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.
Doctors get it wrong, as usual
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.
Traditional cultures with zero 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.
How to eliminate acne
- Sugar. Sugar raises insulin levels, including in the skin. In addition, high blood sugar levels that come from ingesting sugar feed the bacteria, Propionibacterium acnes, that infects pores after they’ve been blocked. High amounts of sugar reliably cause acne. Sugar should be entirely eliminated. Consider cutting way back on refined carbohydrates too.
- Caffeine. The caffeine in coffee and tea stimulates production of oil in the skin, leading to blocked pores and acne. Caffeine is probably not as strong a cause of acne as is sugar, but if someone ingests large amounts of it and has acne, cutting back is advised. Note that many people put milk and sugar in their coffee and tea also, which will exacerbate its acne-producing effect. Also note that chocolate has caffeine and other related stimulants like theobromine, and is usually loaded with sugar. Chocolate has long been fingered as a cause of acne, and stimulants and sugar may be why.
- Milk. There’s something about milk that doesn’t seem to apply to other dairy products in the causation of acne. Milk can cause it whereas cheese, yogurt, butter, and so on do not, or at least don’t seem to. Eliminate milk. Note that many people start the day with a bowl of sweetened cereal doused in milk, a perfect recipe for a spike in blood glucose and insulin and an acne breakout.
- Soap. The dermatologists recommend washing the face several times a day to eliminate oils and kill acne-causing bacteria. The problem is that bacteria don’t live in a vacuum, but coexist with other bacteria in ecological balance. By using soap, the balance is upset, which may aggravate acne. I quit using soap on my face years ago at the suggestion of the late Seth Roberts (who often wrote about his problems with acne). It worked very well for me. I don’t know what the effect might be on someone with extremely oily skin, however, but I think it’s worth a shot.
- Iron. This is a bit speculative, but the bacteria that cause acne need iron to grow and reproduce, as do all bacteria. Iron chelators greatly (4- to >20-fold) potentiate the effectiveness of topical anti-acne drugs like benzoyl peroxide.(6) Keeping iron out of the skin may decrease acne, and the way to do this is to keep overall iron levels naturally low. Alternatively, an iron chelator like IP6 or green tea extract could be added to benzoyl peroxide, a common OTC topical acne med. An emulsion of green tea extract also reduces sebum production in facial skin.(6) Oral supplementation of green tea extract also reduces acne.(7) Incidentally, the bacterium P. acnes has been found growing in arteries, and this is also likely related to excess iron.(8). Interestingly, another commonly used topical acne medication is salicylate, usually put into medicated soaps. Salicylate is a strong iron chelator.(9) It may be effective by depriving bacteria on the face of iron.
- Sunshine. Getting out in the sun can clear acne, probably due to the bactericidal effect of solar radiation. As with sun exposure in general, 10 or 15 minutes exposure may be enough. Longer exposure risks burning, which should be avoided.
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.
Nice article I went paleo a while back & my acne went away. I personally can tolerate some dairy, and still consume foods with sugar as long as it’s a natural food, such as kiwi or watermelon.
As for dairy, I noticed that consuming milk and/or yogurt tends to cause some acne for me. I was blaming (pure speculation) that the carbs (lactose?) inside aren’t digested well. Cheese, butter and cream seem to be fine though.
I agree with the soap thing. I went soap free a few months ago and my skin is much better now.
We talked about this before but again great advice. I started to cut my sugar intake as of now no major results but I realized my caffeine intake is way to high so I’ll cut back on that as well and will see how that goes.
From my own experience, diet is the predominant factor with acne. For me personally, eating papaya and sweet potatoes throughout the week and avoiding sugar and milk banished any breakouts. I have reintroduced whole milk back into my diet and within a few days my skin is either broken out or blemished.
One glass of milk and I’m broken out the next day. I ate a few Girl Scout cookies recently – same thing.
Hey PD, I had a question, and I do not know if you can answer it. I went full paleo a couple of years ago, and went completely off of milk. Now a lot of paleo health guys like you have suggested doing this, and you guys have had a lot of success with this. I went off of milk too , hoping the acne would go away. I had gone to dermatologists before, and as you described in the article, they always prescribe accutane. I hate taking medication and accutane did nothing for me, so I hoped paleo and going off of milk would help.
There was a strange side effect however when I did this. I had horrible, stinky gas and super watery shits everyday. I tweaked my paleo diet a couple of times, but nothing seemed to work . A year later, I decided I would drink milk for a bit to see the effect. No lie, within a day or two, I had solid stools again.
I think most of you paleo experts have European blood, so if no milk works for you, it should work for me. Do you know anything about people with this same problem?
As for the acne, the paleo didn’t and no milk never got rid of it completely. I have stopped using soap on my face and body, and that has really seemed to help. The only spot on my body that still has minor acne is the left side of my back. As well I stopped shaving and just trim my beard with beard trimmer. Taking away the irritation from using a razor on my face has helped a lot.
Any information you may have is appreciated.
Kyle, I’m afraid I don’t have a clue about why you’d have digestive problems without milk.
Duac(Benz peroxide and clyndamycin) will fix mild/moderate acne and is far better then each individually.
Most people cant tolerate a ketonic diet for very long(which is also a cure). If we all had rock hard self control we could do anything. Let me know if there’s a cure for high time preference.
Duac has few sideeffects btw and is only topical.
I woulda thought acne would be a good cure for high time preference.
Mangan, I have to share this with you. I got acne as a young teenager; it was cystic and painful and all over face and shoulders. I had cysts inside my ears and on my earlobes. It was everywhere. My pillowcases were grey and brown from the oil and dried blood that I secreted from my face. I had it well into my 20’s. And I had tried everything the dermatologists could throw at me: topical solutions, anti-biotics, etc.
