Our skin is a reflection of what’s going on with our health beneath the surface. Skin problems are signals that something is off in our body. Conventional medicine deals with symptoms, unlike functional medicine, which addresses the root cause of the issue - which can be due to numerous factors, including nutrition, stress, toxicity, inflammation and hormonal and gut imbalances.
An extensive number of studies now confirm that acne is a manifestation of several underlying root causes, such as hormonal imbalances, gut inflammation, food sensitivities, nutritional deficiencies and stress. In this post, I explain these underlying root causes in-depth, as I believe having this information is empowering and allows you to take actionable steps towards addressing your acne.
HORMONAL IMBALANCE
First, identifying which hormone - or hormones - is out of balance needs to be prioritised, followed by determining why they’re out of balance. 1. ESTROGEN DOMINANCE
Estrogen and progesterone work like two sides of a seesaw that move up and down throughout the body’s hormonal cycle, and a delicate balance between the hormones is required to maintain health. A disruption in the estrogen to progesterone balance can mean that you have normal estrogen and low progesterone, or high estrogen and normal progesterone. Chronic estrogen dominance can be one of the main causes of acne. Estrogen dominance can be caused by:
A missing co-factor for an enzyme that breaks down the active form of estrogen into an inert form, resulting in excess estrogen levels circulating in the body.
Exposure to environmental toxins that mimic estrogen (called ‘xenoestrogens’, such as those found in plastics, make-up, processed foods and pesticides).
2. ELEVATED ANDROGENS Testosterone is strongly associate with acne. Women with elevated testosterone typically have a higher conversion rate to dihydrotestosterone (DHT), a more potent androgen that will ultimately cause clogged pores. It is also responsible for male pattern hair-loss in women and hirsutism (excess hair in undesired parts of the body). Excess testosterone can be caused by Polycystic ovarian syndrome (PCOS), a genetic mutation and chronic elevated cortisol.
NUTRITION
What’s the truth about a poor diet causing acne? Do dairy and sugar cause acne? You might be wondering ‘Why me? I eat a healthy diet and I still have acne! And somehow, my friends who eat junk food and drink alcohol, don’t!’
The three most common dietary triggers for acne include sugar, dairy and gluten. When I first begin working with a client who presents with acne, I strongly advise removing these foods from their diet and see what impact this has on their acne. Sugar, including natural sweeteners like coconut sugar and honey, can contribute to a poor complexion by feeding the bad bacteria in your gut. Wheat and certain grains also contain amylose sugars and similar proteins to gluten that can continue to perpetuate gut dysfunction and increase gut permeability.
Dairy is another significant contributor to acne, especially cystic acne. Dairy products contain a hormone called insulin-like growth factor-1 (IGF-1). This hormone is found in milk derived from all species including cow, sheep and goat. The IGF-1 hormone can mimic our own endogenous insulin, and can therefore signal our ovaries to produce testosterone. This excess testosterone then promotes the development of acne.
While there are no direct studies evaluating the impact of gluten on the development of acne, anecdotally speaking, I have witnessed my clients experience an improvement in their acne after beginning a strict gluten-free diet. In addition, numerous studies have now described the inflammatory effect of gluten on the skin. In fact, gluten sensitivity is associated with skin conditions such as dermatitis herpetiformis, psoriasis and eczema. It is believed that this same underlying inflammatory mechanism is the causative factor for acne in individuals presenting with a gluten sensitivity.
Nutrients that are vital to skin health include vitamin A, vitamin D, omega-3 essential fatty acids and zinc. A deficiency in any of these nutrients can promote the pathogenesis of acne.
DETOXIFICATION
Your body has sophisticated detoxification pathways, made up of your liver and gallbladder, kidneys and urinary tract, bowels, lungs, lymphatic system and skin. Each of these organs plays a critical role in keeping hormones in balance. Here are some ways that hormone imbalances can arise from suboptimal detoxification:
The liver isn’t able to break down and eliminate hormones and xenoestrogens effectively, resulting in more potent/toxic forms of estrogen and testosterone.
The gallbladder isn’t producing enough bile to take hormones from the liver and send them to the bowels for elimination - leading to excess hormones in circulation.
Constipation leads to re-absorption and re-circulation of toxic, broken-down hormones into the bloodstream.
Dehydration can limit the urinary system to excrete extra hormones.
Reduced detoxification in the lymphatic system and skin.
In the Functional Medicine model, the body’s function is viewed in light of seven fundamental systems. Bio-transformation and elimination is the system in which your body interacts with your nutritional inputs and then converts the waste products of metabolism into non-threatening inert compounds that can then be excreted from your body. We need to pinpoint what is under or over-performing to determine what treatment is required. Whether to support digestion, eliminate constipation, provide botanicals and nutrients to support the liver’s ability to break down and eliminate hormones or to ensure the person is well-hydrated.
