Acne is a common skin condition affecting the pores and underlying blood vessels of the skin. There are four main factors that contribute to the development of acne: over production of sebum (an oily substance naturally occurring in the skin), abnormal skin cell activity, bacteria and inflammation. Acne is triggered by a number of both modifiable and non-modifiable causes (1).
Non-modifiable causes are most commonly seen throughout adolescence and include the involvement of puberty and genetics. During adolescence, there is a peak in androgen and growth hormones. Elevated levels of androgens have been associated with an increase in sebum and abnormal skin cell activity. Both of these factors contribute to a blockage in the pores and consequently, acne. The inflammation associated with acne is the result of a certain strain of bacteria, Propionibacterium acnes. This bacterium infects these blocked pores and produces an inflammatory response that leads to the redness, swelling, heat and pain associated with these lesions (1).
Although there are factors that contribute to the development of acne, thankfully there are also a number of modifiable causes that allow us to create changes to best promote good skin and reduce the presence and development of acne. Some modifiable causes include stress, gut health, hormonal imbalances and diet and nutrition status.
Inflammation is the primary cause of acne, alongside excess skin oil. Stress affects your health by causing inflammation throughout your body.
During times of high stress, your body secretes stress hormones, including cortisol. Cortisol and the other stress hormones travel through your blood, signalling your blood vessels to dilate, your heart rate to increase and your blood pressure to rise. High stress causes you to go into a state called the ‘fight or flight’ response.
Chronic stress means that your stress hormones will be continuously released. This results in the immune system always being switched on due to thinking that the body is under attack, resulting in high inflammation in the body. Inflammation can affect our skin and, more specifically, can worsen acne.
Stress and gut health
High stress also affects the functioning of our gut by decreasing its digestive capacity (reduced hydrochloric acid and digestive enzyme production, required to breakdown food) as well as causing inflammation by disrupting the gut microbiome. Stress is one of those things that we all experience at some point and this emphasises the benefit of supplementing with strain-specific probiotics, together with stress reduction techniques, to aid in rectifying disturbances to the gut microbiome and, in turn, skin health. Consult with your naturopath if you are unsure which strain is the most beneficial to your needs.
High stress causes changes to our bowel motions. It can slow down our bowels which causes enterohepatic recycling (gut–liver recycling), where detoxification processes are put under pressure to try and remove some of the waste that isn’t being removed through the rectum. A sluggish bowel and liver can cause increased inflammation, poor microbiome health and therefore also affects our skin health. On the other hand, stress can cause diarrhoea, where vital nutrients for our skin health such as vitamin A, zinc, vitamin D and B vitamins are removed from the body before they are absorbed into the blood – therefore also contributing to acne.
Androgens are ‘masculine’ hormones secreted in both males and females. Excess androgens in our body can lead to a flow-on effect of further hormone imbalances such as elevated testosterone and progesterone, as well as decreased oestrogen. As mentioned earlier, an increase in androgens is associated with the stimulation of follicular cells and sebaceous glands, promoting excess production of sebum, abnormal skin cell activity and thus, the development of acne. Some studies have also suggested that certain androgens may increase inflammation in skin cells (2). Oestrogen is suggested to act as an ‘anti-androgenic’, having a suppressive influence on sebum production and excretion. Therefore, decreased oestrogen levels may also contribute to the development of acne. The influence of oestrogen in acne is further reiterated by the identification of decreased oestrogen levels in individuals suffering from acne (2).
Acne can also be a common symptom of Polycystic Ovarian Syndrome (PCOS). If you would like to know more about PCOS and some of the other symptoms associated with this condition, check out our PCOS blog post by clicking here.
Diet and acne
High-energy foods such as sugar result in increased levels of insulin, IGF-1 hormone, and mTOR. Elevated levels of insulin promote increases in both Insulin Growth Factor (IGF-1) and androgens. Increased levels of these hormones result in an increase in sebum production and abnormal skin cell growth that is associated with the formation of acne. mTOR is an enzyme which stimulates keratin, inflammation and sebum production—all of which contribute to acne.
Reducing high-energy foods therefore reduces the levels of the contributors. Sugar is hidden in everything and the majority of people simply eat too much of it.
Dairy can be highly inflammatory for some individuals due to a protein called A1 casein found in Holstein cow milk. A1 casein causes inflammation and that inflammation, coupled with mTOR activation, is the perfect storm for acne. The A2 casein from goats, sheep, and Jersey cows does not cause inflammation. This kind of dairy is fine for skin and is a healthy food due to lactoferrin and fat-soluble nutrients.
Zinc has many positive influences on the management of acne. Zinc is an important co-factor in wound healing and immune function, and aids in the treatment of inflammation associated with acne (4). Zinc also has various influences on hormones including normalising the production of oestrogen and reducing excessive androgen levels (3). Lowered zinc levels have been observed in the blood of individuals suffering from acne, with levels correlating to acne severity (4). Both oral supplementation and topical application of zinc in the treatment of acne has shown positive effects in acne patients (4). Topical application of zinc exerts both antibacterial activity against Propionibacterium acnes and sebum suppressive influences, working to reduce the presence of acne (4).
How can a Naturopath help?
Our Naturopath, Karly, works with clients by prescribing herbal medicine and nutrients to decrease acne in many patients. However, Karly puts a heavy focus on a client’s diet and lifestyle as these are the long term, sustainable factors to which clients need to commit to see long term results with their skin.
In the first instance, when clients reduce dairy, mainly A1 casein, and remove all high sugar and highly processed food from their diet, there will be a significant reduction in acne within 3–4 months. However, everyone is different and there are many contributing factors which could be causing acne. Age, alcohol consumption, lack of exercise, high stress and hormonal conditions such as PCOS are all other factors that need to be considered when treating acne.
Top six tips for improving acne:
1. Drink more water. Consume 1.5–2 litres of water per day (minimum) and more if drinking tea or coffee, or engaging in physical activity.
2. Reduce sugar. Say goodbye to highly refined foods. Focus on eating a wholesome, well-balanced diet with real food; try to avoid package foods as they often contain a large amount of refined sugar.
3. Eat regular meals. Try eating five smaller meals throughout the day or ensure you are snacking between your meals. This will help to stabilise blood sugar levels and prevent a spike in insulin levels and therefore acne.
4. Reduce A1 casein in your diet. Replace it with the healthier A2 casein found in the milk from Jersey cows, goats and sheep.
5. Get moving. Your bowel and lymph need movement in order to promote healthy bowel movements and the circulation of lymph around your body. Go for a walk at the start or end of the day, do some yoga or maybe you like hitting the gym – whatever it is you enjoy, DO it.
6. Consume more zinc. Increase your intake of zinc-rich foods such as nuts, seeds, meat, eggs and seafood to aid in optimising your zinc status and reduce acne.
(1) Hechtman, L. 2014, Clinical naturopathic medicine
(3) Trickey, R. 2011, Women, hormones & the menstrual cycle
(4) Braun, L. & Cohen, M. 2015, Herbs & natural supplements: An evidence-based guide