PUFA and omega-6 in acne

For now this is a placeholder post for discussion regarding PUFA toxicity and omega-6 fats in acne.

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Hi, I am Acne Einstein(a.k.a. Seppo Puusa). I'm a bit of a science nerd who is also passionate about health. I enjoy digging through medical journals for acne treatment gems I can share here. You can read more about my journey through acne and how I eventually ended up creating this.

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11 thoughts on “PUFA and omega-6 in acne

  1. Right, I see what you’re saying about the paper itself. Matter of fact I would tend to agree. I also find the connection with Zinc and apparent metabolic function interesting thought.

    Anyways, about the PUFAs. Basically the whole marketing push for fish oil and omega and various other oils are a scam. These oils are highly prone to oxidative damage. Coconut oil, a saturated oil (>60% w/ < 0.5gPUFA) tends not to have these negative oxidative effects. Studies have already shown that acne subjects are under higher oxidative stress than those who are non-afflicted. What I was getting at by hinting to these oils was that the oxidation that happens to them is what may be underlying the inflammation that is associated with the very beginning stages of the acne process. Once these oils do their damage, by altering the skin surface lipid profile, P. acnes bacteria then invades the pores. It's been noted that vitamin E counteracts oxidation of these polyunsaturated fatty acids and makes sense in the context of the antioxidant argument.

    Polyunsaturated oils from corn and soybean were originally (around 1940s) used as a paint varnish because of how they turn sticky when oxidized. When the seed oil industry began introducing these oils into the american diet, there was an attempt to market them as being heart healthy and to lower cholesterol, while at the same time blaming saturated fats as being the cause of heart disease. This increased their market. Notice how you rarely find any processed foods with coconut oil in them anymore. If you do some digging, you will find that a lot of the myths about saturated fat are now being shown to be false.

    What I find interesting about these oils in particular is that, according to a Ph.D. researcher named Ray Peat who specializes in Endocrine Physiology, they poison the thyroid system.

    As the thyroid is known to control metabolism, this concept lends an entirely new perspective on the possible causes of acne.

    What makes it even more interesting is to notice that on the Island of Kitava there is no noted evidence of acne in the observed population, and it just so happens that coconut is a dietary staple for them.

  2. So let’s expound on this idea or theory of mine about PUFA consumption and it’s relationship to acne a little bit. We’ll drag it through the mud and see how it holds up.

    First, some food for thought:

    1. How many people have reported terrible results from fish oil? Granted, there are mixed reviews, but for the purpose of this post, let’s focus on a potential cause.

    2. Dairy consumption is a known aggravator of acne, as is iodine (you mentioned onions? onions contain iodine, as does garlic).

    3. What do people in the U.S. usually cook with? Some variety of seed oil. These oils are found in processed foods, and fast food joints likely heavily use them as well. (acne patients have a habit of suspecting fast foods as a culprit in acne. is there a connection here?)

    4. Acne tends to appear in adolescence

    5. A low GI diet tends to help acne symptoms

    6. The Kitavans are free of acne

    Now that we’ve established a few things, let’s test out this theory.

    So, why do people react so badly to fish oil? Many people have reported cystic-type acne after consuming it. This one appears to be simple: they are dramatically increasing their intake of polyunsaturated fatty acids in the form of an oil. See my previous post about it’s oxidative properties.

    Ok, well, what about dairy? It’s possible that the calcium content of milk blocks the absorption and utilization of Zinc, and this coupled with milk’s testosterone and DHT precursors, causes the sebaceous glands to secrete more sebum. Although I am unsure as of yet as to the PUFA content of milk, I suspect that being fatty by nature, contains atleast some. These oils (or those oils that are stored in the persons body) then oxidize the excess sebum, changing the sebum composition and making the pores inhabitable by P. acnes. Acne is the result.

    And iodine? I mentioned in my previous post that, according to Dr. Ray Peat, PUFAs poison the thyroid system. And what is iodine used for? The thyroid. And the thyroid in turn controls metabolism. Acne patients are known to have a bad reaction to iodine. I can only say at this point that I suspect there is some kind of thyroid malfunction.

