Common causes of acne

The development of acne is multi-factorial with a number of causes and exacerbating factors contributing to the onset and persistence of the condition. These include:

  • Gut health and the microbiome – microbial residents of the gastrointestinal tract are now recognised as having wide ranging effects. Links with depression and anxiety, immune issue and skin conditions have been shown. Current thinking proposes that alterations in the microflora of the intestine brought about by factors such as stress, poor diet, allergies and some medications lead to local and systemic inflammation. This in turn promotes skin inflammation and microbial overgrowth.
  • Bacteria – A bacteria species Propionibacterium acnes (P. acnes) is commonly found in the pores of the skin. Under normal circumstances P. acnes is in balance with the skin environment however when stimulated by factors such as excess sebum and pore congestion the environment is ideal for bacterial growth. Overgrowth of P. acnes triggers an inflammatory response, leading to pustules.
  • Sex Hormones – High androgen production is one of the key reasons acne tends to flare up at puberty or with the menstrual cycle. Androgens stimulate the production of sebum in the skin’s oil glands. Oil glands that are blocked by dead skin cells build up sebum creating swelling. Sebum production can also be stimulated by sweat and humidity.
  • Cosmetics and medications – Contact with oily substances such as mineral oil, rich creams or make up and petroleum based products can trigger or exacerbate acne. Cosmetics can also cause skin irritation which may flare-up acne. Certain medication such as stero ids can also stimulate acne production.
  • Stress – There is some indication that stress can exacerbate acne by disrupting hormone levels and suppressing the immune system.
  • Dietary Factors – There are a number of links between diet and acne. Diets high in trans fats, simple carbohydrates and sugars promote inflammation in the body, which aggravates acne. A high glycemic index (GI) diet is also associated with insulin resistance and increased production of androgens.
  • Insulin levels – High insulin levels occur when the cells that usually take glucose up from the blood become resistant to its effects. The pancreas responds by producing more insulin creating a cycle that can lead to an increase in acne, as well as weight gain and hormone imbalances.
  • Nutritional Deficiencies – Zinc, Essential Fatty Acids and vitamin A are important skin nutrients. Deficiencies in any one of these can lead to skin problems. Skin that is dry and inflamed or congested with whiteheads or blackheads may be deficient in EFAs. Skin deficient in zinc can scar very easily which is often the case in chronic acne. Adequate levels of zinc in the skin will help with skin repair and reduce ongoing scarring. Acne and rough or thick skin are also possible signs of a vitamin A deficiency. A visit to your naturopath will help identify low levels of any nutrients.

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Dietary Influences on Acne

truthA recent Australian trial conducted at RMIT University, Melbourne, has shown that a low glycaemic index (GI), high protein diet improved symptoms of acne including the number of facial lesions. It also reduced the causative factors associated with acne such as high androgen levels and insulin resistance. The diet consisted of 25% of energy from protein and 45% of energy from low GI carbohydrates such as fruit and vegetables, grains and pulses.

Interestingly acne is seen as a condition associated with Western diets that are generally higher in saturated and trans-fats, high in simple carbohydrates and sugars and lower in healthy protein sources. Acne vulgaris is seen in up to 79-95% of the adolescent population in Westernised countries. Non-Western diets, which are traditionally high in low glycaemic foods, do not have the same association.

Foods to Enjoy

Dietary recommendations that will support skin health, help to normalise hormone balance and reduce sebum production include:

  • Consume Fish regularly: Fish is an excellent source of protein and essential fatty acids. Protein is important for skin healing. Essential Fatty Acids (EFAs) help to keep skin flexible and hydrated as well as promoting skin healing. Deep Sea fish are the best source of EFAs including tuna, salmon, anchovies and sardines. A fish oil supplement may be a good idea if fish intake is less thank twice a week.
  • Eat Lean Animal Protein: Lean red meat and organic chicken are good sources of valuable protein that is essential for skin healing and repair. A palm size serve of animal protein 2-3 times a week will help support skin health.
  • Eat plenty of Fresh Vegetables: Vegetables are low GI and full of antioxidants and trace nutrients that help to heal and repair the skin. Betacarotene (a precursor to vitamin A) is found in vegetables including carrots, spinach, sweet potato, kale, green leafy vegetables and red capsicum. Regular fruit consumption is also important.
  • Purified Water: Drink at least 8 glasses of water per day. Water promotes healthy digestive habits and helps to flush toxins out of your body. Water is also essential to keep your skin well hydrated.
  • Go for Whole Grains & Legumes: Whole grains are rich in fibre, low GI and nutrients. This promotes sustained release energy and reduces inflammation. Zinc, important for skin healing, is found in whole grains along with sunflower & pumpkin seeds, beef, egg yolks, ginger and lamb.

