Is Acne Linked to Gut Health & Hormones?
Intro
Acne is the most common reason why people choose to see me in-office, and I have been able to successfully clear up people’s skin by holistically, naturally, & integrative-ly addressing their skin concerns. For those of you who don’t know who I am, I am Dr. Bryant Esquejo, ND - a California-licensed naturopathic doctor. As a naturopathic doctor, I am an expert in holistic and integrative medicine.
In this blog post, we are going to dive into what I’m really passionate about - How gut health and hormones affect skin health!
Specific topics we are going to cover are:
How acne develops at the skin level
The underlying causes leading to acne
How a licensed ND may use integrative options to address acne and support skin health
NOTE: THIS BLOG POST DOES NOT CONSTITUTE AS MEDICAL ADVICE; IS MEANT TO BE EDUCATIONAL ONLY; AND IS NOT MEANT TO DIAGNOSE, PREVENT, TREAT, OR CURE. PEOPLE SHOULD ALWAYS CONSULT THEIR TRUSTED LICENSED PROVIDER BEFORE TRYING ANY NEW TREATMENTS
How acne develops at the skin level
Acne is described as a skin condition where there is blockage and/or inflammation of the pore. Acne commonly develops on the face, forehead, chest, shoulders, and upper back. And, a doctor can diagnose acne clinically, which means a doctor can diagnose given the patient’s history and findings on physical examination. There are different types of acne, which are:
Non-inflammatory: Open comedones (blackheads) and closed comedones (white heads)
Inflammatory: Papules, pustules, nodules, or cysts
Understanding how acne develops on the skin paves the way for possible options that a doctor may recommend to their patient. Acne develops on the skin because of 4 elements that take place in the pore:
Pore blockage/occlusion
Excess sebum (oil) production
Bacteria in the pore
Immune-mediated inflammation from bacteria
Pore blockage can be caused by many things. Pores can be blocked by skincare products and/or makeup that are not adequately cleaned off the skin. Pores can also be blocked by cellular debris, called keratin. When pores are blocked by excess keratin, it is called hyperkeratinization, which is a term you may see often when people speak about acne.
While understanding how acne develops on the skin can be meaningful for some, looking for deeper causes of acne and addressing those causes may be more-worthwhile for those with inflammatory acne.
Underlying causes of acne: How hormones & Diet affect skin health
Inflammatory acne tends to be large and painful. And, whenever I see people with inflammatory acne, I want to address their skin holistically, meaning I want to address their skin directly and address the possible underlying causes of their acne. In regards to deeper causes of acne, science tells us that hormones play a large role, and that diet (and gut health) may be affecting hormones!
Hormones & Acne
Research says that androgen hormones (examples: testosterone, DHEA, DHT, androstenedione, etc.), play a role in hyperkeratinization and excess oil production. And, if there is bacteria in the pore, bacteria can feed on the oil to cause immune-mediated inflammation, leading to large, painful breakouts.
Additionally, science tells us that other hormones may be playing a role in the development of acne. Science tells us that insulin and insulin-like growth factor-1 (IGF-1) may trigger the body to over-produce androgens, which may lead to downstream acne. Now, what causes peaks in insulin and IGF-1? Research tells us that diets high in simple carbohydrates cause peaks in insulin and diets high in whey protein (a protein found in dairy) cause peaks in IGF-1!
Beyond insulin and IGF-1, science also tells us that stress hormones may play a role in the development of acne. When the brain detects a stressor (physical and/or emotional), the brain releases corticotropin-releasing hormone (CRH). And, research says that CRH can activate oil production in pores, which is one of the 4 elements that we spoke about earlier that are necessary for the development of acne.
Gut health & Acne
Going back to diet, science reports that the foods we eat can change the bacteria populations in our intestines. Research tells us that people with acne have very different gut bacteria populations compared to people without acne, specifically that people with acne have lower gut bacteria diversity with higher levels of Bacteriodes species and lower levels of Firmicutes species. Additionally, research has linked acne to irritable bowel syndrome (IBS), which can sometimes be caused by bacteria overgrowths in the small intestine. And, because of all of these scientists have questioned whether skin health is affected by gut health when gut bacteria is affected by diet.
When looking at the research on the link between gut health, diet, and acne, researchers have suggested that certain types of diets may change the gut microbiome towards a more-inflammatory state, which leads to gut inflammation and acne. And a recent review of the literature completed in 2021 indicated that branched-chain amino acids made by and broken down by gut bacteria when exposed to animal-based dietary sources were linked to increased risk of blood sugar issues and insulin issues.
How a licensed naturopathic provider addresses acne
Licensed naturopathic providers are trained in integrative and holistic medicine. Integrative medicine entails that providers are trained in both conventional/pharmaceutical therapies AND natural options; and holistic medicine means looking at the patient as a whole being, and understanding their symptoms directly while also identifying the underlying causes leading to their symptoms.
When addressing acne, a licensed naturopathic provider will want to address the root cause of a person’s skin issues while also addressing the symptom itself. So, a provider may recommend various natural and/or conventional options that are tailored and individualized for that person.
