By Dr. Mercola
Acne is one of the most common skin conditions, affecting nearly 85 percent of people between the ages of 12 and 24.1 Not only does acne leave physical marks such as blackheads, whiteheads, inflammation and scars, but it can also create psychological wounds in the form of anxiety, depression and low self-image. As one woman — Emily Goldberg, editorial fellow at The Atlantic — afflicted with chronic acne explains:2
"Over the years I struggled with acne, I had begun to think of it as a personal failure. Something was wrong with my skin, but I also felt like something was wrong with me because I couldn't fix it. Worst of all, there was no hiding this failure. I was convinced it was the first thing people saw when they looked at me, because I knew it was the first thing I saw when I looked at myself."
I have personal experience with acne and can relate to both the physical and psychological pain that accompanies it. From my teens into my late 20s, I struggled with cystic acne, a severe form characterized by large, painful lesions.
Most teens get a type of acne called acne vulgaris, which can appear on your face, back, chest, neck and shoulders. The most common belief about acne is that it begins when the pores in your skin get clogged with oil (sebum) and dead skin cells, causing the growth of bacteria that trigger inflammation.3
Contrary to what you may have been told, acne is more than an aesthetic problem. It is a sign of imbalance in your body, very specifically in your gut. Many physicians miss the acne-gut connection and focus instead on topical treatments and powerful prescription drugs. These approaches are time-consuming, expensive and offer few lasting effects. Because there are no "quick fixes" to address acne, it's worth your time to uncover the hidden aspects of your diet and lifestyle that are very likely contributing to it.
Treating Acne Is Big Business
Acne is one of the most common skin problems for which people seek the advice of a dermatologist, and one of the most frequently misunderstood and mistreated conditions. A focus on external solutions has fueled the growth of the acne treatment industry, which is now estimated at $3 billion in the U.S.4
If you have a mild case of acne, the first line of conventional treatment is often topical. Topical treatments claim to reduce oil production, unclog pores, speed cell turnover and kill off bacteria, thereby reducing inflammation. Your physician will likely recommend creams, gels and lotions, such as benzoyl peroxide or salicylic acid, or topical retinoid medicines, such tretinoin (Retin-A), adapalene (Differin), and tazarotene (Tazorac).
If you have moderate to severe acne, it's unlikely topical treatments will be effective. This may result in your physician suggesting oral antibiotics. Some of the most common antibiotics prescribed for acne include doxycycline, erythromycin, minocycline and tetracycline.5 Remember that while taking antibiotics may kill some of the bacteria that are feeding your acne, it will also destroy your beneficial gut bacteria. Loss of healthy gut bacteria can result in yeast infections, as well as resistant bacterial strains, among other problems.
Antibiotic resistance continues to be a serious and growing problem today. Take erythromycin, a commonly used acne antibiotic. As more strains of bacteria adapt to erythromycin, it is becoming less effective. Because of antibiotic resistance, some physicians have begun to limit the duration antibiotics are used to treat acne, while others have pulled back from prescribing them altogether.
Toxic Medications May Be Offered as the 'Gold Standard' of Acne Treatment
If you have severe acne, the gold standard for drug treatment was previously a powerful and potentially harmful medication called Accutane (isotretinoin). A number of studies linked Accutane to numerous damaging side effects, including birth defects, Crohn's disease and suicide.6 When its patent ended in 2009, Swiss drug maker Roche Pharmaceuticals stopped manufacturing Accutane.
Although Accutane is off the market, several generic equivalents of isotretinoin remain available today, among them Amnesteem, Claravis, Myorisan and Sotret.7 Isotretinoin is extremely unsafe for pregnant women, and it is administered with great care for that reason.
One additional method that has been used to control acne for premenstrual flare-ups and moderate cases of acne in women involves prescribing low-dose birth control pills that contain estrogen, such as Estrostep, Ortho Tri-Cyclen or Yaz.8 While many acne sufferers go through some or all of the treatments mentioned above, it is often to no avail, as affirmed by Goldberg:9
"For years, the cabinet underneath my bathroom sink was a graveyard of skin-care products, filled with the ghosts of face soaps, washes, toners and scrubs past. Bottles of Neutrogena, Cetaphil, Proactiv and Clean & Clear products were all laid to rest after my hopes that they would cure my blemished face were dashed, raised and dashed again. Nothing I tried worked.
