- Sebum overproduction
- Hyperkeratinization of the follicle
- Increase in pro-inflammatory mediators
- Microbes on the skin
- Oral and topical antibiotics have been used a treatments for decades
- Overactive androgen hormones
- High levels of IGF-1 (insulin-like growth factor 1)
- Depression, anxiety, & other mental health disorders
- GI symptoms 37% more likely (bad breath, reflux, bloating, constipation) (5)
- Low stomach acid (up to 40% of people with acne) (6)
- This also increases their risk of developing SIBO
- Trial a dairy-free diet
- MRT/LEAP to address possible food sensitivities (7)
- Zinc supplements if deficient
- Lower glycemic diet (high glycemic diet may be an acne trigger) (8,9,10)
- Rule out PCOS
- Sometimes allergies (IgE) can also be triggers (nuts, dairy, etc.)
- Check topical products as well (lotion, makeup, etc.) for reactive ingredients (based on MRT results)
- Probiotic to improve gut health (may take 8-12 weeks to see improvements) (11,12,13,14)
- Assess for low stomach acid (linked to acne)
- Evaluate for celiac disease
- Check vitamin D status
- Consuming enough omega-3’s? (Want to be in balance with omega-6 intake) (15,16,17)
- Monitor the relation to the menstrual cycle, to see if it consistently appears at certain times (may be hormonal)
- Stop taking whey protein powder, as it may cause acne in some people (18,19,20,21,22,23,24,25,26)
Supplements to consider:
- Zinc Balance by Jarrow – balances zinc & copper so you don’t accidentally cause a deficiency in the copper through zinc supplementation. 1 capsule per day with food.
- Probiotics – could help some people, or be an acne trigger in others. Very individual.
- No standardized recommendations on strains yet, but having a balanced microbiome should help the gut-brain-skin axis & reduce acne risk.
- Strains found to be beneficial in studies include Lactobacillus casei and a 4-part combo of Lactobacillus helveticus, Bifidobacterium infantis, Bifidobacterium bifidum, and a short-chain fructooligosaccharide (FOS).
- LactoPrime Plus may be a good one to try (contains B. infantis, B. bifidum, and L. casei).
- Fish oil supplements (27) – but response seems to be very individual. May help some and make it worse for others.
- 3g daily, containing 930mg EPA for 12 weeks helped improve severe acne, but made mild acne worse in some people.
- Nordic Naturals Ultimate Omega is a good option, but would need 5 softgels/day to reach the levels used in the study above.
- Topical green tea extracts may help reduce sebum production & acne severity (28,29,30,31)
- Curcumin (from turmeric), either in supplement form or applied topically, may help improve acne (32).
- Pure Encapsulation’s Curcumin with Bioperine is a high quality choice.
- Vitamins A, D, & E, as needed.
- Try to get a “before” picture for comparison.
- If see good improvements, can ask for a testimonial with pictures.
- Some people report that a gluten sensitivity is what triggered their acne.
- When removed gluten, cystic acne disappeared in a few months (when previously, even Accutane didn’t resolve it).
- If it is diet-related, improvements usually seen in the first 10 days, then continues to get better from there.
- Many testimonials of people seeing acne improvements.
- If it doesn’t improve w. LEAP, you can at least rule out food-related inflammation as a major trigger, and dig into other possibilities.
MRT testimonials w. permission to share:
“Dr. Andrew Grade, my GI specialist, recommended that I see Alyssa. I was having all sorts of GI problems; but the cystic acne that I was experiencing was bothering me the most with no remedy or end in sight for at least the past ten years.
I had tried Murad, ProActive, dermatologists since age 14, and aestheticians, none could put their finger on anything that could help my cystic painful acne. Also, my parents had prayed for years that something would help me with this cystic acne.
Finally, Alyssa came into my life! Alyssa told me about the food sensitivity testing that was available that I had heard nothing about before. She said that sometimes it is the food that we are sensitive to that causes cystic acne. I let her know that I certainly wanted to find out if this was the culprit.
We found out with the sensitivity testing that I am sensitive to a whole host of ubiquitous foods, such as, coffee, vanilla, almonds, cucumber, mushroom, watermelon and raspberries to name a few. My PCP saw the list and said that she would have cried if she had this list; but I was just thankful that there was a reason for my cystic acne that had plagued me for years that then started going away once I avoided these foods.It was a total miracle!
My aesthetician and dermatologist were shocked to put it mildly! I was shocked as well because when I would literally have a few slices of mushroom or cucumber on my salad, a big painful cyst would appear the next day. I always thought food had something to do with it; but I thought that it was just dairy or chocolate; but I found out that I could eat greek yogurt without a problem. It was the cheddar that I needed to avoid. Talking about pinpoint accuracy!
I would without hesitation recommend Alyssa to anyone suffering from the pain of cystic acne. I have already! She truly is a God-send!!! She has changed my life! I now don’t feel the need to hide my face behind a paper bag when looking at people. Wow what a difference she has made! Also, my GI symptoms are much better.”
Nutrient Deficiencies & Acne
- People with acne found to have lower levels of vitamin A, vitamin E, and zinc compared to control group (33).
- Severe acne group had lower vitamin E and zinc levels than the mild acne group.
- Acne severity negatively correlated with plasma vitamin E & zinc levels. (higher levels = less severity of acne)
- Both zinc gluconate and antibiotics have been shown to be effective at reducing acne, but antibiotics were 17% more effective than zinc at 3 month follow-up (but both groups showed improvements from baseline) (34).
- Can test through Spectracell to see if deficient in these nutrients.
Diet & Acne:
- Dietary factors that may affect acne: dairy intake, high glycemic load diet, and inadequate omega-3 intake. Dairy has the strongest link and strength of evidence (35).
It increases blood sugar levels, which then increases insulin levels.
Insulin increases the activity of androgen hormones & boosts levels of IGF-1, which spurs acne development. This is because androgen hormones and IGF-1 boost sebum production and increase cellular growth rates. Too much sebum & too many skin cells = clogged pores and greater chance of acne.
Some research is also investigating how diet can affect acne development on a genetic level, by stimulating FoxO1 and mTORC1 genes, which control androgen hormone signaling, sebum production, immunity, antioxidant responses, and cellular growth – all of which play a role in acne (39,40,41).
Theoretically, a 30-60 day ketogenic diet may be beneficial by reducing the pathogenic mechanisms of acne and restoring proper hormonal status (42).
How does dairy contribute to acne?
Does chocolate cause acne?
One study gave acne sufferers a capsule filled with 100% cocoa powder, and found that acne lesions increased… but the “placebo” capsule contained hydrolyzed gelatin… which doesn’t seem like a great control substance since gelatin could potentially improve gut health! (60).
Mechanisms are totally unclear, but one study found that chocolate increased the immune system’s response to acne-causing bacteria on the skin… so perhaps that could play a role (61).