To begin we’re going look at the root causes of acne in women, as the first step to healing your acne is understanding what’s causing it.
Acne begins with the production of an oil called sebum within the sebaceous glands near the surface of the skin. When the sebum gets clogged in a hair follicle and cannot reach the surface, acne can form.
Anything that can overstimulate this production of sebum will increase the chances of a hair follicle becoming clogged, and then potentially resulting in acne. Our skin produces the most sebum between 15-35 years of age, which is why it is more common to experience acne in this age range.
The three most common imbalances that can cause excess sebum production in women are:
- Estrogen dominance
- Elevated dihydrotestosterone (DHT)
- Blood sugar imbalance
1. Estrogen dominance
Estrogen dominance occurs when a woman’s estrogen to progesterone ratio is too high. This is either when her levels of estrogen are too high, and/or her progesterone is too low.
A woman with a healthy estrogen to progesterone ratio is less likely to experience premenstrual acne as progesterone helps reduce sebum production.
Many factors can cause estrogen dominance, including diet, obesity, chronic stress, hormonal birth control and polycystic ovary syndrome.
2. Elevated DHT
When a woman’s acne is not cyclic, meaning that it does not appear at roughly the same time each month, then it is more likely due to elevated levels of the hormone dihydrotestosterone (DHT).
DHT is a potent androgen hormone that can cause an increase in the production of sebum in the hair follicles of the skin, and therefore acne.
A number of factors can cause elevated DHT, including chronic inflammation, genetics, hypothyroidism and blood sugar imbalance.
3. Blood sugar imbalance
Both a diet too high in sugars and insulin resistance can cause an excess of insulin in the bloodstream, which can raise the levels of acne-causing DHT.
Excess insulin can also cause an increase in insulin-like growth factor 1 (IGF-1), which promotes the overproduction of sebum and skin cell growth, both of which lead to clogged skin and acne.
Most healthy women experience temporary insulin resistance in the days leading up to menstruation. This is why cravings for carbohydrates and sugars are common and why some women experience more acne during this time.
What is the cause of my acne?
Acne can have more than one cause. For example, it is very common for women to have both estrogen dominance and elevated DHT and/or blood sugar imbalance.
Estrogen dominance is one of the leading causes of acne in adult women. But what exactly is estrogen dominance and what causes it?
What is estrogen dominance?
Women have three dominant types of estrogen in the body: estrone, estradiol and estriol. Estrogen dominance occurs when the level of estrogens outweighs the level of progesterone in the body, causing an imbalance.
Whilst estrogens are a group of essential hormones, estrogen dominance can cause symptoms of imbalance and disease in the body, including acne.
There are two ways that estrogen dominance can occur:
- Normal estrogen levels with low progesterone
- High estrogen levels with normal progesterone
The term ‘estrogen dominance’ can be confusing because much of the time the ratio imbalance is due to low progesterone, and not the estrogen levels themselves. The dominance is the measure within the ratio.
Let’s take a look at both occurrences in more detail.
1. Low-progesterone estrogen dominance
With low-progesterone estrogen dominance, a woman will often experience acne that appears within the two-week period leading up to her menstruation each month.
In women with a healthy estrogen to progesterone ratio, the normal levels of progesterone in this luteal phase work at reducing her body's excess sebum production.
In the case of a woman who has low levels of progesterone, there is less progesterone in the body to reduce this excess sebum production. She is therefore more likely to experience clogging of the hair follicles and acne.
The potential causes of this low-progesterone estrogen dominance include polycystic ovarian syndrome, hormonal birth control, chronic stress and candida overgrowth.
2. Normal-progesterone estrogen dominance
When a woman has elevated estrogens and normal range progesterone, she can also have estrogen dominance.
This type of estrogen dominance is not as likely to cause acne. However, as any imbalance within a woman’s hormonal system can contribute to acne, it cannot be ruled out.
The causes of this type of estrogen dominance include insulin resistance, obesity, imbalance of gut microflora, exposure to synthetic estrogens and an imbalance in estrogen metabolism.
Is my acne caused by estrogen dominance?
There are a number of symptoms that can help you identify if your acne is caused by estrogen dominance.
These include PMS, fibrocystic and tender breasts, heavy bleeding and/or irregular menstrual cycles and weight gain.