    You mentioned that there is evidence to suggest that hormones are what causes excess sebum. I don’t doubt that at all. In fact, it’s been proven. But I suspect that the combined effect of PUFAs, increased androgens, and acne only begins to become noticeable during adolescence. Here’s what I mean: In the american diet, people consume PUFA oils via their cooking and fast foods and processed foods for pretty much the entirety of their lives. The issue here is that, for young children, they haven’t developed sexually yet (either lowered, or no, androgens like testosterone that are responsible for those features). During puberty, there’s a surge of hormones (as in testosterone), and these hormones, as you correctly point out, stimulate sebaceous gland secretion. This is where the problems start manifesting. With this newfound oil on their skin that wasn’t there in earlier years, the stored PUFAs now have a chance to oxidize this facial oil and alter it’s composition, again, leading to acne. It’s been observed in studies that in acne patients, their sebum content is markedly different from those of others without acne. Which teens develop acne may have more to do with lifestyle factors (their parents cooking habits, etc) than hormones. After all, everyone goes through puberty but not everyone gets acne.

    On to the low GI diet. When people go on a low GI diet, what do they typically consume? More whole foods with complex carbohydrates. Eating more whole, natural food implies that they are consuming less PUFAs, as found in processed foods. But this doesn’t explain everything. There are reports of people who continue to eat “healthy”, and yet still break out. What gives? As my understanding of PUFAs, which are explained in fairly good depth by Dr. Ray Peat, will allow me to say is that these toxic oils can accumulate in cells and can potentially take years to get rid of. It’s also possible that there is a lessened insulin spike. As you may know, insulin causes the liver to store glycogen and when glycogen stores are filled up, the hepatocytes will convert excess glucose into fatty acids and release them into the blood stream as lipoproteins. It’s possible that a low GI diet lessens this effect of circulating fatty acids produced by the liver.

    Lastly, in the Kitavan population there is no evidence of acne. Even among test subjects in the age range of 15-25 when acne manifests itself the most. Incidentally, these people’s diet is virtually uninfluenced by the western world. They eat whole, natural foods such as fruit, coconut and fish with no dairy, and no cooking oils other than possibly coconut (saturated oil, not PUFA, remember?)

    These are all possibilities, and to my mind, appear very real.

    In the western world, we push all these PUFA substances like fish oils and whether it is actually good for our health is another question. Don’t you find it odd that there is always mention of how these oils are heart healthy, and lower cholesterol, and yet, the U.S. has more cases of heart disease, obesity and diabetes than ever before? I should point out that there are of course other factors at play and you can’t deny the role of genetics, but I don’t buy that argument with the rates of disease we have seen.

    If it appears to you that I seem to suggest that the american population is slowly being poisoned via diet, that observation would not be far off. Meanwhile, the medical field and industries related to it are booming and are alive and well. The american people? Not so much. While I am no conspiracy theorist, and while this theory of PUFA consumption may seem new and interesting relating to acne, the idea of industry contaminating the food supply is hardly novel.

    Finally, my name isn’t actually John Doe. It’s Glenn. I’m a 27 year old web developer residing in southeast Wisconsin. I do believe this angle should be seriously considered and investigated by the medical communities although seeing as I am no medical doctor and far from it, I have no way to test this other than on myself.

    I have attempted to contact a dermatologist in NYC by the name of Whitney Bowe by email to see whether this idea is worthy at all but so far have not received a response.

    Again, there are some parts that are left unanswered. How can some people eat complete garbage and not develop acne? I don’t know. Although another possibility still is that whether they develop the condition may have something to do with their DEGREE of toxicity via these oils or some form of resistance to it.

    By the way, I don’t generally put my email address up on forums but if anyone wants to chat more about this via email, just request it in a post.

    What do you think?

  3. In regards to another page on your site about omega-3/GLA reducing inflammatory acne by ~40%.

    I myself have used GLA in the past and did notice an improvement. But let me throw something out there as to why I think it worked. This will be a continuation of my previous posts about PUFA consumption.

    GLA, or gamma-linolenic acid, is made from linoleic acid by an enzyme known as delta-6 desaturase. While not the most credible of sources, this comes directly from wikipedia:

    “when acting on GLA, 5-lipoxygenase produces no leukotrienes and the conversion by the enzyme of arachidonic acid to leukotrienes is inhibited.” – https://en.wikipedia.org/wiki/Gamma-Linolenic_acid

    Arachidonic Acid is extremely inflammatory. GLA stops this inflammatory cascade somewhat. Notice that in the study, there was an IMPROVEMENT, but not a A COMPLETE REDUCTION. I suspect this is because, while GLA does stop some inflammation through its action on lipoxygenase and arachidonic acid, it is still an omega-6 (polyunsatured) fatty acid.

