If you are in your 20s, 30s or even 40s and find yourself breaking out like a teenager, you’re not alone. Acne can surface well into the adult years—even for those who never experienced it as a teen—for many reasons. Fluctuating hormones, diet, gut health, and stress can all be culprits. By the time patients come to see me, they’ve usually sampled a variety of “outside-in” remedies, such as over-the-counter products like benzoyl peroxides or topical prescription medication like retinoids and antibiotics, but still find themselves combating acne. As a functional medicine practitioner, I take the “inside-out” approach. Meaning, is there something happening internally that is causing these unwanted flare-ups?
Chances are, if you’ve gone to a doctor for acne, it is unlikely that diet is mentioned. Yet, acne has been found to be a disease of Western civilization and practically unheard of in parts of the world shielded from Western dietary influence. So the first thing I do is look at diet. We know that diets that are high in refined carbohydrates (sugar, white bread, white rice, etc.) and soda are associated with an increase in acne. These types of food lead to insulin resistance, which leads to inflammation that worsens acne. Other inflammatory foods include dairy, especially milk, as well as red meat. Eating to improve skin health consists of a Mediterranean style diet that balances blood sugar and decreases excess inflammation from foods. It includes fresh, whole, unprocessed foods; lots of veggies and berries; whole grains; good fats from avocados, olives, and fish (with anti-inflammatory omega 3 fats);proteins (mainly from fish and legumes); nuts; and seeds. What you don’t see is dairy, added sugars and lots of meat. Luckily, chocolate is not a culprit--keep it dark and dairy free. I also like to put a person suffering from acne on an elimination diet to see if they have personal triggers from foods adding to inflammation and gut disruption.
Looking for other sources of body inflammation is also important for decreasing acne, the big one being gut health. Imbalance in gut bacteria, gut infections and leaky gut are all promoters of inflammation. Following the diet mentioned above is one of the first steps towards good gut health, as well as protocols to heal a leaky gut, reducing stress, and adding in certain probiotics, such as those with Lactorhamnosus GG, which has been shown to improve acne too.
Hormones are another huge contributor to acne. Androgens, a class of hormones that includes testosterone, which are produced in large quantities in men and lesser amounts in women, act on the sebaceous gland to produce more sebum (aka oil). This increased sebum fuels growth of the bacteria c.acnes, which in turn causes inflammation in the follicle and the surrounding area. Some people have higher levels of testosterone (in women, most commonly this is from polycystic ovarian syndrome), however people can also have normal testosterone levels but have an increased sensitivity to testosterone at the level of the skin. Balancing out hormones can be helpful. Both high estrogen and low progesterone can lead to higher effect on the skin of androgens. Stress can also lead to increased androgens.
In fact, stress can add to acne in many ways. Taking care to manage stress and learning how to decrease the sympathetic stress response with meditation yoga, journaling, breathing and maybe adding some adaptogens on board is for sure part of the therapy for acne.
Diving deeper into the body’s root causes of acne can lead to major changes—not just in how good your skin looks, but also how great your body feels. These are not quick fixes, but they are highly do-able, and I always say to give it a good 2-3 months until you’re in the clear.