The link between DHT and acne
DHT is a male-sex hormone, more potent than testosterone, that is also present in the female body.
Elevated DHT is arguably the most common cause of chronic acne in women, so it’s this hormonal imbalance in particular we need to pay careful attention to.
There are many factors that can cause elevated DHT, including chronic inflammation, genetics and hypothyroidism. However one of the most common causes is blood sugar imbalance.
How elevated blood sugar levels cause acne
Any food we eat is broken down into nutrients in our stomach. One of these nutrients is glucose, which is a simple and important sugar that provides us with vital energy.
When glucose enters our bloodstream, our blood sugar level rises. In response, insulin is released by the pancreas, which helps to regulate this blood sugar level. This is a healthy and normal process within the body.
However, insulin resistance occurs when our body becomes resistant to the insulin that our pancreas is producing. As a result glucose remains in our bloodstream, which causes our blood sugar levels to remain high. Having blood sugar that remains high over an extended period of time can lead to a range of health problems. One of these being elevated levels of DHT which can lead to chronic acne.
What causes insulin resistance?
A diet consistent in high levels of simple carbohydrates is a direct cause of insulin resistance. Other causes include polycystic ovarian syndrome, obesity, chronic stress, an inactive lifestyle and certain medications.
Temporary insulin resistance can be caused by puberty and pregnancy. Menstruating women also experience temporary insulin resistance for a few days leading up to their cycle each month (you may notice that you crave sugars and carbohydrates during this time).
Is elevated DHT and/or blood sugar imbalance causing my acne?
Aside from acne, women with elevated DHT may also experience hirsutism (increased body, facial and pubic hair growth) and an irregular menstrual cycle.
A diet high in simple carbohydrates such as sweet foods, white processed grains, cow’s dairy and high-sugar fruits is a direct cause of acne in women. So if your diet is high in these foods your acne may be linked to your blood sugar levels.
Women with PCOS are also more prone to insulin resistance, which we’ll look at in more detail in step four.
Polycystic ovary syndrome (PCOS) is one of the leading causes of chronic acne in women. But not all women with PCOS will experience acne. So let’s take a look at the link between PCOS and acne, and how and why it affects some women.
What is PCOS?
PCOS is not a disease, but rather a cluster of symptoms. It is a hormonal and metabolic disorder that can cause ovarian cysts, irregular menstrual cycles, excess bodily hair growth, alopecia, infertility, obesity and acne.
Not all women with PCOS will have the exact same symptoms and only 20-40% of women with PCOS will suffer from chronic acne.
The exact cause of PCOS is not known. However, because the disorder runs in families, it is thought that the root cause may be due to a mutation of one or more genes.
PCOS and the female hormonal system
Women with PCOS have elevated levels of luteinizing hormone (LH), elevated androgens (specifically testosterone and DHT), low levels of progesterone, and low levels of follicular stimulating hormone (FSH).
This cocktail of hormonal imbalance causes the eggs within the follicles of the ovaries to not mature enough in order to begin the ovulation process, preventing the release of the egg. As a result the follicles (fluid-filled sacs that contain the egg) collapse in on themselves, forming a tiny cyst within the ovary. These cysts are noncancerous. In women with PCOS, there are typically many of these tiny cysts on the ovaries.
How PCOS causes acne
Women with PCOS typically have insulin resistance, which leads to elevated levels of the male-sex hormone DHT.
As elevated DHT is arguably the leading cause of chronic acne in women it’s this hormonal imbalance in particular that is the strongest connection between PCOS and acne.
Women with PCOS can also develop acne due to low progesterone. Progesterone levels rise each month after ovulation occurs in a woman’s menstrual cycle. However, for a woman with PCOS ovulation often does not occur. This results in her progesterone levels remaining low.
Normal levels of progesterone help to reduce the sebum production in a woman’s skin in the days leading up to menstruation each month. So without adequate levels of progesterone, her skin will likely be producing too much sebum during this time and therefore have a higher chance of developing chronic acne.
How to treat PCOS acne
As PCOS is not a disease there is no ‘cure’ per se. However, successful treatment is possible through correcting the imbalances in the body that are caused by the disorder.
As the strongest link between PCOS and acne is high levels of DHT caused by insulin resistance, the best way to treat PCOS acne is by balancing blood sugar levels through diet and supplementation.
