The Nutritional Management Of Acne

 James P. Meschino DC, MS, ROHP

What is Acne

Acne vulgaris is the most common skin disease, affecting 80% of the population between ages 12 and 25.  Acne is a disorder that occurs when the sebaceous glands in a person’s skin make too much oil (sebum).  The oil combines with cells that line the walls of these glands and clog the person’s skin pores.  Clogged pores lead to pimples, whiteheads or blackheads on the face, neck, shoulders, back or chest.  The process of forming acne lesions on the skin is actually completely by the propionibacterium acnes, or P. acnes for short.  The P. acnes bacteria is found on the surface of everyone’s skin, but it is found in greater concentrations on people who have excess sebum production, because it feeds off the oil. This is not a good combination, because when the P. acnes bacteria gets together with the sebum and dead cells, it causes inflammation in the hair follicles; and this leads to the inflammatory and infectious process that results in the formation of pimples, whiteheads or blackheads.   More serious pimples, the deep and large ones, are called cystic lesions, and they can result in painful infections and may even leave permanent scars.

Sebaceous Glands And Puberty

Sebaceous glands are the largest at birth, and then reduce in size until adolescence.  They once again enlarge during pre-puberty with changes in hormone levels influencing sebaceous gland secretion.  This increase in production of sebum is the reason that acne is so prevalent in adolescents and teenagers.  With excess sebum production, bumps called comedones appear on the skin due to blockage of follicles by sebum. Inside these comedones, there are bacteria and yeast that work on the sebum causing it to release free fatty acids, which cause inflammation and sometimes rupture of the comedone.

Sebum levels are increased when testosterone is converted into dihydrotestosterone (DHT) in skin cells.  DHT acts directly on sebaceous glands to increase their size and metabolic activity.

The causes of acne are very complex and involve many different systems and chemicals within the body.  Hormones, enzymes, and the immune system all interact together resulting in different reactions in each individual.  The severest forms of acne are most frequently seen in males, but acne is generally more persistent in females. Females tend to have flare-ups prior to menstrual periods.  Just prior to the onset of menstruation, a woman’s body experiences low blood levels of estrogen and progesterone, which allow her testosterone secretions to become a more dominant hormone during this time of the month. As testosterone stimulates increased secretions of oils from the sebaceous glands below the skin, a woman’s skin is often more oily and prone to acne breakouts during the premenstrual and menstrual period.

Of note is the fact that low-grade persistent acne is often found in professional women.  Some experts attribute this finding to the presence of chronic stress, which is known to increase the secretion of adrenal androgens (e.g., testosterone and androstenedione).  In turn, these hormones act to increase the size of sebaceous glands and the amount of oil they secrete, leading to increased vulnerability to acne.

Skin pH Is Also A Factor

There is also evidence that indicates the pH of the skin can affect acne.   If the pH is acidic, it helps to keep pores clean and discourage bacteria build-up. Under normal conditions, the skin is naturally acidic.  On the other hand, if the skin’s pH balance starts to move toward more alkaline pH, this could lead to potentially damaging bacterial activity.

Once again, the age group most at risk to this scenario are the people with the raging hormones.  The hormonal changes in teens and even young adults may cause the pH balance to swing from acidic to alkaline – and with that comes a wide variety of unpleasant and unwanted microbes.

Don’t make it worse

Even before starting any type of treatment, it is imperative not to aggravate acne.   It can be irritated and even made worse under certain conditions, particularly if tight clothing, straps, athletic equipment, and even scarves and turtleneck sweaters continually rub up against the afflicted areas.    Any area of the body with acne should as much as possible be clear of any impairment which will cause friction.

Even your best efforts at personal hygiene can aggravate the condition. Certain skin and hair products containing irritants should be avoided, as washing with a harsh soap, using very hot water or even scrubbing too hard makes it worse.   And even a small thing like letting oily hair fall on to the forehead and face just feeds the P.acnes bacteria. Excessive sweat and stress can also contribute to the agony.

