“I still have acne even though I’m an adult,” writes this week’s House Call contributor. “Do I need to take antibiotics and put all these drugs on my face? Is there another approach to take?”
Studies show acne can place a heavy emotional and psychological burden on patients that possibly surpasses its physical impact. Researchers find acne’s toll can increase anger, fear, shame, anxiety, depression, embarrassment, bullying and stigmatization within peer groups. 
The Rise of Adult Acne
While acne affects more than 85 percent of teenagers, this skin condition has also increased among adults. In fact, some eight million people visit the dermatologist every year for their skin. We spend over a billion dollars for prescriptions and over-the-counter (OTC) products to cure acne, yet at best these are short-term solutions. 
Conventional medicine deals with symptoms, so their solutions for acne include slathering on potions and lotions, popping and picking pimples and taking antibiotics or strong liver-damaging medications.
There’s got to be another way, right?
Fortunately, there is with Functional Medicine, which addresses the problem’s root cause. From this lens, we can understand that numerous factors contribute to acne, including nutritional status, stress, toxicity, inflammation and hormonal and gut imbalances.
That’s actually good news because it empowers us to make dietary and lifestyle changes that reverse acne and improve our overall health without the adverse side effects of pharmaceuticals and other invasive procedures.
My Struggle with Acne
I want to tell you my own experience with acne. I never had it. That is until I got sick with chronic fatigue syndrome. Chronic fatigue syndrome involves toxicity, gut damage, inflammation, hormonal imbalances, and stress, among other things.
I have told the story of my illness and recovery many times, but I don’t usually talk about the skin problems I had. My acne was triggered by a severe intestinal infection that resulted from an overload of mercury and stress.
Right away, my skin changed. My skin color turned gray, and I developed dark circles under my eyes. I started getting pimples all over my face (a new adventure for me at age 36), and strange rashes around my eyes whenever I ate certain foods. I even developed itchy red patches on different parts of my body.
So what did I do?
Well, I didn’t need creams, gels or lotions such as benzoyl peroxide, retinoid acid, salicylic acid, glycolic acid peels, or topical antibiotics (all of which might have helped symptoms a little bit).
I certainly didn’t need oral antibiotics (which can cause long-term gut complications, immune problems, and yeast overgrowth), or Accutane (which can cause liver damage and increase the risk of depression and suicide), or oral contraceptives (which I would have been offered had I been a woman).
While these are the tools of modern dermatology, they overlook the role of overall health in the health of your skin.
I didn’t need any of these things.
And that’s just what I did.
My pimples vanished, the skin around my eyes cleared up, and my rashes went away (along with my chronic diarrhea, disabling fatigue, brain fog, mouth sores, muscle pain and more).
A miracle? Hardly! I have seen this happen with so many of my patients.
A Different Way to Approach Adult Acne Treatment
Rather than attack acne through superficial solutions, Functional Medicine takes a roots-deep approach to acne and other skin problems. From that perspective, oxidative stress triggers inflammation, which in turn contributes to acne and a host of other problems.
Oxidative Stress and Acne
What is oxidative stress? Well, your mitochondria (which create energy to run your cells) are built to convert calories and oxygen into energy that the body can use called ATP (adenosine triphosphate).
Our cells contain a total of one hundred thousand trillion mitochondria, which consume 90 percent of our oxygen intake. This oxygen is necessary to burn the calories we eat in food.
But free radicals are produced as a by-product of this combustion, much like exhaust that comes out of the tailpipe of your car. These free radicals are dangerous because they damage or oxidize the molecules and cells throughout our bodies.
This damage is called oxidative stress. More damaged cells equal more oxidative stress or “rusting.”
This, in turn, leads to damaged DNA, damaged cell membranes, rancid or oxidized cholesterol (which is what truly makes cholesterol harmful), stiffened arteries that look like rusty pipes, wrinkled skin, and damaged brains.
We have our own built-in antioxidant factories that produce molecules that seek out free radicals and clean them up before they rust our bodies. But these systems are easily overwhelmed by a toxic, low-nutrient, high-calorie diet like the ones most Americans eat.
How Diet Causes and Cures Hormonal Acne
We can get more of these important antioxidant molecules if we eat the right foods. But most of us don’t.
The single most important controllable factor regulating the oxidative stress in your body is your diet. Eating too many calories and not enough antioxidants from colorful plant foods result in the production of too many free radicals, wreaking havoc on our bodies and our minds.
Oxidative stress, as I mentioned, creates inflammation. While some things including toxicity, allergens and nutrient deficiencies contribute to inflammation, the biggest culprit is a processed, sugary diet.
What you eat becomes the root cause of most acne. Along with a high-processed, high-sugar, high-dairy diet, studies show nutrition-related lifestyle factors can contribute to and exacerbate acne. 
In fact, if I could narrow down the culprits to two, they would be:
- Sugar (including flour). Sugar raises insulin levels, which promotes the production of testosterone in women, and inflammation in general, causing acne. Large randomized prospective controlled trials (the gold standard of medical research) found people who had higher sugar intake and a high glycemic load diets (more bread, rice, cereal, pasta, sugar and flour products of all kinds) had significantly more acne.
- Dairy consumption. Hormones (including growth hormones) in dairy contribute to acne. Two large controlled trials found cow’s milk increased both the number of people who got acne and its severity.