    This comes directly from Dr. Ray Peat’s web site: “The suppression of an enzyme system is characteristic of toxins. The “EFA” powerfully, almost absolutely, inhibit the enzyme systems–desaturases and elongases–which make our native unsaturated fatty acids. ” – https://raypeat.com/articles/articles/unsaturated-oils.shtml

    What do fish oils usually contain? EPA and DHA. Where does GLA come from? delta-6 desaturase.

    GLA appears to work because, it’s already in the form necessary to prevent inflammation. When people take fish oil, these polyunsatured fatty acids (according to Dr. Ray Peat) inhibit the desaturase enzymes needed to make GLA, thereby rendering our body unable to stop the inflammation.

    Furthermore, to me atleast, the idea of PUFA consumption and its relationship to acne takes on more significance when we consider that we’re dealing with oils in foods that come from genetically modified seeds and crops, and industrial pesticides. Acne has been referred to as a “disease of western civilization”. Civilization was built on agriculture. It seems like a pretty fitting label to me.

    • Thanks for your long and thoughtful comments. Before replying, let me just say that I’m not an expert on this issue and I don’t know what the truth is. However, I have looked some studies on this and what I found has caused me to be skeptical of the things you say. This doesn’t mean that Dr. Peat would be wrong. It just means that the studies I’ve seen don’t seem to support his position.

      The problem with what you’ve said is that it’s all rather theoretical. Yes, omega-6 fats trigger inflammatory pathway and have been linked to inflammation. And yes, all PUFAs are susceptible to oxidation.

      Medical researchers are aware of this, and the issue is not being suppressed or swept away in anyway. For example, Irish researchers published a paper reviewing the health implications of dietary omega-6 intake in 2012.

      Health Implications of High Dietary Omega-6 Polyunsaturated Fatty Acids
      https://www.hindawi.com/journals/jnme/2012/539426/

      I just read that paper, and while it lists many potential ways omega-6 might be harmful, it presents very little actual data. It’s this mouse study showed this, that mouse study showed that. All potentially very interesting, but you can’t conclude from mouse and animal data that these fats are harmful in humans.

      What’s missing, and what I’ve been trying to look for, is real human data that these fats are harmful. After all, if what Dr. Peat and paleo proponents claim is true, that consuming more of these fats increases oxidative damage, then it’s reasonable to assume that their intake is linked to higher disease rates and mortality. And that is precisely what I haven’t been able to find. In fact, most studies show the exact opposite.

      For example, last month Australian researchers published a paper investigating the association between blood levels of omega-6 fats and mortality. Here’s the link:

      Circulating omega-6 polyunsaturated Fatty acids and total and cause-specific mortality: the cardiovascular health study.
      https://www.ncbi.nlm.nih.gov/pubmed/25124495

      I can’t access the full text of the paper, but the abstract gives the relevant details. Among 2792 participants, higher blood levels of linoleic acid was associated with 13% reduction in total mortality. Other omega-6 fatty acids had no effect on any of the studied mortality rates.

      Note how that study mentioned ‘concerns over theorized proinflammatory effects of n-6 PUFA’. I think that’s the crux of the matter. Omega-6 PUFAs may indeed cause inflammation, but, contrary to what you may read on the net, the scientific consensus on this is anything but settled.

      The results line up with another paper from 2013. In this study they looked at 2837 US adults and looked for correlations between various PUFA blood levels cardiovascular disease. The showed that EPA and DHA strongly reduced CVD events, but there was no association between any of the other PUFAs.

      Circulating and dietary omega-3 and omega-6 polyunsaturated fatty acids and incidence of CVD in the Multi-Ethnic Study of Atherosclerosis.
      https://www.ncbi.nlm.nih.gov/pubmed/24351702

      Here’s another review published in 2014.

      Protective effects of dietary PUFA against chronic disease: evidence from epidemiological studies and intervention trials.
      https://www.ncbi.nlm.nih.gov/pubmed/24308351

      This paper showed that omega-3 fats may be somewhat protective against heart disease, but overall the data shows no real benefit or harm from either omega-3 or -6 fats.