Dietary and Lifestyle Considerations

There is much controversy over the impact that dietary factors have on the development and severity of acne.  Scientific studies have suggested that some foods could encourage acne. These include primarily processed foods and ingredients, citrus fruit, refined vegetable oils, hydrogenated oils, deep fried foods, caffeine, sugar and cocoa, to name just a few. However, there is still much debate about these nutritional influences. I would suggest that those with this condition try limiting their intake of high fat and fried foods, as well as sugary treats and chocolate products as much as possible. As a teenager who once suffered from acne myself, I noticed that these foods tended to make my condition worse. In my early twenties, as a student of science, I researched the relationship between nutrition and acne, which enabled me to put together my own diet and supplementation program that reduced my acne condition by approximately 30-40%.  Although further scientific substantiation is required, some evidence exists to show that the following dietary modifications may be helpful in some cases:

1. Reduce intake of refined sugars
2. Reduce intake of high fat animal products and foods with a high content of hydrogenated fats (e.g., margarine, commercial peanut butter, and shortenings).
3. Avoid fried foods
4. Avoid heavily salted food
5. Avoid chocolate products

Supplements That Are Effective In The Management Of Acne

Many practitioners, including myself, have observed significant improvement in acne cases when clients have been placed on specific nutritional supplements that support skin health, remove toxins from the bloodstream and help to kill the acne bacteria on the skin.

1. High Potency Multi-Vitamin and Mineral: Over the years, a number of studies have shown that supplementation with various vitamins and minerals that support skin health can improve acne conditions. This is something that I found to be true in my own case in my late teens and early twenties; and so, naturally, I have recommended these dietary and supplementation practices to my patients over the past twenty-five years. Studies over the years have particularly highlighted the effectiveness of selenium, zinc and vitamin A in acne treatment. The scientific literature shows that good improvements were achieved with selenium in a study using a group of men and women with moderate to severe acne.    This improvement was as a result of treatments of 200 mcg of selenium in combination with 10 mg of vitamin E twice daily for a period of six to 12 weeks.  Vitamin E works to neutralize the bacteria in the sebum, and in the process, helping to reduce the inflammation of the acne lesions.

Success has also been reported in studies using zinc for the treatment of acne, although experts can’t precisely pinpoint how the mineral undermines the bacteria.   Research has indicated men and women with acne have lower zinc levels in their bodies compared with people without acne.  The more severe the acne, the lower the zinc levels.   Studies have showed that a great reduction in acne inflammation has been experienced by individuals who were treated with zinc, when compared with other individuals who were being treated only with a placebo or a “dummy” pill. Zinc is known to participate in many aspects of skin health and development, including a role it plays in regulating oil gland (sebaceous gland) function.

Skin cells also require many of the B-vitamins for normal growth and development. Therefore, I start all of my acne clients on a high potency multi-vitamin and mineral supplement that is antioxidant enriched and contains a B-50 complex. See details of this formulation at the end of the article.

2. Detoxifying Booster Supplement: A Detoxifying Booster supplement should contain natural herbal agents that are known to enhance the body’s detoxification enzyme systems and improve immune function. Sub-optimal or defective detoxification results in a higher concentration of blood-borne toxins and irritants that can trigger immune inflammatory reactions, which are known to aggravate and/or cause various skin lesions, including acne.

Detoxification is a two-step process involving phase I and phase II detoxification enzymes (primarily located in liver cells and intestinal epithelial cells). The 50-100 phase I enzymes interact with endogenous (originating from inside the body) and exogenous (originating from outside the body) chemicals and convert them (for the most part) into intermediate agents, which are often more lethal and damaging to the body than their original pre-detoxification state. However, these dangerous intermediate agents are quickly passed on to the phase II detoxification enzymes, which convert them into harmless inactive substances that are easily eliminated from the body via the urinary or fecal route.

A number of B-vitamins as well as vitamin C, vitamin E, selenium, and the mineral molybdenum are required as cofactors to facilitate many of these phase II detoxification reactions. Thus, the use of a high potency multi-vitamin and mineral greatly supports our body’s detoxification function.

However, individuals with problem skin have been shown to have sub-optimal detoxification activity, which requires additional support to boost it to a more desirable level of function. Clinical and experimental research shows that the active ingredient in milk thistle (Silymarin) and the Indole-3 carbinol found in cruciferous vegetables (broccoli, brussels sprouts, cabbage, cauliflower and bok choy) boost phase I, and phase II detoxification activity very significantly, helping to purify the blood of many foreign chemicals and toxins. Further, milk thistle has been shown to repair damaged liver cells, protect liver cells against numerous toxic agents, and boost liver cell levels of glutathione, which is both a vital intracellular antioxidant and an important phase II detoxification conjugation agent.  As such, persons with problem skin conditions, including acne, should ingest a supplement that includes therapeutic dosages of milk thistle and indole-3 carbinol. This formula should also contain the two powerful immune modulating herbal agents (reishi mushroom extract and astragalus), which are known to better regulate immune function and minimize immune inflammatory reactions.

