7 Common Paleo Mistakes that Cause Acne

7 Common Paleo Mistakes that Cause Acne

One of the most common complaints I get on social media is “I went paleo and my acne got worse!!”

I hear you, sister. That happened to me, too.

The thing about acne is that it’s almost impossible to just follow some “diet” (such as paleo) and clear your skin. Your diet needs to be specific about supporting clear skin, and what you need for clear skin most specifically. If you adopt some general diet, you might end up worse than you started.

Paleo is certainly no exception to this rule. Here are the 7 most common reasons people make their acne worse with paleo:

1) Too high omega 6 intake

If you go paleo and all of the sudden start eating higher quantities of certain omega 6 containing foods, this may be why. Omega 6 fats are inflammatory and in high doses can cause real skin problems. Examples of foods high in omega 6 fatty acids are:

  • Nuts (except for macadamia nuts)
  • Chicken and other poultry fat
  • Chicken and other poultry skin
  • Fatty cuts of meat (cow, pork, etc) from animals raised on conventional feedlots

Importantly, the omega 6 content of animal fats is higher in animals that are grain fed, raised on feedlots, or fed agricultural scraps. If you “go paleo” then start eating lots of meat that isn’t healthfully sources, you may run into some trouble. The best way to make sure you get a good omega 6 omega 3 balance in your animal products is to buy as much grass-fed (and grass-finished) products as possible. I personally love Butcher Box’s products.

2) Shifting diet to fat (and especially saturated fat)

People who have been on low fat diets and have some acne may experience an acne problem when they make the jump to a fattier diet. This is because fats are the backbones of hormones. Since the male sex hormones testosterone and DHEA-S cause acne, it’s entirely possible that shifting up your body’s production of these hormones (and this is of course even worse if you have a hormone condition such as PCOS) will at least temporarily cause your acne to spike.

This is all the worse if you’re consuming a lot of saturated fat, since saturated fat has the greatest potential of all the fats to be inflammatory.

(You can also have skin problems if you go on a low fat version of paleo, but this is reasonably uncommon.)

3) High intake of insoluble fiber

If you used to eat lots of fiber-free foods, switching to paleo may be a bit of a shock to your system. Insoluble fiber in particular can be rough on the gut. Nuts and vegetable skins are the worst potential offenders in this regard. These problems are exacerbated if you do not have a robust gut flora population hanging around, ready to break down the fiber for you. Hopefully you’re integrating fermented foods (my faves here) into your paleo diet, and that will help you in the longer run. If you’re not, a probiotic supplement such as Prescript Assist may be in order.

4) Consuming foods you may have a sensitivity to or that may exacerbate acne

There are a number of foods acceptable  to “paleo” that may still irritate your gut and/or your immune system. Unfortunately it takes a lot of experimentation to figure out if any of these are problems for you. The most common ones are:

  • nightshade vegetables

These are a class of vegetables that can sometimes be inflammatory, especially for people with autoimmune conditions. Many paleo people know tomatoes, potatoes, peppers, and eggplant are on that list. Also on the list but less often discussed are tomatillos and goji berries. I personally get terrible acne from goji berries, and didn’t understand why until discovering this fact.

  • high B12 foods

High B12 foods and supplements can contribute to acne because of the metabolism of bacteria on the skin. When you eat hefty amounts of B12, they shut off their own production and instead make a pro-inflammatory compound. High B12 foods include eggs, liver, shellfish, tuna. I personally still get small breakouts from these foods if I eat too many of them too many days in a row.

  • chocolate

Studies have actually demonstrated that chocolate (though for uncertain reasons) can cause acne. And it’s not because of the dairy in most chocolate products, but the cocoa itself.

  • egg whites

Some people don’t tolerate egg whites well, which leads to inflammation in the gut.

  • imbalance of vitamins A, D, K

If you’re taking a cod liver oil supplement, a vitamin D supplement, or a K supplement, you may find that your balance of A, D, and K becomes skewed on paleo. This can be a problem. If you haven’t seen any improvement with these supplements to date, consider lowering your dose or discontinuing and waiting for two weeks to see if there is any improvement.

5) Not eating enough

Many people unintentionally reduce their calorie intake when they go paleo. Some do so intentionally. In either case, not eating enough food can cause your body to stop produce the important acne-fighting hormones estrogen and progesterone, and instead produce the acne-causing stress hormone DHEA-S.

Importantly, intermittent fasting can also have this effect. I personally start to get bumps on my forehead after about six hours of fasting after I’ve gotten hunger pangs.

6) Working out too much or not refueling properly

Intense workouts can cause stress hormones to spike. Normally this is healthy, but if you do it a lot and undereat or are stressed out besides, you may be in for a bit of a deluge of stress hormones. Importantly, testosterone (an acne-causing hormone) levels rise during workouts. They fall back down to original levels if you refuel after your workout. But if you do not refuel, testosterone levels stay elevated.

Unfortunately, since I don’t know your personal history or context, I couldn’t say whether you work out  “too much.” (I do have a post on it: Do you exercise too much?) So far as refueling goes, shoot for 200-300 calories of carbs and protein combined. Beef sticks and dried fruit are a great way to do this if you’re on the run.

7) Too much protein

Paleo dieters tend to really go wild with protein. This can be a problem if you’re acne prone, since protein has been shown to participate in the stimulation of growth processes in the skin. Protein does matter; I don’t recommend cutting protein out of your diet or eat much below 50 grams a day.  I usually recommend 50-100 grams a day for women, depending on your activity level. If you’re really active  (or muscular or tall!)120 grams may work great, but it’s ideal for skin not to push too far beyond that.


So those, in sum, are the seven most common reasons people’s acne may worsen on paleo. Now, it’s entirely possible that your acne just stays the same, and you’re left wondering “but wasn’t paleo supposed to heal me?”

Paleo is a great starting template for managing many different conditions and symptoms. But  it is precisely that: a template. Once you dig into paleo, if you have conditions you want to overcome such as acne, it’s important to dig deep into acne-specific science and acne-specific nutrition. 

Coincidentally enough, I have written a comprehensive ebook about the science of causing acne and the ways to specifically tailor your diet and lifestyle choices to overcome it. It has just gone on sale (I haven’t even told facebook yet!) and is 50% off this week only! Plus, fully refundable if you don’t like it for any reason, so not much for you to lose at all! Feel free to check it out here: Clear Skin Unlocked: The Ultimate Guide to Acne Freedom and Flawless Skin. 

If you’d like to read a blog post about the program and how I wrote it, check it out, here.

Cystic Acne and Hormones: Everything You Need to Know

Cystic Acne and Hormones: Everything You Need to Know

Contrary to popular belief, acne doesn’t go away once you turn 18.

In fact, for many women, acne doesn’t even get started until their 20s, 30s, 40s, or even in menopause.

For me, I had some acne throughout my teenager years, though it didn’t become unbearable until I was about 22 or so.

What gives? Why do so many women get acne later in life? Why do women suffer from acne at nearly twice the rate of men?

The answer is hormones. It’s always hormones.

Fortunately, I have done enough research, experimented enough on myself, and worked with enough clients to figure out exactly where acne comes from and what to do about it.

Here’s everything you need to know.

These key things are causing your Cystic Acne

Acne – including the cystic sort – comes from many different sources.

