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Ok, well I originally goofed on my initial Accutane, Insulin, Puberty post http://acne.org/messageboard/viewtopic.php...ghlight=insulin , but I am now about to correct that. ;-)

Truth is that Accutane is a bit of a paradox. It actually INCREASES Insulin Resistance while on treatment, but the effects usually disappear afterwards. http://www.ncbi.nlm.nih.gov/entrez/query.f...5&dopt=Abstract While on treatment you can get High LDL levels, poor glucose disposal rates, increased Insulin Secretion, and low SHBG. Wow, it seems to go against everything that we are trying to accomplish (clear skin) by going on these diets and medications etc.

On the other hand, Accutane still treats acne, but the effects are only during treatment (supposedly). Anyway, apparently it does so because the effects of 13-cis-retinoic acid (causes the above) possibly overrides certain aspects of IR, so that it can still inhibit DHT conversion in the sebaceous follicles, decrease sebum production, and slow skin cell shedding, etc. Therefore, it does still work positively along the hormonal aspect of the Insulin Resistance pathway. Meanwhile, Roche hasn't entirely figured this out:

"Despite important progress made in the understanding of the molecular action of retinoids, there is still a major unanswered question about the mechanism whereby oral isotretinoin reduces sebum production. Most evidence indicates that the antiacne effect of 13-cis-retinoic acid is mainly related to its potential to inhibit the production of sebum Among natural and synthetic retinoids studied in humans, only 13-cis-retinoic acid was found to suppress sebum excretion and to improve acne significantly."

http://www.sinacne-roche.com.co/estudios/arte.html hasn't connected the dots yet (isn't that odd?)

Yet, this article and several others explain why: http://www.thepaleodiet.com/articles/Acne%...%20vulgaris.pdf

(page 4 talks about effects of 13-cis retinoic acid and IGFBP-3)

http://www.ncbi.nlm.nih.gov/entrez/query.f...4&dopt=Abstract (nothing to do with acne but proves that retinoic acid increases IGFBPs)

http://www.ncbi.nlm.nih.gov/entrez/query.f...7&dopt=Abstract (vit. A and it's role)

http://www.ncbi.nlm.nih.gov/entrez/query.f...1&dopt=Abstract (proves that it depends on the form of Vitamin A as to whether a certain type of IGFBP hormone will be increased).

http://www.ncbi.nlm.nih.gov/entrez/query.f...1&dopt=Abstract ( I think this is also a good one to read)

Of course, if you can't understand that, then this is my version of how Acne, Insulin Resistance, & Accutane all tie together:

OK, so you're at lunch and you eat something, lets say a SANDWHICH (meat, vegetables, grain bread), and it enters your digestive system where it's broken down. Now, depending on it's glycemic load, a certain amount of glucose will be available for your body's energy needs. This prescence of glucose will cause your pancreas to produce insulin to enhance glucose utilization and sometimes it will be a HUGE amount of insulin! Insulin works by binding to insulin cell receptors to allow glucose to pass through the cell. Now, if your body (cells, tissues) doesn't need the glucose, it will be converted into glycogen and fat for storage in your liver, skeletal muscle, adipose tissue, and skin.

Now, if your liver can NOT store the glycogen & fat and your cells & tissues will not accept the glucose then you have a problem. This is known as Insulin Resistance, which can later lead to Type I Diabetes (don't make enough or ANY insulin), Type II Diabetes (unable to use the insulin you do make), Heart Disease (due to high LDL cholesterol levels, free fatty acids), Hypertension, Dyslipidemia (lipid imbalance in blood stream), Obesity etc. all prevalant in most Western societies. So anyway, IR occurs because your cells are either too full of glucose or they don't RECOGNIZE the insulin you do have. As a result, you not only have all this extra insulin, but glucose, free fatty acids & amino acids floating around in your blood stream with no where to go....

Now, some of us do not have the same gene defects (read middle of article on CYP450 for specifics). Therefore the PATHWAY to this next part, is different for all of us depending on what our defect, or in other words, hormonal disorder is. Examples of hormonal disorders with acne as a POSSIBLE Symptom are Hypothyroidism, Hyperadrenalism, Insulin Resistance, Polycystic Ovarian Syndrome (PCOS)-Syndrome X, Hyperandrogenism, Congenital Adrenal Hyperplasia (CAH), Hypercortisolism - Cushings Syndrome, etc.

So depending on the pathway, this extra or free insulin is going to cause your Adrenal Glands and Ovaries OR Testicles to produce the followingSteriod Hormones: Estrodial, Estrone, Progesterone, Testosterone, Androstenediol, DHT (5-alpha-dihydrotesterone) and DHEA (Dihydroepiandrosterone). These hormones in excess or in deficiency create your...hormonal imbalance.

Obviously, if it's in excess you know why you have the problem, but what about if you are deficient in a hormone (vitamin, enzyme, etc) right? What happens is that your body is looking for this hormone and if it can't find it, and is capable of making it, will produce MORE. At least it thinks it's producing more, but sometimes it's unable to produce the hormone and as a result, OTHER hormones get overproduced in the process.

The same thing applies to IR, if your cells don't recognize the presence of insulin (can't bind to cells), then your body keeps making more insulin, "thinking" that you don't have enough in your system. Unfortunately, it doesn't matter how much your body produces or tries to produce of a hormone, because there is a problem in the pathway that makes this mechanism work perfectly. Therefore, until the defective pathway is FIXED, the viscious cycle will continue...or get worse (burnout, tumors, cancer).

One of the results of this would be testosterone conversion into DHT (a super androgen) in your blood stream and in your sebaceous glands & hair follicles. There are several enzymes responsible for this conversion such as, 5-alpha reductase, 3-alpha-hydroxysteroid dehydrogenase, and 3-beta-hydroxysteroid dehydrogenase. As a result of DHT conversion, there's an increase production of sebum, skin cell proliferation, inflammation, etc. all thought to contribute to the production of acne in SUSCEPTIBLE individuals.

