Many thanks for your question regarding your client who is experiencing worsening acne symptoms and heavy periods. You mentioned you have undertaken a SIBO test. I suspect there is a gut infection in the colon and as the low FODMAPs diet has helped to some extent I suspect she has bacterial dysbiosis in the colon.
Acne can have a number of triggers including a hormonal one. While acne is typically thought of as a condition of our teenage years the fact is millions of adults are also afflicted. Acne is estimated to affect more than 50% of women aged 20 – 29 and more than 25% of those aged 40 – 49 years.
Contrary to popular belief, acne is not due to poor hygiene but results from a number of underlying imbalances within the body. By targeting these triggers with specific treatments, nutrition and lifestyle changes you can improve the acne long term.
Blemishes arise when hair follicles in the skin become blocked with oils and particles such as dead skin cells and bacteria. Sebaceous glands attached to hair follicles secrete an oil-based substance known as sebum. Sebum normally helps moisturize skin and keep it supple. However, when there is excess sebum produced, the follicle can become blocked. Sometimes, bacteria called Propionibacterium acnes that normally reside in the skin interact with the sebum trapped in a clogged follicle and lead to inflammation. So, anything that clogs pores, leads to the rapid division of skin cells, and/or creates or worsens infection and inflammation will contribute to blemishes.
What Makes Acne Worse?
Hormonal imbalances and in particular excess production of testosterone and subsequently dihydrotestosterone (DHT) can increase the amount of sebum. This is one of the reasons why acne is more common in adolescence. It also explains why women may notice an outbreak just before their monthly period as levels of hormones fluctuate. Stress can also play a role. Cortisol, one of our stress hormones interferes with blood sugar and causes the sebaceous glands to produce more sebum. Stress can also lead to hormonal imbalances worsening ongoing symptoms.
The food we eat and our body’s fat cells also play a role in sebum production, hormones, and inflammation. There has been much debate about the role of diet and development of acne.
The first thing to watch is foods high in carbohydrates. In particular, quick releasing carbs (e.g fruit juices, cakes, alcohol, biscuits, sweet foods, refined white grains) and processed foods as these lead to a sudden rise in blood sugar and the production of excess insulin. This results in the production of certain growth factors particularly insulin like growth factor (IGF-1) that stimulate sebum production, encourage skin cell manufacture and exacerbate hormone imbalances that underlie acne. A switch to slower releasing carbohydrates like wholegrain rice or quinoa or starchy vegetables such as sweet potato, carrots and beetroot is recommended.
For some people, dairy produce is known to aggravate acne. Milk is a direct source of hormones and a number of growth factors including IGF-1 which can stimulate sebaceous glands, promote more insulin in the body and alter skin cell production. Simply switching to a milk alternative such as almond or coconut may lead to improvements.
The type and quantity of fat in your diet is equally important. Certain fats particularly saturated and hydrogenated fats; such as those found in red meat, dairy products and processed foods are known to promote inflammation. Conversely a diet rich in omega 3 fats (found in oily fish, certain seeds and nuts) can lower inflammation and improve overall skin health.
On top of this, a high toxic load can clog up the liver, putting extra pressure on the detoxification function of the skin, as well as interfering with your liver’s ability to do its other jobs, such as processing hormones. This may explain why there appears to be a link between a healthy gut and good skin. Having an optimal level of beneficial bacteria supports digestion, detoxification and prevents harmful bacteria to flourish which can promote inflammation. By removing processed foods and adding in fermented foods like kefir, sauerkraut and kimchi you will not only support a healthy gut flora but also help improve your skin too. In view of the suspected gut infection I would consider using anti-microbials for 4-6 weeks to see if this improves her skin. Long term, the Low FODMAPs diet is not appropriate as it will actually decrease beneficial bacteria and reduce short chain fatty acids like butyrate. This can then lead to a vicious cycle of symptomology within the gut and the development of bowel conditions.
Another group of foods to consider is gluten grains (wheat, barley and rye). These are known to promote inflammation and cause the production of insulin and insulin-like growth factor called IGF-1. The result is the production of more male hormones, which cause your pores to secrete sebum, that attracts acne-promoting bacteria. Simply removing gluten grains for a month may lead to noticeable improvements in the skin.
Here are some references on nutrition and acne:
Collier CN, Harper JC, Cafardi JA, Cantrell WC, Wang W, Foster KW, Elewski BE. The prevalence of acne in adults 20 years and older. Journal of the American Academy of Dermatology. Jan 2008;58(1):56-59. https://tinyurl.com/yalayzvs
Bellew S, Thiboutot D, Del Rosso JQ. Pathogenesis of acne vulgaris: what’s new, what’s interesting and what may be clinically relevant. Journal of drugs in dermatology : JDD. Jun 2011;10(6):582-585. https://tinyurl.com/y8fkkmyy
Dawson AL, Dellavalle RP. Acne vulgaris. BMJ (Clinical research ed.). 2013;346:f2634. https://tinyurl.com/y8xyxwyd
Burris J, et al. Acne: The Role of Medical Nutrition Therapy. J Acad Nutr Diet 2013;113:416-430. https://tinyurl.com/ycpmjb7n
There are some key nutrients that may be helpful.