Dermatologists would have you believe that acne is caused by bacteria overgrowth in the pores of your skin. This is somewhat true -bacteria does play a role. Yet this is a very limited understanding of the processes that cause acne. Every person in the world has bacteria all over their skin. Yet some people get acne, and others do not.

How do we account for that difference?

It’s not simply because of genetics.

Acne is caused by many different internal factors. You can think of these factors like the trigger on top of genetics: genes predispose you to acne, but you only get acne if you “trigger” them with the right signal.

Contributing factors:

Genes:

You may have a set of genes that codes for hypersensitivity to inflammation in the skin, for the “stickiness” and therefore clumping quality of skin cells, and for the rapid production of skin cells which can accelerate pore clogging.

Bacteria

Bacteria is also important (you can read more about bacteria and their role in acne in this post). Bacteria help modulate inflammation levels in the skin. They can also, interestingly, be aggravated by excessive vitamin B12.

How can healthy food give you acne?

Inflammation in the Pores:

Perhaps more than anything, acne is caused by inflammation in the pores of your skin. This is typically a result of systemic inflammation in the body. You wouldn’t be able to inflame a cyst without inflammation.

Poor Nutrient Status:

Acne is also caused by poor nutrient status. Vitamins like A, D, and K are critical for maintaining healthy skin cell membranes and pores. Replenishing stores of those vitamins can help. Things like eating liver, or taking desiccated liver capsules, and/or taking a vitamin A, D, and K rich cod liver oil supplement – can go a long way towards healing many skin problems, including cystic acne.

Hormones:

Finally, acne is caused by hormones. Hormones play a critical role in oil production in the skin. Some hormones – particularly the male sex hormones like testosterone – cause more oil production. Some hormones – like estrogen – cause less. 

Causes of Cystic Acne

Cystic acne and hormones: The imbalances that can occur

There are two primary hormones that cause cystic acne: testosterone and DHEA-S.

Testosterone is a male sex hormone that is still produced by healthy female bodies in small amounts. Testosterone levels often become unhealthfully elevated, mainly because of insulin resistance. (Insulin – the molecule that’s responsible for storing sugar in the blood as fat – can become unhealthfully elevated in the blood when there is a problem with gut health and/or inflammation.)

When insulin is high, the ovaries produce excess testosterone.

This causes many problems – including the fertility condition Poly Cystic Ovarian Syndrome.

Other reasons for elevated testosterone:

DHEA-S is another hormone that acts like a male sex hormone in the body and which stimulates oil production. It is different from testosterone however because it is not produced in the ovaries. It is produced by the adrenal (stress) glands.

When you are stressed out, DHEA-S levels rise.

This is a problem for many women with PCOS, since it exacerbates symptoms like cystic acne. It is commonly a problem for women with hypothalamic amenorrhea, too, since women with HA have already put a lot of stress on their bodies.

Hypothalamic Amenorrhea

This is an even greater problem for women who may have both hypothalamic amenorrhea and PCOS (like I did – read about how that is possible and what to do about it here).

Then there is one more hormone that causes acne, though not as much as testosterone and DHEA-S. It’s progesterone.

Progesterone does not increase oil production in the skin, so it is not quite as cystic as testosterone and DHEA-S are. But it does block estrogen activity in the skin. Estrogen is protective to the skin, so many women who have high progesterone levels – often because of the pill or the progesterone IUD – suffer from increased acne. You can read more about birth control options and how to manage their health effects in this PDF I wrote on birth control, here.

Finally, estrogen heals the skin. It reduces oil production and calms down inflammation in the pores. This is a great hormone for helping sooth hormonal imbalanced cystic acne.

Yet if testosterone levels or DHEA-S levels are so high, not even high estrogen will be enough to curb their effects.

Cystic acne and hormones: oil production in the skin

There are three separate layers to the skin, and pores traverse these layers. To adequately protect your body and keep toxins on the outside, the outer layer of the skin must be hydrated and strong.

To do this, pores deliver oil from the bottom layer to the top of the skin. In healthy skin, oil comes up through the pores and oozes onto the surface, lubricating the skin and making it look soft and glowy. Think of it like a well, or a hot spring, or an oil rig.

In acne-prone skin these 3 things can clog pores:

1) Debris from the surface

2) Bacteria

3) Too much oil rising from the bottom layer of skin

Then all this oil oxidizes and bacteria go on a feeding frenzy – which makes the pores become infected and inflamed. This is acne.

When there is an excessive amount of oil and a bigger, deeper-feeling infection, this is cystic acne.

What is cystic acne? Cystic acne is a normal little pimple on hyperdrive.

Cystic acne comes about often when inflammation is particularly high – or when an infection is particularly bad – or, as is the case with so many women, when hormone imbalance causes oil production to really be in excess.

When oil production is really high, it becomes easy for pores to become clogged, and for there to be a lot of material stuck there in the pores to hurt, get infected, and just be begging to be popped.

So cystic acne may arise as a result of many factors – and in fact it most likely is a result of many factors – but the most important cause for women is hormone imbalance.

Cystic acne and hormones: Is your acne caused by hormone imbalance?

These factors may indicate a hormone imbalance:

  • The cysts are located around the mouth, chin, and jaw. This is where most, or at least the worst of, hormone-imbalance acne occurs because it’s where the skin has the most hormone receptors.
  • The shoulder blades, buttocks, and thighs contain hormone receptors, so this is another place to look for cystic, hormonal acne.
  • Oily skin is the result of hormone imbalance, too. If you have a lot of oil on your skin this may point to hormone imbalance, probably excess testosterone or DHEA-S levels.

Other symptoms of this kind of hormone imbalance include:

  • male-pattern hair growth like facial hair
  • male-pattern hair loss like balding
  • increased irritability
  • low libido
  • and maybe even irregular menstrual cycles.

Cystic Acne and Hormones: What now?

If you suspect your cystic acne is hormone-related (and it almost certainly is, to some extent), I recommend first and foremost getting as many tests done as possible.

Get bloodwork done – you can test your testosterone, DHEA-S, progesterone, estrogen, LH, FSH, and thyroid hormones T3, T4, and TSH to get a good idea of what is going on in your body hormonally. You may suspect then that you have PCOS. If so, I couldn’t recommend my own highly detailed guide to PCOS which you can check out here. If you are curious about treatment options, I have elaborated on a few here.



Check out the risk-free PCOS Unlocked Manual Here for everything you need to know about PCOS

 


You also may find that you do not have PCOS, but that you still need to correct your insulin issues, your stress issues, or your hypothalamic amenorrhea issues. You can read more about stress and hormones here, and about  overcoming hypothalamic amenorrhea here.

You can read more about hormonal acne, it’s causes, and treatment in this blog post: Hormonal Acne: Where It’s Coming From and What to Do About It. Or in this one: The Ultimate Hormonal Acne Treatment Plan.

Most of all, I direct you to the program I wrote specifically for women suffering from cystic and hormonal acne: Clear Skin Unlocked: The Ultimate Guide to Acne Freedom and Flawless Skin.

Clear Skin Unlocked was written specifically for women like you in mind. It’s for when you’re frustrated, looking for answers, and tired of falling through the cracks. In Clear Skin Unlocked I discuss everything I did in this blogpost here at much greater depth, as well as provide a Four  Week Jumpstart to Acne Freedom to get you on your way to robustly healthy and radiant skin, for good.

 

And that’s a wrap! With all the links I provided here at the end you should have a good chunk of reading available to you for your cystic acne needs. In the meantime – what do you think? What is your experience with cystic acne and hormones? I would love to hear all about it!