A couple years and a handful of dermatologists later, piles of prescription products were also thrown into the landfill of acne medications in my bathroom. Tubes of Retin-A, Tazorac and Epiduo cream, and antibiotics like doxycycline and tetracycline had all been prescribed to no avail."
While your physician may try to win you over to one of the treatment options I've just discussed, I hope you will not be content with any of those proposed solutions, which seek to treat only your skin. You can make better use of your time by learning about and beginning to treat your acne from the inside out.
Does Acne Have Its Roots in the Poor Western Diet?
A closer look at the Western diet suggests that sugar and refined carbohydrates (carbs), as well as dairy, may be fueling acne outbreaks. As you can imagine, as the Western diet, with its focus on carb-heavy and dairy-laden fast food and junk food, has creeped into societies around the world, so, too, has acne. Conversely, researchers wrote in the journal Adolescent Health Medicine and Therapeutics:10
" … [T]here are also populations documented that abstain from a Western diet, eating meals … devoid of grains or dairy products. As a result, acne vulgaris is absent in these populations."
Research suggests that diets high in sugar and refined carbs — also known as high-glycemic diets — literally feed acne:11 "The association between diet and acne can no longer be dismissed. Compelling evidence shows that high-glycemic load diets may exacerbate acne. Dairy ingestion appears to be weakly associated with acne."
What Do Grain-Based Carbs Have to Do With Acne?
As you may already know, your body prefers vegetable-based carbs to the ones found in grains. Vegetable-based carbs are slow to break down into simple sugars, and therefore have minimal impact on your insulin levels. On the other hand, eating grain-based carbs raises your insulin and insulin-like growth factor (IGF-1). Higher IGF-1 levels can lead to the release of increased male hormones, such as testosterone, which cause your pores to secrete more sebum.
Sebum is a greasy substance that traps acne-promoting bacteria on the surface of your skin. IGF-1 also causes skin cells known as keratinocytes to multiply, a process that is also associated with acne. While dairy products have a relatively low glycemic index, they also increase the IGF-1 level in your blood plasma, generating the same effects noted above.12
In addition, dairy is very hormonally active, meaning it boosts male sex hormones (various forms of testosterone or androgens) and drives up insulin levels, very similar to sugar and starchy carbs.13 On top of the effects to your skin, the consumption of high-glycemic foods and dairy products increases inflammation in your body. Inflammation not only can trigger acne, but it can also wreak havoc on the makeup of your intestinal bacteria, as mentioned earlier.
Change Your Diet to Control Acne Outbreaks
You'll be happy to know that simply eliminating fast food and junk food from your diet is a great first step toward getting your acne under control. Set a small goal to begin reducing sugary carbs such as baked goods (e.g., bagels, bread, cookies and muffins). Replace those items with whole foods — grass fed meat, organic vegetables and high-quality fats.
Next, move on to grains and start reducing your consumption of corn, oats, rice and wheat. If you regularly consume pasta and potatoes, particularly potato chips or French fries, consider that these items may be feeding your acne, and may need to be eliminated.
As you reduce your consumption of each troublesome food, you will begin to notice changes in your acne. Almost immediately, you should experience less inflammation and fewer flare ups. If you remove a troublesome item from your diet for a time and then decide to reintroduce it, you will likely notice its effect — for better or for worse — on your acne.
In time, you will feel increasingly empowered to manage your food intake in a way that supports your desire for clearer skin and fewer acne outbreaks. In some cases, if certain foods consistently trigger acne, you may decide to eliminate them from your diet permanently.
Besides the foods mentioned above, I recommend you leave fruit juices, soda and other sugar-laden beverages behind. If you have not yet cultivated the habit of reading ingredient labels, begin reading them now. You may be surprised at just how much sugar and empty calories you've been ingesting. Particularly avoid food and drinks containing corn syrup and high-fructose corn syrup, as well as added sugar of any kind.
