Written by Lexie McPhee | Monday, 2 October 2023
In my digital skin clinic, acne is the most common presentation among my clients. Having treated acne exclusively for the last four years both in 1:1 consultations and in my group program, there are five nutrients that I call on time and again.
Acne is an incredibly common skin condition, with up to 80% of people experiencing acne in their lifetime. Acne is a predominantly Western disease – the incidence of acne is practically zero in populations who maintain a traditional diet and lifestyle. Unless you have experienced acne yourself, it is difficult to relate fully to the emotional and psychological burden that accompanies having a skin condition on your face. Acne sufferers report significantly higher rates of anxiety, depression, suicidal ideation, and lower self-esteem than those who are not affected. It is certainly not a trivial or vain desire to want to resolve acne – especially as statistics indicate that acne sufferers experience lower employment and a lower quality of life than non-sufferers.
In my experience, clients with acne are often the most motivated, dedicated, and compliant clients that you will encounter. It is a highly rewarding condition to treat with clear improvements to the quality of life of your clients.
So, let’s get stuck into the nitty gritty. Here are the five nutrients I lean on when supporting my beautiful acne clients!
Retinol is a superstar when it comes to clearing acne. It is a staple in the medicalised treatment of acne (for example, in the form of topical serums and medicated creams) as well as in the form of oral isotretinoin (Roaccutane). Despite this, the consumption of dietary vitamin A is all but forgotten.
Why is it so helpful?
A lack of bioavailable vitamin A can be implicated in every aspect of acne development. The pathophysiology of acne is characterised by abnormal sebum and keratin production. Vitamin A is instrumental in regulating normal keratin production and sebum flow. Excessive sebum and keratin will form a plug in the pilosebaceous unit of the skin, particularly where there is impaired skin cell turnover and a build-up of dead skin cells impeding the skin. Vitamin A serves a purpose here as well – it has the ability to regulate skin cell turnover for the effective sloughing off of old skin. Retinol is not available from plant sources, it must be attained through the consumption of animal products. Whilst orange coloured fruits and vegetables contain beta-carotene, which can be converted to vitamin A in the human liver, they are a far less bioavailable source than eating calf or chicken liver, which are two of the richest natural sources of retinol on the planet.
Lactoferrin is a glycoprotein that is found in human and animal colostrum, saliva and other bodily secretions. It is multi-talented in the treatment of acne, due to its anti-microbial, anti-inflammatory, and immune supportive actions. Acne is an inflammatory disorder of the skin – all the cardinal signs are there: redness, swelling, pus, heat, and pain. Severely inflamed acne is incredibly uncomfortable. In my clinical experience, lactoferrin can be highly effective in reducing inflammation in order to provide relief. This effect is partly due to the ability of lactoferrin to inhibit the overgrowth of infective bacteria and down regulate the production of pro-inflammatory cytokines by the skin. I generally consider lactoferrin for acne cases with marked redness and inflammation with an obvious link to impaired gut health. Supplemental lactoferrin is derived from bovine sources and so is definitely not vegan, however most the of the most effective nutrients for acne are found predominantly in animal-based foods. The therapeutic dose is 100mg twice daily.
This one is a no-brainer. Zinc is generally considered the go-to mineral for treating skin conditions. It rates so highly in part due to its ability to block the uptake of DHT in skin receptors. DHT is a metabolite of testosterone that is responsible for up-regulating the production of keratin and sebum in acne-prone skin. Not only does zinc inhibit the uptake of DHT, it can also help to reduce conversion of testosterone into this pesky acne causing metabolite.
Zinc can be a fabulous companion for vitamin A as they both work to regulate sebum and keratin production. Similarly to lactoferrin, zinc is supportive to the maintenance of skin immunity and a balanced skin microbiome. Acne lesions constitute broken, wounded skin and must be treated as such – and a deficiency in zinc will often lead to prolonged healing time and more pronounced scarring. As with all nutritional supplementation, high quality and bioavailable forms of zinc are best. I favour zinc bisglycinate or zinc citrate in doses of 25-50mg per day. It is best to also assess and support copper status when considering zinc, as the two compete for absorption (and both are equally important for the health of skin) The medicinal foodies will be pleased to learn that seafood contains the highest quantity of zinc per serve. Indulging in a dozen oysters per week (or two oysters daily) will dish up a dose of zinc equivalent to 25mg per day.
Can you sense a theme developing? Skin loving nutrients are naturally found in the highest quantities in animal-based foods. Of course, protein is found in plant foods as well, however even the most omnivorous clients will be unlikely to meet the required intake of protein without special effort. While protein is needed to manufacture skin tissue on a physical level, its use in acne runs much deeper. Acne is most often causally linked to insulin and glucose dysregulation. Regular protein intake throughout the day in adequate amounts and proportion to carbohydrates and healthy fats is essential for stabilising blood glucose levels. Eating a protein dense breakfast within 30 minutes of waking is one of the most effective ways to normalise blood sugar levels throughout the day.
A stable blood glucose response is needed to maintain normal sex and stress hormone levels (imbalances of which are all implicated in acne) This is so important because spiking blood sugar levels stimulate insulin and testosterone production, whilst the inevitable blood glucose crash will trigger the release of cortisol stress hormone. We cannot hope to normalise insulin, androgens (testosterone) and stress hormone without taking care of blood sugar regulation. Your clients need to be aiming for at least 1g of protein per kilogram of body weight, per day. For most, this will need to include a breakfast of 20-30g of protein and a focus on low GI foods throughout the day.
NAC can be made in the liver from foods that are rich in cysteine (think fish, seafood, chicken, and turkey) but is also accessible in supplemental form. NAC makes the list because again, it kills a few birds with one stone. Regardless of what type of acne you are dealing with, whether it be androgen driven, post-pill acne, gut related acne or oestrogen dominant PMS acne, NAC is indicated. I like to use it to support the liver detoxification pathways which can be under functioning in hormonal acne. It is also an effective nutrient for normalising insulin and the blood glucose response in acne, so it really targets the driving cause of androgen driven acne. It is one of my favourites for PCOS acne for this reason. Yet it is also an antioxidant and anti-inflammatory nutrient which can provide benefits to concomitant symptoms in your client. N-acetyl cysteine also features in my treatment plans for gut-related acne, as it can be used to dissolve biofilm laid down by inflammatory and problematic gut microbes. It’s cheap to get, comes with a cute shovel and kind of reminds me of sherbet and so it makes for a great inclusion in your dispensary. The dose is flexible depending on your client’s condition and histamine picture – I find 1000-2000mg per day in divided doses to be effective for most.
Whether you’re treating acne in yourself or others, nutritional medicine is a wonderful resource when resolving the precipitating and perpetuating causes of acne. A varied and nutritional dense omnivorous diet will lay the foundations for healthy skin, although supplementation is often required for a therapeutic effect in chronic cases of acne.
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Lexie is an Endeavour College of Natural Health Alumni and online Naturopath. Her 100% online clinic and e-courses have enabled her to relocate to sunny Portugal whilst still serving her clients worldwide. She focuses on supporting women with acne and mentoring new Naturopaths in the treatment of skin conditions. Her current research obsession is metabolic nutrition and bio-energetic health.