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:
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 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.
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.
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.
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.
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 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.
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.
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.
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
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.
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!
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?
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 Skin, could 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.
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.
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.
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 Options, The 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!
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
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.
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.
These are cysts, classified as “stage 3” acne by dermatologists. There are 4 stages of cysts in hormonal acne
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.
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.
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, serums, creams and topical probiotics I use.
Where to Begin With Supplements
Taking supplements can be an overwhelming task to initiate. There are so many different varieties of vitamins & minerals, brands names of vitamins & minerals, and a lot of variation on mixed feelings about the successfulness of absorption rates. When I first decided to look more into proper supplementation, I must say I was slightly overwhelmed with the synergistic properties.
The fact that some supplements need to be paired with others in order to be fully absorbed was a concept that seemed beyond me, I wasn’t even sure which supplements to take that would work on their own. But! Alas, my wariness did not heed my eagerness to learn more, so I put my nose to the books and have come up with the ultimate basic list of supplements and what they can be used for. As always, I recommend getting your vitamins and minerals from the food you digest but I also understand that sometimes that is not possible in today’s crazy world. Enter the supplement.
Some of the supplement information I have provided below does not elaborate on the synergistic qualities of supplements. For instance, Vitamin D is excellent for the immune system but also can provide relief from anxiety and depression. If you are browsing through and are not seeing a supplement that you had expected under a particular category, try reading through the other recommendations to see if there are alternative vitamins and minerals that can work for multiple symptoms.
Calcium and Vitamin K2: If you are deficient in calcium and supplementing instead you may want to think twice, or do some research on your vitamin K levels. Vitamin K actually helps carry the Calcium into your bones, meaning if you are deficient in Vitamin K2 and supplementing with Calcium then you may not really be doing any good.
Take this if Your Immune System Needs Help or If You Are Feeling Fatigued
Taking D3 keeps me cold-free all year long (literally, I got terrible colds until I started taking it), and keeps me from being depressed and anxious in winter months. If you don’t take cod liver oil, and even if you do but need more D, this is the supplement to take. Vitamin D is associated with overall improved health, and can help with diseases as advanced as cancer.
Vitamin D is one of the most important vitamins, and one we are most likely to be deficient in as Americans. Some estimates say anywhere from 80-90% of the population may have sub optimal levels of Vitamin D in the blood.
This is worrying because Vitamin D plays such an important role in health. From reducing autoimmune issues and inflammation, to preventing disease, Vitamin D is a nutrient we shouldn’t neglect. Vitamin D has a protective effect on the immune system, helping T-cells and B-cells to to fight immune threats while also preventing autoimmune issues.
Several autoimmune diseases (including Lupus and MS) have a high range of deficiency and supplementation with Vitamin D has been shown to improve health in these individuals.
Having sufficient Vitamin D has been shown to reduce upper respiratory infections in both summer and winter. Those with deficiencies of Vitamin D are found to suffer from upper respiratory infections much more often, even accounting for the seasons.
Vitamin D, the sunshine vitamin, is primarily processed through the skin rather than through food. During the summer, we wear less and tend to spend more time outdoors, and this increases the amount we produce. In turn, we get sick less often and feel altogether happier. Vitamin D deficiencies are also associated with lower mood and decreased cognitive function.
However, Vitamin D needs range depending on specific conditions. Recommendations for average adults age 19-50 are about 600 i/u a day to prevent deficiency. This can come from sunlight, diet, or supplements, but it may take up to 1500 or 2000 i/u a day, depending on the individual, to keep blood levels about the recommended 30 ng/ml.
Vitamin D foods: Salmon, Mushrooms (cooked), egg yolk, canned tuna, sardines and cod liver oil.
This vitamin is crucial for immune system health, for the manufacture of neurotransmitters, and for adrenal (stress system) health.
Foods that contain Vitamin C: Leafy greens, other vegetables, and all fruits (yes, citrus, but others too!) all have high quantities of vitamin C. If you are a paleo dieter but don’t go heavy on the veggies you may want to consider upping your dose.
