Acne vulgaris, commonly known as acne, is an inflammatory skin condition that affects over 85% of adolescents and is becoming more common in adults, especially adult females. It manifests as raised red skin lesions on the face, neck, chest and back, and can lead to blemishes and scarring of the skin in severe cases.

While the physical impacts of acne are difficult to endure, they can lead to a range of emotional and psychological effects that are often far more debilitating. Acne is associated with lower self-esteem, social anxiety and higher rates of anxiety and depression.

The conventional medical approach involves masking or suppressing acne with harsh chemical cleansers and creams, extended courses of gut-damaging antibiotics and liver-damaging medications like Accutane (or Roaccutane), which increase the risk of depression and suicide.

When treating acne holistically, it’s critical to explore the root cause of the condition. Topical applications and treatments can help, but because inflammatory skin conditions are manifestations of an internal imbalance, they can only be treated effectively and permanently by exploring diet, lifestyle and health history of someone suffering from acne.

What causes acne?

Acne is characterised by inflammation of the pilosebaceous follicles in the skin. This can be caused by many factors:

• Higher circulating androgens (testosterone) that affect the production of sebum (oil), causing hyperkeratosis and blockage of the follicle

• Colonisation of follicles by the bacteriaPropionibacterium acnes followed by an inflammatory response

• Imbalances in the skin microbiome

• Imbalances gut microbiome (dysbiosis) and intestinal hyperpermeability (‘leaky gut’)

• A sluggish liver overburdened with toxins, resulting in toxins being pushed out through the skin

• Dysregulation of the nervous system

• High levels of oxidative stress

Making nutritional shifts to lower inflammation and oxidative stress, boost skin supportive nutrients and balance blood sugars is a key step to heal acne. Equally important is supporting digestion, optimising detoxification, balancing the gut microbiome and working on gut healing to reduce systemic inflammation.

 Acne and what you eat

• Adopt a low glycemic-load diet by eliminating refined sugar, refined carbohydrates and processed foods. This includes high-fructose foods like honey, dried fruit and fruit juice. High glycaemic load diets are inflammatory, raise insulin levels and cause spikes in IGF-1 (insulin-like growth factor 1) associated with the onset of acne. They can also raise testosterone levels in women, contributing to acne.

• Avoid conventional cow’s dairy including milk, cream, ice cream and yoghurt. Cows dairy has inflammatory A1 casein and causes spikes in IGF-1 which are associated with acne. Opt for goats and sheeps dairy, which have less inflammatory A2 casein and continue having butter as it has very low levels of protein.

• Avoid eating inflammatory trans-fats found in margarine, vegetable shortening and other spreads as this increases inflammatory markers associated with acne.

• Eat an anti-inflammatory and antioxidant-rich diet:
→ Boost antioxidant-rich phytonutrients by eating 4-6 portions of colourful vegetables and 1-2 portions of fruit per day, including dark green leafy vegetables and berries.
→ Include foods high in vitamins A like fatty fish, egg yolks and organic liver
→ Include vitamin C-rich citrus fruit, blackcurrant berries and cruciferous vegetables like broccoli
→ Add sunflower seeds, almonds, hazelnuts and avocado to your diet for vitamin E
→Increase zinc by having oysters, pumpkin seeds and quality red meat
→ Add anti-inflammatory spices like turmeric and ginger to your cooking
→ Drink 3-4 cups of green tea daily and apply green tea topically to your skin to help lower inflammation

• Support the detoxification/elimination pathways – liver, kidneys and bowel – to excrete toxins and help clear androgen metabolites.
→ Eat fibre rich foods like flaxseeds, chia seeds, psyllium husk, oats and green leafy vegetables to support elimination via the bowel
→ Stay hydrated to support the kidneys and elimination via the bowel
→ Support the liver with bitter foods like rocket, mustard greens and dandelion greens and cruciferous vegetables like cabbage, Brussels sprouts and broccoli.

Other considerations for acne

• Supplemental zinc can help acne-prone skin to heal as it is bacteriostatic against Propionibacterium acnes, reduces keratin and lowers testosterone levels. Taking 30 mg per day of a quality zinc supplement in the form of zinc citrate or zinc picolinate is recommended.

• Take encapsulated broccoli sprout powder or add whole powder to smoothies. Broccoli sprout powder contains DIM (diindolylmethane), which naturally blocks androgens. It also contains sulfurophane, which upregulates our body’s detoxification capacity and activates genes related to the antioxidant defence system.

• Photobiomodulation therapy. The therapeutic red light therapy penetrates into deeper layers of the skin, targeting sebaceous glands and providing anti-inflammatory properties by impacting the release of inflammatory  mediators.

Written by Shaz Andrew, Naturopath & Holistic Nutritionist