitigation of the effect of oxidative stress. Damaged barrier will lead to dehydrated, irritated and inflamed skin and a disturbed and vulnerable to bacteria overgrowth skin microbiome. On the other hand moisturizing and boosting our skin barrier will result in stronger, healthier and more resistant skin that is able to maintain bacterial balance and self-exfoliation and ultimately heal and repair itself.
Look for a moisturizer that contains:
- Linoleic Acid or oils high in Linoleic acid (like watermelon seed oil, blackberry seed oil, tomato seed oil, cucumber, grape seed or evening primrose oil)
"skin-identical" ingredients like that are naturally part of the stratum corenum like:
- Hyaluronic acid
- Sodium PCA and Sodium Lactate
Second, over cleansing the skin actually increases oil producing, contrary to popular believe. When you constantly strip off the skin’s natural oils (sebum) the skin will start compensating for this loss by producing more oil.
This is another reason to moisturize, especially after washing with conventional cleansers is to bring the skin pH back down to its healthy level (4.5 – 5.5). Soapy cleansers are usually alkaline and research has been shown that the skin pH increases significantly after washing with products containing detergents. Keeping the skin pH at its optimal range is important for both skin barrier integrity and healthy skin microbiome as most bacteria tent to overgrow given the right conditions, one of them being skin pH.
Best thing you can do for your acne prone skin is switching to oil cleansing. This is a powerful but gentle way of removing impurities and excess oil build up out of the pores balancing the skin sebum production. Oil cleansers are also very effective in removing make up and mineral sunscreen.
Finally skin microbiome, extremely important and until recently not very well researched. The skin microbiome is basically all microorganisms like bacteria, viruses and fungi that live on our skin. Most of these microorganisms are beneficial and necessary for human’s skin health and disturbing the skin microbiome balance could lead to infections and skin issues like acne, rosacea, eczema, fungal infections, dandruff and so on. You can compromise and disturb the microbiome by what you put on your skin and what you put in your body. Certainly washing with conventional, detergent based face washes is the #1 way of messing up with it. Healthy microbiome thrives at a pH of about 5, soap has a pH of 10. Another disturber are most strong anti-bacterial actives often find in products recommended for acne prone skin.
Look for natural anti-bacterial actives as they are a lot gentler to the skin and opt for salicylic acid when choosing an exfoliator.
Barrier and immunity boosting skincare for acne prone skin is our specially, finding out about our unique skincare approach.
The causes for your acne are very personal and different for everybody. The important thing is not to treat the skin as a separate entity but to look at any skin issues as messages your body is sending you.