Shattering the Myth of Fasting for Women: A Review of Female-Specific Responses to Fasting in the Literature

Shattering the Myth of Fasting for Women: A Review of Female-Specific Responses to Fasting in the Literature

 

One of the more esoteric but much beloved tools in the paleo dieter’s tool-kit is intermittent fasting.

What is intermittent fasting? I.F. is the practice of maintaining overall caloric intake while consuming those calories in fewer meals or in reduced time windows throughout the day. The goal is to create conditions of fasting in the body, but not for extreme lengths of time.

Some examples of intermittent fast strategies include 10, 8, or 5 hour eating windows throughout the day, or perhaps eating just two meals each day: one in the morning, and one at night. The evolutionary premise — the argument that proponents of intermittent fasting make — is that humans evolved to optimize their health under less-than-optimal conditions. Intermittent fasting, they say, is a natural and perhaps even necessary part of being human. 

The modern-day scientific correlate appears promising, too:

Most people are nowadays aware that a calorie-restricted diet has the ability not just to decrease body weight but also to lengthen a human life.  Emerging research is beginning to show, however, that intermittent fasting is just as effective as calorie restriction in ensuring these health benefits! Amazingly enough, this happens without any of the psychological crippling side effects of cravings and food obsession that practictioners of calorie-restriction often experience.

Intermittent fasting, proponents say, also may benefit the fight against cancer, diabetes, and autoimmunity. Here is an excellent, up-to-date review of the “benefits” of fasting. It is wholly understandable that fasting is all the rage these days.

Sort of.

Intermittent fasting women is a specific interest of mine because of what I have witnessed both in myself and in working with literally thousands of women in the PfW community.

Many women report to me (read more about that in this awesome book) that intermittent fasting causes sleeplessness, anxiety, and irregular periods, among many other symptoms hormone imbalance, such as cystic acne.

Intermittent fasting women

I have also personally experienced metabolic distress as a result of fasting, which is evidenced by my interest in hypocretin neurons. Hypocretin neurons have the ability to incite energetic wakefulness, and to prevent a person from falling asleep, in reaction to the body detecting a “starved” state. Hypocretin neurons are one way in which intermittent fasting may dysregulate a woman’s normal hormonal function.

After my own bad experience with IF, I decided to investigate intermittent fasting. I looked into both a) the fasting literature that paleo fasting advocates refer to, and b) the literature that exists out in the metabolic and reproductive research archives.

Intermittent Fasting Women: Problems in the Paleosphere

What I found is that the research articles cited by Mark’s Daily Apple (and others),  focus on health benefits such as cancer-fighting properties, insulin sensitivity, and immune function.

However. I was struck by what seemed like an egregious sex-based oversight in that MDA post I linked to above.  MDA cites this article as a “great overview” of the health benefits of intermittent fasting. This startled me because the article MDA cited was for me one of the strongest proponents of sex-specific differences in response to fasting.

Sex differences were relevant in two striking areas:

1) women in studies covered by the review did not experience increased insulin sensitivity with IF regimes and

2) intermittent fasting women actually experienced a decrease in glucose tolerance. 

These two phenomena mean that women’s metabolisms suffered from IF. The men’s metabolisms on the other hand improved with IF across the board.  Recall that the review was reported by MDA as “a great overview of benefits [of IF].”

Secondly, in another fasting post at MDA, of which there are many, the health benefits of fasting are listed and reviewed, but the sex-specific aspects of the hormonal response go unmentioned, and reproduction/fertility/menstrual health isn’t mentioned at all.

This is not to say that Mark is not attentive to who should and who should not be fasting.  He knows very well and cautions people against the dangers of fasting while stressed. Still, the mere fact of being more sensitive to fasting simply by being a woman is, I would assert, pretty important for a woman who is contemplating or already practicing IF.

This goes nearly unmentioned in the blogosphere.

Intermittent Fasting Women: Problems in the Literature

Beyond reporting biases in the blogosphere, there remains an even greater problem of a significant testing bias in the fasting literature. Searching “men” + “intermittent fasting” in a Harvard article database yields 71 peer-reviewed articles. Searching “intermittent fasting women” yields 13, none of which are a) solely about women b) controlled studies or c) about more than body weight or cardiovascular benefits.

The animal studies are more equitable, but also a bit less applicable to human studies.

 It is well-known in both the research and the nutritional communities that caloric restriction is horrible for female reproductive health. This is not news. There is an infertility condition – called hypothalamic amenorrhea – that millions of women suffer from due to being overly restrictive. But what of fasting?

Intermittent Fasting Women: Should we Fast?

The few studies that exist point towards no.

It is not definitive, since the literature is so sparse, and it necessarily differs for women who are overweight versus normal weight (and who have different genetic makeups), but when it comes to hormones, women of reproductive age may do well to err on the side of caution with fasting.

What follows first is a brief review of what can be gleaned in sex-specific responses to fasting in animal studies. Afterwards I talk about what has been concluded by the few relevant human studies.

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Mice & Rats

First up is a study that demonstrates the hippocampal  changes of calorie restriction and intermittent fasting for both male and female rats.  In this study, they do alternate day fasting, which entails free eating on one day and a fast day on the next.

The study found that brain states while fasting were different for male and female rats.  For male rats the change in hippocampus size, hippocampal gene expression, and ambulatory behavior was the same no matter what kind of restricted diet they were on – but for female rats, the degree of change in brain chemistry and in behavior was directly proportional to degree of calorie intake, demonstrating the unique sensitivity of female rats to the starvation response.

” The organization of the females’ response to the energy restricted diets is suggestive of some underlying mechanism that may allow for an organized, pre-programmed, response to enhance survival in times of food scarcity. Comparatively, the males’ genetic response was less specific, suggesting that the males respond to a general stressor but they seem to lack the ability to discriminate between a high energy and low energy stressor.”

Moreover, “IF down-regulated many gene pathways in males including those involved in protein degradation and apoptosis, but up-regulated many gene pathways in females including those involved in cellular energy metabolism (glycolysis, gluconeogenesis, pentose phosphate pathway, electron transport and PGC1-α), cell cycle regulation and protein deacetylation.”  In this study, both male and female rats gained small amounts of weight on IF diets.

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For female rats, even in the most innocuous form of restriction–intermittent fasting–significant physiological changes take place.  Male rats do not experience as dramatic hippocampal and general brain chemistry change as female rats do, and their behaviors, specifically their cognition and their dirunal and nocturnal activity, do not change.  

Female rats, on the other hand, “masculinize.”  They stop ovulating and menstruating.  They become hyper-alert, have better memories, and are more energetic during the periods in which they are supposed to be sleep.  Theoretically, according to these researchers, this is an adaptive response to starvation.  The more the female rats need calories– or at least the more their bodies detect a “starvation” state– the more they develop traits that will help them find food.  They get smart, they get energetic, they get active, and they stop sleeping.

In a follow-up study conducted by the same researchers who explored the masculinzation of female rats, the researchers analyzed the gonadal transcription of male and female rats subjected to IF regimes.

This study found that male reproductivity up-regulates in response to metabolic stress. Female reproductivity down-regulates.  

