Pacific_oysters copyOver the years, evidence continues to mount that adequate levels of zinc help reduce acne symptoms, on average by approximately 40%. While zinc will likely not completely clear anyone’s skin, this is still significant and is more than placebo.

It turns out that oysters contain far more zinc than any other food. In fact, 3 ounces of oysters (about 6 cooked or raw oysters) contain about 74mg of zinc, almost 500% of the daily value for zinc. However, because high levels of zinc can be toxic, be sure to keep your total zinc intake below 100mg per day.

If you are not fond of oysters, supplementing with a 30mg zinc gluconate pill per day should be plenty to get the benefits.

While there is still not enough compelling evidence to conclude that diet and acne are in fact related, in this one instance, perhaps indulging in a few oysters could be a fun way to provide some extra insurance against breakouts.

The last few days I have spent going through all clinical studies/trials regarding acne and Omega-3 fats, iodine, antioxidants, chocolate, calorie intake, fatty/oily food, digestion, and zinc. Adding to this what I have learned regarding dairy and glycemic load, I’m sorry to say that nothing stands out for me as a smoking gun when it comes to diet and acne. We simply don’t have enough research yet, and nothing feels super compelling to me at this point. However, at least researchers are looking into how diet may affect acne, so hopefully by the next time I review the literature, the evidence available to the scientific community will start taking shape. In the meantime, based on digesting everything the research community has to offer regarding diet and acne, here is what I am personally going to do as far as diet goes:

1.  Keep taking fish oil and eating wild delicious sushi :)  I take 4 fish oil pills per day to make up for my Western-style diet, which like almost everyone living in modern society, is overly rich in Omega-6 fats from vegetable oils, grains, etc. There is enough evidence to persuade me of the overall health benefits of Omega-3s and I feel good taking fish oil regardless of whether or not it may be helping with my skin. Also, when I go out to eat, I specifically ask whether the fish or sushi on the menu is wild. Farm raised seafood is far inferior in Omega-3s and other nutrition than wild seafood.

2.  Keep taking a zinc supplement. Having dived deeper into the role of zinc, I am still convinced that it is likely an important nutrient when it comes to combating inflammation and keeping bacteria in check. I’ll keep taking my 30mg per day.

3.  Not worry about iodine, chocolate, fatty/oily food. I’ll keep eating seaweed salad and seafood (contain iodine).  There exists no evidence showing that the amounts of iodine consumed in these foods is in any way detrimental for acne. Based on the available evidence, I’ll also continue eating a little dark chocolate every day without worrying about how my skin will react. I will also keep eating the occasional naughty greasy meal without fear.

4.  Try to be generally healthy. Antioxidants are important calming agents in the body, and eating antioxidant-rich colorful fruits and vegetables is fun and tasty anyway. When it comes to glycemic load, whether or not scientists know if it will help with acne yet, I’ll try to keep my meals balanced with carbs, fat, and protein to keep my energy and mood level and avoid crashes.

A full update to the diet and acne page of acne.org is on its way with much more information on each of the above mentioned topics. In the meantime, when you look at the evidence at hand, eating healthy and in moderation will suffice as a general wrap up for what we know regarding diet and acne at this point. Not exactly a Eureka moment.

If you eat a high glycemic diet with foods like white bread, sugary soda, white potatoes, and white rice, you will experience insulin spikes. This we know. What we don’t know (sorry Josh) is whether this sort of diet will directly affect acne.

Scientists hypothesize that a high glycemic diet and its resulting insulin reaction will result in higher levels of hormones (IGF-1 and androgens) which may contribute to clogged pores and increased skin oil production.

When it comes to high glycemic diets in particular, scientists also postulate that eating this way may lower the amount of beneficial proteins (IGFBP-3) and natural retinoids, which help keep skin cell growth in check and pores from becoming clogged.

However, as is becoming customary in my research on diet and acne, we do not have enough research to make any strong correlations. The only 2 studies which have been done on glycemic load and acne have been performed by the same group of Australian researchers, led by Robin Smith, and while acne lesion counts appear to reduce on low glycemic diets, results are inconclusive. What stands out most sharply is the lingering question of whether glycemic load leads to decreased acne symptoms or whether it is the weight loss that tends to go hand in hand with this sort of diet that causes the reduction in acne. To answer this question, we need data on whether a reduction in acne symptoms is sustained after weight loss has leveled off. Until then, I’m happy that the scientific community is at least starting to investigate.

Thanks for voting for what you guys wanted me to concentrate my acne research on. The last I looked at the poll results diet and acne was winning. Now I see that scars have a few more votes. Well, scars will be next. But first, let’s delve into diet and acne. In fact, let’s get deep and dirty and nitty gritty with it shall we? Yes? Great, then we shall :) I’ve read every published trial and review of literature since 2008 regarding diet and acne there is good news and bad news.