STRESS AND SLEEP
Skin is a hormonal organ, and there’s some research to suggest that stress can influence how local androgens in the skin - like testosterone - behave. Chronic stress can cause imbalances to the reproductive system due to the over function of the adrenal glands, which secretes cortisol and DHEA. Poor sleep disrupts the circadian rhythm, which adds to stress in the body. Sleep hygiene and stress management are fundamental in balancing cortisol; otherwise it will be at the expense of progesterone.
GUT HEALTH AND DIGESTION
Your microbiome is a unique collection of microbes that live on your skin and in your body that influence your digestive health, immune health, brain health, skin health and more. Your microbiome is unique to you - just like your genetics. Disrupting the microbiome by using antibiotics can have long term consequences for your health. With chronic antibiotic use, it’s now thought that your microbiome may never fully recover to its natural state Gut-related factors can contribute to the production of acne due to the gut-immune-skin axis. It can be influenced by:
An imbalance in intestinal gut flora.
Immune cells that live in the large intestine are sent to the skin if it’s exposed to an allergen. Once in the skin, the immune cells cause inflammation that can impair the skin’s integrity, allowing for bacteria to enter and spread
Small intestinal bacterial overgrowth (SIBO) - a condition where bacteria normally found in the large intestine start to form presence and grow in the small intestine. This can cause bloating, constipation or diarrhea, skin breakouts, and food sensitivities.
If there are potential imbalances in the digestive system, certain functional tests can be used to determine the state of your gut health, the GI360 can be useful to look for dysbiosis and gut issues, I order for my clients via Nordic Labs.
Intestinal hyperpermeability (leaky gut) causes proteins from foods can enter the bloodstream, which triggers an immune response and hence systemic inflammation. Another common issue is low stomach acid or Hypochlorhydria, where proteins aren’t able to be broken down effectively. In fact, as many of 40% of acne sufferers have been shown to have low stomach acid levels (1)
NATURAL vs CONVENTIONAL TREATMENT Most people will go to a GP or a dermatologist; the conventional approach to acne usually revolves around the oral contraceptive pill, Roaccutane (isotretinoin), or antibiotics. I am not discarding these options; some of these do work for solving acne, however the effects can be short term and with their risk of side effects.
THE ORAL CONTRACEPTIVE PILL The pill is often prescribed to women because their acne coincides with either an irregular menstrual cycle or heavy bleeds, or they have skin flare-ups around their period. The way the pill works is that it masks a woman’s natural hormonal environment. As hormonal imbalances are often the cause of acne, if you took away the pill, the acne would return. So, the pill is masking the problem of acne, rather than solving it. This is a catch 22 situation of wanting to get off the pill so they can fall pregnant, yet they don’t want their acne to come back. So the pill doesn’t solve acne; it just puts it off for a while. ROACCUTANE Roaccutane is a synthetic derivative of Vitamin A. It significantly reducing sebum/oil production in the skin, and the overproduction of keratin, to stop pimples from forming. One of the well-known side effects of Roaccutane is liver damage. It also causes severe dryness in the lips, mouth and nasal passages.
Roaccutane can be a short term solution. Many people have taken a course of the drug three or more times, and the acne keeps returning. So Roaccutane isn’t a one size fits all solution. ANTIBIOTICS Antibiotics are typically prescribed for acne for a 6-12 month period, to target the bacterial strain, Propionibacterium acnes (Corynebacterium acnes) (2), that’s been identified as the microbe involved in inflammation in acne. We want to make sure that your gut environment is clean/symbiotic enough that to cannot host the bacteria involved in acne formation.The thing with antibiotics they wipe away many strains; which can influence the diversity and the entire health of the microbiome.
THE FUNCTIONAL APPROACH TO ACNE
1. Quit the skin-damaging foods and balance your blood sugar by eating a primarily whole foods, color and diversity.
2. Discover your food intolerances by giving the elimination diet a try.
3. Tap into the power of adaptogens with your practitioner; such as holy basil and pearl powder.
4. Plug in your nutrient deficiencies - especially vitamin A, Bs, Zinc, and D.
5. Heal your microbiome and check for leaky gut.
6. Support your methylation and detoxification pathways
7. Invest in a DUTCH test and look extensively at your hormones.
8. Take Swedish bitters to build up low stomach acid production, fermented cod liver oil for a boost in vitamins A, D, and K2 to help heal your skin, and turmeric to calm inflammation.
9. Consciously de-stress and work on regulating your circadian rhythm.
10. Reduce exposure to xenoestrogen and other endocrine disrupting chemicals .
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