If you suffer 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 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 eventually other conditions such as diabetes, PCOS, cardiovascular disease, and cancer. You can 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. The A2 casein in goat, sheep, and Jersey does not cause inflammation. That kind of dairy is fine for skin and is a healthy food because of lactoferrin (discussed below) and fat-soluble nutrients.
When you stop eating sugar and milk, your skin should clear within 3-4 months. That is my overwhelming experience with patients. But you may need a little more help:
Effective natural treatments for 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 antimicrobial 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.
6) 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 more and more. 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 as the pill, spironolactone, and the most frightening of all: Accutane (isotretinoin).
The drug’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.