What You Can and Can’t Do About Acne

Happy Friday! Crystal, the dietitian who has joined our team and is such an awesome wealth of knowledge, will be writing here once a month. She loves the research just as much as I do so if you have topic requests, please share them in the comments! I hope you enjoy her post today 🙂 

I’ve struggled with acne for what seems like forever, basically since puberty, and I’m 33 now.  In addition to being incredibly frustrating and painful at times, it has also made me very self conscious. The thought, “Skin is the first thing people look at.” was always in the back of my mind. I’ve literally tried everything (or it sure feels like it!) so this post is informed by both research and my personal experiences. I’ve finally gotten my acne under control for the most part; breakouts are limited to that time of the month and when I’m under a lot of stress (which is completely normal) and I’ve honestly just learned to accept that there’s only so much you can do. Genetics play a role here, which I think is important to remember.

Acne is one of the most common skin diseases; almost everyone experiences some sort of acne in their lifetime. Many things can contribute to acne such as the hormonal changes that occur in adolescence as well as hormonal imbalances/abnormalities in adulthood, increased production of sebum, bacteria, genetics, and more.

Before we jump in, let’s clear the air on cutting out foods in the name of clear skin; my diet has not changed and the research is not convincing either about eliminating foods either. If anything, I eat more than I did in the past including higher glycemic foods that have been associated with acne.  I never went on an elimination diet or cut out foods to see if my acne would improve. There were times when I was consuming less of certain foods like dairy or grains and my skin never changed. I did try facials, chemical peels, various products, and antibiotics – with little success and sometimes these thing even made my skin worse. When reviewing the research I found there to be a very weak link between diet and acne. Diet doesn’t cause acne, but certain foods may exacerbate symptoms. What we know from the research is that we can’t blame acne on one food or food group.

Based on the research (not diet culture) the 3 foods most associated with acne are milk and dairy products, high glycemic foods, and chocolate.

In summary:

1. Milk and dairy products: There is an association between cow’s milk intake and acne; however, it is skim milk that is consistently associated which is thought to be due to the changes that occur during processing; low fat dairy products are higher in testosterone. Therefore, if it is a beverage you enjoy daily and think it might be contributing to your acne, instead of cutting it out entirely try purchasing whole milk. There is no association with other dairy products. Bonus is that whole fat dairy has been shown to improve fertility in women.
2. High glycemic foods: a high glycemic index diet may exacerbate acne, but the studies looking at this association compare diets that are very high in processed foods and do not look at diets that include these foods (cakes, bread, chips) in addition to other foods like fruits and vegetables –> these fiber rich foods help stabilize blood sugar.
3. Chocolate: there is still no clear answer on whether or not chocolate contributes to acne because it also contains other components like milk and sugar.

Eating intuitively includes listening to your body and noticing changes which would include things like acne.  It’s hard to know if a particular food is causing acne because so many other things could affect your skin — like stress or hormones. And the foods we eat are in combination with other foods so I wouldn’t recommend eliminating anything, but instead get curious and explore if you notice flare ups with certain foods. That being said, if you are in the process of healing your relationship with food then I would recommend avoiding eliminating foods and consider alternative options. If you are working with a non-diet dietitian they can help you decide what is best for given where you’re at in your healing process.

Hormones:

An imbalance in hormones is associated with acne for a variety of reasons.  Androgens (male hormones), progesterone, estrogen, and insulin are the most common. If you tend to breakout on the jaw line and around the mouth especially in the week leading up to your period it is likely due to hormonal changes.  Some acne during this time is normal, but severe cases may warrant having hormone levels checked.  I was experiencing cystic acne basically all month long in addition to other symptoms so I had my levels checked twice and had high cortisol and low progesterone. For me, using an all natural progesterone cream (made from wild yam) really helped (do not use unless you have had your levels checked). Also, if your nutritional intake is too low, you cannot produce hormones sufficiently so proper nourishment is essential, including fats like avocado, olive oil, and nuts.

Bacteria:

Keeping your skin clean is another way to combat acne. Some easy ways to do this:

1. Keep pillow cases, sheets, and anything that comes in contact with your skin clean (touching the face can be a big contributor). Switching your pillow case every other night and washing sheets/blanket 1x/wk should be enough.
2. Remove all of your makeup at night, if you still see makeup coming off on the towel when you dry your face then it isn’t being removed completely. Try using a wet face cloth along with cleanser.  I really like E.L.F. Daily Face Cleanser as an inexpensive option, but I find the best one that really gets makeup off is this cleanser by Lancome if you want to try that.
3. This bar that combines salicylic acid and sulfur provides keratolytic, antifungal, and antiseptic action. At night I use the E.L.F. face wash or Lancome first and then this soap. I’ve really noticed it helps with oily skin which is great this time of year.

Stress:

Not only does acne cause stress, but stress itself can lead to acne.  During times of stress like before an exam or when work is really busy you may notice a change in your skin. Having a self-care routine can be helpful in reducing stress; even something as simple as deep breathing or meditation can help calm the mind – if you’re resistant to do deep breathing of meditation I highly recommend giving it a try. It might not be as “woo-woo” as you think. Start with a quick meditation using the HeadSpace app. Other ideas include yoga, putting a few drops of lavender on your facecloth at night or in the shower, or just sitting in silence away from the computer for a few minutes during a busy day. Worrying about the food you eat and its potential impact on skin could be a trigger for stress itself – so if you find yourself over thinking food choices it’s better to just focus on other areas. If food is stressful, it’s not longer good for your health.