NOTE: THIS BLOG POST DOES NOT CONSTITUTE AS MEDICAL ADVICE; IS MEANT TO BE EDUCATIONAL ONLY; AND IS NOT MEANT TO DIAGNOSE, PREVENT, TREAT, OR CURE. PEOPLE SHOULD ALWAYS CONSULT THEIR TRUSTED LICENSED PROVIDER BEFORE TRYING ANY NEW TREATMENTS
PHARMACEUTICAL Support
Licensed ND’s may recommend pharmaceutical management for acne when symptoms are severe, if the patient prefers pharmaceutical therapy, and/or if the patient prefers faster results. Also, when licensed ND’s do prescribe pharmaceuticals, they may prescribe concurrent vitamins, minerals, and other supplements to take to prevent drug-nutrient depletions and to optimize overall health and wellbeing. It should be noted that state scope of practice differs from state to state, and that licensed ND’s may not have prescriptive rights in some states.
Some pharmaceuticals that may be prescribed for acne vulgaris are:
Topical pharmaceuticals: First-line treatment for mild acne vulgaris includes topical benzoyl peroxide or a topical retinoid, such as Adapelene. These may also be combined with topical antibiotics.
Oral antibiotics: For moderate to severe acne and inflammatory acne, oral/systemic antibiotics (doxycycline and minocycline) may be recommended - usually done in combination with other antibiotics to prevent drug resistance.
Hormonal birth control: Combined oral contraceptives are recommended for females with inflammatory acne.
Isotretinoin: For severe nodular acne when topical pharmaceuticals and oral antibiotics have failed.
Spironolactone: Spironolactone reduces the production of DHT.
& more
NATURAL Support
Licensed ND’s may recommend natural management for acne when severity of acne is mild-to-moderate and/or if the patient prefers natural therapy. Natural therapy is more likely to address the root cause of a patient’s symptoms when compared to pharmaceutical therapy since natural treatments with a naturopathic doctor involve supporting the foundations of health and wellness (diet and lifestyle medicine) and supporting organ function. It should be noted that natural therapy may take longer than pharmaceutical therapy, but since natural management does address the root cause, natural management may provide longer-lasting solutions compared to pharmaceutical therapy once treatment is withdrawn.
Some root-cause, natural options for acne:
Diet, gut health, & hormones: Remember, diet has been shown to affect both insulin and IGF-1 levels. Research also shows that diet may affect the gut microbiome, as the gut microbiome has been linked to changes in insulin response. And, because of that research, a licensed provider may recommend avoiding simple carbohydrates, dairy, and/or whey protein to support insulin and IGF-1 response and also recommend more-diverse foods to support gut microbiome diversity. However, I do want you to know that there are many other dietary interventions that have bene shown to support optimal insulin response and optimal blood sugar levels. If a provider suspects that someone has IBS, they may do further testing to understand what is the cause of IBS, and address that. (And, I want you to know that there are many pharmaceutical and natural options that can be recommended by a naturopathic provider to address IBS)
Exercise & hormones: While diet plays an integral part in supporting insulin balance, exercise is also another pillar that a licensed naturopathic provider will want to address. Scientific evidence indicates that a combination of exercise (1 hour per day with a maximum heart rate of around 85% for at least 5 days per week for 12 weeks) and the consumption of low-glycemic foods supported optimal insulin response in prediabetic individuals. However, I do want you to know that there are many other exercise options that may be recommended by a licensed provider. And, before you embark on an exercise regime, always speak to your doctor to learn what is safe and right for you.
Insulin response: Beyond diet, exercise, and lifestyle, a licensed provider may recommend targeted vitamin, mineral, and herbal supplementation that has been shown by science to support optimal insulin response and support optimal blood sugar.
Stress response: A licensed ND may also recommend nervine herbs to soothe the nervous system and adaptogenic herbs to help the body adapt to to emotional and physical stressors, such as ashwagandha, asian ginseng, rhodiola, and schisandra.
& more!
There are many other options that a licensed naturopathic provider may recommend to their patients, and their recommendations will always be tailored and individualized to fit the patient’s needs.
Summary & Takeaways
Acne is a common condition that I see in-office. As a licensed naturopathic provider, I focus on providing integrative & holistic support to address skin concerns. When addressing skin concerns from a holistic point-of-view, that really means understanding what is happening on the skin level AND understanding the underlying causes of that person’s acne.
After reading this blog post, you had the opportunity to understand how the brain of a naturopathic provider works, and how they would approach acne. In this blog post, you learned:
The 4 elements that take place in the pore that lead to the development of acne
How diet, gut health, and hormones are some of the underlying causes of acne
The pharmaceutical options that may be used for different types of acne
The natural options that may be used to address the underlying causes of acne
I hope you found this blog post interesting & helpful, and that it inspires you to work with a licensed naturopathic provider. Remember, licensed naturopathic providers are experts in holistic & integrative medicine.
If you want to see me for a naturopathic acne consultation, click here for scheduling information. You can also call the clinic at (213) 269-5911 for scheduling and fee information.
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