Treating and preventing acne with nutrition

We can no longer blame it on adolescent hormones. In the United States, not only do up to 95 percent of teens experience some degree of facial acne, but more and more adults are also suffering from chronic acne, and for some it is crippling.

The conventional notion that acne is purely an issue of facial cleanliness and attention to clean linens is an over-simplification. In fact, more research is emerging that identifies the traditional American diet as the culprit. Acne development starts in the gut, not solely on the skin.

In a general sense, several factors can influence acne development, from gender to genetics, to hygiene to certain conditions relating to hormonal imbalances such as polycystic ovarian syndrome or diabetes.

Food influences acne by affecting hormones like insulin, testosterone, estrogen and other chemical messengers that induce cascades of reactions that can lead to the development of acne.

Normal skin cell formation versus acne pathology

The normal life cycle of the skin cells involves cellular formation, cellular movement towards the more superficial layers of the skin, programmed cell death (apoptosis) and a final sloughing off. The whole cycle called desquamation takes about one month.

In the case of acne, apoptosis is delayed and cells do not slough off easily, resulting in an ultimate blockage and cutting off of oxygen to the pore. Cells remain adhesive, not breaking down as expected, which creates a thick, scaly layer of cells, known as hyperkeratinization.

Under normal circumstances, the adjacent sebaceous gland produces sebum, an oil and wax mixture produced to hydrate the skin and prevent dehydration. Overproduction of sebum and the enlargement of the sebaceous glands contribute to acne formation also.

Once oxygen is cut off in the pore due to pore blockage, the normal bacteria that healthfully sit on the skin’s surface will instead colonize the blocked pore, and thrive in the now anaerobic environment, which brings in additional pro-inflammatory immune cells.

If inflammation is severe enough, the underling hair follicle can rupture and damage the surrounding tissue, presenting as redness and swelling on the skin’s surface. Deeper damage can present as a cyst, with the potential for scarring.

Role of hormones

Now that we understand a little more about how acne develops, we can take a look at how food affects the key hormonal players to either promote or hinder acne development.

The hormone testosterone plays a role, as increased levels of the hormone also increase growth of acne and can lead to excessive sebum production. It is not, however, the absolute amount of testosterone circulating in the blood, but instead the rate at which testosterone is converted to its more active form, dihydrotestosterone (DHT).

The enzyme 5-alpha-reductase, existing in the skin, is responsible for this conversion, and people who have higher enzymatic activity of this enzyme also have greater acne development. A high protein diet has been shown to slow the activity of this enzyme.

In addition, newer resources cite insulin’s role in acne development via two hormones: insulin-like growth factor binding protein 3 (IGFBP-3) and insulin-like growth factor 1 (IGF-1).

Both of these growth factors are impacted by insulin to affect the development of acne, and each play a specific role in the pathogenesis. IGFBP-3 increases the rate of apoptosis, while IGF-1 stimulates cell growth and proliferation.

Insulin decreases IGFPB-3’s availability to the cells, an undesirable outcome since apoptosis is needed to maintain normal rtes of sloughing off; while insulin increases IGF-1, further exacerbating the hyperkeratinizaiton problem leading to a blocked pore.

Dietary Recommendations

It is important to understand the pathogenesis of chronic acne, as well as the key metabolic players like testosterone and insulin, to be able to treat the condition through food elimination and dietary manipulation.

Seventy-percent of the standard American diet consists of a combination of refined oils, refined sugars, grains and dairy. Insulin release is higher when consuming refined sugars, grains and even the low-glycemic dairy. Thus, it is advisable to avoid all processed, refined grains and cereals, refined sugars and all dairy (cheese, milk, whey, etc) to control insulin release.

A study published in the Journal of the American Academy of Dermatology (Smith et al., 2007) concluded that acne sufferers who undergo a low GI diet have significantly reduced lesion incidence versus a group undergoing a high GI “traditional” diet.

And more recently, a study published in the Journal Molecular Nutrition & Food Research (Smith et al., 2008) showed that a low glycemic load diet significantly reduced biochemical markers for acne development (such as insulin, sex hormone binding globulin, IGF-1, etc) in as little as seven days on a low GI diet.

Systemically pro-inflammatory foods like fatty meats, refined vegetable oils and alcohol will affect the inflammation associated with acne also, and should be limited. Choose foods that contain higher relative amounts of omega-3 to omega-6 unsaturated fatty acids, like walnuts, flaxseed and wild Alaskan salmon to reduce inflammation further.

Another food component that could impact acne development is lectin, made up of protein or a combination of proteins and carbohydrates and are found frequently in grains, beans and legumes. Although many believe these food components are minimally absorbed, they are, in fact, absorbed in the gut via EGF receptors.

In the bloodstream, they can bind to certain enzymes that hinder the breakdown of connections between skin cells, increasing cellular adhesion, hindering sloughing off, and blocking the pore. Thus, it may be advisable to avoid the legume/nut family (except for walnuts).

To lower your risk of developing chronic acne or improve current acne, eat the following:

• High amounts of low glycemic index fruits and vegetables
• Organic poultry and lean beef (grass-fed is better since it is higher in omega-3s)
• Lean cuts of pork and eggs (mostly whites, though 1-2 yolks/day are okay)
• Wild salmon and white fish
• Walnuts, and olive and avocado oils
• Grain products on the whole should be avoided, though for extremely active individuals, small portions of lower GI carbs like oat bran and yams can be eaten in moderation

Skinned Almonds not as disease-fighting as natural almonds – choose almonds in their natural state over skinned or slivered almonds. Ideally, eat raw, organic almonds. Add them to green salads, potato salad, rice and even meat dishes, even if you don’t like the taste of eating these nuts straight out of your hand.