Does any of the above sound familar? Well it should considering that by now we should have learned that during Puberty, we ALL go through a state of INSULIN RESISTANCE! The only way our tissues can grow is if they become insulin resistant (IR). Therefore, IR increases the proliferation of not just tissue cells, but skin cells, etc. Now through your DIET you will accquire or overproduce IGF-1 (Insulin-like Growth Factor) and Insulin, both of which increase our male hormones. However they do this because we have DECREASED levels of IGFBP-3 (Insulin-like Growth Factor Binding Protien) and SHBG (Sex Hormone Binding Globulin). Both of which bind steriod hormones and growth factors that are responsible for the production of acne and certain other hormonal & health (cancer, tumors) problems.

Now, this is the pathway to which Accutane (13-cis retinoic acid) works. It increases your IGFBP-3 hormone which prevents IGF-1 from binding to the androgen receptors. In turn, this prevents the production of Androgen which means a decrease in the amount of DHT (5alpha-dihydrotestoterone) that will be converted in the sebaceous follicles. Furthemore, it also DIRECTLY prevents the conversion of DHT by inhibiting the enzyme (3alpha-hydroxysteroid dehydrogenase) neccessary for this function.

So Vitamin A, Natural Accutane (program by which you create your own 13-cis retinoic acid), and Accutane are going to attack acne by INCREASING IGFBP-3. Which prevents IGF-1 from binding to androgen receptors, decreases androgen production, DHT conversion, skin cell proliferation, and sebum production. While various other medications, supplements (like the popular B5) and also various DIETs are going to attack acne along other Insulin Resistance pathways.

So if we continue discussing diet, then by avoiding certain problematic foods for YOU, like High Glycemic Load Carbohydrates, etc you can naturally INCREASE SHBG and IGFBP-3. Now, we already know what IGFBP-3 does by reading the above articles, and SHBG works by having a higher affinity to binding male hormones over female hormones in your system. In fact, in the presence of Estrogen (birth control pills), SHBG will be further synthesized in the liver, but in the presence of Insulin, it won't be produced and Obesity, Acne, Hirusitism, PCOS, Hypothyroidism, ovarian tumors, and enlarged prostates, and gigantisism can result.

Furthermore, just by lowering or balancing your insulin levels which HAVE been done through dietary changes and/or medications/supplements, you will also prevent the conversion of DHT by inhibiting enzyme (5-alpha reductase and 3-beta hydroxysteriod dehydrogenase) function, skin cell proliferation, inflammation, and sebum production. However, not everyone notes a complete decrease in sebum production, despite dramatic improvements in clarity. Which indicates that sebum production isn't neccessarily NEEDED to have acne. If you think about people with dry skin with acne and others with ingrown hairs, the problem isn't sebum but skin cell proliferation, poor exfoilation, and inflammation, right?

Of course that aspect can be controlled or prevented, topically anyway, by following a regimen similar to the "Acne Cure" I've been doing the Acne Cure for years now and I didn't even know it...lol. Using (gentle) acids and exfoliants on your skin is great way to help unglue the clogged pores (sebum helps here), and encourages faster skin cell turnover & shedding. Not to mention, taking certain vitamins will also enourage faster healing and skin cell shedding, which I guess is what makes an acne sufferer's skin different from someone that happens to just have "Oily" skin.

Now, I would like to clarify once and for all (LOL) that we don't all experience the same SYMPTOMS and that is also why Diabetics (type 2) and kids going through Puberty (medically defined state of Insulin Resistance) don't ALL get acne, hirsutism, etc. Symptoms can be external or internal and they vary WIDELY depending on what ENZYME/GENE is defective (usually somewhere on a CYP450 gene [link=drnelson.utmem.edu/P450lect.html]drnelson.utmem.edu/P450lect.html[/link] ) and they could occur at the age of 10 or possibly catch up to you in late adulthood. I guess that's what makes people feel safe and comfortable to do whatever they please DESPITE the scientific evidence behind it all.

For example, did you know that Insulin Resistance is not only genetic but can also simply be passed on if the Mother is in an state of Insulin Resitance during pregnancy? Perhaps that's why some kids have terrible problems that their parents didn't have. Of course, the research wasn't there 50, or even 30 years ago, but it is here now! So in terms of general good health, that right there is the reason we should be getting the Willett's Food Pyramid in 2004 http://www.sciam.com/article.cfm?articleID...umber=1&catID=2. Thankfully, they have admitted that the USDA Food Pyramid was not based on much scientic research and may be the reason behind increasing Obesity and Diabetes rates.

Therefore, I understand one's skepticism and distrust, but you've got to learn to research and connect the dots for yourselves. For when you do, you'll discover that while there are MANY different ways to attack acne, there are also treatments in existence that are SAFE & effective, but were never fully publicized (like topical spironolactone)

http://www.ncbi.nlm.nih.gov/entrez/query.f...2&dopt=Abstract and http://www.ncbi.nlm.nih.gov/entrez/query.f...0&dopt=Abstract . Nevertheless, the majority of the topicals, medications, supplements (like B5), dietary changes (allergic or not), and alternative methods (meditation, exercise, etc) b]all work on some hormonal level. As such, they are all attempting to either fix your homonal imbalance by Controlling your Insulin, by preventing the Conversion of DHT in sebaceous follicles, by preventing the proliferation of skin cells, or by reducing your free testosterone/androgen in the blood stream, etc. ALL of which could be caused by a lack of Insulin sensitivity or Insulin Resistance.

