Growing Up with Acne
There was a time when I blamed all the difficulties of my life on acne. I do feel it impacted the course of my life. It certainly did not help that my breakouts started in about the 3rd grade. Having learned about nutrition and my nutrition related genetics, I now have more insight into what forces were at play that resulted in the severe cystic bumps, blemishes, and white heads that plagued my life and resulted in many social struggles.
As a youngin, it was so isolating and really made me believe there was something really wrong with me. It’s not like I didn’t wash my face, but of course that’s what everyone seemed to think. The whole thing definitely left me feeling depressed, hopeless, and rejected. The psychological harm of living with acne is well documented in research. In retrospect, these struggles made me a more empathic and sensitive person, and I’m even thankful. These problems are one of many reasons I felt a drive to learn more about root causes and nutrition.
I’ll share with you the things I think make the biggest difference in the state of my skin health. And I use the current tense, because to this day, as a 42 year old woman at the time of this writing, I still can’t get away eating certain foods without seeing something manifest on m’face. I think of it as “the blessing and the curse of the healer”. I know because I’ve experienced it. And learning scientific reasons why has been so interesting and exciting.
An Environment with Acne Causing Foods
Now, when I was young, my mom and dad were both working full time. They were stressed ‘middle class’ folks like most of us, and my mom cooked (and cleaned up) a lot of dinners for our family of five with basically no help from anyone. We also ate out a lot as it helped alleviate some of the stress which my dad was happy to be able to do by paying for dinner. Sometimes it was fast food and sometimes one of the many large buffets popular in Florida, where I grew up.
In our house, there was a lot of soda, ice cream, cheesecake, and ultra processed snack food. I have to have compassion with all of this, because life just isn’t all that sweet much of the time, and I think we crave sweetness and joy. In this day and age we also happen to have easier access to sweets and ultra processed foods than probably anyone, ever. We are also under considerable stress, and have evolved under stress that has taught us on a genetic level to go for the sweets and fats to survive, frankly (think famished cave people and early civilizations). So there is alot going on under the surface that makes our food choices rather doomed if there is no major conscious and intentional effort made to make a decidedly different choice.
So I’m a kid, and am drinking Pepsi and eating Frito’s for a snack and sometimes even cheesecake for breakfast. To this day, regular sodas will make me break out. If ice cream or candy have any sort of frequency to them, I break out. Every once in a while I can get away with it. I usually have a break out early October, when my husband and son have birthday’s a week apart and there is cake around. And again at my birthday for the same reason. At the time of this writing I’m pregnant, and give into cravings for sweets more, which shows up on my face. Why?
Sugar: High Intake Sets a Stage for Acne
Foods with a high glycemic index, or foods that cause your blood sugar to spike quickly, can play a role in acne. Without having diabetes, some people with acne have higher levels of insulin, which brings sugar into the cells. Larger glycemic loads, or larger portions of sugary or carbohydrate rich foods, cause a larger rise in IGF-, a hormone that also happens to stimulate cell proliferation and sebum. This sets the stage for acne to develop. So for some people, a big sugary beverage can set all of this off and increase their chances of developing acne.
Dairy Linked to Acne Risk
Dairy is also frequently found to be a culprit in the development of acne. While I am no longer vegan, I have to admit that when I was, my skin cleared rapidly. To put this in context, at that time I basically went from eating a fast food standard American diet (SAD) to hanging out with some vegans, getting inspired, and making a dramatic diet change. Vegetarianism ideas had already been seeded in me through my sister, who was a vegetarian for a while, and I was really drawn to experimentally with plant based meals occasionally.
A meta-analysis, where the results of many studies are pooled together for a larger effect size, found a positive, dose response relationship between dairy, total milk, whole milk, low-fat and skim milk consumption and acne occurrence. The same analysis found no significant association between yogurt or cheese and acne development.
Interestingly, research has found links between lactose intolerance and acne. It may be possible to avoid some of the acne associated with consuming dairy products but choosing lactose free dairy products. Lactose free dairy products have simply had the lactase enzyme added to the milk to break down the milk sugars. For those who don’t make adequate lactose, symptoms of whole lactose sugars that did not get digested adequately would be GI upset like gas, bloating, and diarrhea. Yogurt has little to no lactose, as the bacterial fermentation that makes yogurt yogurt breaks down lactose in the process. So it would make sense that the meta-analysis did not find a relationship between yogurt and acne if lactose is the culprit.
High Fat Foods and Fat Types Impact Acne
Research links the consumption of high fat foods to acne, but I would go on to make a more nuanced distinction about fats and how they affect acne. Fats we consume become part of our cell membranes, and when the body is creating or resolving an inflammatory process, it cleaves off fats from our cell membranes to create some of the molecules involved in these inflammatory responses.
We have all heard that you are what you eat, and it is literally true. As your body takes substrate for different metabolic processes that are a normal part of life from your body, which is ultimately made from the food that you eat, you are essentially getting broken down for parts. Those parts can be of high or poor quality. With fats, we have different types of fatty acids that make up fats, and fats can become oxidized. When we eat fried foods, the fat is already oxidized.
This in and of itself creates inflammation that must be mitigated if possible. If you aren’t eating adequate antioxidants from foods like fruits and vegetables, it may never really resolve the inflammatory process. Additionally, we have omega 6 and omega 3 fats. A standard American diet, or SAD diet, has been estimated to have a high ratio of omega 6 to omega 3 fats. Omega 6 fats perpetuate inflammation while the omega 3 fats help calm and resolve inflammation.
So, we want to improve the balance of omega 6 and 3 fats with our diet, avoid fried foods, and possibly supplement with some omega 3s. Avoiding hydrogenated oils will also have a positive impact on skin health, along with reducing risk of diabetes and heart disease. Some studies link chocolate to acne. I believe this is in part due to the high sugar content of many chocolate candies and that it may also be linked to the use of hydrogenated oils in many poor quality chocolate products. Chocolate is made from cacao beans that innately do not have qualities related to acne risk.
