by Dr. Samantha Zahavi ND

If you are reading this, you likely suffer from acne or know someone who might need help improving their skin. Acne may be on our skin, on the outside, but it often reflects what’s going on deeper in our bodies – namely, in our digestive system (stomach, liver, intestinal health, removal of waste products and so on). In many cases, it is also a reflection of our hormonal health. Do you know something even cooler? Our gut health and our hormonal health are intimately connected. In fact, all our organ systems are, which is why we can’t just treat acne by applying creams or ointments to our face.

Acne is thought to be due to several factors, some being:

• An increase in sebum production (oil produced by the sebaceous glands in the skin)
• Hormonal imbalances – some being:
  • Elevated androgen levels: Testosterone and DHT (Dihydrotestosterone)
  • Female hormone imbalances: estrogen, progesterone, prolactin
  • Elevated DHEA-S
• Increased levels of inflammatory mediators in our body
• Microbial imbalance in the skin, particularly, colonization of a bacteria called p.acnes
  • Research is also progressing to suggest a strong link between the gut microbiome and skin conditions such as atopic dermatitis and acne
• Insulin resistance and/or elevated blood sugar levels
  • This is especially true for women with PCOS (Polycystic Ovarian Syndrome)
• Like most conditions, lifestyle factors like sleep, stress, hygiene, nutrition and exercise may play a significant role in the progression and intensity of acne.

I have lots of women that come to me suffering with acne, from their teens to well into their 30s and even 40s.

The first steps always include:

• An extensive lab works up (CBC, nutrient/vitamin deficiency testing, hormonal testing, fasting insulin/glucose. inflammatory markers) and any other tests that are indicated for the particular patient case. Serum testing and salivary testing options are both available.
• Should a patient have significant symptoms indicative of intestinal inflammation or microbial dysbiosis, a comprehensive stool analysis may be required as well.
• A discussion about lifestyle, hygiene, gut health, stress, sleep, hydration, nutrition, etc. is always essential to creating an individualized treatment program.

When it comes to treatments there are several options but understanding YOUR ROOT CAUSE/S is the most important aspect to seeing improvement.

ACNE SUPPLEMENTS

1) Berberine

Berberine is an herbal compound that has antimicrobial properties (specifically against p.acnes) and also improves insulin resistance. In a randomized controlled trial comparing Berberine to Minocyclin (an antibiotic commonly prescribed for acne), there was no difference seen between the groups – this means that Berberine may be just as effective as Minocyclin/antibiotic treatment but without the side effects and drawbacks (further disruption of the microbiome being a big one).

Furthermore, stabilizing blood sugar and reducing insulin resistance is a big piece in curbing acne, especially those with PCOS, diabetes or a high carbohydrate/sugar diet. Berberine also reduces proliferation of keratinocytes (skin cells) and lipogenesis (oil/fatty acid production) of sebaceous glands and thus may reduce excess sebum production.

This is a top option for women with PCOS, SIBO (small intestinal bacterial overgrowth), microbial imbalances and high fasting insulin/glucose levels (high HOMA-IR).

2) EGCG (Green Tea Extract)

EGCG is one of the main compounds found in Green Tea. EGCG modulates several key factors in the etiology of acne – it can act as an antimicrobial agent against p.acnes, decreases local and systemic inflammation and also reduces the production of sebum/oil in the skin as well. In a randomized controlled trial comparing 1500 mg of EGCG compared to placebo in women aged 25-45 years old, there was a significant decrease in acne lesions as well as decreased blood sugar levels. There is also some evidence that EGCG helps to inhibit the conversion of testosterone to DHT which reduces signs & symptoms of excess androgens in women.

EGCG can be taken internally as a supplement and also applied to the skin directly. I recommend 1%-5% EGCG in a hypoallergenic carrier lotion applied to the affected area 1-2x/day for 30-60 days. This can be prescribed by your Naturopathic Doctor (ND) or Doctor through a compounding pharmacy.

3) Hormonal Modulators

Depending on your test results, we may want to either modulate your progesterone/estrogen levels or decrease levels of DHEA-S, testosterone or DHT.

Vitex-agnus-castus

Vitex may be helpful for some women as it binds to estrogen receptors and acts on LH and FSH in the pituitary to then effect downstream production of estrogen and progesterone. Vitex has long been used to decrease PMS, regulate cycles and stabilize female hormones. It is particularly beneficial for boosting progesterone levels, specifically in the luteal phase (second half of the cycle) which is why it can alleviate PMS and even treat short luteal phase syndrome. Some studies suggest it can help to restore menstrual cycles after periods of amenorrhea (lack of menstruation) to the same degree as low-dose estrogen therapy. It is commonly used to improve fertility rates, when used appropriately. In addition, vitex can lower prolactin levels which tend to be elevated in PCOS patients. High levels of prolactin can block ovulation and lead to irregular cycles, therefore, vitex therapy may not only improve acne but increase ovulation rates in women with PCOS, too.