So once again, prolonged hormonal imbalances are due to some sort of lack of an enzyme, which explains why some people cleared when taking Probiotics, Digestive Enzymes or doing Liver Cleanses & Detoxes. Not to mention, that since most of us use treatments ranging from topical anti-androgens to Internal Anti-androgen medications, supplements, diets or exercise programs we have found ways to reduce, control or ELIMINATE acne (and other hormonal problems). Therefore, you must analyze your body's own "blue print" and depending on YOUR own external and/or internal factors and personal sensitivty level, you may need to use one or all of these methods to solve your problems.

Also, I am not ALWAYS entirely for dietary changes only. Not everyone has to do that. I believe that many factors (Environmental, External, Internal-Mental) are involved with acne and just because one is irrelevant to you, doesn't mean that it is for someone else. Unfortunately because there are NUMEROUS choices out here, at some point we have ALL chosen the wrong ones. The truth is, whether some of you like it or not, certain methods work BEST for certain people. Hence, one must know their body and understand just what hormones & enzymes are involved in causing their problems. Once they do that, it is easier to find a treament (natural or traditional) that will be more effective than anything they've done before. Unless of coure they simply GROW OUT OF IT, as I'm more often wondering is the case with Accutane...

If you don't know what is wrong inside, then you should discuss your problems & "symptoms" with your doctor so that you can be referred to a Gastroenterologist, Endocrinologist, Allergist, Nutritionist, Naturopath, or some other Specialist that will help you find out. For most of you this is, thankfully, only puberty (still suxs), but for others this can continue for several decades. While I know some of you tend to worry & overdo things, thanks to the angst acne can put us in, please note that it's impossible to eliminate ALL DHT or ALL sugar from your system and still function (normally). Therefore, when trying to find the connection for yourself, PLEASE don't obsess over avoiding every possible problematic food or give up too quickly. Remember, we are all different and our bodies will decide when we've done the RIGHT things, not us ;-) So, the sooner you find out the truth for you, the less hormonal and health problems you may have to deal with in the future.

Oh and one more thing, the reason it's Important to know how Accutane, the "greatest discovery for acne in the past 30 years," they say, works is because now we know how to implement this for ourselves. Now that we know how it relates to diet, we can take that information and find a way to increase those chemicals "naturally." So instead of orally taking 13-cis-retinoic acid or finding a natural way to convert this in our system, we can jump straight into what's REALLY doing the job. Remember, Accutane inhibits the actions of IGF-1 by INCREASING IGFBP-3! We already know that we can accomplish this through diet as well. Therefore, we need to eat right, take the right supplements, or find some miracle pill that will effectively increase IGFBP-3 at a safe level for us. Then we have the acne controlling effects of accutane, only permantly and hopefully without any negative side effects. Whadda you think? ;-)

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LOL, thanks boys and girls. If you are on the road to getting clear, then I wouldn't read it either. Yet you did click on it, so the interest was there. While I do wish that the post was shorter, I did actually leave out other aspects.

I do this because I'm pretty much clear (99%+) and I really enjoy helping others. While I do have a social life, work, school, and other obligations I try to still find some personal time to sit here and research and listen to your questions and see if I can find an answer for you. I do this because I know that SOME of you may not have the time or want to take any of your own precious time to do so. I'm trying to help those that may not understand the mechanism behind it all or are still having trouble improving their skin. Afterall, once you understand how something works, you can possibly get a littler closer to figuring out what went wrong to begin with.

I'm so grateful to the many helpful posters I've met along the way. Whether they were talking about skincare, topicals, diets, supplements, meditation, etc. I've always managed to learn something from it. So if you are really interested, you can always print it out and read it in sections. There's always a way to get what you want, if it's what you really want.

Take care

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Thank you for such an informative article. I was wondering what specific regimen worked for you? What supplementary vitamins do you recommend?

Thanks,

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Sweetjadee, thanks for putting the time and effort into such a long and elaborate theory.

I think there are a few things that beg further question.

One of things you state, I am not sure of its accuracy. "The only way our tissues can grow is if they become insulin resistant (IR)". I was of the belief that insulin resistance is detrimental to the growth of cells, as insulin itself is an anabolic hormone?

What would be an interesting test of your theory would be to test the levels of androgens in the blood plasma before, during and after accutane therapy.

" Accutane inhibits the actions of IGF-1 by INCREASING IGFBP-3"

I am sceptical that this is the way in which accutane operates, however, as it does not account for accutane curing individuals from their acne for a long term period of time. From your hypothesis it would seem that it was only possible for accutane to inhibit acne during the course of treatment.

You also discuss the CYP450 gene defect. I am not sure that this would be relevant. CYP450 is an enzyme involved in liver detoxification. Even if a person had difficulties in oxidising and eliminating certain hormones due to a defect in one of these enzymes, then they would have fairly significant hormonal imbalances.

Anyway looking forward to hearing your thoughts,

Jonathan.

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I know you have done your homework Sweetjade, and there is lots of good information there. I do not have time to read your whole post however, much less all the links you provide. I think it would be helpful, like Consumer Reports does at the end of their articles, to provide your recommendations. Make it short and to the point, and tell us what exactly you want us to do. Just some basic rules. Thank you.

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Jono,

Thanks for being interested enough to ask those questions. When I do my research, I don't look to prove a specific point, but rather I end up bumping into the answers that I wasn't even looking for (isn't that how it works?). Such is the case with Accutane, I NEVER cared about this because I felt it would never work for me and I was afraid of suffering the side effects. Yet there are many people who trust it to take care of their hormones over ANYTHING else! They kept telling me that it was because it took care of their oil....it does far more than that. The more I tried to answer questions for myself and others, the more connections I made. While my theory hasn't been tested out in the manner that we need it to, it is based upon facts.