Inflammation
The vegan diet contains no animal products of any kind, so the dairy was not there when my skin improved. I was also eating a lot more fruits and vegetables, less sugar, more whole grains, and that these changes also would improve the overall nutritional quality of a diet and translate to better health. Ultra processed foods became off limits as part of an overall withdrawal from the mainstream that provided a much needed detox and attunement with my body and health. A healthier diet quality undoubtedly lessens inflammation in the body. Inflammatory markers have been found to be higher in those with acne.
I stayed vegan for a few years, transitioned to a vegetarian diet after working on a farm with great eggs and when I started dreaming of cheese. After 10 or 11 years I didn’t get why I wasn’t improving athletically, learned I was anemic, and started eating some pasture raised, grass fed, organic animal products. This is another story. Interestingly, while I was vegan in college, my chemistry professor said that if you eat a lot of carrots the palms of your hands may turn orange. I was already drinking fresh carrot juice, so as an experiment, I tried having it every day for a while. And to my amazement, my palms indeed, did turn orange.
Vitamin A Issues Impact Acne Risk
While I did not know it at the time my palms were orange, nutrigenomics had another piece of the puzzle. Acne has genetic and environmental factors involved. Many years later, when I started learning integrative and functional nutrition, I investigated the raw data from my 23andMe test and ran it through Pure Encapsulations Pure Genomics report.
I found out I have two SNPs on BCMO1. SNPs are little genetic variations we all have that change what proteins our DNA makes when it is building things like enzymes, which help us convert the beta carotene, a precursor to vitamin A, we get from a carrot or sweet potato into retinol, the active form of vitamin A. Having 2 SNPs in this area of my genes meant that I don’t do this conversion very effectively at all. In fact, having 1 SNP results in a 32% reduction, while having 2 SNPs results in a 69% reduction. So going back to the carrot juice days, I now think that all that beta carotene was backing up a bit as it was in a sort of bottleneck traffic jam trying to get converted to retinol with poor efficiency.
Vitamin A is used by the body to grow new skin cells, break down dead skin cells, and regulate keratin production in the skin so dead skin cells don’t clump together to allow acne causing blockages in your hair follicles. It also regulates skin tone and impacts the scars left by acne on the skin. And, it affects your oil glands’ size and productivity. So you can see how having a less effective inner vitamin A factory could impact one’s risk of developing acne. I did end up going on 2 rounds of Accutane which helped a lot, but was no picnic.
You really have to be careful with vitamin A, and I cannot emphasize this enough. When I was on Accutane, there were many warnings about avoiding pregnancy as it causes birth defects if you become pregnant while taking it. It is recommended by Accutane to wait at least 1 month after completing a course of Accutane until becoming pregnant. This is the kind of thing you really have to discuss with your doctor rather than take into your own hands.
That said, the dose makes the difference. From a strictly daily multivitamin standpoint, one approach would be to choose a multivitamin with some amount of preformed vitamin A. Some supplements will have all of the vitamin A provided as beta carotene, whereas some will provide part beta carotene, and part a preformed vitamin A. This can be helpful if you are someone with the SNPs that impact conversion of beta carotene to retinol as I mentioned before. The amount of vitamin A provided in a daily multivitamin would not typically exceed the RDI, which is 900 mcg for adult men and 700 mcg for adult women. Preformed vitamin A is possibly unsafe when taken in doses greater than 3,000 mcg (or 10,000 units) daily.
Get Your Guide to Clear Skin!
There is a nutrition based solution to acne and I’ve created an easy, informative guide so you can start seeing clearer skin.
If you are ready to put an end to your acne woes, and to make some changes to your diet, then you’ll want to get my PDF guide that gives you all the deets on changing your diet to stop acne in its tracks. Experience the relief and joy of not feeling like a helpless victim, living a small life as you shyly hide your face from the world. In the guide, I also suggest the right vitamins and supplements you should take to support your skin (and overall) health and you will get a discount on any supplement orders you place through my Full Script site. It’s on sale now for just $9.99 so it’s a no brainer. Get your guide to clear skin today!
References
Meixiong J, Ricco C, Vasavda C, Ho BK. Diet and acne: A systematic review. JAAD Int. 2022 Mar 29;7:95-112. doi: 10.1016/j.jdin.2022.02.012. PMID: 35373155; PMCID: PMC8971946.
Penso L, Touvier M, Deschasaux M, Szabo de Edelenyi F, Hercberg S, Ezzedine K, Sbidian E. Association Between Adult Acne and Dietary Behaviors: Findings From the NutriNet-Santé Prospective Cohort Study. JAMA Dermatol. 2020 Aug 1;156(8):854-862. doi: 10.1001/jamadermatol.2020.1602. PMID: 32520303; PMCID: PMC7287950.
Aghasi M, Golzarand M, Shab-Bidar S, Aminianfar A, Omidian M, Taheri F. Dairy intake and acne development: A meta-analysis of observational studies. Clin Nutr. 2019 Jun;38(3):1067-1075. doi: 10.1016/j.clnu.2018.04.015. Epub 2018 May 8. PMID: 29778512.
Cook M, Perche P, Feldman S. Oral Vitamin A for Acne Management: A Possible Substitute for Isotretinoin. J Drugs Dermatol. 2022 Jun 1;21(6):683-686. doi: 10.36849/JDD.6781. PMID: 35674761.
Cook MK, Perche PO, Feldman SR. The use of oral vitamin A in acne management: a review. Dermatol Online J. 2022 Oct 15;28(5). doi: 10.5070/D328559239. PMID: 36809126.