Good news: Scientists are all over it! No longer is diet and acne relegated to a back seat. According to the Journal of the American Academy of Dermatology (2010), “…it is evident that dermatologists can no longer dismiss the association between diet and acne…In light of the last decade of research investigating the relationship between diet and acne, it is no longer dermatologic dogma to state that any association between diet and acne is mere myth.” In other words, researchers are conducting studies and we’re getting interesting data.

Bad news: The data is still spotty and almost all of the recent studies come with serious “design limitations” as they call them. An example of a design limitation is researchers relying on subjects’ personal recollection of their diet habits instead of actually watching what they eat. Another example of a design limitation is trusting subjects to define for themselves whether they have “acne” instead of employing a professional to count lesions across a study cohort. In other words, we can’t trust the data that’s coming out yet. We need more trials, and better trials, before we make conclusions.

Um, a little more bad news: Because pharmaceutical companies do not make money from educating the public on diet, funding for diet and acne studies is sparse. But hey, even without the pharmaceutical companies, we’re seeing a resurgence of interest in the topic of diet and acne.

My gut feeling on the subject: Regardless of whether some hunter/gatherer tribes do not have acne, it is literally impossible for us to go back to a hunter/gatherer way of living, and for real concrete answers to acne, we’ll have to include diet as only one piece of a much larger puzzle. As much as I would love for it to happen, I don’t think we’re going to find a magic bullet. I don’t think we’ll find a super bad food or food group which we’re all eating which is causing acne. I also don’t think educating people to “eat right” and “low glycemic” will clear people up to the degree any of us want.

I’ll keep updating the blog with specifics regarding some diet and acne subtopics like dairy, glycemic load, iodine, etc. for the next few updates. Hopefully with all of us wading deep into the muck of the latest research we can pool our minds and get food working for us as much as possible.

I’ve been looking into Vitamin D lately and what I’m finding is jolting.  It turns out most of us are deficient, and achieving adequate levels is critical to our health…and perhaps to acne.

What vitamin D does in our bodies:  Vitamin D helps keep cells healthy.  Pretty much all of our cells use Vitamin D, including our skin cells, and they don’t work optimally when they don’t have enough.  When our cells don’t have enough Vitamin D, they tend to mature incorrectly.  This may result in cancers, diabetes, stunted growth, muscle weakness, arthritis, bowel disease, and skin conditions like psoriasis and perhaps acne.

We don’t get enough:  Evolution has created the human body to be a well tuned Vitamin D factory which makes just the right amount of Vitamin D for ideal health.  Over billions of years, all the way back to some of the very earliest cellular lifeforms on earth, living things were designed to soak up the sun and produce vitamin D. Throughout human evolution, our species evolved many different skin tones depending on where we lived around the world in order for our skin to soak up just the right amount of sunlight to produce optimal Vitamin D levels. It’s that important.

Some varieties of fish and some fortified foods contain Vitamin D, but the sun is by far the leading way that our bodies get Vitamin D. However, in modern society, most of us no longer get the sun exposure Mother Nature intended, and thus do not produce adequate amounts of Vitamin D.  The darker the skin tone, the more serious the deficiency tends to be, but even people with the light skin are often deficient.  A 2006 Mayo Clinic review reported that 57% of general medicine inpatients in the U.S. were deficient.  Levels were even higher in Europe.  Chances are you may be deficient as well.  My doctor ordered a full blood work done recently, and the one thing he expressed concern about was my slight Vitamin D deficiency.  I take a Vitamin D pill almost every day, but even with this I remain slightly deficient.

What about acne? I’ll be looking more deeply into a possible Vitamin D and acne connection.  Since Vitamin D helps keep cells from overproducing, it makes sense that proper amounts of Vitamin D could help prevent pores from overproducing cells, which is what ends up producing a clogged pore and an ensuing zit.  Supplementation with Vitamin D or topical application of Vitamin D are both potentially an option.  Already, the front line in psoriasis treatment is the application of topical Vitamin D. Could it help with acne too? I think it would be interesting to find out.

How to get enough:  In almost every study I’m reading on Vitamin D deficiency, scientists recommend 5-10 minutes of exposure to the sun during 10am and 3pm, without wearing any SPF.  Since most of us either work or go to school during those times, this can be difficult.  In that case, they normally recommend taking a Vitamin D supplement.  The minimum recommended amount seems to be 1000IU per day.  However, this is what I take each day and I’m still slightly deficient.  I’m considering bumping it up.  Vitamin D can be toxic in super high amounts, but even at levels over 7000IU per day, researchers saw no adverse effects after two months of supplementation.  From what I’m gathering from my reading, Vitamin D3 in particular is a safe choice, and is widely available on store shelves.