Puberty is defined as a state of Insulin Resistance. I got this off of a few websites, one I may have posted on other topic, but I'll try and find one for you. While Insulin can be deterimental in some aspects it is also positive in others. Insulin increases IGF-1 and probably other growth hormones and factors and as such, these are what is responsible for the growth of our cells. Now just because it helps our cells grow, doesn't mean that it's not hurting us in some way. Insulin is a must in our system and is probably a part of the normal pathway of Steriod hormone production, however too much Insulin, will cause us a variety of problems.

Also, in terms of accutane, I absolute agree that the level of androgens should be tested and in fact, I believe that they have been. If you have access to scientifc or medical databases you can research that. Otherwise, visit http://www.pubmed.com to get abstracts on these articles. I know that they did studies to determine whether accutane increased the rate of Diabetics. I know they mentioned hormone levels before, during, and several years after treatment. Without a doubt, accutane does decrease your 5-alpha dihydrotestosterone (DHT) levels, which is our most potent form of androgen. Since Roche's website and various studes have stated that hormone levels return to normal after treatment, this is only a temporary effect. To sorta prove that point, there are people that have have gone through up to FOUR accutane treatments and finally gave up or went on a "maintenence dose" to stay clear. Not to mention, the people that have taken accutane and are on this and other boards, usually aren't clear (from accutane). Some form of their acne returned.

Now, one of my teachers told us that we can store a years worth of Vitamin A, so perhaps that is why accutane still works even a few years after treatment. While Vitamin A is not the same as accutane, perhaps we can store 13-cis-retinoic acid for just as long or longer. The biggest part of my theory that I would actually call a theory is whether accutane cures anyone. Depending on the severity of your hormonal imbalance, we all go through Insulin Resistance as Children, Pre-teens, Teenagers and/or unfortunately some of us into Adulthood, it leads me to think that those that were "cured" actually just grew out of that stage of Puberty. I'm certainly not stating that the rest of us that have acne are still going through puberty (would be nice to be a bit taller,etc), but for some of us, our bodies are not responding to Insulin properly.

Accutane (13-cis retinoic acid) increases your IGFBP-3, in order to bind to IGF-1, in order to prevent it from binding to androgen recpetors on the cell, in order to prevent additional androgens from being produced. It also inhibits the conversion of DHT in your cells by inhibiting specifc enzymes. I personally have not researched on how those enzymes are inhibited but all anti-androgens inhibit or decrease DHT conversion or the enzymes need to do the job either directly or through some sort of chain reaction like the above.

Obviously, if you decrease your androgen levels, you will decrease the amount of enzymes needed to convert it into DHT, thus decreasing the amount of DHT that will be produced, but other than that... I haven't looked deeply into how else these enzymes are inhibited, but that is on my list ;-) However I know that some of you WILL NOT accept things at face value which is why I posted all links to how I bumped into this particular answer on accutane. Then to prove that 13-cis retinoic acid does increase IGFBP-3, I posted more studes. I also found links on IGF-1 and it can not only increase acne, but also tumors and growth of cancers (it's growth factor, that' its job). I could continue, but wouldn't some of you have more fun if you started researching from there?

Anyway, you also mentioned CYP450 genes and the reason I included it is because some of us DO have deep enough hormonal imbalances (some may not know it) ;-) I mentioned more about this in an early post, but I also gave the link ( http://drnelson.utmem.edu/P450lect.html or click on Intro Lectures under http://drnelson.utmem.edu/hum.html) for those that wish to read more on it. For those that don't wish to, this gene can have defects that are connected to a variety of hormonal disorders that happen to have acne as a symptom.

There's still uncharted territory here, but I kept bumping into this when I was reaserching various hormonel disorders for school and that my Endocrinologist was testing me for. CYP450s are genes that are responsible for various enzymes neccessary in the conversion or production of trans-retinoic acids (accutane, retinA), testosterone, cortisol, detoxification etc So that is another theory, that maybe there are other imbalances on the gene that gives us all acne. So on another post, I made a point to mention the liver problems if this enzyme is defective because some people cleared by taking liver detoxification supplements, following a Detox & Cleansing program, or by altering their diets (making it easier on the liver) and I thought that was interesting.

I'll try to get you some more links, but did that clarify anything? ;-)

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I also found links on IGF-1 and it can not only increase acne, but also tumors and growth of cancers (it's growth factor, that' its job).

I was at a paramedical skin care seminar back in February, and one of the dermotologist said that accutane may help with skin cancer. What you wrote made me think about that :-k

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Cad and Lori,

I don't know what I want you to do ;-) Um, just be happy, healthy and clear...easier said than done, right? You know, I actually came up with a consumer reports version and posted it on the Prescription forum, but I'll post here for you too =)

Now as for what I do, it's a little bit of everything. Afterall, when you are severely acne prone, there are many contributing factors. Even when you get clear, some of us still have to pay attention not to make our skin angry ;-) So along with a fairly simple skincare regimen, dietary changes, and a prescrption med I've been a very happy girl lately. To be honest, I'm not too good with determining the exact percent that my skin has cleared since I can get acne pretty much anywhere on my body =( So, taking that into account I would say I'm around 99% or more clear.

My biggest skin challenges now are some left over hyperpigmention (feared this worse than the acne) and the occasional reactionary breakout. That's right, my Regimen is not flawless and sometimes when I do something wrong in my diet or I used some ingredient on my skin that it didn't like, I will get a few pimples. Sometimes it's a few small pimples that go away rather quickly and sometimes I get cysts. What's interesting is that sometimes these cysts take LONGER to go away than they used to. This seems to happen to other acne sufferers that alter thier diets, but some do eventually grow out it. My guess is that because we are no longer overloading our sensory system with inflammatory food (whatever causes your breakouts) to the point that it becomes a bit Insensitive to stimulation, that once it gets a break from the irritant, your body will react STRONGER than ever to it. Did that make sense? ;-) Anyway here's my Consumer Reports version of my regimen.