Other acne-triggering dietary culprits include processed fats like trans fats, which increase arachidonic acid levels and compete with omega-3 fats in the body, leading to more inflammation and acne.
But the big two – dairy and sugar (in all its blood sugar-raising forms) – cause spikes in certain pimple producing hormones. Dairy boosts male sex hormones (various forms of testosterone or androgens) and increases insulin levels, very similarly to sugar and starchy carbs, which quickly raise blood sugar and spike insulin.
Insulin resistance, the inevitable result of chronically elevated insulin levels, becomes bad news. It leads to hair growth on the face and body and loss of hair on the head in women. Many women also get acne and irregular menstrual cycles. For some, it manifests as polycystic ovary syndrome (PCOS), primarily caused by too much sugar, which becomes associated with acne among other problems.
While pimples are not as simple as too much milk or sugar, both have a significant impact on acne. The biggest factor affecting your hormones is the glycemic load of your diet (how quickly the food increases your blood sugar and insulin levels).
The Acne Diet
To reverse insulin resistance, inflammation and other acne triggers, you’ll want to eat a diet rich in omega-3 fats and fiber (to reduce testosterone in women), cut out sugar (to reduce insulin), and consume whole soy foods to help balance hormones.
Gut health certainly plays a role in skin health: Foods like gluten, dairy, yeast, and eggs can be problems if you have a leaky gut.
But many of these conditions trigger or exacerbate elevated insulin levels, knocking other hormones out of balance and contribute to inflammation, metabolic havoc and conditions like acne. Simply put, to get your acne under control, get your insulin levels under control.
10 Ways to Eliminate Acne
In my practice, I’ve seen numerous patients struggle with acne and other skin problems. I find these 10 strategies almost always remedy the issue without resorting to harmful antibiotics and other conventional therapies.
1. Go Low Glycemic
Cut out all sugar and processed food. Opt instead for whole, real, fresh foods, which tend to be lower glycemic. One randomized controlled trial showed a low-glycemic-load diet improved symptoms in acne vulgaris patients. 
2. Eliminate Food Sensitivities
3. Eat an Anti-inflammatory Diet
Foods like wild-caught fish, turmeric, ginger, green tea, dark purple and red foods such as berries, green foods like dark leafy vegetables, and barnyard-raised eggs all help reduce inflammation that contributes to acne.
4. Fix Your Gut
Taking probiotics (such as lactobacillus), prebiotics, and digestive enzymes can improve acne. Work with an integrative physician to correct leaky gut and other gut issues. I have seen serious cystic acne resulting from gut imbalances and parasites that resolve when the gut is fixed.
5. Stress Less
Chronic stress causes acne flare-ups by increasing inflammation and oxidative stress, raising cortisol and depleting zinc, magnesium, and selenium, which help control acne. Stress also causes poor dietary choices.
You can manage stress through meditation, yoga, saunas, massage, biofeedback, aromatherapy, and more. Relaxing is anti-inflammatory. My UltraCalm CD provides a great way to reduce stress and anxiety.
6. Address Nutritional Deficiencies
These include zinc, omega-3 fats, and some anti-inflammatory omega-6 fats like evening primrose oil, which can boost immunity, reduce inflammation and reduce acne. Saw palmetto, most often used for prostate health, can reduce facial hair and acne in women.
Take 320 mg twice a day, once with breakfast and once with dinner. You can find all of these nutrients and more in my store.
7. Get Great Sleep
Studies show sleep loss contributes to inflammation, which feeds the flames of acne and numerous other issues.  Those are among the many reasons you want to aim for eight hours of solid, uninterrupted sleep every night. Grab 19 of my top sleep tips here.
8. Get More Antioxidants
I find antioxidant levels are low in acne patients, especially vitamins A and E, which are critical for skin health. People who eat more fruits and vegetables (containing more antioxidants and anti-inflammatory compounds) have less acne.
9. Exercise Regularly
Among other benefits, exercise helps improve insulin function, reduces inflammation and boosts self-confidence. You can learn more about exercise’s many benefits here.
10. Choose Skin Care Products Wisely
Finally, I hope you will try The Blood Sugar Solution 10-Day Detox Diet. This book provides an easy way to eliminate sugar, processed foods, food sensitivities and other culprits that contribute to acne. You wouldn’t believe a number of testimonials I received from this book that said their skin got better when they ditched these problem foods in just 10 days.
If you’ve struggled with acne, what tactics did you find helpful? Did you take a conventional approach or implement Functional Medicine for healthy, vibrant skin? I want to hear your story below or on my Facebook page.
Wishing you health and happiness,
Mark Hyman, MD
Hearty Soul Edit: Think you might need a detox?
As we’ve learned skin, liver, and gut health all go hand-in-hand. Because we are constantly fighting against environmental toxins, as well as all of the toxins we eat, drink, and put on our body, it’s often helpful to give our liver a little bit of a break.
Take this quiz to see how badly you might need to detoxify your liver:
This article was republished with permission from drhyman.com.
 Ayer, J., & Burrows, N. (2006, August). Acne: More than skin deep. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2585707/
 Smith, R. N., Mann, N. J., Braue, A., Mäkeläinen, H., & Varigos, G. A. (2007, July). A low-glycemic-load diet improves symptoms in acne vulgaris patients: A randomized controlled trial. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17616769
 Mullington, J. M., Simpson, N. S., Meier-Ewert, H. K., & Haack, M. (2010, October). Sleep Loss and Inflammation. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548567/
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