      Again, I want to stress that I’m not an expert on this, and there may indeed be something I’m missing. My question to people who say that PUFAs and omega-6 fats are dangerous is that why aren’t we seeing the effect on human data? Why aren’t people who consume more omega-6 unhealthier? Why aren’t they dying earlier?

      My take on all of this is that I’m not horribly concerned about omega-6 fats. I don’t recommend consumption of vegetable oils and I recommend avoiding most processed foods, etc. That anyway eliminates a significant portion of omega-6 fats. Beyond that I’m not too concerned about reducing omega-6 fats in my diet.

      I do acknowledge that they are a potential concern, like the study below suggest, and I do believe it’s a good idea to avoid vegetable oils and other major sources.

      New insights into the health effects of dietary saturated and omega-6 and omega-3 polyunsaturated fatty acids
      https://www.biomedcentral.com/1741-7015/10/50

  4. Fair enough.

    Indeed, there are mixed results. Some studies say omega fats reduce risk of heart disease, while others say they increase that risk. One thing I would say is that Dr. Peat makes clear that a short-term study of say, 12 weeks, isn’t long enough to determine whether omega and PUFA fats are dangerous or not (i’ll touch on this in a moment).

    Additionally, I’d like to point out while some would say this is argument from authority, he holds a Ph.D. in biology and has been doing work with hormones, aging, and fats for approximately 50 years. I would tend to think he knows what he is talking about. What he says may not be mainstream, but often, information coming from the mainstream can be misleading. The opposite is also true, however. Just keep in mind that the fish oil and seed oil industries have a real incentive to promote these products.

    Directly from Dr. Peat’s web site:

    [EDIT BY SEPPO: Sorry, but I had to remove the long text you pasted here. Due to copy-right issues, I can’t have large amounts of copyrighted content on this site.]

    If fish oils are indeed immunosuppressive and Dr. Peat says they are, it appears this is why fish oils in short-term studies seem to be beneficial. They reduce inflammation in the short term by inhibiting prostaglandins. That says nothing though about their long-term cancer-causing and heart-destructive effects.

    Here’s the link for further reading:

    https://raypeat.com/articles/articles/fishoil.shtml

  5. Here’s another piece I find particularly interesting:

    “The degenerative diseases are all associated with disturbances involving fat metabolism and lipid peroxidation. Alzheimer’s disease, alcoholic and nonalcoholic liver disease, retinal degeneration, epilepsy, AIDS, diabetes, and a variety of circulatory problems involve breakdown products of the PUFA. The products of PUFA decomposition include acrolein, malondialdehyde, hydroxynonenal, crotonaldehyde, ethane, pentane, and the neuroprostanes, which are prostaglandin-like molecules formed from DHA by free radical lipid peroxidation products, especially in the brain and at a higher level in Alzheimer’s disease.”

    The mention of malondialdehyde seems noteworthy in light of your other page (https://www.acneeinstein.com/studies-reveal-almost-irrefutable-evidence-for-the-root-cause-of-acne/) which has a chart about a quarter of the way down the page showing increased levels of this substance among severe acne patients. Does this prove anything? No way. But it’s interesting to note that unless people go on a complete caveman-style diet, which few people ever do or are willing to do, these fats are virtually impossible to avoid.

    Even then on a very restrictive diet, you still consume these fats because they are naturally found in small amounts in nature. The idea though is that the additional intake in the american diet is unnecessary and could possibly cause health problems.

    In dermatology, it seems to be acknowledged that there are differing skin types (i.e. dry, oily, etc). It makes me wonder whether the oily skin type, and the one that corresponds to acne, is more susceptible to the lipid peroxidative processes of these fats. It appears to make sense when you consider that acne patients are lower in antioxidants. With their excess oil, they naturally NEED more. This is an assumption of course but with current research focusing on lipid peroxidation and antioxidants, makes some sense. As for why they need more, the oxidation that these fats undergo naturally uses up these antioxidant stores more quickly.

    Just some more thoughts.

  6. In some respects, I agree with not finding enough information about the possible dangers of PUFAs.

    However, the american population is a perfect example of a population that consumes high amounts of these fats and are in ill health. It’s very possible that the RATIO of n-3/n-6 fatty acids is what is important, and you can find plenty of studies that consider this angle. But I think there’s more to it than that. A question I have is: If the consumption of high amounts of PUFAs (whether n-3 or n-6) in the american diet are not to blame for the rates of inflammatory disease we have seen, then what are those diseases attributable to? Everyone has to eat. Smoking may play a role, but again, many Kitavans are also smokers, and they still have virtually undetectable levels of heart disease.

