If you suffer from acne or treat acne, then 2012 was an important year. That’s 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 food energy. Here’s how it works.
High-energy foods like sugar and dairy can cause increased levels of insulin, IGF-1 hormone, and mTOR, which is an enzyme. mTOR, in turn, stimulates keratin, inflammation, and sebum production—all of which contribute to acne.
mTOR is not all bad. You need some mTOR to be able to build muscle. But too much mTOR causes acne and put you at risk for diabetes, PCOS, cardiovascular disease, and cancer. Think of mTOR and acne as an “early warning signal” of metabolic dysfunction. (Acne was nonexistent in traditional hunter-gatherer societies.)
Does inflammatory casein play a role in acne?
The research shows that dairy causes acne. Insulin, IGF-1, and mTOR are the proposed reasons, but there’s more to the story. Many acne sufferers do improve off dairy, but some do not. That’s where intestinal permeability, zinc status, and inflammation come into play.
Dairy can be highly inflammatory for some people, and it’s all because of the A1 casein from Holstein cow milk. A1 casein causes inflammation, and that inflammation coupled with mTOR activation is the perfect storm for acne. Conversely, the A2 casein in goats, sheep, and Jersey dairy does not cause inflammation or acne. In fact, A2 dairy can be beneficial thanks so lactoferrin (discussed below) and fat-soluble nutrients.
When you stop eating sugar and normal A1 dairy, your skin should clear within 3-4 months. That’s my overwhelming experience with patients. But you may need a little extra help from supplements.
Supplements for acne:
1) Zinc. Hands down, zinc is the best supplement for acne. 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. Berberine can relieve acne by improving intestinal permeability (and thereby reducing inflammation), having a local anti-microbial on the skin, and also improving insulin sensitivity (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.
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.
4) Estrogen reduces sebum production. That’s why the synthetic estrogens of hormonal birth control relieve acne. Your own estradiol can work just as well, and remember: The best way to make estradiol is to ovulate regularly.
5) DIM (diindolylmethane) — 2016 update. After writing this post, I received many comments and questions about the broccoli-derived nutritional supplement DIM. It does work well for acne, and I have started to prescribe it. It works by blocking androgens.
Acne is not trivial. Skin problems can damage self-esteem and happiness and lead to harmful medications such as isotretinoin.
Avoid Accutane (isotretinoin)
Accutane’s mechanism of action is to alter DNA expression, which means it targets the deepest level of your 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.