Vitamin C Supplement
Take this for Mood & Sleep Improvement
70% of Americans do not get the recommended daily dose of magnesium. And magnesium is crucial for more than 300 essential chemical reactions in the body. Without magnesium, these vital reactions simply don’t take place.
Without magnesium, systems malfunction all over the map, from bone growth to adrenal health to the ability to fall asleep at night. Magnesium is also, and perhaps most importantly, one of the primary nutrients involved in the regulation of cellular stress and activity. And when I say stress here, I do mean stress. Any sort of cellular activity is a stress of sorts, because it upregulates activity and requires energy and resources.
Magnesium’s role is simple: it opens channels on cell membranes. When a muscle fiber, for example, needs to tense up and become active, magnesium will open the membrane and help usher in calcium, which helps make it tense. Then, when the period of stress is over and the muscle can relax, magnesium opens up the cell membrane to usher the calcium out of the cell again. The problem for most people is that they have enough magnesium to usher calcium into the cell, but not enough to usher the calcium out.
This leaves them in a chronically up-regulated state, leaving muscles tense, nerves firing, and neurons on high alert. This is why magnesium deficiency is associated with muscle tension, with headaches, with poor adrenal health, and with anxiety.
Without magnesium, the body simply cannot calm down.
Magnesium is very hard to get in a paleo diet (really only in grains) and is CRUCIAL for over 300 enzymatic reactions in the body. You need it to prevent headaches, relax your muscles, calm anxiety, prevent depression, and fall asleep at night, among so many other things. At one point it nearly saved my life.This is the form of magnesium that is easiest on the gut. Other forms in high doses can cause intestinal motility to speed up enough to cause diarrhea. This one is the best for avoiding that if you have a sensitive stomach.
High quality magnesium citrate supplement
As important as magnesium is, it unfortunately is no longer abundant in the human diet. Research estimates that at least 48% of Americans do not get nearly enough magnesium in their diets. This is in part because magnesium has been depleted from American soils.
Unfortunately for paleo dieters, the majority of foods high in magnesium are not on the typical paleo menu. High magnesium foods include mostly legumes, nuts and seeds: soybeans, pumpkin seeds, sesame seeds, quinoa, black beans, cashews, navy beans, sunflower seeds, almonds. Grains are also reasonably high in magnesium.
Fortunately for paleo dieters, kale, swiss chard, and beet greens are all great sources. Nevertheless, magnesium is probably one of the greatest “risk” minerals for paleo dieters, which is why I typically recommend supplementing.
Take this if You’re Breaking Out
Zinc is an essential mineral that is not only found in several enzymes–which makes it crucial to lots of bodily functions–but it also, notably, is critical for immune system function. It also plays a key role in the metabolism of RNA and DNA, and promotes plasticity (flexibility) in the brain. It is important for immune health, hormone health, insulin modulation, and brain health. Zinc also has anti-inflammatory properties that resist and combat bacteria, making it wonderful for helping acne relief.
The best sources of zinc are oysters (by almost a factor of ten), followed by liver, beef, and lamb. Turkey and shrimp also have good amounts of zinc. From plants, zinc can be obtained from lentils, quinoa, chick peas, and many kinds of seeds including pumpkin and sesame seeds.
High quality Zinc supplement
Take this if You’re Trying to Heal Your Gut
This vitamin is rare because even though you think you might be getting it every time you eat a carrot (the packaging always says “good source of vitamin A!”), you are unfortunately being misled. Carrots do not have vitamin A in them. Neither do any other plant foods. What these foods have in them instead is beta carotene.
Beta carotene can be converted into vitamin A in your intestines by gut flora (here’s a great probiotic and great probiotic foods that can help with that). If you do not have the right gut flora it just won’t happen. Unfortunately that’s the case for a lot of people today. Gut flora just aren’t as robust as they could be.
