For a long time, acne has been blamed on p. acnes – a bacteria that lives on the skin. Millions of teens and adults have been prescribed antibiotics to kill off the purposed acne perpetrator. The truth is, acne is not simply a bacterial infection – it is a complex condition that is really a symptom of something greater – inflammation.
The majority of people have experienced acne at some point in his or her life. Those pesky red bumps, sometimes white pustular bumps, and blackheads are no stranger to most people. A memory many want to forget, and for some, a condition they still struggle with.
For some people, acne is severe and results in cystic acne – deep painful boils in the skin, which often lead to scarring.
One thing that is true for the majority of acne sufferers is that acne can negatively affect self-esteem. Given the option, most would choose NOT to have acne on their skin.
It is common for people to try various therapies in the hope of managing their acne as well as covering it up with expensive makeup.
The acne industry is a multibillion-dollar industry. In includes fancy skincare systems – creams, serums, and zit creams, expensive laser therapies, and various types of facials, as well as prescription medications including antibiotics and the infamous Accutane.
For some, topical therapies and facials help manage their acne breakouts. For example, micro-needling facials can help with skin congestion and acne scars.
Medications like antibiotics and Accutane can be helpful; however, they have harsh side effects and can create a bigger problem than they are solving. Common symptoms of Accutane use are:
- Liver damage
- Dry, cracking skin
- Inflammation of the eyes
- Joint pain and back pain
Antibiotics cause problems too. Unfortunately, they do not travel up to the skin on your face and only kill off bacteria there – they kill bacteria all over the body, including the digestive tract. This approach can lead to more significant problems later on by disrupting the gut microflora– we will take a deeper dive into this as well!
The True Cause of Acne
Acne is not really a condition of the skin – it is a condition that affects the skin. In other words, it means that the cause of acne is more than skin deep.
First, let’s dive into what happens during a breakout.
- Skin cells begin to divide and create a ‘plug’ in one of the millions of hair follicles on our face
- Excess oil (sebum) is produced
- This creates a perfect environment for bacteria that normally live on the skin to divide as they feed on the excess oil
- This results in an immune response and inflammatory response
Our skin is designed to produce sebum – it is an integral part of our skin’s moisture barrier. Also, our skin is supposed to be covered in bacteria. This skin has its own microbiome, just like the digestive tract. These bacteria are part of our skin’s ecosystem. So as you can see, the problem isn’t merely too much sebum or bacteria. The problem is the perfect storm of when the skin overproduces sebum, can’t slough off dead skin cells, and inflammation that follows.
Hormones and the Skin
It is clear that acne is linked to changes in hormones. The most obvious example is acne development during puberty.
Hormones like DHEA and testosterone increase the amount of oil that the skin produces. This is why we often see adolescents, especially males, develop acne during puberty.
In women, we often see acne flares at different times of their menstruation cycle. This is because estrogen and progesterone, which fluctuate during the month, also impact the skin.
Hormone changes happen in every person, so it makes sense that acne is common during puberty. However, it does not explain why some people’s acne is persistent, and they struggle with acne later in life.
For some people, they favor a particular breakdown pathway of testosterone – DHT through the enzyme 5-alpha-reductase. This process creates a stronger form of testosterone, which both the skin and hair are sensitive to. DHT can increase hair loss as well as acne.
Fortunately, there we can test for this preference using a DUTCH hormone test as well as treat using specific herbs.
In short, there is more to the story than just hormones – and factors that cause this persistent acne are rooted in inflammation.
Where Does the Inflammation Come From?
Despite what dermatologists have been saying for years, food does affect acne. Some of the main culprits are sugar, gluten and dairy. However, any food intolerance can affect skin conditions including acne. We will dive into those later, but first lets talk sugar.
The Sugar Conundrum
Sugar is one of the most pro-acne foods a person can eat. Sugar consumption promotes acne in a handful of ways.
Sugar intake stimulates the release of insulin, the hormone which tells our cells to take up sugar, therefore, lowering sugar levels in the blood. Insulin also signals to our sebaceous glands to produce more oil.
Also, insulin decreases the production of a protein called Sex Hormone Binding Globulin (SHBG). The job of this protein is to bind to sex hormones, including testosterone. When these hormones are bound to SHBG, they are not as active in the body, and when SHBG is low, there are freer, active hormones in the body.