    Yes, it is true that the Kitavans also consume fish (n-3 fatty acids). But they also consume high amounts of saturated fat from coconut and their total dietary intake of fat only accounts for about 20% of their diet, with carbs being 70% from fruit, and 10% protein. There is a difference between eating fish and getting their natural supply of n-3 fatty acids versus consuming vegetable oils that are highly concentrated PUFA oils.

    Besides their intake of fish and the respective n-3’s, their intake of other sources of PUFAs are pretty much 0%. Again, their n-3/n-6 ratio would therefore favor n-3’s. However, since total fat consists of only 20% of diet, it may be that their low consumption is what accounts for their health. Considering their coconut intake, which in all likelihood is higher than fish n-3’s (because they only consume fish during one of two meals a day, at dinner time) and the idea that saturated fats are bad, we can see the stark contrast between the U.S. (with it’s high rates of obesity and heart disease, acne, thyroid problems, and diabetes) and the Kitavans who suffer from pretty much none of the aforementioned diseases.

    Coconut consumption is in line with what Dr. Peat suggests – that coconut stimulates metabolism and fosters proper thyroid function thereby keeping the kitavans lean and healthy whereas PUFAs would have the opposite effect. This is exactly what we see here in america. While some studies as you have on this site do indicate that n-3 fatty acids can reduce inflammatory acne during a short-term study of several weeks or months, this can be accounted for as Dr. Peat mentions that PUFAs have immunosuppressive effects and inhibit prostaglandin formation in the short-term, which appears beneficial on the surface.

    If n-3 fatty acids are indeed beneficial for acne, it logically follows that consuming more of them will continue to reduce acne symptoms further, therefore stacking the n-3/n-6 ratio in favor of n-3. That is not consistent with not only my own experience (I break out terribly from fish oil), but many others who report cystic-acne lesions after consuming fish oil products, often in places they have never broken out in before.

    This may not prove a thing, but I find this discussion interesting so let’s continue.

    • N-3/n-6 ratio may indeed provide clues to this. Theoretically balancing them should help, but evidence is again mixed. I don’t have the studies at hand now, but I did look into this while I was researching my book. From memory, epidemiological studies show that people with more balanced n-3/n-6 ratio have lower incidence of certain diseases. But intervention studies where they try to correct the balance haven’t shown good results. That said, I don’t think you can call those studies conclusive.

  7. You dumped a massive amount of info on me again 🙂 I’m not an expert on this topic and I can’t answer all the points. It’s possible that Dr. Peat is correct on this, but it’s equally possible he’s wrong. At the moment the best we can say is that we don’t know for sure.

    I understand that these fats are prone to oxidation, but that doesn’t mean they will oxidize in the body. Perhaps normal antioxidant levels are enough to protect them, or perhaps there’s something else going on that keeps them from oxidating. The body is incredibly complex and it’s difficult to make predictions from proxy measures and theoretical points. That’s why I’m always looking for human data.

    And yes, I do understand that there are limits to what we can conclude from short term studies. Most of the studies I quoted earlier were either long term epidemiological studies or systematic reviews that look at all the available evidence. For example, this one (https://www.ncbi.nlm.nih.gov/pubmed/25124495) followed people for 18 years and included almost 3000 participants. If these fats indeed are so dangerous as some people make them out to be, then I find it incredible that a study of this size and length didn’t find any evidence of it.

    Perhaps there is something that explains these results. I’m not qualified enough to say that. It’s up to the people making these claims to provide supporting evidence and explain these results.

    Yes, Dr. Peat has a Ph.D. and is probably a very smart man. Of course you could say the same thing of the tens, if not hundreds, of researchers who publish and peer review the studies.

    One thing skepticism and critical thinking has taught me is that everyone is subject to the same cognitive biases and errors. Humans just aren’t that great when it comes to evaluating things logically and without bias. Even the smartest people fall for these things. That’s why I don’t put much faith into what any single person says. When possible, I always look for published evidence from as many sources as possible.

    Most such evidence suggests that while PUFAs may potentially be dangerous so far there’s no real evidence that they are. And while I don’t recommend consuming vegetable oils, or foods containing them, I also don’t see a point in avoiding nuts or other whole foods high in omega-6 fats.

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