Contrary to the belief most dermatologists have that lotions solve everything and food solves nothing, there is nothing more powerful for skin health than improving the quality of your diet!
If you eat garbage, your cells will swim in it, and they are not going to be able to help it if they get red and sick. If you eat nutrient-dense foods and support healthy hormone function with an anti-inflammatory diet, on the other hand, your skin will heal, glow, and radiate. (Read the great guide that changed my life on how to make your skin glow, here.)
How skin works
The skin is the largest organ in the body. It is also one of the key players in keeping you toxin free, as it is the primary barrier between you and the outside world. If you have skin disturbances, it is completely understandable, and you are definitely not alone. The skin does a lot of heavy lifting, and in this toxic, inflamed world, it’s no wonder that this incredibly multi-faceted and important organ often struggles to keep up.
The skin is composed of three layers: the epidermis, which is the thinnest of the three layers and sits on the very top; the dermis, which sits in the middle; and the hypodermis, which connects skin to bone and muscle. Contrary to logic, the epidermis—the layer everyone gets to see—is not all that important. It is composed of dead skin cells that are in a constant state of being replenished and sloughed off. This process takes approximately 35 days.
The real action takes place in the middle layer, the dermis. This is where collagen provides firmness to the skin and is where hair follicles, sweat glands, nerve endings, and blood vessels reside. Most important for acne sufferers, inside the dermis sit the sebaceous glands, which secrete oil onto the surface of the skin. This oil normally performs a good, protective function. In excess, however, it can create oily skin and acne. When inflamed, it exacerbates acne and leads to skin disorders such as eczema and rosacea.
Topical elements can affect your skin, too. You can abrade your skin with harsh chemicals, for example.
For some of my favorite topical solutions to acne, check out the antioxidant cleansers, serums, creams and topical probiotics I use. They really do work amazingly well, and help push my skin from being in the “clear and good enough” category to “truly radiant.”
But far and away the most important thing I do for my skin is eat well.
Here is how acne is caused and what to do about it:
Acne in three steps:
hormones, inflammation, and infection
Conventional dermatological wisdom is that bacteria are the primary cause of acne. This has a grain of truth to it, since bacteria do play a role, but it is minimal compared to the internal conditions that start acne in the first place. Acne in reality develops in three steps. First, male sex hormones can cause excess oil production in the dermis layer of the skin, which clogs pores (though surface debris can also clog pores, rendering hormones less important in this case). Second, inflammation attacks the clogged pores. Third, bacteria infect the clogged pores and cause low level inflammation to increase to large, painful, irritated pustules. The two primary causes of acne are hormone balance and inflammation, and bacteria are only a tertiary concern.
Male sex hormones can come to dominate female sex hormones in the blood a number of different ways. Insulin resistance, blood sugar spikes stress, starvation diets, or the menstrual cycle are all potential culprits, many of which often occur simultaneously. It is also possible for progesterone (albeit, while a female sex hormone) to cause acne, and this occurs as a result of the menstrual cycle and birth control pills.
Insulin resistance and hormone imbalance
Insulin resistance gives millions of women hormonal acne every year. It occurs by a simple mechanism: insulin stimulates testosterone production in the ovaries. Chronically elevated insulin levels lead to chronically elevated testosterone. Testosterone is a male sex hormone that directly stimulates oil production in pores. If you are insulin resistant and experience acne, testosterone is likely a primary contributor to your acne woes. This explains why so many women with polycystic ovarian syndrome experience acne. A high testosterone level is one of the primary characteristics of PCOS.
If you have PCOS or think that you might have PCOS, you may want to check out my guide on PCOS. I am regarded as the paleo world’s expert on PCOS. If you want to overcome PCOS fast, my advice may be just the thing you need to put PCOS behind you for good. You can read all about it here.
Blood sugar and hormone imbalance
Blood sugar spikes contribute to acne largely because they elicit an insulin response, which in turn spikes testosterone production (in addition to causing inflammation). This phenomenon is not confined to women—it occurs in men as well. It is so common, in fact, that it partly explains why many people break out around the holidays—large quantities of sugary foods lead to blood sugar disasters. It is also part of the reason why many people have skin reactions to dairy, particularly milk: dairy is highly insulinogenic.
Stress and hormone imbalance
Stress is a major player in skin health, and for a wide variety of reasons.
First, the skin contains stress-hormone receptors. When you are stressed out, your skin knows it. It has the ability to panic under stress just as much as your brain does.
Stress is also inflammatory. It inflames the gut, incites the immune system, and makes the skin leap into overdrive. This point is brief, but it is a big deal and needs to be taken seriously. Both psychological and physiological stress contributes to inflammation in a big way.
Finally, stress performs a function in the body known as pregnenolone steal. In this process, the stress glands steal the hormonal resource pregnenolone that would otherwise be devoted to making estrogen and other female hormones and instead directs its use to stress hormones such as DHEA-S. This is problematic not only because estrogen has a balancing effect against testosterone and is great for your skin, but also because DHEA-S acts similarly to testosterone with respect to the skin and stimulates oil production.