Completely opposite to the female rats becoming infertile while fasting, male rats become more fertile. In the researchers’ own words: “our data show that at the level of gonadal gene responses, the male rats on the IF regime adapt to their environment in a manner that is expected to increase the probability of eventual fertilization of females that the males predict are likely to be sub-fertile due to their perception of a food deficient environment.”

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In the final relevant IF rat study I could find, researchers subjected rats to the same diets– to 20 and 40 percent Calorie-Restricted (CR) diets, as well as to alternate-day fasting diets, and monitored them over the long term for hormonal responses.  The results were striking.  Below is the abstract in full because it’s so powerful:

Females and males typically play different roles in survival of the species and would be expected to respond differently to food scarcity or excess. To elucidate the physiological basis of sex differences in responses to energy intake, we maintained groups of male and female rats for 6 months on diets with usual, reduced [20% and 40% caloric restriction (CR), and intermittent fasting (IF)], or elevated (high-fat/high-glucose) energy levels and measured multiple physiological variables related to reproduction, energy metabolism, and behavior.

In response to 40% CR, females became emaciated, ceased cycling, underwent endocrine masculinization, exhibited a heightened stress response, increased their spontaneous activity, improved their learning and memory, and maintained elevated levels of circulating brain-derived neurotrophic factor. In contrast, males on 40% CR maintained a higher body weight than the 40% CR females and did not change their activity levels as significantly as the 40% CR females. Additionally, there was no significant change in the cognitive ability of the males on the 40% CR diet.

Males and females exhibited similar responses of circulating lipids (cholesterols/triglycerides) and energy-regulating hormones (insulin, leptin, adiponectin, ghrelin) to energy restriction, with the changes being quantitatively greater in males. The high-fat/high-glucose diet had no significant effects on most variables measured but adversely affected the reproductive cycle in females. Heightened cognition and motor activity, combined with reproductive shutdown, in females may maximize the probability of their survival during periods of energy scarcity and may be an evolutionary basis for the vulnerability of women to anorexia nervosa.

They also found this:

The weight of the adrenal gland was similar in rats on all diets; however, when normalized to body weight CR and IF diets caused a relative increase in adrenal size, the magnitude of which was greater in females, compared with males. 

And this:

The testicular weight was unaffected by any of the diets. In contrast, both CR diets and the IF diet caused a decrease in the size of the ovaries.

And this, bearing in mind that “daytime” for nocturnal rats is “nighttime” for humans:

The daytime activity of females was doubled in response to IF, whereas the IF diet did not affect the activity level of males. Nighttime activity levels of males and females were unaffected by dietary energy restriction.

And this:

 Uterine activity was monitored daily with vaginal smear tests; cyclicity was scored as regular, irregular, or absent. The mild energy-restriction diets (20% CR and IF) significantly increased the proportion of animals displaying irregular cycling patterns, whereas the 40% CR animals displayed an almost complete loss of estrous cyclicity.

And this:

 In males, corticosterone levels were elevated only in response to the 40% CR diet, whereas in females corticosterone levels were significantly elevated in response to all three energy-restriction diets, suggesting a relative hyperactivation in females of the adrenal stress response to reduced energy availability.

For lipids, all the rats did well: “Collectively, these data suggest that atherogenic profiles of both males and females are improved by dietary energy restriction.”  Interestingly, too, as they pointed out in the abstract, human females also perform cognitively much “better” (memory and alertness) on CR and IF diets than on normal feeding schedules.

There are of course some caveats to this study: A) They are rats.  B) They are somewhat “metabolically morbid” rats, which may make them more susceptible to disease.  C) The rats were allowed to eat ad libitum on the IF days, but they simply did not meet their caloric requirements this way.  So while it is a somewhat natural form of IF, it is still calorically reduced, such that that must be taken into account when gasping in horror at the hormonal responses of IF-ing female rats.

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The Few Human Studies

I mentioned above that through the same review that MDA used as a “great overview” of IF benefits for all sexes, I found harmful metabolic effects for women subjected to alternate-day fasting regimes.

This is the study:

Heilbronn et al found that with IF, insulin sensitivity improved in men (21 participants) but not in women (20 participants): after three weeks of alternate day fasting, insulin response to a test meal was reduced in men. Women experienced no significant change. “It is interesting that this effect on insulin sensitivity occurred only in male subjects,” they report.

With respect to other health markers female health actually declined, specifically with respect to glucose tolerance:

“Another diabetes risk factor that has shown a sex-specific effect is glucose tolerance. After 3 weeks of ADF, women but not men had an increase in the area under the glucose curve. This unfavorable effect on glucose tolerance in women, accompanied by an apparent lack of an effect on insulin sensitivity, suggests that short-term ADF may be more beneficial in men than in women in reducing type 2 diabetes risk. ”  The opening line of their discussion reads: “Alternate day fasting may adversely affect glucose tolerance in nonobese women but not in nonobese men.”

In a follow up study,  Heibron et. al studied the effects of alternate-day fasting on cardiovascular risk.  When human subjects fasted on alternate days for another three week period, circulating concentrations of HDL cholesterol increased, whereas triacylglycerol concentrations decreased.  This is a good thing.  However, the shifts in lipid concentrations were shown to be sex specific: ie, only the women had an increase in HDL-cholesterol concentrations, and only the men had a decrease in triacylglycerol concentrations.

The most recent review of IF agrees with my conclusion: sex-specific differences in metabolism exist and need to be studied further.

This study of alternate day fasting included 12 women and 4 men.   In eight weeks, body weight decreased by about 10 pounds, and body fat percentage decreased from 45 to 42.  Blood pressure decreased, total cholesterol, LDL cholesterol, and traicylglycerol decreased.  These people were significantly obese, which limits the results of this study to an obese population.  However, “perimenopausal women were excluded from the study, and postmenopausal women (absence of menses for >2 y) were required to maintain their current hormone replacement therapy regimen for the duration of the study.”  (Their words, my emphasis)

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The one, big study of intermittent fasting conducted on men and women looked at differences between isocaloric feeding schedules: 3 meals/day feeding versus 1 meal/day.

The study focused on body weight composition, blood pressure, and body temperature in subjects.  Subjects were fed isocalorically either one meal each day or three meals each day.  All subjects were between 40 and 50 years old (excluding women of reproductive age), and between BMIs of 18 and 25.  They ate, so far as I can tell, a healthy diet with 35 percent fat, PUFA < MUFA < SFA.   Only 15 of the original 69 completed the study (which goes to show just how fun everyone thought fasting was).  As for the results,

“Systolic and diastolic blood pressures were significantly lowered by ≈6% during the period when subjects were consuming 3 meals/d than when they were consuming 1 meal/d.  No significant differences in heart rate and body temperature were observed between the 2 diet regimens.    Hunger was enormously larger in the one meal/day than in the three meals/day group.  “The 1 meal/d diet was significantly higher for hunger (P = 0.003), desire to eat (P = 0.004), and prospective consumption (P = 0.006) than was the 3 meals/d diet. Feelings of fullness were significantly (P = 0.001) lower in the 1 meal/d than in the 3 meals/diet.”   Body weight dropped only four pounds after several months.  Cortisol dropped, but  Total, LDL, and HDL cholesterol were 11.7%, 16.8%, and 8.4% higher, respectively, in subjects consuming 1 meal/d than in those consuming 3 meals/d.

In sum: patients on the one meal/day regiment were unhappy, hungry, lost a little bit of weight, increased cholesterol.  This was a small sample, included somewhat menopausal women, and all people of normal body weight.