Skincare

--IsoCare's Skin Control 3 piece system (2 years)

--Dream Products Face Dream Lotion & Coppertone Sports Gel Sunscreen (4 or 5 years)

---Bye Bye Blemish (2 years) or a DDF Sulfur mask to spot treat, sometimes Paula's Choice 2% BHA

--To lighten marks if I don't have a skin lightener around, I use Lemon Juice and I just recently discovered the Vinegar Solution (50% water, 50% Apple Cider Vinegar, 3 - 6 Asprin tablets). I've been doing this almost (can be a bit drying) every night for 2 weeks now. It gently exfoilates and so it's really helping with my hyperpigmentation.

For my Body-- Shower with natural based cleansers, no special treatments there. I use lemon juice and/or Peter Thomas Roth's Potent Body Lightener (will also treat some body acne). This stuff is expensive so I don't use it everyday or even every week. Currently I just need these spots to lighten a bit more and hopefully I'll never have to buy another bottle of this stuff again. ;-)

Oral Treatments

150mg of Spironolactone (5 years). -- I usually take it every day, but I don't suffer if I've gone a week of not taking it. It may be more effective for my mild hirsutism than my acne and that's why I keep taking it.

Alternatives

Gluten Free Diet -- my method of Low Carbing although the only grains I eat are Corn, Rice, and occasionally Potato. Otherwise, I also avoid bananas, peanuts and cashews. I drink mainly water because I've greatly reduced what sugar cravings I had. I eat practically anything else...beef, pork, seafood, poultry, diary (organic milk), nuts, seeds, dried fruit, fruit, vegetables and some "junk" and fried foods. To get the details please do a search on this board

Fiber Supplement-- Diet isn't perfect. I still eat like I'm a working college student. As such, I haven't naturally replaced the amount of Fiber that I dropped from my diet when I stopped eating Bread & related products. Other people dont have this problem, but I'm pretty sure it's because I don't eat enough vegetables ;-)

That would be my regimen. I'm definately not perfect when it comes to balancing my meals (who is?), but I'm working on it. I don't exercise regularly and dont' always get enough sleep, which are both good at balancing hormones and reducing Insulin Resitance. I've always been under stress and that hasn't changed, but my skin doesn't show it (if that was ever a problem). So I don't know where the 1% comes from, but I have a few ideas. I'm not stressing over it though because 99% clear compared to 60%- 80% (usually closer to 60%) depending on the season, is a HUGE difference. Can't wait to see with this coming year brings ;-)

Please let me know if you need to know more about something specific. Otherwise, I hope that helped to answer you question.

Take care

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Castle Builder,

Wow, that's pretty cool. That does seem to make sense. Someone else mentioned that since I accutane increases insulin resistance (and still treats acne), that could be why people get an intial breakout. =)

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In my nutritional supplement book it list chromium picolinate as one of the minerals for acne, and states that chromium is needed for proper insulin utilization. Here are three paragraphs about chromium:

http://www.chromiumpicolinate.org/WHAT_chr...ium_insulin.htm

I wanted to know if anyone has had sucess clearing/reducing their acne from using this mineral? 8-[ Also, what do think about this SweetJade1980? :)

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Castle Builder,

Absolutely. That was something that I bumped into 2 summers ago, when I was first dx. I normally don't buy magazines at the store (like the discount) but I just picked up Energy magazine and when I read it I found an article discussing Skin Diabetes. Chromium Polynicotinate (or Nicotinate) was suggested along with CLA (conjugated linoleic acid). There's still debating as to whether these are extremely effective or not. However on another board there's people that have raved about ALA (alpha lipoic acid) or it's pure form R-ALA. Unfortunately R-ALA is more expensive but the say it works to help utilize more glucose in your system, thus reducing breakouts.

There's actually many supplements and vitamins that are good for insulin and sugar control. There are also various medications that will do the same thing. Maybe I'll post that for you a little later, if you're interested.

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Yes, that would be great if you could post some supplements/vitamins and medications that are good for regulating insulin and sugar levels(no rush). Thanks for all of your help :)

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It really is amazing how the teeniest thing could throw your entire system off. People have mentioned braces and fillings and depending on what the trace minerals are inside them, it could increase or decrease your testosterone levels. I suppose that explains how other people managed to clear by doing a heavy metal detox ;-)

Anyway, a year ago, I didn't know what I know now, but I wish that I had. Certainly six, let alone 3 months ago, I didn't know, nor cared how topicals or certain medications worked. I was just glad that they did. Yet, the more I learned, the more connections I found, and the more questions I needed to have answered. As a result, I realized that not only is it important to know the Why's & How's of acne, but also the mechanisms of successful treatment methods. Since we don't have the FINAL answer in regards to acne, we can learn to work our way backward (treatment to cause) by studying what helps us control, prevent or eliminate our breakouts. So, would everyone agree with me that most definitions of ACNE state that it's a condition of having clogged pores or follicles caused by a combination of the factors below?

Bacteria (P. Acnes or some other)

Excess Sebum

Skin cell proliferation (overgrowth of skin cells)

Hyperkertinization (build up of skin cells, poor skin cell shedding)

Poor Desquamation (skin cell shedding, exfoilation)

Inflammation

Hormones (specifically DHT converted in the sebaceous follicles)

Now, if I left something out (Castle?) please let me know. Otherwise, this would explain why there are a variety of acne treatments on the market. They aim to stop one or more aspects of the above problem either topically or internally. As such, that is why different methods work better for certain people than for others. In truth, it really does depend on what your own genetic factors are when it comes to treating your acne problem.