Foods to Avoid

  • Processed Foods & Sugar: Foods high in sugar increase the body’s production of insulin, promote inflammation and can cause or exacerbate acne. Ensure that the following foods make up no more than 10% of the diet: cakes, lollies, processed flour products, white bread, white rice (with the exception of Basmati), fruit juices, baked goods, and trans or hydrogenated fats.
  • Soft drinks & diet soft drinks: Soft drinks are full of sugar and often caffeine. The phosphorus and sodium in soft drinks can lead to skin drying and the carbonate can cause digestive disorders. Drink water, herbal teas, and vegetable juices instead.
  • Dairy: There is some research that suggests that a high consumption of milk and dairy products may be linked with acne. One study reported in the Journal of American Academy of Dermatology showed that milk was positively associated with acne in teenage girls. Suitable milk substitutes may include soymilk, rice milk, almond milk and fresh goat’s milk.

A healthy, low GI diet is important in the management of acne, both in teenagers and adults. In combination with good hygiene practices and natural, healing topical treatments, acne is a condition that can be managed effectively before resorting to medications.

E-mail  to request a copy of my Clean Skin handout. Or for more comprehensive dietary and detox programs for acne and skin conditions consider making an appointment.

Sleep well to look good

A bad nights skin can leave us looking tired but usually after a few good nights sleep things improve and our appearance returns to normal. As a one off, poor sleep can be managed but long-term sleeplessness can have a profoundly negative effect on skin health. Skin issues relating to sleeplessness range from premature ageing to chronic inflammatory skin conditions such as eczema, psoriasis and dermatitis.

The primary reason for this is stress as both the initial cause of the insomnia and the eventual damage to skin tissues.  Insufficient or poor quality sleep has been associated with a rise in cortisol levels (the stress hormone) and a decline in melatonin (the sleep hormone) and seratonin (the feel-good hormone).

Insomnia also disrupts the optimal processing of collagen formation, which is essential for skin structure and integrity. The follow on effects from poor collagen formation include the disruption of the acid mantle leading to excessive moisture loss and increased sensitivity and permeability to topical products.

Studies have shown that stress-induced insomnia can lead to the following skin issues:

  • Increased skin permeability leading to heightened skin sensitivity
  • Immune deregulation which precipitates or aggravates chronic skin conditions
  • Increased potential of bacterial invasion due to a breakdown in skin membrane integrity
  • Poor skin elasticity leading to premature ageing
  • Skin dehydration

To maintain healthy skin, it is recommended you get at least 7 to 8 hours of restful sleep each night.

So what does this mean for those with chronic skin conditions (including premature ageing and chronic skin dehydration)? Assess your sleep patterns. Ask yourself these questions:

  • Are you getting enough sleep?
  • Is the sleep you do get good quality sleep?
  • Do you toss and turn throughout the night?
  • Do you wake feeling exhausted or tired?
  • Do you feel chronically tired a lot of the time?
  • Do you wake in the night and find it difficult to get back to sleep?
  • Do you have thoughts going around and around in your head at night?

If can answer yes to any of these questions on a regular basis, it may be worth addressing your sleep patterns.