Intermittent Fasting Women: In Conclusion

All that being said, that’s it. That’s all that exists! Women don’t have much to go on.

There are a few rodent studies. They found that when alternate-day fasting,female rats and found significant negative hormonal changes occurring in the females.

There are even fewer human studies. Human studies on alternate day fasting have not been conducted on women of reproductive age at all, nor have any studies analyzed reproductive responses to fasting.  

Moreover, the few studies that have been conducted on non-obese women have demonstrated that their metabolic responses are not nearly as robust as those of men, and may in fact be antagonistic to their health.

This post has focused on sex-specific responses to fasting, specifically intermittent fasting women. Another important distinction to make is between different body weights. Overweight and obese patients appear to experience significant improvements with IF regimes, but normal weight patients do not show the same across-the-board benefits. For women this may be a particularly sensitive issue. Overweight women may experience metabolic benefits, whereas normal weight women do not. I suspect that that may roughly be the case, but who knows. Honestly, no one at this point.

The practical solution, then, I believe, is to look at options, to be honest about priorities, and to listen to one’s body with awareness and love.

Is fasting worth trying if a woman is overweight and trying to improve her metabolic markers, and so far hasn’t had much success?  Perhaps.  Should it be undertaken if a woman is of normal weight?   What if she is a light sleeper?  What if her periods begin to dysregulate?  Or stop?  What if she starts getting acne, getting a stronger appetite, or losing her appetite altogether?  These things happen, and I see them in women who fast and contact me time and time again.

We women (people!) should be honest with ourselves about our priorities, and act constantly with our mental and physical health foremost in our minds.  All women are different. But the literature is so sparse in this area that we cannot make any real statements or predictions about the effects of fasting, other than that we just don’t know, and that we should continue to emphasize the centrality of awareness, caution, and loving nourishment in moving forward.

intermittent fasting women

——–

IF is one realm in which the female body has unique characteristics and needs that demand attention. There are boatloads of others. If you’re interested in reading about the collective set of them and learning how to optimize female skin, weight loss, and hormone balance, for a few examples, you could do worse than my best-selling book, Sexy by Nature, here.

 

——-

And that’s a wrap! What do you think?

High Testosterone Levels in Women: Everything You Need to Know

High Testosterone Levels in Women: Everything You Need to Know

High testosterone levels in women is one of the most common hormone disorders. Literally tens of millions of women suffer from it in the United States alone. So how do you know if you have high testosterone?

1. Acne

Testosterone is elevated around ovulation cycles if you are menstruating which can lead to hormonal acne breakouts commonly around your jaw or chin. If you have PCOS you may be suffering from breakouts like these most of the time. (If you suffer from acne, my brand new program, 50% off this week, Clear Skin Unlocked: The Ultimate Guide to Acne Freedom and Flawless Skincould be a great resource for you).

2. Irregular Menstrual Cycles

Having irregular menstrual cycles creates a hormonal balance allowing testosterone to become dominant or recessive. Another reason you may be having irregular menstrual cycles could be stemming from PCOS.

3. Blood Sugar Swings

Insulin encourages the ovaries to produce more testosterone.

4. Low Libido

Your testosterone levels can be high but if your other primary sex hormones are not balanced, then high testosterone will not result in higher libido.

5. Male Pattern Balding and Hair Growth

Another sign of high testosterone levels in women is male pattern balding and hair growth.

 

So what causes testosterone levels in women to be elevated?


1. Insulin Resistance and Diabetes

If you have type I or II diabetes or know that you are insulin resistant, high testosterone is probably a problem for you.

Approximately 25% of the testosterone in female bodies comes from the ovaries. This is natural. However, insulin in the bloodstream stimulates the ovaries to produce more testosterone. This can seriously increase the ovaries’ output of testosterone.Depending on the severity of the dysregulation, insulin can lead to a significant increase in testosterone in the bloodstream. This is as much as 2 or 3 times over the optimal and healthy testosterone levels.

This is very often the case in polycystic ovarian syndrome.

2. Thyroid Disorders

Sex hormone levels and thyroid hormone levels are intimately related in many ways.

One important way is through Sex Hormone Binding Globulin (SHBG). When thyroid function slows — as in hypothyroidism — SHBG levels fall. SHBG binds excess hormones to it in the blood. It is incredibly important for maintaining healthy hormone balance. When hormones like testosterone threaten to increase and there is bountiful SHBG then it can bind the testosterone and minimize its threat. Without SHBG, excessive hormones can become a real problem.

In healthy women, 80% of testosterone is bound by SHBG in the blood. With decreased SHBG however, significantly more testosterone runs free and causes testosterone-related issues.

3. Stress

Stress can have a wide variety of negative impacts on the female body. Many of these have the potential to elevate testosterone levels.For example, stress can cause hypothyroidism and the concomitant decreases in SHBG.Stress can also decrease levels of estrogen and progesterone in the blood. Estrogen and progesterone perform a counter-balancing function to testosterone. Without them, testosterone levels in women can rise to unhealthy levels.

Stress also causes a rise in DHEA-S, which is a male sex hormone produced by the adrenal glands. It is not testosterone – but it is one of testosterone’s closest cousins. It acts in a chemically similar way and will often cause the same hormone disruptions. Read more about this process here, and about how stress negatively impacts hormone production here.

sleep and stress effect testosterone, high testosterone levels in women

4. Fasting After Workouts

If you work out frequently and do not eat afterwards, your testosterone levels – specifically as a woman, can rise. After intense exercise, several hormone levels are elevated including Cortisol – the “stress hormone” – and testosterone.

Cortisol levels fall naturally after a workout. But testosterone levels do not. They remain very high and decrease much more slowly if you do not eat afterward. If you do this on a regular or even daily basis this can cause a chronic problem.

high testosterone levels in women increase from fasting

5. Polycystic Ovarian Syndrome (PCOS)

Finally, the most common cause of high testosterone in women is PCOS.


Read about the in’s and out’s of PCOS


Now, it is not altogether clear what causes what: does high testosterone cause PCOS, or does PCOS cause high testosterone levels in women? There is no certain answer. But what is certain is that the two are inextricably linked for many women. It may very well be the case that they both cause each other: high testosterone causes PCOS and PCOS causes high testosterone.

PCOS stands for Poly Cystic Ovarian Syndrome and is the condition of having multiple cysts on one’s ovaries. There are three criteria used in diagnosing PCOS. In order to be diagnosed you must meet two of the three criteria:

  • irregular or absent menstrual cycles
  • elevated testosterone or other male sex hormone levels
  • cysts on the ovaries as demonstrated by an ultrasound

PCOS affects as many as 15% of in America today, and is actually the leading cause of infertility, by a long shot.

So if you suffer from symptoms of high testosterone, from any of the above conditions such as hypothyroidism, stress, or insulin resistance / diabetes, you may want to investigate PCOS as a potential underlying cause or secondary effect of your condition.

PCOS may be a complex condition but this does not mean that it is insurmountable. I myself overcame my own PCOS (despite receiving terrible medical advice). So many of the women I have worked with on the issue have, too.

To read more of my work on PCOS and find out how it’s unique from what other people have done, check out any of these posts: What is PCOS? PCOS Treatment OptionsThe PCOS Diet, or my program on overcoming PCOS, PCOS Unlocked: The Manual.