Now if you read various research articles and other's postings, then you already know that acne is always hormonal. Whether you are exhibiting an allergic response, have dry skin, or extreme hormonal imbalance, there are still hormones, enzymes, vitamins (cofactors), etc that are responsible for the proper maintainence and health of your skin. If these are disturbed in some way, then a variety of skin problems will result, such as rosacea, eczema, psoriasis, keratosis pilaris, dandruff, pseudofolliculitis (ingrown hairs) etc. So, how many of you have more than 1 type of skin problem (includes hair, nails, and hyperpigmentation)? I certainly do...

This made me realize that while a lot of you feel that sebum is the problem, when you think about those that have the above skin disorders, someone with acne that has DRY skin ,or someone that's extremely oily with no acne, sebum can't possibly be the MAIN culprit, but it can contribute. When you consider that everyone has P.Acnes bacteria on the skin, that particular form of bacteria can't be the culprit either, but it may also contribute. Yet, I absoultely believe that either through their own existence or our bodies trying to attack them, that there are various forms of bacteria that will indeed cause, at the very least, an inflammatory response.

Therefore, that only leaves Hyperkeritinization / reduced Desquatmation and Skin Cell Proliferation as the "cause". Why? Well, because of all the dead skin building up due to poor exfoilation is the reason you got the inflammed, clogged oil & bacteria filled pores in the first place. Indeed, these problems right here are the reason why The Regimen and the "Acne Cure" have worked so well for many of us. So as you can see, there's not always a need to use expensive prescriptions. Yet, if you've done enough research on your favorite acne medications or other treatments, you should have found that the more POPULAR and MOST EFFECTIVE do a combination or ALL of the following:

Prevent DHT conversion--which enoucrages desquamtion, prevents hyperkeritinization, skin cell proliferation, EXCESS sebum production, and inflammation.

Decrease or absorb sebum ---which could prevent hyperkeritinization and inflammation

Exfoliate --- prevents hyperkeritinization, encourages desqaumation, dissovles sebum oil, reduces inflammation

Kill bacteria--- which prevents inflammation

Reduce or prevent Inflammation

Great, so Antibacterial agents (antibiotics, anti-inflammatories, benzoyl peroxide, tea tree oil) reduce inflammation and Exfoilants (Acids, AHA, BHA, sulfur) encourage healthy skin cell turnover, yet that doesn't help us get to the deeper source of our problems. If using the above allows you to control your acne problem then you can stop reading now. Yet, if your acne keeps coming back and you breakout worse during certain seasons of the year, then you may want to keep reading.

If you want to go for the ULTIMATE acne treatment, you want to pick the one that is going to prevent DHT in the follicles. Now in case some of you aren't familar, DHT stands for 5-alpha-dihydrotestosterone. This is the most produced and most potent form of male hormone in our bodies and the cause of several hormonal disorders such as, acne, hirsuitism, hair loss, and prostate problems. With the exception of removing your reproductive organs and adrenal glands there is NO way you can ELIMINATE all DHT! So please don't even start to obsess over it ;-) However, there are plenty of, hence the arguing and confusion, ways we can reduce and even "normalize" the levels in our system.

So the goal here is to inhibit the conversion of DHT in our system. As far I as know, there are around 5 - 6 enzymes that are responsible for the conversion of testosterone into this form of "super" testosterone. Usually a drug hits 1 or 2 of these enzymes, like 5-alpha reductase. Since DHT can effect hair follicles, sebum glands, and other tissues in the body, some drugs work better than others based on gender, genetic factors, and your target area. Of course, diet, exercise, and/or supplements can do the same thing and can be equally confusing. ;-)

One of these versatile DHT inhibitor drugs is Spironolactone. I'm sure you've heard women talk about it, but since we use it internally men usually don't get the opportunity to reap the rewards. This drug can and HAS been used by both men and women since it's actually a diuretic, used in the the treatment of heart disease, high blood pressure, and has been used to treat hormonal acne for over 20 years. Now, believe it or not, it has been utilized in a TOPICAL form (5% cream or 2% solution) for just as long.

http://www.minoxidil.com/topical.htm (sells orderless solution)

http://www.hairsite.com/o-spironolactone.htm

http://www.anagen.net/spiroin.htm (gives the recipe for making your own spiro solution...2% instead of the 5% gel though)

http://www.wholesalehairproducts.com/ (finally a place to purchase, are they legit?

Unfortunately. while the results seemed rather favorable you can only purchase this on hairloss websites or make your own solution. Since this drug is suppose to be safe and effective for males (and females), even with body acne, I am perplexed as to why it's not very popular. It's effectiveness was proven many years ago and here's what was found: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2972662&dopt=Abstract

www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2150020&dopt=Abstract

So like I mentioned above, there are more than one choice when it comes to DHT inhibitors. Since they don't inhibit or reduce all the possible enzymes that are used to convert DHT, that's probably why the most severe or sensitive of acne sufferers require a combination of or the most "drastic" (i.e. accutane, diet) methods to achieve clear skin. Below is my "Consumer Reports" version of mainly DIRECT Anti-Androgens and I'm sure you'll recognize a few. ;-)

TOPICAL:

Finasteride (Proscar, Propecia)

Aldactone (Spironolactone)

Flutamide (Eulexin)

Cypertone Acetate (Cyprostat)

Azelex (Azeliac Acid)

Retiniods-

RetinA (Tretinoin...13-cis retinoic acid)

Tazorac (Tazoratene)

Differin (Adapalene, retinoid mimicker)

Vitamin A (Retinol)

ORAL

Finasteride (Proscar, Propecia)

Aldactone (Spironolactone)

Avodart (Dutasteride)

Flutamide (Eulexin, Drogenil)

