Let’s face it: we all have health issues, however mild they may be. Some health issues are more visible than others, and it is these health issues that often cause the most anxiety. Acne is one of those relatively benign conditions that gets displayed to the world; consequently, it is one of the most distressing.
Obviously, acne can be a normal and transient phenomena connected to shifts in hormone levels during puberty. But acne that lingers into adulthood is a symptom that can be persistent and hard to treat. There are long-term negative side effects from medications such as Accutane used in the conventional treatment of acne. These include development of bowel diseases such as Crohn’s, liver damage, depression, and miscarriage and other birth defects if taken during pregnancy. This leaves adults who suffer from chronic acne faced with two choices: take health risks with current medications, or take the time to get to the root of the causes of their acne.
Personally, I think the silver lining of acne is that an individual can use this symptom as a barometer of measuring how well they are doing in bringing their body back to a state of balance. So what are some of the root causes of acne? And what are some natural treatments that can help? A common theme of most forms of acne is gut imbalance and hormonal imbalances.
In Chinese medicine, we describe acne as “toxic heat and phlegm at the skin level”. The word “heat toxins” in Chinese medicine refers to bacterial or other microbial infections that lead to inflammation, and can be visibly seen as abnormally red or pink discoloration. “Phlegm” refers to any build up of abnormal thick and viscous fluid in the body. We will typically ask a patient with acne to remove foods that contribute to phlegm and heat (inflammatory) build up in the body, such as dairy, sugar, alcohol, peanuts, coffee, wheat, spicy food, chicken, shellfish, and fatty/greasy foods. It is interesting to note that many of these traditional foods to avoid for acne are also common allergens.
While removing these foods may help and in some cases even significantly clear up the acne, many adults with chronic acne will need to work more deeply on gut repair and/or hormonal balance. Acne on the face is more indicative of a hormonal imbalance, whereas acne on the chest, back and shoulders is often due to bacteria and fungi on the surface of the skin and in the bloodstream in addition to occluded pores. Adding antimicrobial herbs or substances both internally and topically can be helpful in managing this type of infection.
But how did the abnormal microbes get there in the first place? Isn’t that part of the real issue, and the acne simply a signpost? The reason abnormal microbes make their way into the bloodstream is usually through a common modern gut imbalance called leaky gut syndrome. Leaky gut syndrome occurs when the spaces between the microvilli (tiny cells that comprise the epithelial lining of the small intestine) widen so much that small food particles and microbes that normally are only present within the digestive tract are able to directly enter the bloodstream. There are many reasons why this is occurring, but suffice it to say that both our modern age of drugs and antibiotics, and our excessive exposure to gluten in both food and topical products, are two major contributing factors.
As if healing the gut weren’t complex enough, hormonal changes also contribute substantially to acne break outs. Any woman can tell you that when she is emotionally stressed, often the first place it shows up is through menstrual or premenstrual issues: bloating, emotional lability, acne. Elevated levels of stress cause the body’s adrenal glands to overproduce a hormone called cortisol, which raises blood sugar and blood pressure levels; excess blood sugar will contribute to the proliferation of microbes circulating in the bloodstream if the woman has leaky gut syndrome.
More significantly, since the adrenal glands produce both cortisol and sex hormones from the same mother hormone called pregnenolone, the overproduction of cortisone can lead to an imbalance in the sex hormones. In addition, abnormally high levels of cortisol will directly contribute to a restless and poor quality of sleep, negatively affecting many important systems, including neurological, immune, digestive, and endocrine (hormonal). Managing stress therefore becomes a critical component of hormone balance and acne reduction. This is one area where acupuncture can contribute significantly to acne management.