To read more about acne and it’s relationship to testosterone and other hormones, check out my most popular posts on acne, or my program, Clear Skin Unlocked: The Ultimate Guide to Acne Freedom and Flawless Skin.

So that’s it for common causes of high testosterone levels in women. Do you have other ones in your own experience? Questions, concerns? I’d love to hear about it – please let me know!

The Real Truth Behind Autophagy Inducing Fasts

The Real Truth Behind Autophagy Inducing Fasts

Fasting can have vast effects on women’s health. If you are unfamiliar with this effects and the stress it can put on your body, check out this post here to get you started.  It is clear that fasting is huge in the health and wellness industry right now. Fasting has been around for thousands of years, however, mainly known for its large role in religious ceremonies and journeys. People would swear of the powers that fasting could bring, from refined wordly clarity, visions, and even mystical powers to those brave enough to pursue it. But what really gives? Can fasting be beneficial in this day and age? And what the heck does this have to do with Autophagy, you ask?

Autophagy is basically a scientific process of recycling dead cells, or “self-cleaning” that occurs when the body is under stress, either from fasting, exercising, or ketosis.

Lets Debrief on Intermittent Fasting:

One of the more esoteric but much beloved tools in the paleo dieter’s tool-kit is intermittent fasting.

What is intermittent fasting? I.F. is the practice of maintaining overall caloric intake while consuming those calories in fewer meals or in reduced time windows throughout the day. The goal is to create conditions of fasting in the body, but not for extreme lengths of time.

Some examples of intermittent fast strategies include 10, 8, or 5 hour eating windows throughout the day, or perhaps eating just two meals each day: one in the morning, and one at night. The evolutionary premise — the argument that proponents of intermittent fasting make — is that humans evolved to optimize their health under less-than-optimal conditions. Intermittent fasting, they say, is a natural and perhaps even necessary part of being human. 

The modern-day scientific correlate appears promising, too:

Most people are nowadays aware that a calorie-restricted diet has the ability not just to decrease body weight but also to lengthen a human life.  Emerging research is beginning to show, however, that intermittent fasting is just as effective as calorie restriction in ensuring these health benefits! Amazingly enough, this happens without any of the psychological crippling side effects of cravings and food obsession that practitioners of calorie-restriction often experience.

Intermittent fasting, proponents say, also may benefit the fight against cancer, diabetes, and autoimmunity. Here is an excellent, up-to-date review of the “benefits” of fasting. It is wholly understandable that fasting is all the rage these days.

Sort of.

Intermittent fasting women is a specific interest of mine because of what I have witnessed both in myself and in working with literally thousands of women in the PfW community.

In Comes Autophagy:

The word derives from the Greek auto (self) and phagein (to eat). (literally “self-eating”) 

It has been proven that the body runs its biological processes similar to a recycling plant. Old cells that are degraded or just no longer needed in the body can be “eaten” by the body to help streamline and allow our bodies to exist more efficiently. One of the ways the body can enter this self-cleaning mode is by fasting. Most of our cells are already pre-programmed to do this in a process called apoptosis. Apoptosis basically means cells are programmed to die after a certain amount of time to benefit the body.

Autophagy has been studied in relation to its effects at killing cancerous cells in the body. There is not a tremendous amount of data on how this process works and how we can harness it to our benefit. The studies are in effect, however.

Ketosis and high intensity interval training can also engage autophagy in addition to fasting. You get a lot of the same metabolic changes and benefits of fasting without actually fasting while in ketosis, which is typically the main appeal of ketosis versus intermittent fasting.

Negative Side Effects:

  1. We just don’t know exactly what we are dealing with and how it will effect our biochemistry long term.
  2. Growth is occurring. By recycling, autophagy is also allowing new growth to occur in the body. This means bacterial cells or cells like Lyme can be produced or encouraged to grow. 
  3. This is the same to note when thinking about cancer cells. If not harnessed properly, the same growth could occur with cancer cells, instead of just death. This is why autophagy is looked at often as preventative tool, not a treatment.
  4. Every persons biological makeup has their own unique traits. Again – we do not have the information to make a quantitative and educated guess on whether this is successful and beneficial in the short and long term.
  5. Autophagy is a stress induced response, so in order to activate it you have to produce more stress in the body. This is a common parallel that we see with over-exercising especially with programs like CrossFit. People maintain success to a certain point on these programs but is the overall detrimental effects of putting our body through more stress worth the rewards? Does the stressed state of our body even let us benefit from these rewards or are the effects inhibited?
  6. a) Women in studies often do not experience increased insulin sensitivity with IF regimes and
    b) intermittent fasting women actually experienced a decrease in glucose tolerance. These two phenomena mean that women’s metabolisms suffered from IF, the primary and preferred catalyst for autophagy.

Positive Side Effects:

In some studies Autophagy has been shown to produce the following results:

  1. Reduced inflammation levels in the body
  2. Prevention or delay of neurodegenerative diseases (Parkinsons and Alzheimers)
  3. Increased life span

Verdict:

All that being said, that’s it. That’s all that exists! Women don’t have much to go on. Its up to you to determine whether the benefits of autophagy are really worth the stress that can occur with fasting.

As for fasting, there are a few rodent studies. They found that when alternate-day fasting,female rats and found significant negative hormonal changes occurring in the females.

There are even fewer human studies. Human studies on alternate day fasting have not been conducted on women of reproductive age at all, nor have any studies analyzed reproductive responses to fasting.  

Moreover, the few studies that have been conducted on non-obese women have demonstrated that their metabolic responses are not nearly as robust as those of men, and may in fact be antagonistic to their health.

An important distinction to make is between different body weights. Overweight and obese patients appear to experience significant improvements with IF regimes, but normal weight patients do not show the same across-the-board benefits. For women this may be a particularly sensitive issue. Overweight women may experience metabolic benefits, whereas normal weight women do not. I suspect that that may roughly be the case, but who knows. Honestly, no one at this point.

The practical solution, then, I believe, is to look at options, to be honest about priorities, and to listen to one’s body with awareness and love.

Is fasting worth trying if a woman is overweight and trying to improve her metabolic markers, and so far hasn’t had much success?  Perhaps.  Should it be undertaken if a woman is of normal weight?   What if she is a light sleeper?  What if her periods begin to dysregulate?  Or stop?  What if she starts getting acne, getting a stronger appetite, or losing her appetite altogether?  These things happen, and I see them in women who fast and contact me time and time again.

We women (people!) should be honest with ourselves about our priorities, and act constantly with our mental and physical health foremost in our minds.  All women are different. But the literature is so sparse in this area that we cannot make any real statements or predictions about the effects of fasting, other than that we just don’t know, and that we should continue to emphasize the centrality of awareness, caution, and loving nourishment in moving forward.

intermittent fasting women

——–

IF is one realm in which the female body has unique characteristics and needs that demand attention. There are boatloads of others. If you’re interested in reading about the collective set of them and learning how to optimize female skin, weight loss, and hormone balance, for a few examples, you could do worse than my best-selling book, Sexy by Nature, here.

 

 

 

Hormonal Acne: New Science on How to Beat It

Hormonal Acne: New Science on How to Beat It

Even though many dermatologists would deny it, hormonal acne is a real and serious problem for women.

Gut health and inflammation are both major players in acne. (read more about causes of acne other than hormones in this post, or my brand new acne program, for 50% off this week!).

Yet hormones can be the biggest problem for women.