Controlling Acne Takes a Whole-Body Approach
Your skin is an organ of elimination and your body's largest organ. Because your skin is a channel for eliminating toxins, it's important to tune into the message acne is trying to convey.
When your complexion is broken out — be it dry, inflamed, oozing, red or splotchy — it is signaling the presence of underlying issues that need your attention. While most conventional acne treatments address the superficial level of your skin, you must take a whole-body approach to nourish and heal your skin from the inside out. Below are some essential factors that you may consider integrating into your acne-busting plan over the long term:
Avoid starchy carbs, sugars, grains and dairy: As mentioned above, changing your diet is probably the single most important step you can take to improve your skin health. Replace acne-triggering foods with whole foods and healthy fats, such as avocados, grass fed butter, coconut oil, olives and olive oil.
Balance your bacteria levels: You can reestablish your bacterial balance by incorporating naturally fermented foods and/or taking a high-quality probiotic supplement. Proper bacteria balance is particularly important if you have been on antibiotics, because those drugs kill off the beneficial bacteria in your gut that are vital to a strong immune system.
Drink more water: Hydrating your body with pure, filtered water facilitates cell growth and regeneration, eliminates waste and improves your skin tone. Every day, drink enough water so that your urine is a pale-yellow color. If your urine is bright yellow, you probably need to drink more water (unless you take B vitamins, which themselves turn urine bright yellow).
Eat animal-based omega-3 fats: Omega-3 fats help to normalize skin lipids, reduce inflammation and prevent dehydration in your cells. Fatty acid deficiency can manifest in a variety of ways, but skin problems such as eczema, thick patches of skin and cracked heels are common. In one study, 45 individuals, with mild to moderate acne, were given a daily omega-3 supplement for 10 weeks that was shown to decrease their acne significantly.14
Get adequate vitamin D: Without adequate vitamin D, your body cannot fight infections on your skin or elsewhere. Exposing large areas of your skin to appropriate amounts of sunshine is the best way to optimize your vitamin D levels, but you can also take a supplement.
Make time for exercise: Getting plenty of high-intensity exercise promotes blood circulation, regulates hormones and reduces stress, all of which help fight acne. If you have access to an infrared sauna, it can be helpful for detoxing because sweating can help flush unwanted toxins out through your skin.
Manage your stress: My favorite tool for destressing is the Emotional Freedom Techniques or EFT, which involves tapping on your body's energy meridians to clear emotional blocks and restore your mind-body balance. Other proven stress-busters are meditation and yoga.
Prioritize sleep: Did you know that a good night's sleep can decrease your stress and lead to clearer skin? Your body's main time for healing and restoration, including renewing your skin, is at night while you sleep.
Six Natural Remedies for Temporary Relief From Acne Flare-ups
If you are dealing with a major acne flare-up right now and are seeking temporary relief, you may want to try one or more of the home-remedies presented below.15
Using a spoon, scrape the gel from an aloe leaf, and apply it to clean skin as a moisturizer. Repeat one to two times daily, or as desired.
Apple Cider Vinegar
Mix one part organic apple cider vinegar and three parts water (use more water if your skin is sensitive). Apply the mixture to the affected area using a cotton ball. Wait five to 20 seconds, then rinse with water and pat dry. Repeat this process one to two times per day, as needed.
Steep green tea in boiling water for three to four minutes and allow to cool. Apply tea to skin using a spray bottle or cotton ball. Allow to dry, then rinse the area with water and pat dry.
Honey and Cinnamon Mask
Make a paste with 2 tablespoons honey and 1 teaspoon cinnamon. Apply the mixture to the affected area and leave on for 10 to 15 minutes. Rinse off and pat your skin dry.
Tea Tree Oil
Mix one part tea tree oil with nine parts water. Use a cotton ball to apply the mixture to affected areas. Repeat one to two times daily, or as needed. (Tea tree is potent, so always dilute it before applying it to your skin.)
Eat More Zinc-Rich Foods
Low zinc levels have been associated with severe acne,16 so if you suspect your levels may be low consider adding more zinc-rich foods, such as grass-fed beef and pastured chicken, pumpkin seeds, mushrooms and spinach, to your diet.