Acne vulgaris (acne) is a common skin condition affecting the pilosebaceous units of the skin. The four main factors that contribute to this condition are over production of sebum, abnormal skin cell activity, bacteria and inflammation. Various factors have been identified as triggers of acne. Whilst some of these factors are out of your control, many of them can be modified to reduce the occurrence and severity of breakouts.
Non-modifiable causes most commonly occur throughout adolescence and involve an interaction between genetics and the hormonal changes that occur with puberty. During puberty, there is a peak in androgen and growth hormones. Elevated androgen levels can result in increased sebum production as well as abnormal skin cell activity. Both of these factors contribute to a blockage in the pores and the formation of acne lesions. Following pore blockage, a certain strain of bacteria known as Propionibacterium acnes infects the blocked pores. This produces an inflammatory response that leads to the redness, swelling, heat and pain that is characteristic of acne.
Even though these non-modifiable factors are essentially out of your control, the numerous modifiable causes that exist allow us to create changes to best promote optimal skin health and reduce the presence and severity of acne. Some of the primary modifiable causes include stress, gut health, hormonal imbalances and diet/nutritional status.
Stress can contribute to the development of acne in various ways. During times of stress, your body secretes various stress hormones, one of which is cortisol. High levels of cortisol increase androgen activity in the skin and up-regulate sebum production, thereby resulting in the excess oil production that can contribute to the development of acne. Prolonged stress also results in systemic inflammation which can contribute to the development and severity of acne lesions. Stress will additionally impair immune function which can prevent the clearance of Propionibacterium acnes in blocked pores. Finally, stress can contribute to the development of acne by impairing our digestive processes and gut health, as we will now discuss.
Poor gut health, as evidenced by symptoms such as bloating, flatulence, nausea, constipation and/or diarrhoea can also affect skin health in various ways. When our digestive capacity is reduced due to insufficient hydrochloric acid and digestive enzyme production, we are unable to adequately break down and assimilate the nutrients we are consuming. This will reduce the availability of the nutrients required for skin health and it will also disrupt the gut microbiome. An altered gut microbiome has numerous consequences for skin health including its effects on increasing inflammation and impairing immune function, both of which contribute to the development and severity of acne.
Poor gut health can also result in changes to our bowel motions. If bowel motions slow down or are infrequent, the gut becomes unable to eliminate toxins from the body and this puts pressure on our other organs of elimination such as the skin. As the skin attempts to eliminate the toxins that the bowels have been unable to, the formation of acne lesions can occur. On the other hand, if bowel motions are too frequent or too loose (diarrhoea), we will lose vital nutrients for skin health from the body (such as zinc, vitamin A, vitamin D and the B vitamins) before they are absorbed into the blood.
Androgens are the ‘masculine’ hormones secreted in both males and females. Whilst it’s normal for both sexes to have androgens, excess levels can have a flow-on effect and create further hormonal imbalances such as elevated testosterone and progesterone, and decreased oestrogen. As discussed previously, increased androgen levels are associated with increased sebum production and abnormal skin cell activity, both of which contribute to the development of acne. Oestrogen is thought to act as an ‘anti-androgenic’ hormone that has a suppressive influence on sebum production and excretion. Decreased oestrogen levels therefore, may also contribute to the development of acne.
DIET & NUTRITIONAL STATUS
Whilst there are numerous dietary and nutritional factors that can contribute to skin health, some of the primary ones include sugar, dairy, saturated and trans fats, zinc and vitamin A.
Refined carbohydrates and sugar stimulate the release of insulin which causes increased levels of IGF-1 hormone and mTOR. Increased levels of IGF-1 results in an increase in sebum production and abnormal skin cell growth, thereby promoting the development of acne. mTOR is an enzyme which stimulates keratin, inflammation and sebum production, each of which also contributes to acne.
Specific types of dairy can be highly inflammatory for some individuals. A1 cow’s milk has a 3-6 times higher GI and insulin response than would be expected from its carbohydrate content. A1 cow’s milk also contains growth-stimulating hormones and testosterone precursors which can result in an increase in sebum production and acne development. In contrast to this, the A2 casein from goats, sheep, and Jersey cow’s milk has been shown decrease acne severity, number of lesions and sebum production.
Saturated and Trans Fats
Saturated and trans fats are highly inflammatory and they also change the composition of sebum which makes it harder to remove. Fats high in omega-3 essential fatty acids however, are beneficial for acne as these types of fats reduce inflammation and improve the composition of sebum so it is easily removed.
Zinc has many positive influences on the management of acne. It’s an important co-factor in wound healing and immune function, and aids in the treatment of the inflammation associated with acne. Zinc also has various positive influences on hormones including normalising the production of oestrogen and reducing excessive androgen levels.
Vitamin A is essential for healthy skin cell activity and it has also been shown in clinical trials to reduce sebum production.
TOP TIPS FOR IMPROVING ACNE:
- Drink more water.Consume a minimum of 2 litres of water per day, plus additional if drinking black tea, consuming coffee or engaging in physical activity.
- Reduce sugar.Eliminate all refined foods from your diet. Focus on eating a wholesome, well-balanced diet with real food. You should also try to avoid package foods as they often contain a large amount of refined sugar.
- Reduce A1 casein in your diet.Replace it with the healthier A2 casein found in the milk from Jersey cows, goats and sheep.
- Consume more zinc.Increase your intake of zinc-rich foods such as nuts, seeds, grass-fed meat, organic eggs and seafood to aid in optimising your zinc status and reduce acne.
- Consume more vitamin A. Increase your intake of vitamin A-rich foods such as organic liver, grass-fed red meat, organic eggs and A2 milk.
- Consume ample healthy fats.Increase your intake of foods rich in omega-3 essential fatty acids such as fresh oily fish, chia seeds, flaxseed meal and flaxseed. This will reduce inflammation of the skin and optimise the consistency of sebum to allow for its easy clearance.
- Get moving.Your bowel and lymph need movement in order to promote healthy bowel movements and the circulation of lymph around your body. These processes are essential for the management of acne. Go for a walk at the start or end of the day, hit the gym or do some yoga – whatever it is you enjoy, DO it.
- Manage your stress. Practice daily stress management techniques such as meditation, rhythmic breathing or gentle yoga to reduce the negative impact that stress can have on skin health.