Zinc is a mineral with several properties that may help relieve acne. It is known for its anti-inflammatory and antioxidant actions and antibacterial effects against P. acnes. It also helps balance hormones and reduces the production of sebum. Good sources of zinc include seafood, nuts and seeds especially pumpkin seeds and mushrooms. Zinc is also effective when added to topical solutions for acne.
Niacinamide is a compound derived from niacin (vitamin B3). It is known for its anti-inflammatory action within the skin and appears to reduce spots as well as improve healing. Niacin rich foods include fish, seafood, poultry, peanuts and beef.
Vitamin A is often used topically in creams to improve skin health and is a crucial vitamin for improving skin health and lowering inflammation. Try and include vitamin A rich foods such as liver, eggs and tuna and those rich in beta carotene a precursor to vitamin A. Good sources include sweet potato, butternut squash, pumpkin, carrots, apricots, leafy green vegetables. Please note as your client is on Isotretinoin she should NOT take vitamin A as a supplement.
Selenium is an important antioxidant mineral involved in the production of another potent antioxidant called glutathione. Poor levels of selenium in the soil, inadequate intake can all lead to minor deficiencies which can affect our skin health. Selenium can be helpful for healing scars and lowering inflammation. Fish such as cod, tuna, halibut, sardines, and salmon are excellent sources, along with eggs, liver and meats like turkey and lamb. Brazil nuts are also a rich in selenium, and just two brazil nuts a day will give you the 200 micrograms necessary for an adequate intake.
Vitamin E is the most abundant fat-soluble antioxidant found in the skin. It is secreted on the skin surface through the sebum and is important for protecting our skin. It’s also a potent anti-inflammatory agent. Good sources include nuts and seeds so try and eat a handful each day.
Pantothenic acid, a B vitamin has been shown to support wound healing, especially when applied topically, by improving the regrowth of cells when injured. It can be particularly useful for improving appearance of skin if there is scarring.
As well as your diet there are some simple steps you can take to help acne.
Excess oils on the skin, either naturally-produced or derived from oil-based moisturizers, cosmetics, or hair products can exacerbate acne – so switch to oil free products.
Scrubbing or rubbing your skin is not recommended, as it could spread the bacteria making your skin worse. Scrubs, however, can be more of a preventative measure to ensure follicles stay free of sebum and dead skin cell debris.
As stress may lead to a breakout or worsen your acne it is important long term to make changes to lifestyle to address ongoing stress.
Wash face gently with unscented, oil-free cleansers and keep skin clean.
Use only oil-free moisturisers.
Use cosmetics sparingly. Use only hypoallergenic, oil-free cosmetics.
Resist the urge to squeeze, scratch, or pick at acne lesions.
In view of her heavy periods you may wish to look at whether there are other underlying imbalances – for example I presume your client has been checked for fibroids and PCOS for example. Hormone balancing may be appropriate and as she is keen to stop medication there may some additional considerations – I would not recommend any glandulars while she is on contraceptive pill but these could be considered after she stops. You could, however, look at including phytoestrogen rich foods – fermented soya like tempeh, natto and miso. I would also include soy beans, flaxseed, chia seeds, beans and legumes – although at the moment these may bloat her too much. Include a detox green formula may be helpful as well. If she does has bacterial dysbiosis then you may find beta glucoronidase is high – this is included in certain stool testing. In which case, tackling the bacteria imbalance and adding in calcium-d-glucarate can be helpful. If she experiences cramping and pain then I would consider a formula of calcium, magnesium and potassium. I would also consider blackcurrant seed oil or evening primrose oil.
The following supplements are suggested for you to consider in light of your relevant expertise and intimate understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.
Anti-microbial support for bacterial imbalances
ADP Oregano (BRC) – take 3-4 with each meal – https://tinyurl.com/hdjg9c5
PMT (BRC) (does not contain glandulars) – take 2 at each meal
Blackcurrant Seed Oil (BRC) – take 1 three times daily
Ca-D-Glucarate (BRC) – take 2 twice daily
Bio-CMP (BRC) – take 3 at each meal or when pain is bad – https://tinyurl.com/y9xr5o9t
Pro Greens (ARG) – take 1 scoop twice daily – https://tinyurl.com/gtqgbyo
Zn-Zyme (BRC) – take 1 daily – https://tinyurl.com/lnlffjd
I hope this helps with your client
Registered Nutritional Therapist Helen Perks is collaborating with Clinical Education to bring you the first-ever Functional Medicine book club for Practitioners.
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