Supplements/Essential Oils

1. Omega 3s are anti-inflammatory and have been shown to decrease acne – if you don’t eat sources rich in Omega 3s like fatty fish weekly you may want to consider a supplement like fish oil.
2. Zinc gluconate has good evidence in reducing acne and studies show lower zinc levels in people with acne (this is also seen in anorexia nervosa). This could be an issue particularly in vegans/vegetarians because zinc is highest in animal sources. The dose varies depending on the study with the lowest being 100mg 2x/day with potential side effects including nausea/vomiting. Of course check with your RD or health care provider when starting supplementation.
3. Probiotics can also be helpful in reducing acne, particularly lactobacillus. Eating fermented foods/beverages, taking a probiotic containing this strain, or applying topically could help reduce lesions. Remember probiotics are not for long term use.
4. Essential oils are safe when applied topically and relatively inexpensive. My favorites for acne are hempseed, rosehip, jojoba, tea tree (needs to be used with a carrier oil like jojoba, do not apply near eyes, try on a small area first as it can cause itching), and castor oil (rosehip and castor are particularly good for acne scars). They are also great replacements for facial moisturizers which can cause breakouts.

With all of this said, please have compassion for yourself and know that so many others have this same experience. There is only so much that be done about acne and honestly, there are so many other great qualities we have that we shouldn’t let our skin determine how we feel or live in this world. I’d also like to bring up the whole comparison piece with skin because it’s something I’ve certainly run into where I see a post on Instagram or some other social media platform of a woman with “perfect” skin and go down that comparison rabbit hole.  It’s important to remember that these photos are not reality. I don’t care if #nofilter or #nomakeup is hash tagged, let me say this loud and clear, IT.ISN’T.REAL. Real story –> I remember arguing with the girl who did my makeup for my wedding because a certain Kardashian was posting pictures saying that she wasn’t wearing makeup and the PROFESSIONAL make-up artist was trying to explain to the bridal party how it was basically utter garbage, but we didn’t believe it because that’s how influential celebrities are.  Luckily, now I can look back and laugh because ya know what?! She was right.

This blog post by Georgie from the Init4thelongrun blog also has some great insight on how to deal with the emotions that came up dealing with acne and what she’s NOT doing to heal it. This previous blog post that Robyn wrote also adds some great points to the conversation.

Have a great weekend!

References

1. Kwon H, Yoon J, Park S, Min S, Suh D. Comparison of Clinical and Histological Effects between Lactobacillus-Fermented Chamaecyparis obtusa and Tea Tree Oil for the Treatment of Acne: An Eight-Week Double-Blind Randomized Controlled Split-Face Study. Dermatology. 2014;229(2):102-109. doi:10.1159/000362491
2. Jooya A, Siadat A, Iraji F, Enshaieh S. The efficacy of 5% topical tea tree oil gel in mild to moderate acne vulgaris: A randomized, double-blind placebo-controlled study. Indian J Dermatol Venereol Leprol. 2007;73(1):22. doi:10.4103/0378-6323.30646
3. Fabbrocini G, Bertona M, Picazo Ó, Pareja-Galeano H, Monfrecola G, Emanuele E. Supplementation with Lactobacillus rhamnosus SP1 normalises skin expression of genes implicated in insulin signalling and improves adult acne. Benef Microbes. 2016;7(5):625-630. doi:10.3920/bm2016.0089
4. Jung J, Kwon H, Hong J et al. Effect of Dietary Supplementation with Omega-3 Fatty Acid and Gamma-linolenic Acid on Acne Vulgaris: A Randomised, Double-blind, Controlled Trial. Acta Dermato Venereologica. 2014;94(5):521-525. doi:10.2340/00015555-1802
5. Jung J, Kwon H, Hong J et al. Effect of Dietary Supplementation with Omega-3 Fatty Acid and Gamma-linolenic Acid on Acne Vulgaris: A Randomised, Double-blind, Controlled Trial. Acta Dermato Venereologica. 2014;94(5):521-525. doi:10.2340/00015555-1802
6. Jung J, Kwon H, Hong J et al. Effect of Dietary Supplementation with Omega-3 Fatty Acid and Gamma-linolenic Acid on Acne Vulgaris: A Randomised, Double-blind, Controlled Trial. Acta Dermato Venereologica. 2014;94(5):521-525. doi:10.2340/00015555-1802
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8. Lin T, Zhong L, Santiago J. Anti-Inflammatory and Skin Barrier Repair Effects of Topical Application of Some Plant Oils. Int J Mol Sci. 2017;19(1):70. doi:10.3390/ijms19010070
9. Steventon K, Cowdell F. Acne and Diet: A review of the latest evidence. Dermatological Nursing. 2013;12(2).
10. Kucharska A, Szmurło A, Sińska B. Significance of diet in treated and untreated acne vulgaris. Advances in Dermatology and Allergology. 2016;2:81-86. doi:10.5114/ada.2016.59146
11. Cervantes J, Eber A, Perper M, Nascimento V, Nouri K, Keri J. The role of zinc in the treatment of acne: A review of the literature. Dermatol Ther. 2017;31(1):e12576. doi:10.1111/dth.12576
12. Kober M, Bowe W. The effect of probiotics on immune regulation, acne, and photoaging. Int J Womens Dermatol. 2015;1(2):85-89. doi:10.1016/j.ijwd.2015.02.001