Diane 35 - (contains cyproterone acetate)

Accutane (Isotretinoin...13-cis retinoic acid)

NATURAL ALTERNATIVES (topical and/or oral):

Controlled Diet

Zinc (must be used with B6)

Saw Palmetto

Nettle

Beta SitoSterol

Vitamin A (requires other vitamins and minerals)

EFAs Blend (Essential Fatty Acids - Fish Oils, Omega 3-6-9)

EMU Oil

To tell the truth, there are actually more of them than these above. These are what somewhat directly do this, but if you were to take other supplements or medications, you would be able to indirectly effect your level of DHT. That's why you hear some of us raving about taking B5, ALA (alpha lipoic acid), Digestive Enzymes, Thyroid meds, Avandia, Prednisone, Birth Control pills, etc. There's definately more than one way to treat hormonal imbalance. The trick is knowing what the imbalance is inside of YOU and then proceeding to treat it properly.

Please remember, unless you grow out of acne, you will ALWAYS have to follow your successful treatment method. Some of these Anti-androgens are more effective than others and depending on your own "blue print", you may need something that is the strongest, the Weakest, or a combination of the two, to solve your problems. Some of these are completely safe and "easier" to follow than others. Others produce painful, irritating, or harmful side effects. While others may throw our other vitamins & nutrients out of psync. Fortunately, some of these can be remedied by taking a good multivitamin, fiber supplement, or detoxing to correct any imbalances, but what about the others?

Since they ALL do the same thing, it really is up to you, but don't think that a Pill is MORE powerful than some dietary change, because for some of us it was the other way around. ;-) Through my own ordeals, I've learned that there is a treatment or combination that is the BEST one for you and your body will let you know if you made the right choice. So think about what your skin concerns are and then chose a product or method that is going to help you eliminate this problem. If it's not right, you'll keep breaking out, so keep testing various methods until you find the one (or combination) that helps you the most, better yet, gets you completely clear. =)

So I hope that my long post helped some of you out. If not, I've got another post that lists other forms of hormonal balancing medications,etc. Yes, I wish it shorter, but it really could take a (another) book to discuss acne so please don't feel so overwhelmed by my extremely reduced version. ;-)

Take care

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Sweetjade said "Now, one of my teachers told us that we can store a years worth of Vitamin A, so perhaps that is why accutane still works even a few years after treatment. While Vitamin A is not the same as accutane, perhaps we can store 13-cis-retinoic acid for just as long or longer."

When they say we can store years worth of vitamin A, they mean years worth in the sense that your body only requires a small amount of the vitamin for surivival and function. Your body would not deliberately store huge excess of vitamin A. It is similar to Vitamin B12. Your body can store large amounts of this vitamin, as only 1 mcg a day is required for bodily functions, yet it will not store a massive excess.

Either way both of these two theories could be easily assessed. Simply test the levels of Vitamin A, and levels of 12-cis-retinoic acid in an individual in the months after isotretinion treatment. Say 2 months, then 4 and then 6 months later.

Looking forward to hearing your thoughts, Jonathan.

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Sweetjade

I read an article on pubmed about the relationship between red meat, sat fats, and carbs with IGF-1 and IGFBP-3. I dont know what they mean with the words "negatively" associated or "positively" associated? Does the article say that red meats increase IGF-1? What about sat fats and carbs? Bye.

Here's the link: http://www.ncbi.nlm.nih.gov/entrez/query.f...2&dopt=Abstract

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Jono,

Thanks for clearing that one up for me. I was wondering just how much Vitamin A that would be ;-) That's definately a good way to test out the just how much remains in our systems after treatment on both of these retinoids. Since I had to go off of my medication for 2 months so that my hormones could "normalize" back to their high levels, in order to get a baseline, that was something I got first hand knowledge on. I was off of my Birth Control and Spironolactone for about 3 months before I was DX and started a new treatment plan (avandia). My face & body was just starting to breakout again around the time I started taking my medication so in terms of Tri-Levlen and Spiro on me anyway, their effects wore off in about 3 months I guess.

Of course, that is far from a scientific study, but perhaps accutane does slowly wear off or maybe the IGHBP-3 that it increased slowly decreased over a period of time. I dont know, several variables to test out, but that is definately a good idea. LOL, it's a shame really, they should be asking us acne sufferers what kinds of tests to run. Maybe there is a study like that already

Take care

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Acneman,

LOL, I am with you on that one ;-) I actually posted that abstract on another board and decided to just focus on this section " Serum IGF-1 and/or IGFBP-3 concentrations are associated with red meat, carbohydrate intake, and fat intake and, thus, may mediate the effect of these dietary factors on the pathogenesis of several disease states. "

http://www.ncbi.nlm.nih.gov/entrez/query.f...2&dopt=Abstract

Now, to help us clarify that a bit more, I found another study : "The major sources of animal protein, including milk, fish, and poultry, but not red meat, as well as total vegetable protein, were associated with an increase in IGF-I levels"

http://www.ncbi.nlm.nih.gov/entrez/query.f...6&dopt=Abstract

"Higher fat intake, in particular saturated fat, was associated with lower levels of IGFBP-3. We conclude that higher energy, protein, and milk intakes were associated with higher levels of IGF-I. These associations raise the possibility that diet could affect cancer risk through influencing IGF-I level." http://www.ncbi.nlm.nih.gov/entrez/query.f...9&dopt=Abstract

"We examined the association of diet with insulin-like growth factors (IGF) in 344 disease-free men. Raised levels of IGF-I and/or its molar ratio with IGFBP-3 were associated with higher intakes of milk, dairy products, calcium, carbohydrate and polyunsaturated fat; lower levels with high vegetable consumption, particularly tomatoes. These patterns support the possibility that IGFs may mediate some diet-cancer associations."

http://www.ncbi.nlm.nih.gov/entrez/query.f...0&dopt=Abstract

OK, so with the above it seems that yes, proteins raise IGF-1 levels but at the same time they are also supposed to help balance out your sugar levels when you consume them before eating carbohydrates (???). However, if you noticed, saturated fats (what types?) and milk also do this. Now I can't grasp that whole negative-postive thing, but carbohydrates also raise IGF-1 levels because they raise our Insulin levels. In turn that lowers our IGFBP-3 that is neccessary for binding this growth factor.