This will result in the fastest improvement of lowering the DHT to normal levels, and correcting the insulin resistance – both which will provide the best chance at clearing the chronic acne.
Hormonal birth control is one of the most common pharmaceutical treatments for all severities of acne in women.
But for some women, hormonal birth control can be the cause of their acne.
How hormonal birth control works
There are many different types of hormonal birth control, such as the birth control pill, hormone releasing intrauterine device (IUD) and the the birth control implant.
Each method works in slightly different ways, but they all release synthetic hormones into the woman’s body.
Some hormonal birth controls release both progestin and ethinyl estradiol, and some progestin alone.
Progestin is a synthetic form of progesterone. Progestins are well known to cause acne, as acne is one of the common side effects of using a progestin only or low estrogen pill.
In the past, progestins had strong androgenic properties. This meant they were able to cause acne by raising the levels of acne-causing DHT.
Newer forms of progestin have lower androgenic properties so are less likely to be the sole cause of acne. However, if a woman already has elevated levels of DHT, then it’s likely that the progestin in the pill will raise her DHT levels even more and then contribute to her getting acne.
In addition, as progesterone helps to regulate healthy sebum production, with less natural progesterone in her system, a woman is more likely to experience an overproduction of sebum and therefore acne.
Ethinyl estradiol is the synthetic form of estrogen in most hormonal birth control.
Ethinyl estradiol is the component in some hormonal birth controls that can help clear and prevent acne. It does this by reducing the levels of 5a-Reductase (5AR), which in turn lowers acne-causing DHT.
However it is important to note that women whose acne clears from the DHT-lowering effects of ethinyl estradiol in birth control often experience a return or worsening of their acne once they come off birth control. This is because the underlying root cause of the acne has not been addressed or rebalanced.
How coming off birth control can cause acne
On average it takes a woman’s body about three months to adjust back to its natural hormonal state after coming off hormonal birth control.
It’s therefore common for women to experience a sudden acne breakout or worsening of the skin three months after stopping birth control.
As the synthetic hormones leave the woman’s body, her natural levels of progesterone, luteinizing hormone, follicle-stimulating hormone, DHT, testosterone and SHBG will begin to normalise.
While for many women their hormonal system will naturally go back into a healthy balance, for some women their levels of progesterone may not return to healthy levels. For others their acne-causing DHT levels may remain high. And for some, they may find that the synthetic estrogen in their body is contributing to estrogen dominance. All of these imbalances can cause chronic acne.
These women may need supplementary and dietary assistance to help their hormonal system return back to normal, healthy levels after coming off their birth control.
Supplementation to restore hormonal balance
Targeted supplementation with the following ingredients can be highly effective in rebalancing a woman’s hormonal system after coming off hormonal birth control:
- Probiotics to help to restore the gut microbiome.
- Indole-3-carbinol (I3C), broccoli seed extract, rosemary extract and grapeseed extract to detox toxic and synthetic estrogens from the body.
- Vitamin C to restore the body to healthy levels, as Vitamin C can be depleted by the body whilst on birth control.
- Vitamin A, Vitamin D3, chromium picolinate and inulin to help to balance blood sugar levels.
- Zinc and Indole-3-Carbinol to help to normalise androgen levels.
As we discussed earlier in the program, a hormonal imbalance, such as estrogen dominance or elevated DHT, is usually the cause of acne in women.
But what causes this hormonal imbalance in the first place?
The link between gut health and hormones
There are a number of different factors that can cause a hormonal imbalance, including diet, chronic stress, disease and medications, as well as an imbalance of microorganisms in the gut, known as the gut microbiome.
These microorganisms are responsible for the metabolism and regulation of healthy hormones. So when there is an imbalance in the gut microbiome, there can also be imbalances in hormones, which can then result in acne.
How to rebalance the gut and clear acne
It can take up to six months to restore the gut’s microbiome back to healthy levels when there is an imbalance. However, there are many things that can be done to restore a healthy gut microbiome, including:
- Taking a probiotic supplement
- Eating fermented foods, such as sauerkraut, kombucha and kefir
- Eating prebiotic foods, which are found in fruits, vegetables and whole grains
- Reducing alcohol consumption
- Maintaining a healthy body weight
- Exercising regularly
- Reducing stress
- Getting enough sleep
Not everyone that eats a bad diet will get acne. But for those who have acne-prone skin, eating the right diet will help in both the healing of the skin, and in the prevention of new blemishes.
