acne vulgaris: a disease of Western civilization?

I have struggled with acne vulgaris since the start of puberty. In middle school…it was terrible. I looked like a greasy little pepperoni pizza…with a fiery temper…Puberty was quite weird ya’ll. They’re called teenage mutant ninja turtles for a reason… Cut to 17, I started oral contraceptives and found within a year my skin was so much better…not perfect…but better. I stopped taking birth control 2 and a half years ago for a multitude reasons. Now, my body could speak to me again. I could finally hear her without the loud interruption of exogenous hormone therapy. She was mad…! I lost 10 pounds and my face became so inflamed and angry. I knew my body had been out of balance and unhealthy for years and it was time for me to reclaim this perfect feminine form. I am blessed with a highly regular 27 day cycle, with strict 5 days of menstruation. That’s why, when my face never got better it was hard to make excuses. Oh it’s genetic, or I need better products etc. Acne is NOT normal, even though acne is common in Western society-that does not make it physiologically normal. The research is very interesting, pointing towards Western lifestyle and dietary habits as the culprit for these symptoms.

As with any disease process or presenting symptom it’s important to look into that patient’s history, whether it be their family history or…human history. The first question is: Has acne been around forever, or is this a disease of Western Civilization?  Acne vulgaris is an EPIDEMIC disease characterized by inflammation of the sebaceous gland. It affects around 85% of adolescents in Westernized civilization(1) In fact 96% of Brazilian adolescents have some form of acne vulgaris(1) yet no acne has been found in non-Westernized countries still following Paleolithic dietary habits. This was demonstrated in a comprehensive study involving 1,200 Kitavan Islanders of Papua New Guinea and 115 Ache hunter-gatherers of Paraguay (1). The results were astonishing…not a single case of acne was seen, with grade 1 being multiple comedones (small blackheads or white heads) and increasing through to grade 4 after being observed for 843 days. Paleolithic dietary habits constrain high glycemic carbs, dairy products, and most grains. The focus is on low glycemic tubers, meat, and vegetables. The researchers concluded that incidence of acne rates cannot be solely attributed to genetic differences because… Eskimos transitioning from a hunting society to “civilized” Canada, Okinamas, and Chinese all demonstrated a high increase of acne prevalence upon neglect of their traditional dietary habits (2 )Could it be possible that primitive, traditional civilization had it right? Is a Paleolithic diet, close to individual ethnic, cultural norms the way to heal our bodies of chronic inflammation? Are we in constant battle with our environment and food because we have lost contact with our traditional roots and habits? It starts to get dense here, so skip down to the recommendations portion if you would like!

Acne vulgaris covers a broad spectrum of inflammatory skin changes. Acne looks different on everyone, in severity in color and in type of lesion. But there is a subset of serological markers that seem to link most cases of acne. These include insulin, insulin-like growth factor, mechanistic target or rapamycin complex 1 (mTORC1), and sex hormone binding globulin(4,5). The sebaceous gland is the main site of hormone biosynthesis, especially for androgens-sex hormones. Multiple studies have implicated increase and fluctuations in sex hormone as culprits of acne vulgaris. Acne is seen throughout multiple life stages: puberty, normal menstruation, pregnancy, post menopausal, and adulthood. Acne has classically been referred to as an androgen-mediated dermatosis, though theories of bacterial overgrowth such as Propionibacterium acnes also exist (5) Dihydrotestosterone, a more potent version of testosterone, is synthesized directly in sebocytes and increased in people exhibiting acne vulgaris(4). One study found 54% of women with moderate to severe acne exhibiting increased testosterone levels and  decreased sex hormone binding globulin (4). Sex hormone binding globulin is like a mop for sex hormones, it soaks up all three sex hormones: estrogen, dihydrotestoterone (DHT), and testosterone. SHBG controls the amount of free, active testosterone that your tissues can use. Diet does not have a direct effect on SHBG levels. Some foods have been reported to increase its production but evidence is lacking. Insulin levels, however, may play a part in decreasing the levels of SHBG (6)Increased insulin levels are also implicated in increased production of androgens (6). Two randomized controlled studies demonstrated improvement of acne after reduction of glycemic load (7, 8).

