The web is filled with bad acne advice. Q&A sites are full of well-meaning but simplistic advice about how to cure acne. Often how to cure acne questions are answered with put toothpaste on it or use this homemade skin care recipe type of advice. While there’s some truth to such answers and they miss the complexity of acne, and therefor fail to be useful to other than a handful of lucky people.
The truth is that acne is a very complicated condition. The complex causes vary from genetic sensitivity to hormones to skin irritation. This means that you probably have to do more than apply toothpaste on your skin to get over it. Lucky few will find simple solutions, but the vast majority will have to do more.
In this post I want to give you an idea of what you have to do to get over acne.
All acne is hormonal. Because of genetics acne-prone skin is far more sensitive to many hormones. This causes excessive sebum production and skin cell growth and ultimately leads to blocked pores and pimples.
I talked about this in detail in the hormonal acne page. In summary, the hormones responsible for acne are androgens (male sex hormones), insulin and insulin like growth factor 1 (IGF-1). Aside from dangerous prescription drugs there’s not much we can do to androgen levels. But the good news is that insulin and IGF-1 multiply the effect of androgens on the skin, and there’s a lot we can do to insulin and IGF-1 levels.
- Eat a diet that’s low in sugar and refined carbohydrates. Sugars and refined carbohydrates spike insulin and IGF-1 levels. Focus on complex carbohydrates. You can use glycemic index to guide your food choices.
- Eat a balanced diet. I recommend 50/30/20 ratio as a starting point. That means 50% of your calories should come from carbohydrates, 30% from fat and 20% from protein. This is not a strict rule, but rather a guideline to start from.
- Saturated fat in moderation. Eating too much saturated fat can cause insulin resistance and thus aggravate hormonal acne. It doesn’t mean saturated fat is bad or forbidden, but that you should keep it in moderation.
- Get enough sleep.
- Exercise regularly.
Skin friendly diet
What you eat can affect your skin, though the diet-acne relationship is not as strong and common as many people claim. How much diet affects the skin varies between people a lot. That’s why I’m not a fan of strict dietary regimens, because often they are useless (in curing acne) and adhering to them causes a lot of stress.
However there are some things that I would recommend for everybody to at least try.
- Avoid dairy. The relationship between dairy products and acne is stronger than for any other food. Dairy products increase the androgen, insulin and IGF-1 levels, and that’s why there are many studies linking dairy consumption to acne. The only exception to this is homemade yogurt. The fermentation process reduces the levels of IGF-1 in yogurt and makes it safer to eat. Yogurt is also great for gut healing.
- Try gluten-free. Gluten can trigger acne and other skin conditions. Contrary to what many natural health proponents and acne gurus claim gluten is not a problem for every acne patient. The best estimate is that 18% of acne patients may have problems with gluten. That’s why I recommend trying gluten-free diet for 3 to 4 weeks.
- Avoid foods you are allergic/sensitive. Such foods cause a lot of inflammation in the body and can trigger acne.
These tips are a good starting point, and probably cover most diet changes you have to do to cure acne.
There’s a good reason to believe gut problems are linked to skin problems, see the gut-skin axis page for reason why. That’s why you should make gut healing as part of your acne treatment program. Things like:
- Consume probiotic bacteria, either from supplements or fermented foods (preferably homemade).
- Avoid antibiotic use. Antibiotics often destroy the probiotic bacteria in the gut, and this opens the door for harmful bacteria and leads to gut problems. Use antibiotics when absolutely necessary. Especially avoid long-term antibiotic use as a way to get over acne (it just makes the problem worse long-term).
- Eat fruits and vegetables. Plant fiber feeds probiotic bacteria and keeps the gut moving.
- Pay attention to any digestive problems you may have. Digestive problems are the first step to gut problems (and ultimately to acne). If you experience flatulence, constipation, stomach pain or other digestive problems, seek guidance and address the issues. You can’t have healthy gut if your digestion doesn’t work properly.
- Manage stress levels. Stress is really detrimental to gut health.
- Get sufficient sleep.
Acne is more than skin deep, but it’s also skin deep (if this makes any sense). Because we acne patients for a bit unlucky in the genetic lottery our skin is far more sensitive to hormones. Genes also cause the immune system in the skin to be a bit trigger-happy. It reacts too strongly to bacteria on the skin, and this causes excessive inflammation on the skin.
Luckily we can mitigate these problems with smart use of topical treatments. Topical green tea is a fantastic example.
Here are few things to look for:
- Salicylic acid (or something similar) to manage hyperkeratosis and keep the skin pores open.
- Benzoyl peroxide to keep bacteria under control. But be careful with BP as it can also cause a lot of problems for sensitive skin. Make sure it’s buffered with soothing ingredients.
- Green tea or other ingredients that can reduce the effect androgens have on acne-prone skin.
- Good facial moisturizer to keep the skin barrier intact.
As you choose your skin care products, keep in mind that they can also contain irritating ingredients.
If you want a simple solution, I highly recommend Exposed Skincare. Of all the acne treatments I’ve seen it has by far the best formulation, and that’s why I use it myself.
We already talked about stress earlier in this article. But because stress has such a negative effect on the skin I want to have a dedicated chapter to it. Several studies have demonstrated a clear (causal) link between stress and acne. For example studies on students show more acne during exam periods.
Aside from the indirect effects already talked, stress also has a direct effect on the skin. Studies have shown that Neurotransmitter known as substance P increases sebum production, creates inflammation in the skin, and increases skin cell growth. In other words, it contributes to the three primary causes of acne.
Stress is serious, and you should take it seriously. For many acne patients it’s much better to work on reducing stress than to improve diet.
Oh my god! I have to do all that??
I know that I covered a lot of issues in this post. And all this may look scary at first glance. But we can’t get over the fact that acne is a complicated condition. That’s why simple cookie-cutter approaches fail.
Acne has both internal and external causes, and that’s why you need to attack it from both sides. The things I listed on this page are known factors behind acne. But there are also lots of differences between acne patients. So everything here may not be relevant for you. For example gluten is only a problem for a portion of acne patients. Similarly, there are a lot of people who can eat a lot of sugar with no effect to their skin.
What I have here is not a step-by-step recipe for clear skin (there is no such thing) but a starting point. You have to do little detective work. Start implementing the changes and see what works for you and what doesn’t.
I wish I could give you simpler answers, but I’m afraid they don’t exist. So rather than giving you simplistic answers, I prefer to tell you what really works – even if it takes some work and dedication.