In today’s post I discuss all the variations of hormonal acne, where it comes from, and what to do about it.

Hormonal Acne: When and how it shows up

When: 

Hormonal acne for many women presents at certain times of the month. Popular times include 1) at ovulation, which occurs almost precisely smack in the middle of the cycle, two weeks after the first day of bleeding (read about how to pinpoint ovulation in this post), 2) the few days before a period, and 3) at the start of a woman’s period.

Hormonal acne can also be present all of the time. For women with hormonal problems such as PCOS (read here to start figuring out if you have PCOS) and Hypothalamic Amenorrhea (read here to figure out if you have HA), this is unfortunately the case.

When I had both PCOS and HA at the same time, I had terrible acne every day for three years.

Appearance: 

Hormonal acne usually occurs in the form of cysts. Cysts are those lovely, pus-filled, painful and inflamed red bumps. They often culminate in a peak of white pus.

Hormonal acne also appears as more mild forms called comedones. These are those whitehead “bumps” that never break the surface.

Hormonal acne can even show up just as smaller lesions. These are not quite as angry and painful as full out cysts, and may appear more rash-like or just smaller than typical acne. Below is a photo of my own cysts (on a “good” day) back in 2011.

Stage 3 Hormonal Acne

These are cysts, classified as “stage 3” acne by dermatologists. There are 4 stages of cysts in hormonal acne

Location: 

Hormonal acne occurs first and foremost around the mouth. It shows up on the chin, below the nose, around the sides of the mouth, and sometimes up the jawline.

As hormonal acne worsens, however, it spreads to the cheeks and the forehead.

Other body parts can be affected, too. This usually includes the shoulders, back, and buttocks–where the body’s testosterone receptors are most prominent.

The physiological mechanism of hormonal acne

Hormonal acne is caused by increased oil production beneath the skin. Think of it like a river. Ordinarily there is a healthy flow of oil to the surface. This is important because it lubricates the skin.

But when there is too much oil – and when it combines with the normal skin cells and other debris on the surface of the skin – it can clog the pores.

When oil clogs pores, bacteria go on a feeding frenzy. This causes inflammation.

The worse inflammation is, the more irritated the oil gland can become, and thus the more red, and the more painful.

Yet it is important to remember that hormonal acne does not occur unless there is an oil problem.

This is the reason no amount of washing will ever completely eliminate hormonal acne. Admittedly, it can be helped by antioxidant cleansers, serums, or creams.

But it will never go away completely without curing the hormonal acne from underneath. The only way to fix it is from the inside out.

Hormonal Acne: Causes of increased oil secretion

The primary causes of oil secretion are male sex hormones, also called androgens. Testosterone is the primary culprit. Another androgen, called DHEA-S, is also very important. They both increase oil secretion.

This effect is worsened when female sex hormone levels – particularly of estrogen – fall. Estrogen balances male sex hormones in the skin. Without a healthy balance, problems occur.

1. The most prominent androgen is testosterone.

Testosterone causes oil production in the skin.

Why might you have high testosterone?

You might have it if you have PCOS.

(Acne is one of the clearest indicators of PCOS.)

You may also have high testosterone if you have diabetes or insulin resistance, because when the body produces insulin, the ovaries produce testosterone. It’s a very simple yet very damaging process.

When might you show hormonal acne from high testosterone?

If you still have a menstrual cycle, you may find that you break out around ovulation. This is the middle of your cycle. It is also when your testosterone levels are the highest.

But if you have a hormone condition like PCOS – you will probably have hormonal acne most of the time.

(If you struggle with PCOS or think that you may have it, you may want to check out my handy guide on overcoming PCOS.)

2. Another androgen, called DHEA-S, causes oil production as well.

Yet unlike testosterone, which is a sex hormone, DHEA-S is a stress hormone.

It is produced primarily in the adrenal (stress) glands. Whenever a woman is under any degree of stress, her body faces a choice: it has to decide if it wants to produce normal sex hormones like progesterone and estrogen, or if it wants to produce stress hormones like DHEA-S.

For this reason, Hypothalamic-Pituitary-Adrenal (HPA) Axis dysregulation is usually the first place to look to as the origin of DHEA-S problems. Women with a lot of stress – whether from emotions, poor sleep, or under-feeding – have higher levels of DHEA-S levels.

3. Estrogen fights acne.

Estrogen helps promote clear skin. It does this in a number of ways.

First, it has the power to off-set high testosterone levels in the blood. Estrogen increases levels of sex-hormone-binding-globulin (SHBG), which in turn binds testosterone and makes it impotent.

Second, the skin has many estrogen receptors in it, so estrogen directly performs a balancing and soothing function at the site of acne.

For women with chronically low estrogen, hormonal acne is often a consistent problem. They have acne 100% of the time.

In women with relatively healthy hormone systems, low estrogen can still be a problem. This is because estrogen levels fall at the end of each menstrual cycle, and are low at the beginning. Having such low estrogen levels during this time can lead to monthly breakouts.

Because hypothalamic amenorrhea is characterized by low hormone, and particularly low estrogen levels, boosting estrogen is one of the main and most helpful ways women with hypothalamic amenorrhea cure their acne.

Because menopause significantly decreases estrogen levels–almost to zero–this is also the primary reason women in menopause can see a re-emergence of hormonal acne after decades of clear skin.

4. Finally, progesterone can also play a role in acne. Progesterone, in high doses, acts as an inflammatory agent, and can cause acne to flare up. Progesterone levels are highest during the days leading up to menstruation, which explains why many women experience outbreaks at this time.

Synthetic progesterone, such as that found in birth control pills, can also cause acne.

Whether a certain variety of the pill causes acne for you or not, however, is entirely dependent upon your own body chemistry and how your body reacts to external hormones. Know only that if you noticed a change in your skin while experimenting with birth control methods, this is most likely why. You may want to consider a birth control method that has a different kind of progesterone in it, or one that has a different progesterone-estrogen balance, to see if it helps relieve your acne.

(I discuss hormonal causes of acne with more complexity and depth in the program I just published, Clear Skin Unlocked: The Ultimate Guide to Acne Freedom and Flawless Skin.)

Aggravators of hormonal acne

There are many factors other than hormones that can worsen hormonal acne. Here is a list of the most common:

Stress: Stress plays an important role. It acts as an inflammatory agent, especially if cortisol levels remain high for a long time. Stress also  decreases production of healthy, skin-supporting hormones like estrogen, and increases production of acne-causing stress hormones like DHEA-S. Stress is not necessarily the cause of hormonal acne, but does exacerbate it, and prevent proper healing.

Heat.  Heat is inflammatory, and also causes sweat, which can clog pores.

UV Rays. The sun’s rays are some of the most potent acne inflamers out there. Protect the skin on your face with at least an SPF of 20, or consider wearing a hat in the summer months.

Inflammatory foods: grains, dairy, nuts, and omega 6 vegetable oils can all contribute to poor gut health and inflammation.

Dairy: While already mentioned for being inflammatory, dairy deserves special mention because it is a highly hormonal food.  Pregnant cows produce several hormones designed for growth. Growth hormones can both cause androgen levels to rise as well as promote production activities that lead to acne.

I have seen enormous success with women with hormonal acne eliminating dairy for their skin.  Many people at least anecdotally least respond to dairy with acne more strongly than any other food.