All of this evidence supports the claim that acne is a Western disease mediated by insulin resistance and hormonal imbalances.  Yet is this whole story? If so, why aren’t patients having complete cure of acne with Spironolactone and oral contraceptives? Why are individuals still having breakthrough, breakouts on these drugs..?

Hormones have always been the go-to theory for acne development, though recent evidence is pointing toward a new friend, protein kinase mTORC1.  The mTORC1 responds to environmental cues leading to many different cellular processes in the body. The mTORC1 is a controller of cell growth and anabolism (5). mTORC1 is  implicated in many metabolic diseases specific to Western civilization.  In fact, increases in mTORC1 signaling is seen in obesity, insulin resistance type 2 diabetes, and cancer (5, 9).  It is activated by growth hormones such as insulin, insulin-like growth factor and branched chain amino acid (found abundantly in milk and dairy protein) (9). During the past decade, research has pointed to a strong relationship between acne vulgaris and mTORC1 expression. Consumption of milk products (high in branch chain amino acids), hyperglycemic carbohydrates, and chronic stress (leading to insulin resistance), are implicated in the increased prevalence of this notoriously bad serological marker (9). All of this, plus mountains more of evidence, are painting a picture of Western society and culture perpetuating acne vulgaris by increased expression of mTORC1.

Well what the F&*% can I do about it? I live here…and grew up here…and this is my stressed mess of a life

To be honest, I do not have a catch all answer for you. I wish this article could be the magic cure for your acne, hormonal imbalance, insulin resistance etc. But I would only be doing you a disservice in claiming that. There is so much to this story and it just keeps being written…

Here are some dietary and lifestyle habits you can adopt that can lead to decreased mTORC1 signaling in acne vulgaris!

All of these recommendations have been studied individually and are proven to decrease mTORC1 signaling in the body (5, 9) I have been personally taking all of this advice for a month and my skin is the best it has ever been:

1. CHILL OUT– try to stop stressing, huge problem for me and why my face still will not clear completely (getting there!). I have recently adopted a meditation practice that has been amazing…when I decide to do it… I use the Calm app and would highly recommend!
2. Reduce hyperglycemic carbs and glycemic load
3. Reduce milk and dairy protein consumption
4. Decrease some of your animal muscle intake, this part of the animal is high in branched chain amino acids. Increase your intake of varied animal amino acids  by sipping on bone broth and increasing organ meat intake.
5. Reduce saturated fats, this means…COCONUT OIL! I used coconut oil so much on whole30 and do believe that was contributing to my skin not clearing as well as it could have.
6. Increase consumption of epigallocatechin-3-gallate (green tea!)
   • I drink a lot of matcha, a very concentrated green tea.

7. Consider a fish oil supplement, omega 3s have been shown to decrease the free radicals made by increased mTORC1 and inhibit its activity/expression. This is changing the game for me,fermented cod liver oil!
   • Typical fish oil supplement has 1,000mg fish oil~180mg EPA and 120 mg DHA (10)
   • Fermented Cod liver oil: has vitamin A, vitamin D, + omega 3s (ding,ding,ding! OBSESSED with this supplement! I believe EVERYONE should consider supplementing some form of fish oil) (10)
     •  WHY? Seafood is a great source of omega3s, but it contains varying amounts of methyl mercury. Mercury levels in our ocean and seafood are devastatingly on the rise. Mercury is processed out during purification of supplements (10).
8. Have a nontoxic facial regime, and stick to it! Also look at yourself with love,    gratitude and acceptance every time you do this routine to increase self love and compassion on your body.
   • I use a Thayer’s Witch Hazel Rose petal toner in the morning and at night I use a tea tree wash, toner, and moisturize with jojoba oil.
   • Favorite charcoal mask: 1tbsp charcoal 1tbsp bentonite clay 2tbsp water
9.  Metformin…is a drug…that is special. It is on the market first line for Type II  diabetes, it is now also used to treat PCOS patients…it has recently been found to  increase fertility in infertile women…AND inhibits mTORC1…this drug is being heavily studied but is a relatively safe last resort (5,9) . Other drugs like spironolactone and oral contraceptives have been shown to improve acne, but are falling out of favor. Isotretinoin (accutane) kills all the sebocytes of the face but does nothing for the hormonal balances and abnormal cellular signaling systemically. These only mask the symptoms.

As always talk to your physician before starting any new regime and love your way through this very complicated health issue with me !