So what's the point right? Well If your goal is to decrease IGF-1, guess we need to find a way to raise or add IGFBP-3 in our system. So far we either do this by consuming or converting 13-cis retinoic acid, controlling our insulin levels, or reducing/avoiding the above foods. Remember now, regular commercial milk automatically supplies you with IGF-1 from the cow (if it works the same in our system) and therefore it rasies your levels more so than the other foods above. If you want to control your insulin levels you can do this through proper sleep, exercise, but probably more effectively through diet, medications, or supplements.

That's all I've got, anyone else?

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I suspect Isotretinion may also exhibit long term effects through a permanent physical alteration of the size of the sebum glands within the skin. I suspect that somehow the shrinkage of the sebum glands that Isotretinion is known to cause may be a semi-permanent phenomenon. That is, in certain patients it produces a shrinkage in the sebum glands that lasts for a long period of time, whereas in others it produces a shrinkage that doesnt appear to be permanent (hence oily skin returning eventually afterwards). Why in some patients this shrinkage is not permanent, I am unsure.

I do think that promise exists in the area of research on chemicals that block the conversion of DHT in the skin. I think that eventually a medication will be created that effectively blocks DHTs action in the skin, and hence stops acne in its tracks. At the moment, unfortunately, the current generation of topical retinoids are the best that we have.

I would be interested, however, in hearing how effective you have found topical Spironolactone to be in treating your acne.

Sincerely,

Jonathan.

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Hey SweetJade, you didn't think optizinc has B-6 in it because I said I was going to take it did you? I read your post on the clearskin4me forum. If so that's kind of funny...lol. The only zinc that I know of that has B6 in it is Good'n Natural's zinc for acne. Only 20mg to 50mg of zinc gluconate though. It makes me wonder about the combination :-k

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f*ck man. That's a lot of confusing stuff you wrote. Lost ya after the first sentence of your first post. But that's ok. I got a few questions. So what foods should I avoid? Just those 3? Bananas, peanuts and whatever the hell that other one was? I eat a western diet so if you could point out which foods I should stay away from, that'd be great. Maybe you could sum up what you said in English please. It's really confusing. Also list the list of supplements and where I can get them. That'd be great thanx. Oh and one more thing, how come B5 works so well for some?

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congratulations, i think you are hitting the nail on the head, this is precisely the problem that should be, being worked on by acne research scientists. It is exactly the problem that i have been researching for the last 3-5 years (i have been researching acne for 8 years), and i have come to the same conclusion as 'sweetjade1980'...

the 'solution' to acne is multi-layered, using accutane is like sealing up a leaking roof with plastic bags. The leak will stop (for a while) but because you haven't fixed the root cause of the leak there is no way of knowing if or when the leak will return.

However i still feel as though although you are on the right tracks that there is something else that we've missed as a causative agent. Let me briefly explain...

inflammation...this can be blocked my taking NSAIDS like ibruprofen, low dose, or more naturally a combination of fish oils, and evening primrose. both of which block the pro-inflammatory prostaglandins.

DHT, formation can be reduced to some extent by taking high dose zn (picolinate or glutamate), as well as high dose omega 3 and 6

and we all know the things that we can do to prevent the other 'causes' you've mentioned, i.e p. acnes, excess sebum, hyperketitinization, etc etc.

so why, even still if we do all these things does acne still return, now to say that it is all due to DHT, (in my opinion) is simply wrong, (although i do agree that it plays a major causal role)... this is because although as you have pointed out spironolactone is affective, i still think that the measures that i have mentioned (Zn etc) will inhibit the conversion enzymes (esp 5-alpha red...which is the main such conversion enzyme).

I believe this because DHT, (as opposed to simple testosterone) is what stimulates the seb glands to enlarge and produce so much sebum. So why is it that a significant few of acne sufferers (including severe ones) have relatively dry skin, as compared to the 'average' none acne suffer.

This i deduce to mean that DHT, although important can not be the major causative factor, which obviously is our genes. But negating that (as there is nothing we can do about that), i am at a loss as to what else may be the cause...

the most interesting one that i have discovered in recent months is the consumption of what is known as 'dirty protein' i am sure many of you will have heard of this. The theory is that the protien is altered at the molecular (amino acid) level, during processing and cooking to make it much less useful to our bodies.

Thus some is shifted to our skin which then attracts water (by simple osmosis) and this causes the pores to close, then the excess sebum (due to excess DHT, which itself is due to genes) causes the pore to block, this sebum block is infested with p. acnes, which converts the fatty acids into irritating agents which cause a 'hyper-immune responce' by many front line members. Such as monocytes and neutrophils, these produce free radicals to kill the bacteria

and in turn increase the pus level.

They also release prostaglandins which dilate the blood vessels to 'make the spot red'. Et viola...a spot.

i would very much like to hear your views on any other causative agent (other than DHT), or why you think DHT is in fact the main cause, 'sweetjade'... as reading your post i think insight from you would be helpful. Or anyone else that may want to comment...I do believe we are on to something here and it is through pooling our minds and infomation that we may be able to come to a solution. Remember it is us the sufferers that know best, not some scientist in a white coat mixing chemicals, that could wipe out half of london.

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