A few simple tips to optimise sleep hygiene:

  • Set a regular bedtime and stick to it
  • Avoid stimulating TV shows or reading just before bed
  • Have a cup of chamomile tea an hour before bed (ensure you have time for it to pass through before you hop into bed!)
  • Create a pleasant sleep environment e.g. regularly change your bed-sheets and pajamas as there is nothing nicer than hopping into a clean bed.
  • Listen to a relaxing meditation CD before bed or as you are going to sleep
  • Add a few drops of quality lavender oil to your pillow slip as it will help to encourage relaxation
  • Exercise during the day as it will help tire you out physically
  • Avoid caffeine containing drinks after midday

There are many other tips to help you get a good nights sleep but remember if it is a chronic problem, seek help as there are solutions that don’t involve sleeping tablets. And ideally, deal with the stress (physical, mental or emotional) that is causing the insomnia in the first place.

The role of diet in skin ageing

Can diet play a role in skin ageing? The simple answer is yes. Environmental factors, nutritional status and dietary intake more than genes can add years to a person’s appearance. While topical applications make a difference, a healthy glow is more often a sign of internal health than anything else. There is a growing body of evidence to show that what we eat certainly influences skin aging and not surprisingly, the dietary correlations that relate to reduced skin aging also relate to reduced aging in general. Apart from dietary interventions, research is showing that supplementation with specific nutrients and antioxidants supports the use of topical anti-aging products and that in fact the combination is more effective than either treatment alone. Below is a review of the most significant dietary and nutritional influences on aging.

An Australian study at Monash University looked at the effects of food and nutrient intake on skin wrinkling in areas exposed to the sun. The participants were from Melbourne, Greece and Sweden.

Food intake questionnaires were used to measure diet and microphotography of the skin was used to measure skin wrinkling. The study showed that Swedish had the least skin wrinkling, followed by Greeks and Australians had the most. The types of foods consumed did have an effect on the degree of skin wrinkling with more damage seen in those with a higher intake of meat, dairy and butter. Foods that had a protective effect against skin wrinkling included vegetables, legumes, olive oil, tea, prunes and apples (see full list below). Overall, positive dietary habits trended towards a low-GI diet.

Another study supports the above food associations showing that skin wrinkling in a sun-exposed site in older people of various ethnic backgrounds may be influenced reducing intakes of fats and carbohydrates and increasing antioxidants and beneficial fats, dietary measures which are associated with better skin-aging appearance.

It is worth noting that research linking skin aging and dietary habits should not be taken out of context. Overall dietary trends produce these effects rather than any single food group in isolation. However, the dietary trends in both studies show that high GI and saturated fats seem to have the most significant pro-wrinkling effect. Due to their higher saturated fat content meat, dairy and butter can increase skin inflammation and lead to faster skin aging. In addition a high sugar intake is also associated with greater skin wrinkling. Simple sugar has a pro-inflammatory effect but it also promotes the production of advanced glycosylation end products (AGE). AGEs are closely associated with oxidative stress. A combination of a high antioxidant diet and low sugar reduces inflammation, free radical damage and AGE production in the body. Again the trend shows that the protective foods are low or have no saturated fats and are low GI and rich in phytochemicals which support skin collagen and reduce inflammation.

The Monash study indicated that these foods associated with less wrinkling:

  • Mono-unsaturated fat including those from olive oil and olives
  • Nuts and legumes
  • Vegetables
  • Fish (particularly those rich in essential fatty acids)
  • Low fat milk and milk products, such as yogurt
  • Wholegrain cereals
  • Fruit and fruit products (especially prunes, cherries and apples)
  • Eggs
  • Tea and Water

More wrinkling was associated with diets that included higher intakes of:

  • Saturated fat (including butter)
  • Trans fats (including margarine)
  • Meat (especially fatty processed meats)
  • Full fat dairy products
  • Refined carbohydrates and sugars such as cakes, pastries and desserts
  • Soft drinks and cordials
  • Confectionary of any kind
  • Many packaged and processed foods contain hidden sugars
  • Packaged cereals

Apart from dietary trends, certain nutrients also show promising effects on skin aging. Studies have shown that antioxidant nutrients, specifically vitamins C and E, as well as lipoic acid and flavonoids, exert protective effect against oxidative stress in the skin, in particular photoprotective effects. That is they help protect the skin from the oxidative damage caused by the sun. Lycopene, lutein, and zeaxanthin as a specific subset of carotenoids may also be used as oral sun protectants and contribute to the maintenance of skin health. In fact, taking carotenoids prior to sun exposure will increase the depth and lasting effect of a sun tan (not that extended tanning is advised).