Let's begin by looking at the foods that can cause acne.
Simple carbohydrates are the main food group that can cause acne. The connection between simple carbohydrates and the skin is through a complex pathway of reactions in the body. These reactions lead to elevated levels of the androgen hormone DHT, and therefore increased sebum production. And when there is an increase in sebum production, there is always a much higher possibility of acne.
Simple carbohydrates include refined sugars (white sugar, raw sugar, high fructose syrup), white flours (bread, pasta, wheat tortillas) and dairy products (milk, cheese, yogurt).
Fruits are packed full of essential vitamins and minerals and are important in a healthy diet, but they are also very high in sugars.
When eating for healing or the prevention of acne, it is better to consume fruits in their whole form and not fruit juices. As juices are significantly higher in sugars.
It is also helpful to consume fruits that have a lower glycemic index. These fruits include berries, grapefruit, pears, peaches, grapes and oranges.
Always practise moderation! It’s okay to eat a variety of fruits with a higher glycemic index, just in smaller amounts.
Dairy products contain insulin-like growth factor 1 (IGF-1). An elevated level of IGF-1 is associated with insulin resistance, as well as an increase in 5a-Reductase activity. Both can result in higher levels of the androgen hormone DHT, and therefore acne.
Gluten sensitivity is one of the most common food intolerances. Women with a gluten sensitivity may experience headaches, brain fog and depression, as well as acne from consuming foods that contain gluten.
Why doesn’t everyone with a bad diet have acne?
Some people are acne-prone, and others just aren’t.
It does not mean that someone who eats a diet high in acne-causing foods and does not get acne is necessarily any healthier. It just means that their imbalances will manifest in the body in a different way.
Also, acne-prone skin often changes with age. As a woman approaches menopause, she may find that she no longer has any issues with acne.
Do I need to cut out acne causing foods completely?
While it is good to reduce acne-causing foods in the diet, it is always best to practise moderation. For any of these food groups to be the sole cause of the acne, they need to be consumed on a regular basis.
So it is possible to consume these food groups in small amounts and in moderation without them causing acne.
Foods that can help clear the skin
Omega-3 fatty acids have an anti-inflammatory effect which helps to clear acne lesions. Foods high in omega-3 fatty acids include salmon, sardines, chia seeds, flax seeds and walnuts.
We need to consume good fats in order to build healthy levels of progesterone in the body. Progesterone is a hormone that helps to keep cycles regular, minimise PMS and clear acne. Foods that contain good fats include coconut oil, cacao butter and dark chocolate, fatty fish, avocado, nuts and seeds, olives and olive oil.
Dark leafy greens are a powerhouse of vitamins and minerals, which make them a great supportive food in any healing regime. Some of the most common dark leafy greens include kale, spinach, Swiss chard and bok choy.
Most dark leafy greens (with the exception of spinach and lettuce) are classed as cruciferous vegetables. Whilst it’s important to include dark leafy greens in a healthy diet, it is equally important to do so in moderation as consumption of cruciferous vegetables in high doses over a long period of time can contribute to hypothyroidism.
Consuming enough protein is essential for healthy hormones. Low levels of protein intake have been linked to low estrogen, low progesterone and compromised thyroid function. Without healthy, functioning hormones from a lack of protein in the diet, a woman can develop acne due to estrogen dominance.
Protein is also essential for blood sugar balancing as protein lowers the glucose load of a meal and improves the blood glucose response. Keeping blood sugar levels in balance is one of the best ways to keep the skin clear.
There are many protein options for all diet choices, including vegetarian and vegan. Good proteins include meat and chicken, dairy, fish, eggs, nuts and seeds, quinoa, tofu and legumes. It’s important to note here that dairy products can be a cause of acne, including both cow’s and goat’s dairy.
The best diet for clear skin
In summary, the best diet for the healing and prevention of acne is the following:
- High vegetable intake, with a variety of vegetables including dark leafy greens (aim for one cup of vegetables in each meal).
- High in good fats.
- A protein source in each meal.
- Whole grains, preferably gluten-free.
- Whole low glycemic fruits (not juice).
- Only small amounts of natural sugars (honey, maple syrup).
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