Phytoestrogens: soy and flax are the primary phytoestrogens to be concerned about, with legumes and nuts coming in a distant second place. Phytoestrogens (“phyto estrogen” is greek for “plant estrogen”) have the power to act as estrogens in the body. This may sound like a good thing for acne, but this role is ambivalent and should be treated with caution, especially with the skin. Different estrogen receptors read different kinds of phytoestrogens differently, such that phytoestrogens usually perform estrogen-lowering effects in skin tissue despite what they do in other locations.

Low carbohydrate diets: Having sufficient glucose stores is important for skin healing, and can speed the recovery of acne lesions. Glucose is also helpful for preventing hypothyroidism. Find out 8 of the most important signs you need to eat more carbohydrate here.

Poor sleep: Sleep both enables healing and promotes healthy hormonal production.

Hypothyroidism:  Without sufficient levels of T3, the active form of thyroid hormone, in the blood, a woman’s skin cells lack the ability to heal properly.  Many women who suffer hypothyroidism suffer chronic acne.

Dealing with hormonal acne

The best thing you can do for hormonal acne is get blood work done and figure out precisely what your underlying problem is. That way you can target the problem and treat it effectively.

Unfortunately not all of us can afford this, so it’s okay to guess. Nevertheless, the better an idea you have of what is going on in your body, the more specific you can be about what to do to fix it.

In general, hormone dysregulation that leads to acne can be broken down into a few broad categories:

1) high testosterone from PCOS (specifically the overweight and insulin resistant type of PCOS),

2) low estrogen from low body fat levels, chronic restriction, or living in an energy deficit,

3) low estrogen from menopause,

4) high progesterone from general hormone imbalance, possibly related to PMS,

5) any of these conditions worsened by stress or hypothyroidism, and

6) any combination therein.

The ultimate hormonal acne solution

The solution to all of these problems is to correct the hormone imbalance.  I have discussed methods of doing so above and elsewhere.

So to get rid of hormonal acne for good, check out my manual that has now helped several thousand women overcome their PCOS, or some of my work on hypothalamic amenorrhea.

For women with menopause, it may just “take time” or perhaps medical interventions are appropriate, depending on the severity of the problem.

Medication for hormonal acne?

There are drugs designed to help with hormonal acne.  Spironolactone and flutamide are the two primary ones that come to mind (though I don’t recommend taking either of them), as well as birth control.

The reason birth control pills are helpful for acne is because they enforce hormone regularity on a woman’s system.  The precise pill that is helpful for each woman varies by her particular condition– but in general, BCPs are comprised of estrogen and of progesterone. BCPs can for that reason 1) raise estrogen levels–which either corrects an estrogen deficiency or helps balance the activity of runaway testosterone–and they can also 2) restore proper balance between estrogen and progesterone, which is important for keeping progesterone levels within their proper parameters.

Some BCPs also contain anti-androgenic substances, such as drospirenone, which is an added benefit for women who are living with androgen excess (but poses some health risks).  In all cases, I do not generally recommend that women get on BCP, as it can cause worse hormonal dysregulation in the long run (sort of like handicapping a delicate hormonal system), and does not solve the underlying problem.

Flutamide acts in a similar way to spironolactone, but less effectively, and with more side effects.  So spironolactone is typically the drug of choice.

Spiro has been hailed by many acne sufferers as God’s gift to womankind: it decreases testosterone activity. For many women this begets truly miraculous effects. Yet one should step cautiously with spironolactone. If a woman’s primary problem is not testosterone excess, spironolactone will very likely do more harm for her skin than good.  (Check out the panicked discussion forums at acne.org to see what I’m talking about.)  Moreover, even for those who have testosterone excess as their primary problem, spironolactone merits caution for a variety of reasons.  First, spiro usually induces an infamous “initial breakout” which can last anywhere from weeks to months.  This isn’t always the case– sometimes women improve immediately. Sometimes they never really do (I never did: in fact, my acne got worse on spiro.) But the typical case is for women to see an initial worsening of their acne, followed by relief in the upcoming months, especially if they increase their dosages.

Secondly, spiro cannot be taken by pregnant women because it induces birth defects, so women cannot stay on spironolactone indefinitely. This is problematic because spironolactone acts as a band-aid on the hormone problem, and does nothing to fix it whatsoever. What spiro does simply is block testosterone receptors.  In most cases, if the underlying problem is not addressed while a woman is taking spironolactone, her acne will return once she comes off of the drug.  This is why I recommend that women only consider taking spironolactone if they want a “quick fix” while they work on their diet and exercise in order to improve their PCOS.

Finally, spironolactone has a couple of other health concerns.  First, it lowers blood pressure, since spiro is actually a blood pressure lowering drug proscribed “off label” for acne.  Secondly, it acts as a diuretic, so women on it need to drink water constantly, may not be able to consume alcohol anymore, may have dysregulated salt cravings, and may never actually be properly hydrated.  And finally, spiro acts as a potassium-sparing diuretic, such that women cannot eat potassium rich foods, lest they risk the chance of becoming hyperkalemic, which can lead to sudden death.  It hospitalized me. An imbalance of electrolytes in the blood is no laughing matter, so women on spiro should limit their potassium rich foods as well as get their potassium levels checked periodically.  Potassium rich foods include melons, bananas, potatoes, avocadoes, tomatoes, and leafy greens, among others.

For these reasons, spiro can help, but it cannot be relied on long term.  It does not get at the root of the issue–drugs rarely do–and the true path to hormonal help is diet and lifestyle modifcation.

As a final note, bio-identical hormone supplementation can be helpful for women going through menopause.  Estrogen patches can release small amounts of hormone into the bloodstream, and can lessen acne considerably. I do not think this is necessarily detrimental to a woman’s health, if it is in fact the case that her estrogen levels have simply dropped off during menopause.  However, it does, in my opinion, make it difficult for estrogen levels to rise and hormone balance to re-establish itself on its own. This is a decision best left to the individual and to her doctor.

In conclusion

Hormonal acne is terrible, and for many women can seem incessant, and never ending.  Girls are assured growing up that they will eventually out-grow their acne, yet many women see it persist throughout their twenties and thirties, and some actually do not even see the acne manifest until their twenties and thirties.  Some women do not even see acne appear until after the birth of their first children, as their progesterone and estrogen levels are flying all over the map.

There are downsides to medication, and large ones. Medication is only ever a band-aid, and it can be a band-aid that in the long run leads to more harm than good.  

Playing with hormones is like playing with fire.  Sometimes things can go horribly wrong. For this reason, meds may be best left alone, depending on the circumstance and the level of risk a woman is willing to bear.

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It is entirely possible as well as supremely healthy to cure acne from the inside out with good diet and lifestyle practices alone.

To do so with an experienced scientist (me!) walking you step-by-step through the process, check out my new program: Clear Skin Unlocked: The Ultimate Guide to Acne Freedom and Flawless Skin.

Clear Skin Unlocked was written specifically for women like you in mind. It’s for when you’re frustrated, looking for answers, and tired of falling through the cracks. In Clear Skin Unlocked I discuss everything I did in this blogpost here at much greater depth, as well as provide a Four  Week Jumpstart to Acne Freedom to get you on your way to robustly healthy and radiant skin, for good.

You may also wish to check out my guide on weight loss, or my guide to overcoming PCOS. It may take experimentation and patience, but don’t all good things, in the end?

For some of my favorite topical solutions to acne, check out the antioxidant cleansers, serumscreams and topical probiotics I use.