If you suffer acne, or treat acne, then 2012 was an important year. That was when this ground-breaking paper came out of Germany: Diet in Acne: Further Evidence for the Role of Nutrient Signalling in Acne Pathogenesis.
One sentence from the abstract says it all:
“Acne should be regarded as an mTOR-driven disease of civilization, like obesity, type 2 diabetes and cancer induced by Western diet.”
What is mTOR?
Don’t be intimidated by the biochemist-speak. In layman’s terms, mTOR is a sensor of certain types of food energy.
High energy foods like sugar and dairy cause high levels of insulin and IGF-1 hormone. Those hormones activate an enzyme called mTOR, which, in turn, activates different parts of your physiology, including sebum, keratin, and inflammation. A perfect storm for acne.
mTOR is not all bad. For example, you need some to stimulate muscle-building. mTOR is only a problem when it is over-activated, as it is with our modern diet. Over-activated mTOR also leads to diabetes, PCOS, cardiovascular disease, and cancer. Acne is the ‘early warning signal’ of metabolic dysfunction. It is a disease of our modern insulin-surging, inflammatory diet. Acne was unheard of in traditional hunter-gatherer societies.
Does inflammatory casein also play a role in acne?
The research says that dairy causes acne. Insulin, IGF-1 and mTOR are the proposed reasons, but there may be more to the story. Many acne-sufferers improve off dairy, but some do not. There must be other factors such as intestinal permeability, zinc status, and inflammation.
Dairy is more inflammatory for some people than it is for others. It’s all to do with the type of casein. A1 casein (from Holstein cow milk) is inflammatory for some people. Acne occurs when mTOR activation is coupled with casein-inflammation. That’s why the A2 casein in goat, sheep and Jersey is better for skin. A2 milk (Jersey, goat and sheep) is a healthy food with saturated fat, lactoferrin (discussed below), and fat-soluble nutrients. Best to consume dairy with high fat content (like butter and cream) because it contains less sugar, less casein, and less insulin-promoting whey.
When you stop eating sugar and milk, your skin should clear within 3-4 months. That is my overwhelming experience in clinic. But you may need a little more help:
Effective natural treatment of acne:
1) Zinc. Hands down, zinc is the most helpful supplement. It reduces keratin production, so it keeps pores open. Zinc kills bacteria, and reduces inflammation. Zinc is also essential for healthy ovulation, which increases estrogen, and reduces testosterone in women.
2) Berberine. During my 18 year career, I have consistently prescribed berberine-containing herbs (Goldenseal, barberry, phellodendron) for skin, and have usually had good results. Berberine improves intestinal permeability (and thereby reduces inflammation), has a local anti-microbial at the skin, and also improves sensitivity to insulin (thereby lowering insulin and IGF-1). Berberine also directly inhibits mTOR.
A recent clinical study found that just 4 weeks on berberine improved acne by 45 percent. I recommend berberine not be used for more than eight weeks continuously, because its anti-microbial effect may damage intestinal bacteria.
3) Lactoferrin is a dairy protein that is anti-inflammatory and anti-microbial. It has shown promise for skin. Lactoferrin is included in some probiotic formulas, and follows nicely after berberine.
4) Reduce stress. Stress worsens skin because it disrupts insulin and female hormones, and because it causes inflammation.
5) Estrogen reduces sebum production. That’s what the birth control Pill’s synthetic estrogens do. Your own estradiol can work just as well, but remember: The only way to make estradiol is to ovulate. See The Ups and Downs of Estrogen.
6) DIM (Diindolymethane) — 2016 update. After writing this post, I received many comments and questions about the broccoli-derived nutritional supplement DIM. Yes, it works well for acne, and I prescribe it more and more often. It works because it is an androgen-blocker. DIM also assists in the natural detoxification of estrogen, but that’s a separate effect, and is not why it helps acne.
Acne is not trivial, and as a doctor, I take it very seriously. Skin problems can damage self-esteem and happiness, but not only that. They often lead to harmful medications such the Pill, spironolactone, and the most frightening of all: Accutane (isotretinoin).
The drug’s mechanism of action is DNA damage, which means that it targets the deepest level your core biology. Accutane also damages the hippocampus, which may be why it causes depression, and is linked to inflammatory bowel disease and osteoporosis.
One of my patients intuitively said this about Accutane: “I felt its side-effects at my deepest soul-level.”
I beg you not to take it.
Yours in Health,