In other research, a daily dosage of soy isoflavones (40mg per day) resulted in the improvement of fine wrinkles and increased skin elasticity after 12 weeks of supplementation in middle-aged women with aged skin. Interestingly, a common arthritis supplement glucosamine also improved the appearance of visible wrinkles and fine lines. Glucosamine is incorporated into glucosaminoglycans (GAGs) in the body. GAGs work to increase epidermal thickness and elasticity of the skin although they have no effect on skin hydration.

Research into oral proanthocyanidins flavanoids from grapeseed extract or pycnogenol has shown they both have a significant protective effect on the collagen matrix of the skin and capillaries. They work by reducing capillary fragility and inhibiting collagen, hyaluronic acid and elastin breakdown. Both substances also have an anti-inflammatory effect and can improve peripheral circulation.

Again it is important to note that while supplemental nutrition can support skin health in a number of ways, if concurrent dietary changes aren’t made, the supplements will be combating the constant inflammatory cascade from high GI foods and saturated fats. Removing these dietary items will ensure that inflammation, AGEs and oxidation are all reduced allowing the supplements to work to their optimal level and effect real changes in skin health.

References:
Jenkins, G., Wainwright, L. J., Holland, R., Barrett, K. E., & Casey, J. (2014). Wrinkle reduction in post‐menopausal women consuming a novel oral supplement: a double‐blind placebo‐controlled randomized study. International journal of cosmetic science, 36(1), 22-31.
Purba, M. B., Kouris-Blazos, A., Wattanapenpaiboon, N., Lukito, W., Rothenberg, E. M., Steen, B. C., & Wahlqvist, M. L. (2001). Skin wrinkling: can food make a difference?. Journal of the American College of Nutrition, 20(1), 71-80.

Two minute health tips

Good health doesn’t have to be an effort. In fact it is the many little things you do on a regularly that add up to a feeling of wellbeing. If you don’t already try adding a few of these two minute health tips into your daily or weekly routine and see how you feel after a couple of weeks – I bet you will notice the difference:

1. Add a dash of lemon to your water first thing in the morning. As you boil the kettle for tea or coffee, drink a glass of warm water and lemon juice. It helps to flush out toxins and prime your digestion for breakfast.

2. Dry brush. Two minutes of dry body brushing before a shower stimulates the lymphatic system which helps to clear toxins out of the body), gets your circulation moving and sloughs off dead skin cells allowing your skin to absorb moisturiser more effectively.

3. Add more antioxidants to your food. This is actually much more simple than it sounds. Some great suggestions include half a teaspoon of Tumeric for its anti-inflammatory effects, a cup of green tea, a dessert spoon of organic Tomato paste in your cooking (which is rich in lycopene), a handful of berries and/or have greens at least once a day.

4. Deep breathing. If you feel stressed, anxious or are just sick of driving in traffic take a few deep breaths. It can just be enough to break the cycle of thoughts contributing to your stress. Set the alarm on your phone a couple of times across the day with the message “remember to breathe”. Just those few moments will help you take the stress down a notch. If it helps, try counting as you breathe – count to 4 as you breathe in and 6 as you exhale. Exhaling for a longer period helps to push your body our of “fight or flight” and into relaxation mode.

5. Call a friend. Connection is important to our wellbeing and it can be too easy to chat on Facebook instead of picking up the phone. Sometimes it is enough just to check in and say Hi.

6. Take the stairs. Instead of choosing the elevator or the closest carpark, head for the stairwell and park your car 5 minutes away from your destination. The minutes of extra exercise all add up.

7. Hug someone! Make it someone you know :-) . Physical contact is relaxing. Think of it as a handshake from the heart. Virgina Satir, who was often referred to as the mother of family therapy, determined that “We need four hugs a day for survival. We need eight hugs a day for maintenance. We need twelve hugs a day for growth.”