Starvation and hormone imbalance
The reproductive system does not like being toyed with, so denying it nourishment does not go well. Restricting calories, exercising too much, and radically depleting fat stores are three surefire ways to signal starvation.
The female sex hormones estrogen and progesterone are hit particularly hard by these starvation signals, which is unfortunate, because estrogen is one of the most powerful molecules for healthy skin. If estrogen levels decrease far enough relative to testosterone or DHEA-S, acne often results. It is also worth noting that estrogen is produced in fat cells. If your fat stores fall below a healthy level, your estrogen levels may end being up too low for healthy skin.
The menstrual cycle and hormone imbalance
Many women experience breakouts in connection with their monthly cycles. Unfortunately, hormone balance functions differently in different women, so I can’t make any overarching statements about the precise events occurring in your body. However, there are some clues I can point to.
The first two weeks of the menstrual cycle, which include the week of bleeding and the following week, are generally quite calm for women and entail great skin health. At the two-week mark, however, or during ovulation, testosterone levels spike. For women for whom oil production is a problem, or for whom testosterone levels are already out of balance from insulin resistance and the like, ovulation can cause acne outbreaks.
The second half of the menstrual cycle can be problematic, too. Estrogen and progesterone levels both fall and rise periodically throughout this time in delicate balance. If one leaps out ahead of the other or drops through the basement, skin changes can occur. Estrogen is generally regarded as a balm for the skin. In contrast, unnaturally elevated progesterone causes acne. What is the best thing you can do to reduce monthly breakouts? Achieve better hormone balance between testosterone, estrogen, and progesterone by eating an anti-inflammatory, hormone-balancing diet like the Sexy by Nature diet.
Birth control pills and hormone imbalance
Because all these hormone irregularities can lead to acne, many women begin taking hormonal birth control in the hope of clearing their skin. Sometimes it works. But sometimes it doesn’t, and instead makes it much worse. For this reason, some women go through several different pills before finding one with the “right” combination of estrogen and progesterone that enables them to have clear skin. Others never achieve clear skin on birth control, but accept acne as a necessary component of their birth control regimen. This is unnecessary. Not only do several dozen birth control options exist, but a few of them require no hormonal interference at all.
I talk about birth control options and how to manage side effects like acne in my quick guide to birth control, here.
Acne is perhaps the most visible symptom of systemic inflammation. If if you have significant acne, there is inevitably at least some amount of inflammation in your blood.
For this reason, healing your gut and cooling inflammation is perhaps the most powerful step you can take to overcome acne. Focusing on antioxidants, which fight inflammation, in your diet (such as those found in fruits and vegetables) and in your skincare routine will also go a long way toward soothing your acne.
Both supplemental and topical antioxidant use has been shown to reduce breakouts by as much as 50 percent. For some of my favorite topical solutions to acne, check out the antioxidant cleansers, serums, creams and topical probiotics I use.
To read all about antioxidants and the effect they have on your skin (hint: it’s a huge effect, check out the guide that taught me most of what I know about antioxidants and skin, here).
Bacteria’s role in acne: not guilty!
Bacteria live in and around the layers of everybody’s skin. Many dermatologists insist that the key to clear skin is killing off these bacteria, so most topical acne treatments do just that. The thing is, however, that not only do bacteria exist naturally all over the surface of everybody’s skin, but they can even promote healthy skin.
Sure, it is the case that bacteria infect clogged pores. But this is only the case if the bacteria on your skin are in an unhealthy state. The role bacteria play in acne is much like the role it plays in the gut: there are both “good” and “bad” bacteria on your skin. You can develop acne only if you have a significant imbalance between good and bad, which occurs as a result of both topical and internal stressors.
Many strains of harmful bacteria are present almost exclusively on the skin of people who have acne relative to those who don’t, which demonstrates that bad bacteria are the ones responsible for infecting pores. Yet even more remarkably, some healthy strains of bacteria are only present on the skin of people who do not have acne. This indicates that good bacteria can actually fight acne. Topical probiotics may soon become an important component of skin care regimens, and some of them are already on the market.
the role of touching, picking, cleansers
Counterintuitive as it might sound, one of the best things you can do for your skin is to stop washing it.
Much like with food, today’s culture has this idea that skincare products designed in a laboratory are better for us than natural methods. The chemical barrage to which we subject our skin on a daily basis is unnecessary and often harmful. First, consider the fact that benzoyl peroxide, one of the most popular topical acne treatments available over the counter, reduces antioxidant activity in the skin. Antioxidants are crucial for reducing inflammation. Consider too that the skin has natural oils and cleaning and healing processes that work delightfully well on their own. Washing the skin removes those natural oils, so the skin often dries out in response. With dry skin, women often turn to lotion. However, the skin also tries to rectify the dryness on its own by increasing oil production. At this point, both you and your skin are engaged in efforts to increase lubrication. Too much lubrication clogs pores, so your washing and moisturizing routine is counterproductive.