I’ve been telling all my friends and family to consider hanging out in the sun a little more, or alternately supplementing with Vitamin D.  I really think it’s important.  For people with acne in particular, I think daily supplementation of fish oil, zinc, a good multivitamin, and at least 1000IU of Vitamin D makes a lot of sense.

I’m always on the lookout for ways to combat stress. Stress can wreak havoc with hormone levels and, especially in women, can aggravate breakouts. This is because stress activates the adrenal gland. The adrenal gland is where we produce adrenaline, which the body pumps out in response to stress. Well, it just so happens that women make much of their testosterone in the adrenal gland as well. So, that means stress can alter testosterone levels in women more radically and inconsistently than in men. Voila…breakouts. Even though the stress/acne issue may be a larger issue for women than for men, I heavily suspect it is also of real concern for men.

So on comes Oprah talking about how she’s done with endless dieting and declares that her war with food is over. My interest was piqued, partly because I have so many women in my life with food issues (don’t we all…), and partly because I had a sneaking suspicion that the food/stress psychology that Oprah says was liberating her might be of interest to all of us, regardless of our stressors.

So I bought the book she was speaking about, Women, Food and God by Geneen Roth, and read it. At first I read it just keeping in mind women whom I care about who have food issues, and it rang true. Then I read it again, trying to imagine that Ms. Roth was speaking about stress in general. It made good sense again.

In a nutshell: Stress, and its subsequent outgrowths of overeating, overworking, overthinking, overdrinking, drug use, etc. is precipitated by “leaving ourselves” many times a day. She means this quite literally. We become so afraid that our emotions in our bodies will “kill us” that we escape into our chosen method of flight from what is happening inside our bodies. The remedy is to stay with whatever we’re feeling in our body, bringing curiosity to it, and giving it the time to expand and unwind. Feelings, Ms. Roth contends, simply want the attention and room to dissolve on their own. She urges the reader to practice living a new, embodied life in the moment through eating guidelines, and a process she calls “Inquiry”.

If you guys read this, let me know if it affects your stress levels. Thanks!

For years I’ve been hoping to find a natural way to cure acne from the root. While some things help (zinc for instance), I’m starting to think there may be no silver bullet. Instead, I wonder if a cocktail approach might prove more effective. Here’s my gut read on what a natural cocktail, if indeed there were one, might consist of:

Sun: Yes, this might be controversial, but I think we might not be getting enough sun. We make vitamin D through our skin, and as homo sapiens we are literally made to be in the sun. The darker the skin, the more we need it. I tend to think that limited exposure on a regular basis may be beneficial for a wide variety of conditions. My gut also tells me that responsible sun exposure is going to be more beneficial than vitamin D supplementation. I personally try to get some sun each day around lunch time–15 minutes front, 15 minutes back–and I feel generally healthier because of it. I keep my face covered, but if I weren’t so vain about wrinkles, I might expose my face as well and see how that affects acne. I am certain from personal experience that over-exposure will bite back with acne because a sun burn is skin damage, but light exposure on a daily basis intrigues me.

Oxygen: Each and every one of our cells need oxygen to live, and as land dwelling animals we obviously need oxygen to survive. I am looking into how oxygen specifically affects the causes of acne. I have a sneaking suspicion that oxygen, or the lack thereof, may play a part in acne formation. Could deep breathing or oxygen therapy help? We’ll see.

Greens/Food: Eating a natural diet makes sense. Emerging research hints toward a potential diet and acne link, but we simply do not have enough research to draw any conclusions. Common sense tells us that eating fruits, veggies, and perhaps real, organic meat in low quantities is the way to go.

Touch/Tribal Community: Stress and acne are related. Also, our hormone levels are intricately connected with acne formation. Touch and love mediate our stress levels and help keep our stress hormones in check. My gut tells me that if modern society valued touched more, we might see less acne. Also, we are tribal animals and are much happier when we are a valued part of a group. While modern society seems to have strayed from this way of living since the Industrial Revolution, perhaps there are still ways of getting that supportive feeling in our lives (choir, clubs, groups, practicing unconditional love).

Exercise: Our blood is what brings nutrients to all of our cells. Exercise gets the blood flowing and improves nutrient delivery. Exercise also is a giant part of keeping stress in check. It just makes common sense that we need to get the blood going on a regular basis.