And then my parents sent me a little booklet; I wish that I could remember who published it. It was a prescribed diet, and here is what it was as best as I can remember:
Days 1 through 3: water fast with lemon juice added. Honey could be added for energy. I would take a teaspoon here and there for energy. (I must add that I had probably never missed a meal in my life up to that point, so it was quite a hardship. I had weak knees by the end of the third day.)
Days 4 and 5: fruit and vegetable juices (and water) only. I froze some of the juices just to have the sensation of chewing.
Days 6, 7, 8: added raw fruit and raw vegetables to what I was doing days 1 through 5. I made salads, and I cheated a little bit with some Italian and oil and vinegar dressings.
Days 9 and 10: added cooked vegetables to days 1-8.
Days 11 and 12: added cooked meat and eggs, avoiding processed meats. The meat category had a hierarchy: fish, poultry, beef, lamb, pork, etc.
Day 12 was what you were supposed to eat the rest of your life, much like what you promote. Avoid processed food, milk, etc.
I was cured of my acne within weeks. I could not believe it, because my acne was bad. The scars have never gone away, but it was worth the discipline of those 12 days just to reboot my metabolism and know how to proceed into the future.
This is a great site, Mangan, and I share some articles with my son so that he can avoid dietary and lifestyle errors that I have made over the years.
Great story, Conan, thanks for sharing and for the kind words. Acne that bad must be horrible almost beyond imagination. My older brother still has his acne scars to this day; fortunately I never got much in the way of scarring.
In any case, your story confirms what I wrote, that diet is all-important.
I was shocked to learn that the primary sugar in milk, Galactose, is used as an actual aging accelerant by researchers:
Advanced glycation in d-galactose induced mouse aging model
I’m surprised WHEAT isn’t mentioned. Years (decades) ago I literally stripped all foods out of my diet, then started adding them back in one by one. Wheat was the #1 cause agent for me. If I had anything that was wheat/bread, literally the next day or so I’d get breakouts. Pizza was one of the worst foods for me. A Paleo type diet helps, but that’s because it excludes the wheat as well.
+1 on the wheat. I discovered this for myself (and my family) about 5 yrs ago. We have bagels at work, and occasionally a pizza day. If I partake, almost guaranteed 1-3 painful pimples the next day, dependent upon how much I’ve eaten.
FWIW, gluten-free pasta seems to be OK.
Sugar and milk. I practically lived on bowls of cereal with milk as a teenager.
Sunshine: I remember the dermatologist lighting up my face with the UV lamp. He coulda just told me to go outside!
Good advice, changing my diet has helped prevent acne breakouts, but I still have some some acne scars . Do you have any suggestions for getting rid of post acne scars or redness?
Hard to say, Richard. Scars fall into the same category as wrinkles – generally considered permanent. A sibling of mine has terrible acne scars; fortunately I escaped them. In any case, glucosamine taken orally, and CoQ10, applied topically, have shown some success against wrinkes, so they might be worth a try.
Tamanu oil has helped me with acne scars! You can buy it online.
For me, zinc was the answer. I saw a reference to increased gut permeability in acne sufferers. I figured that low stomach acid (due to zinc deficiency) was causing undigested food to irritate the gut lining and enter the bloodstream (the skin takes up the stress of an overworked liver). I took zinc, L Glutamine and cod liver oil supplements and my acne was gone in about two weeks. You have to refrain from “typical teenage pass-times” cough, cough – while normalising your zinc levels, otherwise you’ll break-out and never improve. I’m sure that’s a oversimplified explanation for what’s actually occurring, but it worked for me. Note: zinc requirement goes up during adolescence – unfortunately at a time when certain urges kick in, compounding the deficiency. This, I believe, accounts largely for the phenomena of teenage acne.
Good point! I know there are a lot of factors that may cause acne problems, but it is also crucial that we find the particular culprit why acne just can’t seem to get enough of our skin. Doctors would recommend the same product to everyone as if everyone is the same. Me, personally, I stay away from dairy products, but I drink 2-3 cups of coffee in a day. I use a gentle cleanser (Cetaphil), diluted Apple Cider Vinegar as my toner and spot treatment if need be, and coconut oil as my moisturizer. These things are great on the skin. You guys should give a try! 🙂
what do you think about a topical DHT blocker? such as a 2.5% or 5% spironolactone cream? does it lower DHT significantly enough to cause problems? might it work?
i also have a thinning hairline (im 19 male) so i thought i am likely to have high DHT and might also benefit from using it on my scalp.
well, ive done all this stuff and then some, my diet has been very strict with limited results. (currently just eating lots of meat, vegetables, some macadamias and cheese, maybe a small piece of fruit after a workout. and i take fish oil which seems to help.)
just to clairify the diet helps a lot, had severe acne now its mild-moderate, want to get it clear though,
so what do you think about a topical DHT blocker in my case and/or in general?
Hi Sean – as far as I can tell, the mechanism of DHT blockers overlaps with what I discussed in this post, which I suggest you read. If you’ve had both acne and are now balding, that suggests that you could be insulin resistant, although your diet sounds quite decent. Make sure you don’t consume refined carbs, sugar, or veg oils. Also exercise is important for improving insulin resistance.
I also believe that doctors see it the wrong way always, that they always recommend expensive treatment and skincare products to get rid of acne, where in fact lifestyle factors can only be the solution to the problem. That is why I depend on searching my own ways to get rid of my acne. I perform healthy habits like, eating more fruits and vegetables, avoid dairy products, drink lots and lots of water, enough sleep, workout routine and use natural skincare products. After a couple of months, I can see great changes and glad that using these ways are effective to treat acne without breaking the bank for expensive treatments.