Polycystic Ovarian Syndrome (PCOS) is a complex hormonal imbalance involving higher than normal levels of testosterone and androgens. Women with PCOS often exhibit symptoms related to excess androgens, including hirsutism or the growth of excess facial or body hair, irregular or absent menstrual periods, excessive production of oil in the sebaceous glands resulting in acne, insulin resistance (elevated blood sugar), high blood pressure, and alopecia or thinning hair on the head. In these women, bringing down levels of testosterone and other androgens, balancing blood sugar, and eating an anti-inflammatory (low carb) diet is critically important in clearing up acne. Most women can safely manage PCOS with diet, exercise, and natural herbal and supplement therapies. If you suspect you might have PCOS, it is important to get confirmation with your doctor with an ultrasound and lab testing.
Since hormones are processed in the liver, it makes sense that optimizing liver health would be an important factor in addressing chronic acne. Other signs of a sluggish liver might include a tendency to allergies, fatigue, frequent waking between 1-3am, moodiness, dry and itchy skin, red and itchy eyes, and poor digestion with a tendency to constipation. I recommend that everyone complete a liver cleanse once or twice a year; in Chinese medicine the liver is most active in the spring, and this is the best time. We can provide suggestions for a 2 or 4 week food-based liver cleanse at DCA or you can find different types of liver cleanses online. Foods to include on a year-round basis to support liver health include cruciferous vegetables, beets and beet greens, and turmeric. To read more about liver health, check out our article on Liver Qi Stagnation here and our article on allergies and liver here.
Finally, there are numerous scientific studies connecting acne with nutritional deficiencies. Important deficiencies affiliated with skin health include zinc, vitamin A and E, vitamin B3, B5 and B6, as well as selenium and copper. Supplementing with these nutrients can be an effective way to help reduce acne. In this article I’ll discuss two: zinc and B5, specifically pantothenic acid.
Zinc has been one of the most studied natural treatments for acne; several clinical studies have shown a correlation between zinc deficiency and a tendency to acne. Zinc reduces activation of keratinocytes--cells that produce keratin, a tough protein that binds skin cells together. Too much keratin prevents cells from separating, leading to blocked pores. Zinc has antibacterial and anti-inflammatory properties, and additionally is a mild DHT blocker, meaning it reduces the effect hormones have on skin. Although clinically, modern-day antibiotics have been shown to be more effective in treating acne than zinc, several studies show zinc’s effectiveness to be about on a par with antibiotics of the 70’s and 80’s. More bioavailable forms of zinc work best, including chelates of zinc, and zinc picolinate.
High dose pantothenic acid (formed with two B5 molecules and sulfur) has also been used to successfully clear up acne and improve skin quality. As in the case of PCOS, elevated testosterone in both males and females is associated with increased oil production in the skin, resulting in acne. This increase in oil production occurs within the sebaceous glands at the root of the hair follicles. Both Accutane and pantothenic acid work by two different mechanisms on reducing this oily buildup: Accutane shrinks the sebaceous glands while pantothenic acid directly reduces the oil production of the glands.
Pantothenic acid is a major component of Co Enzyme A (CoA), which is used at the cellular level for fatty acid oxidation and energy production. The more CoA, the more fatty acids can be metabolized (oxidized or burned for energy production); if there is a deficiency, the oxidation of fatty acids slows down, and the skin becomes oily. Taking vitamin B5 or pantothenic acid, is the quickest way to increase CoA, and the rate of fatty acid metabolism. The doses of pantothenic acid required to have a visible effect on acne are large--5 to 10 grams--which can cause uncomfortable symptoms, including gastrointestinal gas and bloating. Fortunately, when combined with L-carnitine (which transports fatty acids across the mitochondrial membrane where they can be oxidized), the dose can be dropped to around 2.5 grams per day, eliminating symptoms. An additional bonus to supplementing with this duo is increased energy metabolism and consequent weight loss.
At our apothecary here at DCA we carry Acnutrol by Designs for Health, which contains all the nutrients described above in the doses that are optimal for acne resolution. A topical Acnutrol gel additionally contains antimicrobial compounds for faster results. Other supportive therapies include acupuncture, which helps to clear inflammation and increase circulation in the affected areas, and facials designed for clearing up acne.