Skin issues, such as acne vulgaris, is a multi-faceted issue that requires a multi-faceted treatment approach.
Various hormonal factors are key players in the onset and continuation of acne – primarily the production of excess androgens or over-sensitivity to the regular level of androgens present. Androgens increase the production of sebum at the level of the sebaceous gland. The increased production of sebum supports the growth and proliferation of bacteria on the skin, most notably propionibacterium acnes (P.acnes). P. acnes then releases various inflammatory mediators at the level of the the sebaceous gland and the surrounding tissue.
Thus, in order to treat acne in a holistic manner, we need to:
Address hormonal balance
Support the health of the skin microbiome
Provide the necessary nutrients for cellular health of the skin
1. Eat for your skin
Encompassing the colours of the rainbow, a varied diet full of fruits and especially vegetables contain antioxidants, polyphenols, prebiotics and nutrients that help to reduce inflammation and support the health of the microbiome.
Including healthy fats in the diet are essential for optimal skin health. Omega-3 fatty acids, derived from fish (and some algae-based supplements) play a key role in reducing inflammation and providing cellular structure, integrity and fluidity of skin cells.
Avoiding sugar, refined carbohydrates and vegetables oils (except for EVOO) help to reduce inflammation and will have a beneficial impact on managing blood sugar and reducing insulin resistance, which is a driver of increased androgens. Dairy (especially milk) has been associated with increased incidence of acne, likely due to the hormones and growth factors inherent in cow’s milk.
Other specific beneficial nutrients include vitamin A, zinc, vitamin B6, selenium, vitamin C and E. Sources of these nutrients can be found in foods such as eggs, liver, pumpkin seeds, sweet potatoes, carrots, green leafy vegetables, almonds and Brazil nuts.
2. Remove the environmental triggers
Triggers can present themselves differently for each person – food intolerances and/or allergies playing a big part in the bio individuality people experience. However some generally accepted triggers include the class of chemicals known as ‘endocrine disrupting chemicals’ (EDC’s). EDC’s are found in a plethora of things in our environment, from plastic food and drink containers to children’s toys and the ink on shopping receipts and airline tickets.
The reason EDC’s can negatively impact skin health is due to their interference with hormones in the body. Specifically they can disrupt the synthesis, binding, action, utilisation and excretion of hormones. Since certain skin problems are exacerbated by hormonal imbalance, EDC’s are best to be avoided when possible.
Another source of potential irritation is the topical ingredients being used in the form of skin care and makeup products. Many of these products contain EDC’s directly, however many other product ingredients strip away the protective acid mantle of the skin barrier – leading to increased sensitivity and a greater propensity for bacteria like P. acnes to grow and proliferate.
Minimising the amount of personal products used and switching to ‘cleaner and greener’ products that work synergistically with the skin barrier can go a long way in helping restore optimal skin
function. Brands such as Bare Roots, Dermaviduals, DMK, Inika, Ere Perez, Kora Organics and Antipodes are a good place to start. As are websites that curate brands and products that are ‘clean, green and environmentally-conscious’ – such as Nourished Life or the EWG’s Skin Deep Cosmetic Database.
3. Look to the GUT
Gut health plays a vital role in all areas of health, and acne and skin health are no different. Hormonal metabolism and excretion is largely affected by the balance of bacteria living within the gut. When there is dysbiosis (imbalance in the gut microbiome), oestrogen can build up and continue to be recirculated around the body, affecting hormonal balance and the subsequent downstream effects to hormone-mediated skin conditions (hello PMS acne!).
Moreover, dysbiosis and inflammation within the gut, such as intestinal hyper-permeability (i.e.‘leaky gut’), can lead to more inflammation, reduced assimilation of nutrients and reduced frequency of bowel movements, further propagating the inflammation and dysbiosis cycle.
To support the microbiome, include a wide variety of plant-based fibres from fruits and vegetables, lactofermented foods such as kimchi, sauerkraut, miso or coconut yoghurt. Taking a daily probiotic containing specific strains can be beneficial in certain circumstances also.
Increasing water consumption to 2-3L per day can help facilitate optimal bowel movements. Ensuring adequate bowel elimination is key in reducing the overall toxic load on the body and therefore taking the pressure off the skin as an elimination organ.
4. Love your Liver
The liver is the body’s main detoxification organ, responsible for metabolising and breaking down hormones and for generally ‘taking out the trash’ of metabolic waste products. If either of these functions are impaired then the flow on effect will inevitably put more pressure on the skin to assist in the elimination of ‘the trash’.
Particular foods that are beneficial for optimal liver function include broccoli, cauliflower, kale, Brussel sprouts, spinach, turmeric, beetroot, grapefruit, lemon, berries and beverages such as green tea, dandelion tea and coffee (quality matters).
5. Address the Stress
Stress is the elephant in the room. Even with the ‘best’ diet and treatment plan, you can only get so far without addressing the stress. Whether its physical, mental or emotional stress it all matters as it can alter the regulation, production and action of hormones involved in systemic health (including the skin!).
Stress management looks differently for everyone – find what works for you. Perhaps its meditating, yoga, journaling, walking in nature, exercise, more sleep or a nice chat over a cup of tea.