In short, excess sugar = high insulin = lower SHBG, which = more free testosterone, which we know increases the oil production of the skin.
Lastly, excess sugar consumption promotes yeast overgrowth in our guts. Candida, which is part of our natural gut flora, can become out of balance when we are eating tons of sugar. When Candida levels become high in the gut, it can lead to more sugar cravings, higher levels of inflammation, as disrupt the balance of microbes in the gut.
We will dive more into this soon when we discuss the effect the microbiome has.
As you can see, eating sugar does have a direct effect on our skin and acne.
How Dairy Affects the Skin
For a long time, people have suspected foods like chocolate trigger acne breakouts, and for a long time, dermatologists supported that food does not impact acne. As previously discussed, sugar significantly affects acne development, and there is science to back it up!
The same can be said for dairy. Today, the evidence supports that dairy can, in fact, worsen and aggravate acne.
Diary contains two different proteins: whey and casein. Whey is the type of protein usually found in protein powders, and casein is the protein found in cheese. Whey protein increases insulin release, much like sugar does, and increases insulin-like growth factor 1 (IGF-1), which then promotes more sebum production and the development of acne.
Dairy also increases mucus production, which in general causes congestion in the skin, nasal passages, and throat – yuck!
Dairy is a pro-inflammatory food for many people. On top of increasing hormones that affect acne production, it also creates inflammation, which we know is part of the acne puzzle.
How Food Intolerances Affect the Skin
As noted, any food intolerance can negatively affect the skin. This is because food intolerances cause an immune reaction, which leads to inflammation.
Therefore the body is in an overall inflammatory state, which is the perfect environment for blackheads, whiteheads, and pustules to form.
Food allergy testing is an excellent option for people who suspect they are reacting to foods, and want to find out all of their food intolerances.
The most common food allergies are dairy, gluten/wheat, eggs, soy, nuts, and peanuts. However, each person is different.
Click the link below to schedule a free 15 minute consult to find out more about the food allergy testing we offer at Onyx Integrative Medicine & Aesthetics.
The Gut Microbiome and Acne
The microbes in our gut significantly affect the skin. They are implicated in acne, psoriasis, as well as eczema. In other words, if you have a skin condition, likely the gut is involved.
Our digestive tracts contain trillions of microbes such as bacteria, yeasts, fungi, and viruses. These microbes can produce different metabolites that can be of benefit to us or cause harm.
For example, some strains of bacteria produce a substance called lipopolysaccharide (LPS). LPS causes damage to the intestinal cells, making them leaky, then travel through the blood and cause inflammation throughout the body as well as the skin. As we previously mentioned, inflammation is a critical component of acne, and a very common origin of inflammation is from the gut.
Gut microbes can also stimulate cell turnover or prevent proper turnover. In other words, our bacteria can control the rate at which our skin renews. With acne, usually skin turnover is slower than optimal. This results in dead skin cells plugging up pores, which is one of the steps of acne development.
One of the leading causes of dysbiosis or an imbalance of gut flora besides taking antibiotics is low stomach acid (hypochlorhydria). The most common causes of low stomach acid are medications for heartburn and chronic stress. Both of these factors decrease the amount of acid in the stomach, allowing more bacteria to enter to the digestive tract and overpopulate.
On the other hand, the microbes in our gut can have a positive effect on our skin. Some strains can create beneficial byproducts, such as short-chain fatty acids (SCFA), which are anti-inflammatory to the skin and body. These fatty acids feed the intestinal cells supporting their health and reduce the creation of inflammatory chemicals.
Probiotic supplements, which contain beneficial gut bacteria, have been shown to improve our skin’s barrier function. They do this by increasing transforming growth factor-beta, which is protective to the skin. Studies have also shown that certain bacteria in the gut microbiome can help skin recover after trauma or sunburns.
Also, studies have shown that probiotic supplements have reduced acne in 80% of the people who took them! This finding is very promising news for probiotics and acne.
Understanding if you have an imbalance in your gut flora can be a key factor in resolving your acne and skin issues. Testing such as a complete, stool analysis is a great start as it looks at all the different strains of microbes in your gut.
If you would like to get to the bottom of your acne, schedule a free 15 minute phone consult with our Naturopathic Doctors to get started on your health journey.