I see many women in my clinic with acne, and what most of them tell me is that they eat really well but they still breakout all the time.
They get exhausted and frustrated because they see their friends eat whatever they like and they have perfect skin. For someone with acne, this can really be irritating.
The thing is, yes you do need to eat well, not just for your skin, but for your overall health. Some people who eat terribly might have clear skin, but they'll probably have other health issues and sooner or later it's going to catch up with them.
But the real reason why so many women struggle with acne is because their hormones are out of balance. Particularly oestrogen, progesterone and androgens.
Don't get me wrong- diet is super important- but once you get into the cycle of acne it can sometimes be hard to crack with just diet alone. So if you're one of these people, read on.
What Is Acne Caused By?
Acne is caused by inflammation in the body, which stimulates the over-production of sebum in your skin's oil glands. Too many hormones or a hormonal imbalance can promote this inflammation. Hormone imbalances are in turn triggered by poor gut health and poor liver detoxification.
Androgens
Androgen are a group of steroid hormones that include testosterone, DHEA-S and DHT and are often called 'male hormones' even though women have them too (they're important and we need them). DHT is a strong androgen that is also produced in our peripheries (our skin). When testosterone and DHT are high then you'll start to make more sebum and get oily skin. This leads to clogged pores and a great breeding ground for bacteria, and then acne.
Androgens can be elevated for a number of reasons:
- You have androgen driven PCOS (Polycystic Ovarian Syndrome).
- You have insulin resistance and/or type 2 diabetes (high insulin elevates androgen production).
- You eat a diet high in refined carbohydrates and sugars.
- You're stressed (cortisol plays havoc with your blood sugar and insulin, which then affects androgens).
- You have dysbiosis and/or leaky gut (this causes inflammation which can affect androgen levels).
How do you know if you have high androgens?
- Get a blood test to start with from your doctor
- Functional pathology testing can be helpful also, but it's pricier. My favourite test is the DUTCH test for hormones which gives an in-depth analysis of all hormones and the breakdown of their metabolites. It's really great for pinpointing where you're getting stuck balancing your hormones.
What to do about high androgens?
- Cut out the sugar
- Address any gut issues (you might not even have classic gut symptoms- Acne can also be a 'gut' symptom, not just things like bloating and indigestion).
- Address PCOS if you have it (diet and lifestyle works well here)
- Manage your stress (stress includes emotional stress and physiological stress like inflammation- the brain doesn't differentiate)
- Support your liver detoxification of hormones and make sure you're pooping everyday to clear them
Oestrogen
Oestrogen is again found in men and women, but in higher amounts in us ladies. Oestrogen is super important for hormonal health, so please don't be afraid of it. Oestrogen is like Goldilocks- it only likes to be 'just right'! If we're making too much oestrogen or if we're not clearing what we're making then this can cause inflammation and acne if you're prone to it.
Oestrogen can be elevated and cause inflammation for a number of reasons:
- You're making too much of it to begin with. This can be due to excess body fat, as fat secretes oestrogen.
- You're not effectively detoxing your oestrogen in your liver, and the levels start to get backed up.
- Your oestrogen is being broken down into the inflammatory oestrogen metabolites (the 4 and 16-hydroxyestrone forms, instead of the more favourable, protective from of 2-hydroxyestrone). This happens in your liver.
- You're not effectively clearing oestrogen from your body via your kidneys and bowels (your poop), and the levels start to get backed up. This can go hand in hand with poor liver detoxification.
- Your diet is low in fibre, so you're not eliminating oestrogen from your body like you should. Fibre is what binds to oestrogen and moves it out of us.
- Your gut bacteria are imbalanced and are over-producing an enzyme called beta-glucuronidase which removes oestrogen from it's fibre package so it gets re-absorbed into your system (how annoying).
How do you know if you have high oestrogen?
This can be a bit tricky to test for, as sometimes you can be making a normal amount of oestrogen, but you're just not clearing it properly. This means you'll be backed up with higher oestrogen, but the clearance is the problem, not the production. A blood test is a great place to start, but it'll only show the levels of oestrogen (oestradiol) in your blood. A blood test also won't show how it's being broken down: if it's moving down an inflammatory pathway or the anti-inflammatory one. So a blood test might show normal levels of oestradiol, but it won't show how you break it down. And this is a really important thing to know.
The DUTCH test, which is a functional pathology test, shows all of the metabolites of your hormones and this is why I love to use this test when working with my acne patients.
What to do about high oestrogen?
- Make sure you're moving your bowels every day (at least once)
- Eat more fibre to ensure you're moving your old hormones out of your body to make space for the new ones being made. See more about fibre and oestrogen here.
- Support your liver detoxification (both Phase 1 and Phase 2)
- Balance your gut bacteria to reduce your beta glucuronidase production so you're not re-absorbing old oestrogens
Support Hormonal Balance
Alongside a good diet, hormonal balance is the key to clear skin. Balancing your hormones is really the end result of reducing inflammation in your body. The source of inflammation is most always coming from you liver and your gut, so you've got to focus on these areas!
Look out for more posts soon on how to support your liver and your gut to balance your hormones. I've also got a tonne of information on Instagram too xx
In the meantime, if you're confused about your skin, why not make an appointment either on Skype or at my Clinic in Northcote (Victoria, Australia).