What can I do about my Acne?

Let’s talk about acne.  I’m not talking about a few pimples here and there, I am talking about breakouts or cystic acne. I get a lot of questions about this type of acne.

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Often, high androgens are a big contributor to this type of acne. Androgens are testosterone and testosterone cousins DHT (di-hydro testosterone) and androstenedione. These androgens act in the skin tissue to increase sebum (skin oil). Sebum provides a great place for bacteria to grow.  The androgens also increase the amount of cells that are shed and stay in the pores, blocking them and causing infections. Together, the increased sebum, and more dead cells within the pores, cause blockage of the pores and infection with inflammation, leading to acne.

If you have been diagnosed with Polycystic Ovarian Syndrome (PCOS), you will have increased androgen activity and this article will be especially helpful for you. 

But why is there a lot of androgen activity?  Let’s explore some causes.

There is an enzyme in the body called aromatase.  Aromatase is responsible for converting estrogens to testosterone. When levels of insulin are high in the body, then aromatase is more active, making more testosterone and other androgens.  Insulin levels are increased by consumption of carbohydrates. 

So:

Carbohydrates (starches) --> Insulin production --> Aromatase stimulation --> androgen production

 

High carbohydrate foods would include breads, rice, pastas, corn, peas, potatoes, and sugar.  Limiting high carbohydrate foods to 1-2 servings per meal is helpful in controlling acne. Because testosterone is stored in fat in the body, the effects of diet changes can take 10-12 weeks to notice significant differences. This may seem discouraging when you make changes, but hold on and it will make a difference.  

 

In diabetics who are on insulin, it is also helpful to count carbs and limit them to 45 grams or less per meal so that insulin dosing requirements aren’t so high. This will help to decrease the production of testosterone and help to control acne. 

 

High inflammation can also increase the production of testosterone by increasing the aromatase enzyme activity. To explain what inflammation is, it is like when you sprain your ankle, and it gets swollen, red, and painful. This is an example of localized inflammation. We can also have inflammation all over our bodies because of our environment and our diet.  An anti-inflammatory diet can be very helpful in decreasing overall inflammation and controlling acne. 

An important part of an anti-inflammatory diet is reducing High Polyunsaturated fatty acids (PUFA) containing oils.  In English, that means trying to avoid canola, corn, soybean, vegetables, safflower, and sunflower oils. These oils are often used in processed foods, fried foods (chips, French fries), salad dressings, mayonnaise, and some sauces.  You can buy some dressings with olive or avocado oil instead, or you can also make your own.  I will include a couple of recipes at the bottom.

 

Second, grains can increase inflammation, especially wheat.  Avoiding most wheat, corn, and rice for a few months and then adding in small amounts can help to reset your system. 

 

Sugar is a huge culprit in acne. Not only does it increase inflammation, but it will directly decrease your natural immunity and healthy bacteria that compete with the acne causing bacteria P. acnes.

Want to make changes fast? I think you would be amazed at the change in your complexion with just avoiding sugar! Most people notice a difference within 1-2 weeks.

 

Increasing Omega-3 containing and anti-inflammatory foods can also be very helpful.  Eat fish a couple of times a week.  Take Omega-3 supplements if you can.  Try to eat 4-5 servings of non-starchy vegetables a day.  Use olive, avocado, and coconut oil for cooking.  Eating food with turmeric and ginger or consuming golden milk (recipe at bottom).

 

 

Avoiding dairy for 30-60 days and then slowly re-introducing it can be an incredible help for a clear complexion. Not only is dairy very inflammatory, but it also increases the production of insulin-like growth factor-1 or IGF-1.  IGF-1 has been shown to contribute to acne.

 

How does Estrogen affect acne?  There is a protein in the blood that binds testosterone and estrogen.  It is called Sex hormone binding globulin, or SHBG. It binds 97-99% of testosterone. When estrogen levels are low, the body decreases the production of SHBG. With less SHBG in the blood, there is more testosterone available in the tissues, and that can worsen or initiate acne.  So, even if your testosterone levels are normal, you may have too much in the tissue if your estrogen levels are low.  What a great reason to test your hormones!

Knowing what your hormone levels may be an important step in appropriate treatment.

 

What about other hormones?  Synthetic progestins are man-made chemical made to act like progesterone in the uterus. They are used in birth control pills and some IUD devices.  Progestins can weakly bind at the testosterone receptor and cause or worsen acne.  Levonorgestrel is notorious for binding to the testosterone receptor.  If you are using a synthetic progestin, and you have tried the other suggestions here without success, it may be worthwhile to try a different hormone.

 

Breathing and sleep can be the missing key!  

When you are under stress, your body increases the production of cortisol and DHEA.  Cortisol is sometimes called the stress hormone.  DHEA can act at testosterone receptors, and your body uses it to make testosterone. So, stress can increase testosterone activity.  We often don’t realize how much stress our body is feeling. Things like large blood sugar fluctuations, short night sleeps, emotions (anger, frustration, sorrow), environmental exposures, infections, mold or endotoxin exposure, relationship struggles, lack of connection, and everyday “get everything done and pay the bills” stress.

Many patients find that just getting to bed early consistently and getting a full night’s sleep can make a huge difference with their acne.  Another HUGE help is learning to use belly breathing instead of chest breathing. If you notice, most of the time adults breathe into their chest.  This type of breath is a fight-or-flight breath and will stimulate cortisol production a little. A breath that causes extension of the diaphragm or the belly to expand (sometimes called a belly breath) is beneficial to increasing the relaxation chemicals in your brain as well as decreasing cortisol (and DHEA) production.

 

Recipes

Basic vinaigrette with variations

• 1 cup of the vinegar (any type is fine, balsalmic is delicious)
• 1 1/3 cup of olive oil (I use 1/2 extra virgin olive oil and 1/2 light olive oil)
• 2 tablespoons of water
• 1/2 tablespoon garlic powder or 1-2 clove fresh garlic (fresh garlic is better)
• 1/2 tablespoon onion powder
• 2 tablespoon honey
• 1/2 teaspoon ground black pepper
• 1 tablespoons salt

Italian dressing variation:

• 1 tablespoons dried oregano
• 1/4 teaspoon dried thyme
• 1/2 teaspoon dried basil
• 1/2 tablespoon dried parsley

Pour ingredients into a blender. Blend on medium speed for 30 seconds.

 

Greek Dill Salad Dressing  

• 1/4 cup slivered red onion
• 1/4 cup chopped fresh dill
• 1/3 cup extra virgin olive oil
• 2 tablespoons red wine vinegar
• 3 cloves garlic
• 1 teaspoon dried oregano
• 1 teaspoon kosher salt
• 1 teaspoon freshly ground black pepper

Instructions

• Mix the everything except the dill and oregano in a blender.  Add the dill and oregano and pulse the blender.  the feta cheese. Adjust seasoning and serve or refrigerate overnight.

 

 

Golden Milk

• 1-1/2 cup unsweetened coconut, almond, or any milk
• 1/4 tsp ginger
• 1/4 tsp cinnamon
• 1/8-1/4 tsp turmeric
• Pinch of black pepper
• Stevia or honey to taste.
• May add cocoa to make it more of a hot chocolate flavor. 

I prefer to warm it after adding everything.  The turmeric tastes better when it has been cooked in with the milk.