See details of this formulation at the end of this article.

3. Digestive Enzymes and The Prebiotics FOS and Inulin: Individuals with skin conditions, including acne, have also been shown to benefit from the use of a combination formula that includes digestive enzymes and the prebiotics FOS (fructo-oligosaccharide) and inulin. Incomplete digestion due to digestive enzyme insufficiency, as often occurs in patients with skin conditions, results in partially digested food matter entering the bloodstream and triggering immune inflammatory reactions that aggravate a host of skin and complexion problems, including many cases of acne. As well, studies reveal that individuals with various skin conditions also have an imbalance in friendly-to-unfriendly bacteria in their large intestine. The high concentration of unfriendly bacteria in the large bowel, produces toxins that leak into the bloodstream. These toxins in turn, have been shown to trigger the immune inflammatory reactions that aggravate skin problems. For this reason I also include supplementation with the prebiotics FOS and inulin, which are a type of soluble fiber that feed the friendly bacteria of the large bowel. In turn, this enables the friendly bacteria to replicate quickly, crowding out the unfriendly gut bacteria and correcting the imbalance in friendly-to-unfriendly bacteria. I usually give prebiotic supplementation in an all-in-one formula that contains a full spectrum, high potency blend of digestive enzymes together with FOS and inulin. See details of this formulation at the end of this article.

1. High Potency Oil of Oregano:  The high potency form of oil of the oregano, which stems from the easterly tip of the Mediterranean, has been shown to be an effective treatment for acne, because it contains anti-inflammatory and antibiotic properties which work as a one-two punch against this difficult skin condition. The antibiotic action works to break down and kill the acne bacteria that cause the acne lesions, while the oregano oil’s drying action causes the enlarged acne lesions to shrink and even dissolve.

The reason that the high potency form of oil of oregano is able to kill acne is owed to the concentrations and variety of antibacterial and antifungal ingredients the herb contains, including the volatile oils known as carvacrol and thymol.  Working in unison, the various properties of oregano oil fight a wide assortment of microscopic invaders, including acne-causing bacteria.  This is why I recommend that patients with acne should ingest a high potency oil of oregano capsule and apply the oil of oregano topical cream to affected skin areas at bedtime, so it can directly kill the surface bacteria on the skin while they sleep.

Does it really work? Yes, like a charm. The original work by Dr. Cass Ingram D.O., first made me aware of the multiple health benefits available from the use of a high potency oil of oregano supplement, as well as its topical application in cases of acne, rosacea, psoriasis, eczema and skin fungal infections. Acknowledged by many as perhaps the world’s leading expert on the use of oil of oregano, Dr. Ingram’s research and case studies prompted me to start using the form of oil of oregano that he has used clinically over the years, and had showed good results with his own patients.

In cases of acne, I recommend that patients take one to two capsules, twice per day. Each capsule contains 450 mg of a proprietary blend of wild high mountain oregano herb blend that is loaded with the active ingredients that kill off the bacteria that cause acne lesions. Oil of oregano should also be topically applied directly on the acne lesions overnight in the form of the oil of oregano cream.

In my opinion, high potency oil of oregano capsules and skin cream should be tried as therapy for acne before initiating use of antibiotics. The use of antibiotics is associated with many undesirable side effects such as killing the friendly gut bacteria, which can lead to problems with elimination, detoxification, immune regulation problems and increased susceptibility to infections in the intestinal tract.  This includes increased risk of inflammatory bowel disease, and the development of antibiotic-resistant strains of bacteria, which can cause infections that the individual is not able to control any longer with antibiotics.

The list doesn’t stop there.   Results may also include the birth of super-infections from yeast organisms, which can affect the mouth, intestinal tract, rectum, and/or vagina.   Other side effects may result in intestinal upset, abdominal cramping, drug-induced hepatitis or jaundice, anemia and/or low platelet blood count causing abnormal bleeding or bruising, tremors and the activation of the autoimmune disease known as Lupus.