So many people are deficient in vitamin A. The only robust source of true vitamin A in the diet is organ meat, particularly liver. Most people cringe at the idea of eating liver. Yet ancestral human cultures prized the liver above almost all other parts of the animal. Presumably this is because they figured out how important it is for health. If you cannot stomach the idea of eating liver a couple of times a month (but you should because it’s delicious), you can try a desiccated liver supplement like this one, which is my favorite.
You can also obtain vitamin A from cod liver oil, which is actually a better supplement for absorbing vitamin A specifically because oil is the right form for a fat soluble vitamin. (Desiccated liver is the best for a lot of other nutrients, though, including the rare and important choline). Most people do well with 10-15,000 IU’s per day.
This is the healthiest, most nourishing cod liver oil supplement on the market today.
Take This if You Are Combating Brain Fog
Vitamin K is rare in the diet today for a few reasons. One is that people do not eat organ meats anymore, and organ meats are one of the only good sources of vitamin K2.
Another reason is that most animals today are raised on grain products and other random bits of food instead of grass. Yet grass is the natural diet for cows, bison, and other ruminants. The highest quality beef comes from cows that eat grass specifically because it enables them to make the right nutrients that they need.
Vitamin K2 can be found in grass-fed butter, but it cannot be found in grain-fed butter. So you can boost your vitamin K (K2, specifically) intake by getting some grass-fed butter in your diet. If you cannot do that, then you may definitely want to consider that cod liver oil supplement I mentioned earlier. Because not only does it have cod liver oil and vitamins A and D in it, but it also has high quality butter oil added, which is rich in vitamin K.
This is how fermented cod liver oil kills three birds with one stone. Most people will do well with 100 mcg/d.
Vitamin B2, also known as riboflavin, is necessary for energy production and normal cell function and growth.
Riboflavin deficiency is common in women of child-bearing age and of a low socioeconomic level. Using hormonal birth control exacerbates that problem. Studies have shown that vitamin supplements remediate riboflavin issues in women taking the pill.
Altogether, these findings suggest that vitamin B2 supplementation in women taking OCs may be important where vitamin nutrition is poor.
Greens, eggs, turkey, other sources of animal protein, and plant protein sources such as beans and legumes tend to be good sources of vitamin B2. With a diet rich in animal products, vegetables, and fruits, B2 should probably not be a problem to obtain enough of. Not many sources of B2 are excellent sources, but there is a wide variety of foods which contain a decent amount of it.
High quality B complex supplement
If Your Liver is Needing Assistance Detoxing
Vitamin B12 (also known as cobalamin) is an essential nutrient for many things, but perhaps most of all liver support and detox.
Vitamin B12 is fortunately very rich in pretty much all animal protein sources, especially liver. But beef, lamb, poultry, seafood, and eggs all have fairly abundant B12. Dairy also has a reasonable amount of B12 in it. If you are a vegetarian, and especially if you are a vegan, you will need to supplement with B12.
If you struggle already with a slugglish liver or have a condition like estrogen dominance or PCOS, the following supplements help support the liver through Phase I and Phase II detoxification and can be really helpful:
- Methylated forms of B12 (find it here), B6 (find it here), and Folic Acid (find it here): important for the passing of methyl groups which helps with the excretion of hormones like estrogen and is sometimes difficult in women with PCOS.
- DIM (I like this one): contains the strongest components of cruciferous vegetables known to help break down excess hormones.
- Calcium D Glucarate (I like this brand) supports the glucuronidation of the liver and prevents excess estrogen from being re-absorbed in the bowels.
- Glutathione (find it here): important for the detoxification of alcohol. Smoking, chronic stress, and infections or inflammatory disorders also deplete this important nutrient
So there you have it! Where will you be starting on your supplementing journey? Maybe you are sticking to food instead? Leave me a comment and let me know!
Our body uses its own particular language to communicate problems to us. This may be in the form of an ache, pain, or of all things, a pimple. Our body is literally trying to talk to us to tell us something is not aligning with our physiology, and we need to learn that language.
It may be difficult to decipher this language, but no worries I’ve got your back!