Supplementation: We may be quite simply too far from our hunter/gatherer roots to get an appropriate amount of sun, non-contaminated food, and the sense of belonging that comes from living in close knit tribes. So, we may need to supplement with appropriate vitamins (Vitamin D and fish oil for example), and make a point to fit good food, touch, and community into our lives in convenient, modern ways.

So what do you guys think? Check in with your gut. Do you think if all of the above were dialed in, you’d have less of a battle with acne?

I have found no conclusive research linking vitamin D with acne, but then again, I have found no research signaling that there is not a link. This is true for, well, most vitamins and minerals. We can only make educated guesses at this point.

From a common sense perspective, it is logical to ensure adequate amounts of essential vitamins and minerals. Vitamin D is one of the big ones. And since our bodies make vitamin D in the skin (by converting cholesterol), it’s interesting to look into how vitamin D might affect the skin itself, and in our case, acne. Recently, scientists have located vitamin D receptors in the skin, and they are hypothesizing that vitamin D may facilitate normal skin functioning, including playing a potential role in cell maturation as well as perhaps aiding in the fight against skin bacteria. No one knows for sure if, and to what degree, vitamin D might affect acne.

I figure it’s better to be safe than sorry. So how do we get the vitamin D that we need? Exposing the body to the sun for 15 minutes or so at least twice a week during the summer months makes for adequate supplies of vitamin D in lighter skinned people. The darker your skin, the more time that is required. However, in the winter, getting enough sun exposure can be tough. Food manufacturers often fortify dairy products and some juices, cereals, and breads with Vitamin D, so that can help. However, from what we’re learning about a potential dairy and acne connection, many of us are limiting our dairy exposure. Cod liver oil, salmon, and mackerel also provide some vitamin D. Since I personally don’t eat much dairy, bread, or cereal, and since I rarely intake salmon or mackerel, and do not supplement with cod liver oil, I choose to take a vitamin D pill once a day just to be on the safe side.

I hope the scientific community will look into the Vitamin D and acne connection more in the coming years. If I find anything more out about this topic, I’ll be sure to pass it along.

I’ve been reading acne related articles and studies from around the world, with topics ranging from genetics to Accutane flare risk factors. After reading them all I took a moment to see if there is a common thread linking them together. One thread I seem to keep finding is stress. Keep in mind that I am simply starting a discussion and not trying to draw any sort of scientific conclusion. Please present your own evidence as well.

stress

1. A Canadian study I read found that living in urban areas was related to Accutane relapse. I know from personal experience that living in an urban area comes with added stressors. While I personally prefer the urban lifestyle, driving is more difficult, sirens wail, and crowds are common. You must stay more on guard to stay safe, even if that means staying more aware while crossing busy streets.

2. A Norwegian study showed a possible link between poor diet and acne in adolescents. While the conclusion was “too early to give evidence-based diet advice” it nonetheless once again shed light on the diet/acne connection. Researchers do not have a consensus about which type of diet is best or worst for acne sufferers, but if poor diet is related to acne, stress would be a factor here as well. A poor diet physically stresses the body. High glycemic (sugary) diets also cause mood swings and can affect mental stress levels.

3. An International Journal of Dermatology article focused on the impact of DHEA-S, an androgen (male sex hormone), on female adult-onset acne. Leutenizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone, sex hormone binding globulin (SHBG), and DHEA-S were all evaluated. DHEA-S was the only androgen that was significantly higher in women with acne. DHEA-S is produced in the adrenal gland, the same gland that is activated during times of stress.

So what if stress was more intricately related to acne than we previously theorized? Anything that helps mitigate stress would then help with acne symptoms. Eating a low glycemic diet, getting plenty of rest, exercising, and breathing or meditating, would be potentially beneficial options.

So the clocks turned back and we all got another hour of sleep. Guess what? That’s good for acne.

Lack of sleep is a huge physical stressor. It’s not just mental stress that can aggravate acne. Physical stress like overworking, overexercising, and undersleeping can also increase the symptoms of acne. Getting your eight hours, or however much sleep your body requires, is a great way to help keep your skin in check.

Working the night shift: Dr. Fulton, one of my big heroes in acne research has said in his classes, “I can get pretty much anyone cleared up, unless they work the night shift.” His comment has always stuck with me. While I have not had lots of experience with people who work the night shift, if his experience is correct, it is not just the amount of sleep that is important, but also when we sleep. Science has named our internal biological clock the “human circadian rhythm”. Melatonin levels rise sharply at night and fall during the day. Our hypothalmus and much of the rest of our bodies are hardwired to produce a natural rhythm of sleep and wakefulness.

So if you or someone you know works the night shift and can’t seem to clear up, this may be something to think about.