Some antibiotics may also cause a serious skin rash upon exposure of the skin to sunlight. So, if possible, antibiotics should not be the first choice for the treatment of acne; instead the use of a high potency oil of oregano supplement and topical cream is highly recommended. It’s a safer way to go, and in some cases, it’s more effective. However, acne can be a stubborn condition to treat, so individuals who have acne should try a high potency oil of oregano first, in conjunction with the rest of the nutrition and supplementation protocol I have summarized in this article. If the client still requires the use of antibiotics after 60 days of using this approach, then a consultation of this nature should be arranged with a medical doctor or dermatologist.

Summary Of Nutritional Supplements For Acne

I have seen excellent results in cases of adolescent and adult acne with the use of high potency oil of oregano capsules and topical cream, used in conjunction with a high potency multi-vitamin and mineral supplement, the detoxifying booster supplement and the digestive enzyme-prebiotic supplement I have described in this article. In my view, all of these supplements should be included in the global management of acne cases. Unfortunately, nutrition and supplementation interventions in acne management have not been universally recommended or acknowledged by skin care professionals. Hopefully, a greater number of estheticians, dermatologists and allied skin care professionals will incorporate these effective measures into the overall management of acne cases, as an important means to help combat this difficult condition. I have seen these practices work first hand and I recommend their inclusion in the management plan for all acne clients.

Supplement Formulations Used In Acne Management

Selected References:

1. Michaelsson G, et al. Erythrocyte glutathione peroxidase activity in acne vulgaris and the effect of selenium and vitamin E treatment. Acta Derm Venereol. 1984;64(1):9-14.
2. Amer M, et al. Serum zinc in acne vulgaris. Int J Dermatol. Oct1982;21(8):481-4.
3. Michaelsson G, et al. Patients with dermatitis herpetiformis, acne, psoriasis and Darier’s disease have low epidermal zinc concentrations. Acta Derm Venereol. 1990;70(4):304-8.
4. Dreno B, et al. Low doses of zinc gluconate for inflammatory acne. Acta Derm Venereol. 1989;69(6):541-3.
5. Verma KC. Oral zinc sulphate therapy in acne vulgaris: a double-blind trial. Acta Derm
6. Jan1980;60(4):337-40.
7. Lidén S. Clinical evaluation in acne. Acta Derm Venereol Suppl (Stockh). Jan1980;89:47-52.
8. Meynadier J. Efficacy and safety study of two zinc gluconate regimens in the treatment of inflammatory acne. Eur J Dermatol. Jun2000;10(4):269-73.
9. Ayres S Jr, et al. Acne vulgaris: therapy directed at pathophysiologic defects. Cutis. Jul1981;28(1):41-2.
10. Ingram, C., D.O. The Cure is in the Cupboard, Knowledge House, 1997
11. Dorman HJ, et al. Antimicrobial agents from plants: antibacterial activity of plant volatile oils. J Appl Microbiol. Feb2000;88(2):308-16.
12. Leung AY, Foster S. Encyclopedia of Common Natural Ingredients, 2nd ed. New York: John Wiley & Sons, 1996, 398–9.
13. Hammer KA, Carson CF, Riley TV. Antimicrobial activity of essential oils and
14. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative Medicine Communications, 1998, 358–9.
15. G Weber et al, The liver as a therapeutic target in dermatoses. Med Weltz; 34: 108-111 (1983)
16. J Pizzorno, total wellness. Prima Publishing (pub) 1996; Chpt Decreasing toxicity: 87-162
17. M Murray and J Pizzorno, Encylcopedia of natural medicine. Prima health (pub) 1998. Chpt Detoxification: 104-125
18. G Michaelson et al, Erythrocyte glutathione peroxidase activity in acne vulgaris and the effect of selenium and vitamin E treatment. Acta Derm Venerol; 64: 9-14 (1984)
19. B Snider et al, Pyridoxine therapy for premenstrual acne flare. Arch Dermatol; 110: 103-111 (1974)
20. H Majarmaa et al, Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol; 99: 179-186 (1997)
21. E Isolauri et al, Probiotics: effects on immunity. Am J Clin Nutr; 73 (suppl): 444-450 (2001)
22. J Schrezenmeir et al, Probiotics, prebiotics, and synbiotics – approaching a definition. Am J Clin Nutr; 73 (suppl): 361-364 (2001)