Since every case of PCOS is unique, Vitex may not be right for everyone. In addition, vitex may not be appropriate to use in women under 18 years old. Supplementation should always be supervised by a qualified healthcare practitioner.

Saw Palmetto & Spearmint Tea

The use of saw palmetto or spearmint tea may also used to treat acne – especially in women with higher levels of DHT or free testosterone.

The belief is that saw palmetto blocks the conversion of testosterone to DHT (the hormone that causes androgenic characteristics like male pattern hair loss, male pattern facial hair in women and increased sebum production) and that it may also block the absorption of DHT.

Spearmint tea can reduce free testosterone (unbound, usable) in the blood, while leaving total testosterone and DHEA-S unchanged. Studies show that drinking Spearmint Tea twice daily for 30 days, may lead to a reduction in hursitism (male pattern hair growth in women), self-reported reductions in acne lesions and improved quality of life. I recommend 2 cups/day steeped well for 4-5 minutes, daily for at least 30 days.

**These herbs and supplements should not be taken on your own without the supervision of a qualified healthcare practitioner.

Inositol

Inositol is a super supplement for women with PCOS – improving the hormonal and metabolic profiles and ovulation rates in these women. Though not considered a hormonal modulator per-say, it can be used to significantly reduce insulin resistance help restore ovulation in women with PCOS. Studies show Inositol may also mildly reduce testosterone levels and decrease overall hyper-androgenism in women with PCOS.

4) Gugulipid

This funny sounding plant has many beneficial properties. It is antimicrobial, lowers cholesterol, anti-inflammatory, anti-arthritic and has antioxidant properties. In a randomized controlled trial of patients with nodulocyctic acne, comparing 25 mg Gugulipid to 500 mg of Tetracycline (antibiotic used in acne treatment), both treatments produced a significant reduction in acne lesions. Tetracycline showed a 65.2% reduction in inflammatory acne lesions compared to a 68% reduction in the Gugulipid group.

5) Other

• Microbial Support
  • Diet rich in whole foods (reduction in sugar, processed/packaged foods)
  • Consider stool analysis to identify and treat microbial imbalances
  • Repairing leaky gut, SIBO, IBS, Inflammatory Bowel Disease, H. Pylori, hypochlorydria, etc.
  • Reinoculate with appropriate probiotics and pre-biotic/probiotic rich foods once the microbiome is balanced and gut lining is repaired
• Other anti-inflammatories
  • Anti-inflammatory supplements, such as curcumin/turmeric for example, may help to decrease inflammatory acne and systemic inflammation in conjunction with an anti-inflammatory diet
• Waste & Toxin Removal
  • To improve toxin and waste removal from the body, you want to:
    • Ensure you are drinking plenty of water daily (~2L+day)
    • Ensure you are sweating/exercising (even going into the sauna helps!)
    • Ensure you are eliminating properly (having regularly formed bowel movements 1-3x/day)
    • Eat foods high in soluble and insoluble fiber, focussing on the cruciferous vegetables (aim for at least 2 cups of kale, broccoli, cauliflower, cabbage, brussel sprouts per day.) If you have hypothyroidism, you may need to refrain from overdoing it on these vegetables, however.
    • Boost antioxidant & polyphenol status through nutrition and supplementation to help eliminate excess toxins, hormonal waste products, etc.
      • Consider an ACES+Zinc supplement (vit A, C, E, selenium and zinc)
      • You may also want to consider supplementing with certain supplements like NAC, liposomal glutathione, sulforaphane, DIM or calcium-d-glucarate to improve the detoxification process in the liver and in the gut, if your ND finds it important for your case.

Of course – lifestyle, nutrition, sleep, stress & more is equally, if not more, important than supplementation. Further discussion on these topics will be discussed in a follow up article, which will later be linked here.

Well, I hope you learned a few new things about Acne today. I see first-hand how acne not only effects people physically, but also very much so mentally. Treating acne naturally takes time and is a commitment, but I find most women not only improve their acne on this journey but their overall health and well-being, too!

If you live in Ontario and you’d like to work with me please book online here .

I look forward to chatting with you and hearing your story!

Dr. Samantha Zahavi, ND

Resources:

1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655679/

2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5454980/

3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693613/

4) https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/1471-0528.14754#:~:text=Inositol%20appears%20to%20significantly%20improve,longer%20term%20metabolic%20health%20outcomes.

5) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878906/

photo source: Pixabay