The act of washing your face can make it either too dry or too oily, depending on how your skin reacts. Rarely does washing leave it in tip-top shape. And moisturizers that contain unnatural chemicals often don’t heal the skin; they just cover it up. Many natural alternatives to washing and moisturizing, such as apple cider vinegar, baking soda, coconut oil, lard, cod liver oil, and vitamin blends provide real healing to the skin and can be protective in times of dryness or oiliness.
In all fairness, there are probably some manufactured toiletries that do not aggravate your skin. It is not absolutely necessary to “go all natural” and expressly forbid cosmetics. It is only important to note that they can be problematic, and to do your best to find a product—natural or not—that works for you.
In my experience, the only way to know if a lotion, if you choose to use one, is a good match for your skin is to try it for a few days and see. A different, more specific test is to apply lotion to one side of your face and not the other in order to witness its effects, or to apply it to the sensitive skin on your wrist or neck before using it on your face. I do not forbid using any manufactured cosmetic products—in fact, I use a lotion I buy at a mall. But it took me a long time to find one that did not irritate my skin. I opted to use it because it has white tea extract in it, and white tea is a powerful antioxidant. Applying antioxidants such as white tea, green tea, vitamin C, and B vitamins to your skin can help reduce inflammation in your skin as long as you are certain that you have found a lotion that does not aggravate your skin.
Another way to aggravate your skin is to pick at it. Just as with scabs and wounds, the skin does best when it heals on its own. Have you ever noticed that breakouts often occur near each other? This is because wounds act as beacons for inflammatory molecules. The more aggravated a wound is, the stronger the inflammatory response becomes, so pimples become bigger and nastier the more you touch them. Even worse is the fact that picking causes new pimples to crop up around old ones. Keeping your hands off your face is one of the harder habits to practice, but the less you touch your zits, the more your skin will thank you.
Even the simple act of touching clear skin can lead to the development of acne. Fingers carry all kinds of bacteria, dirt, and oils. When you touch your face, you put these dirty oils directly in contact with your pores. When I was in high school and college, I always had acne around my mouth, particularly on the right side of my face. It took me years to realize that I was breaking out because I rested my chin on my hand while I studied. Once I broke that habit, the acne faded away.
What to do for radiant skin
Eliminate sugar and insulinogenic foods and focus on reducing inflammation.
Eliminate gut-irritating foods such as grains, legumes, and dairy.
Include gut healing foods such as fermented foods or consider probiotic supplements.
If you eat a lot of fiber, consider reducing the amount of fiber in your diet, particularly insoluble fiber. Lots of fiber can irritate your gut lining if you are already dealing with inflammation or a sensitive gut.
Keep protein intake on the lower end of the spectrum—at 50 to 75 grams per day. Excess protein is a key player in oil production and oxidation.
Eliminate (or experiment with) hormonal influences on your skin. The most important hormonal foods are dairy, particularly milk, and phytoestrogens, especially flax and soy.
Eat to meet the needs of your metabolism: estrogen levels are at their best when you assure your body that it is being properly fed.
Consume plenty of fat to assure adequate collagen stores.
Consume at least three servings of fatty fish such as salmon every week. Alternatively, consider supplementing with cod liver oil, which delivers vitamins A and D—crucial vitamins for healthy skin—as well as anti-inflammatory omega-3 fatty acids.
Consume liver on a regular basis. Liver is the densest source of vitamin A available in the human diet.
Consume homemade bone broth—that is, a broth made from simmering bones in water—which is rich in collagen, calcium, magnesium, and other nutrients necessary for skin health.
Consume a diet rich in antioxidants, such as leafy greens and other vegetables and fruits.
Manage your specific health issue: PCOS and hypothyroidism are particularly problematic when it comes to skin health. PCOS because of its hormonal effects; hypothyroidism simply because cells lack the energy they need to heal.
Discontinue the use of soaps and abrasive cleansers, consider natural alternatives to conventional products, or make your own remedies from natural ingredients such as baking soda, coconut oil, and olive oil. Store-bought alternatives may work fine. The trick is to find one that works for you.
Consider using a topical probiotic spray on your skin. Topical probiotics add “good” bacteria to your skin that have the ability to offset the “bad” bacteria that inflame pores.
Consider applying an antioxidant lotion that includes green tea, white tea, vitamin C, or B vitamins to your skin.
Exfoliate with a clean washcloth once a week.
Do not pick at your skin.
Use a clean pillowcase.
Keep sunburns and harsh sun exposure to a minimum.
Consider supplementing with zinc, an antioxidant that has been shown to be particularly helpful for clear skin. N-acetylcysteine, milk thistle extract, and selenium have also been shown to have powerful effects on skin.
Consider supplementing or focusing on other nutrients that are crucial for the skin, such as vitamin A, vitamin C, vitamin E, omega-3 fatty acids, sulfur, B vitamins (particularly niacin), and vitamin K.
The above text is an excerpt from my book on women’s health, hormones, and love, Sexy by Nature, which is available on Amazon here.
Check out my absolute favorite guide for overcoming acne, by the man who taught me the most about acne, Seppo Puusa, here.