We now have enough science and research behind us demonstrating that the locations of our breakouts can be caused by certain things.
For instance, if I eat dairy (an inflammatory food for me) I break out around my chin or jaw line. This is something that took me a decent amount of time to comprehend, but now that I have, it is a very reliable way to understand my skin.
So, what are the main things causing breakouts?
Acne primarily originates from two things, our diet and our hormones.
How Hormones Affect Our Skin
The most problematic hormones for your skin are the male sex hormones, called androgens a group. The two most prominent ones are testosterone and DHEA-S.Testosterone is a male sex hormone that you’ve probably heard about. It’s produced in reproductive organs in every body, though at much higher rates in men than in women. DHEA-S is not a sex hormone. It is produced by the stress glands (adrenal glands) in the body. But it resembles male sex hormones so much that it has androgenizing effects in the body. The body has unusually high concentrations of androgen receptors in certain areas:
- around the mouth
- the chin
- the jaw
- the forehead
- the shoulders
- upper back
So What Does This Mean?
Androgens or male sex hormones cause the body to do two things, make more sebum than what is normal, and boost skin cell growth rates. Too much male hormones means too much growth. Too much male hormone power in the blood means too much growth. When these growth processes occur with too much frequency or intensity, acne develops.
Check out my article here to learn more about whether you may have too much testosterone.
When we are able to eliminate hormones as the cause of our breakouts, (check out my program Clear Skin Unlocked if hormones could be the primary factor causing your breakouts.) we can then look at the next most inflammatory thing, our diet.
Dietary Factors Causing Acne
Unfortunately, there are a lot of dietary reasons we could be breaking out. A lot of them stem from causing inflammation in our bodies. The following are some of the main dietary reasons we develop breakouts :
- A diet high in omega 6 fats
- A diet high in deep fried and fried foods
- A diet that includes trans fats
- A diet low in omega 3 fats DHA and EPA relative to the amount of omega 6 in the diet
- A diet high in refined and added sugars
- A diet high in grains or dairy
I know this seems like a lot. If you have been following a paleo diet then most of these will not be an issue for you. If not, I recommend starting by eliminating processed foods, and go from there. I have more tips on how to do this, located in my program Clear Skin Unlocked, here.
So what do the locations of our breakouts mean?
- The Chin and Jaw & Neck : The highest concentration of testosterone receptors are found in the skin here. If you have a hormone imbalance you will likely see pimples in this area in a range of sizes. These can occur often around our menstrual cycles, when our hormones are fluctuating.
- Cheeks : We use our phones a lot, right? Make sure you are cleaning your phone often otherwise you are introducing loads of foreign bacteria to your face here. In addition, if you are smoking, this has a habit of showing in the cheeks because this area is believed to be linked to our respiratory system.
- Chest : Our chest is a very sensitive area that we can sometimes forget about when it comes to washing and cleaning our face and other areas of the skin. Definitely take extra time to make sure you are washing your chest adequately. If that doesn’t do it, and your breakouts are happening in the summer, check out this blog post on other things that may be causing the breakouts to occur.
- Forehead, upper back and glutes : There are also testosterone receptors found in these areas, not as potent as around the mouth. but they are real. This combined with natural sweat and dirt can cause serious breakouts.
So – long story short, we should be looking to our hormones first to understand if we have any imbalances that could be causing breakouts, especially in the jaw, chin, forehead, upper back & glutes.
Here are a few more resources for understanding hormone imbalances and what your breakouts mean:
Hormone Balance and Inflammation
Cystic Acne and Hormones: Everything You Need to Know
The Ultimate Hormonal Acne Treatment Plan
5 Signs You Suffer From High Testosterone
Then, we look to our diet.
As we pay more attention to our skin and the contributing environmental and dietary factors in our life that may be influencing it, I promise it will become easier to understand and recognize where these breakouts are coming from and why. I am a big fan of journaling, especially to notice stress levels which could really be causing inflammation to spike.
Best of luck, and as always, I am always here.