Acne is a condition in which pores in the skin become clogged, leading to inflammation and infection. It’s a particularly embarrassing condition because the clogged pores are typically on the face, so the person with the condition displays it to everyone. In the light of evolutionary psychology, the display of an illness, especially an infection, makes the person with acne something of a pariah. But you can eliminate acne.
While acne is most often associated with teenagers, it often persists into adulthood. I have some experience with this, and had flare-ups all my adult life, into my fifties, until I figured out how to prevent and eliminate it.
As with so many other health problems, it’s my belief that doctors look at this problem wrongly. They see it as something that needs to be treated with drugs and other treatments, rather than as something that can be prevented or that is due to lifestyle factors.
In their overview of acne, the American Academy of Dermatology does not mention a single lifestyle factor as being involved in acne. To them, it just sort of appears, and then you need to see one of their members for expensive treatment.
In contrast, it’s easy to see that diet — and some other lifestyle factors — play a key role in acne.
Consider that an examination of over 1300 people, including several hundred aged 15 to 25, failed to turn up a single case of acne: “Acne Vulgaris, A Disease of Western Civilization”.(1)
The subjects examined were Kitavans (in the South Pacific) and Aché (Paraguay). The authors believe that genetic factors are not paramount, since members of closely related groups develop acne when living in Westernized societies.
From the study, the authors make the case that hyperinsulinemia due to a Western diet causes acne:
Although diet is infrequently considered as an etiologic agent in the development of acne, it represents a well-recognized factor in acute and chronic hyperinsulinemia. Recent evidence has demonstrated that the hormonal cascade triggered by diet-induced hyperinsulinemia elicits an endocrine response that simultaneously promotes unregulated tissue growth and enhanced androgen synthesis. Hence, hyperinsulinemic diets may represent a previously unrecognized environmental factor in the development of acne via their influence on follicular epithelial growth and keratinization and on androgen-mediated sebum secretion.
Another study makes the same case for increased insulin secretion, and focuses on mTOR (or mTORC as they refer to it), the cellular growth machine.(2) (NB: I don’t agree with everything in this article.)
These new insights into Western diet-mediated mTORC1-hyperactivity provide a rational basis for dietary intervention in acne by attenuating mTORC1 signaling by reducing (1) total energy intake, (2) hyperglycemic carbohydrates, (3) insulinotropic dairy proteins and (4) leucine-rich meat and dairy proteins.
So, increased insulin looks like a prime candidate in the causation of acne. The Kitavans, with zero cases of acne, do indeed have much lower fasting insulin (and glucose) levels than age-matched Swedes.(3)
The Kitavans eat no processed foods in their version of a paleo diet; the staples are fish, coconut, and sweet potatoes. Of interest to note that it’s a high-carbohydrate diet, with up to 70% of calories from carbohydrates.(4) However, the diet has a low glycemic index; they eat no grains or flour. This fact lends some support to the idea that carbohydrates per se aren’t the problem in Western diets, but “dense, acellular carbohydrates”, which cause obesity and other health problems.(5)
(By the way, 80% of Kitavans smoke cigarettes, and they have no heart disease.)
With all of that as well as my personal experience in mind, here’s how to eliminate acne.
The dermatologists don’t recognize lifestyle factors as being important in acne, one reason being that it cuts into their very high income. And the most effective topical anti-acne treatment, benzoyl peroxide, is dirt cheap and over-the-counter. Accutane, a prescription anti-acne drug, has a raft of terrible side effects, including psychiatric effects – suicidal depression being one.(8)
As we’ve seen, a number of lifestyle factors, including diet, soap, and sunshine are intimately involved in the genesis of acne. As in so many other diseases of Western civilization, looking to correct these factors may be a more effective, cheaper, and healthier alternative.