Welcome! This is Part 3 in my series, Holistic Nutrition for Clear Skin and this one is all about the root causes of acne. You can find the other posts in the series here:

• Part 1 – Initial Thoughts on Acne 
• Part 2 – The Drawbacks of Conventional Treatments for Acne 
• Part 4 – Eating and Nourishment for Acne
• Part 5 – Stress and Acne
• Part 6 – Acne and Exercise
• Part 7 – Acne and Self-Kindness (10 Practices to Build Self-Compassion)
• Part 8 – Acne, Skincare, and Clean Beauty Products (Plus: My Favourite Products) 

In this post, we’re trying to understand what actually causes acne. I’m taking you on an in-depth journey to help you understand the health factors that may be at the root of your skin struggles. This post in IN. DEPTH. We are taking no prisoners on the understanding acne front. Why? Because knowledge is power, and I want you to feel empowered! That’s step 1 to achieving happier, healthier skin.

On to the good stuff!

Holistic Nutrition for Clear Skin – Part 3: The Root Causes of Acne

What Is a Root Cause Anyways?

We holistic nutrition and functional medicine folks use the term ‘root cause’ A LOT. It’s a simple phrase but a really important concept for understanding the holistic approach to health, nutrition, and wellness. In fact, it’s one of the reasons I was pulled to holistic nutrition as the approach I wanted to learn: the root cause concept just made such intuitive sense to me.

So what is a root cause? Collins English dictionary, helpful as ever (I love a good dictionary definition!), offers the following:

Root Cause: the fundamental reason for the occurrence of a problem.

So, a root cause for a health problem is the underlying reason that the health problem occurred in the first place. This may seem very obvious to you: addressing any health concern should involve looking at what was responsible for that health concern in the first place.

But, though perhaps obvious to you, it has not yet become obvious to conventional, modern medicine, which typically seeks to identify and diagnose the health concern and then find a pill to relieve or manage the symptoms. This is not the same thing as prevention, and it is certainly not the same as finding out the reason that the health problem started in the first place and trying to address THAT. In the case of acne, failing to really investigate the root causes of your acne might explain why you’ve tried conventional treatments for acne but not really found lasting, positive results.

A Quick Review: Acne and Your Skin

I wanted to quickly review what acne is – I don’t mean here the root cause, I mean, what’s happening to your skin. Knowing this information is helpful in understanding why certain body systems could impact acne. So here is Emily’s quick learning session:

• SHORT VERSION: Acne is considered an inflammatory condition and requires three things: excess skin sebum, blocked pores, and bacteria. Glands produce oil, oil gets trapped, pore gets infected by bacteria and becomes inflamed, face hurts.
• TELL ME MORE: Skin sebum – an oily, waxy substance produced by the sebaceous glands of the skin (it’s a natural and good, protective thing! it’s just troublesome in excess) can accumulate in skin pores. If those pores get blocked, certain bacteria of the skin –  including p.acnes – thrive, and that results in the typical signs of inflammation: redness, heat, swelling, and pain. The resulting pimple is effectively a small infection; or rather, the small infection that results is called a pimple – which is why there are also often the signs of infection, like pus. 

7 Root Causes of Acne

So now I’ve rambled on and on and you’re thinking, dear god, tell me about the root causes already. But at least now we know some background information that will help us understand the root causes. So let’s turn our focus to those, shall we? Below are the primary root causes that contribute to acne. They are, in no particular order:

• hormonal imbalances
• detoxification difficulties
• skin nutrient deficiencies
• problems with your gut microbiome
• problems with your blood sugar
• stress
• inflammation

And now, let’s get IN DEPTH.

Root Cause # 1. HORMONAL IMBALANCES

When our hormones are not balanced, it impacts our skin. Why? Primarily because hormones, among their many tasks in the body, also speak directly to the oil production of our sebaceous glands. That’s why in puberty, when hormones are really starting to make themselves known, skin issues also start to surface. Hormones are designed to work together as a beautiful orchestra, and it’s important that they remain balanced. When one is imbalanced, it affects the others. Here are two common imbalances important for acne:

• High Androgens/Androgen Sensitivity: androgens are the precursor group to the male sex hormones (i.e. testosterone is made from the androgen group) and are produced in women in small quantities by the ovaries and the adrenal glands. These hormones are normal, healthy, and required in balance. Many women, however, have excess androgens, as happens in something like PCOS, or, women have a regular amount of androgens but are particularly sensitive to their effects. This matters because androgens increase sebum production and also may enlarge sebaceous glands. That’s why women with hormonal acne often have breakouts along the cheek and jawline – that’s the standard place for a man’s beard, and where both men and women have more androgen receptors (and therefore cells that are influenced by its activities). High androgens/androgen sensitivity is another reason why women with PCOS often see acne among their symptoms.
• Estrogen/Progesterone: as discussed in this post on estrogen dominance, it’s really important for our reproductive health to have balanced estrogen and progesterone – that is, a balanced ratio of one to the other. This matters for two reasons:
  • Estrogen, when balanced, is positive for our skin and actually helps suppress sebum production. Part of how estrogen does this is via a balancing/opposing effect on the androgen group (mentioned above), which are often implicated in hormonal acne. Estrogen that is too low or too high doesn’t have this same balancing effect. We live in a world that is pro-estrogen, as it were, and so it becomes quite easy to become dominant in estrogen and to throw off that ratio. Many things can contribute to how balanced (or imbalanced) our estrogen is – our liver health, the foods we eat, the toxins and plastics we’re exposed to, etc – and maintaining the right, acne-protective balance can be difficult. Read my article on estrogen dominance to find out more about supporting estrogen balance.
  • Progesterone, when balanced, also helps regulate the production of the androgens I mentioned above, specifically by regulating the balance between the androgens produced and those converted into a more potent, sebum-encouraging form, known as Dihydrotestosterone or DHT (5x more potent that testosterone). LOW progesterone, then (quite common for many women) means that there is less regulation of this androgen->DHT balance, and therefore less of an acne-protective effect.

Root Cause #2. DETOXIFICATION DIFFICULTIES

We have few key routes for the elimination of wastes: the liver, kidneys, lymphatic system, colon, and skin, among them.  These systems work together to shoulder the load of keeping our bodies healthy and free (to the degree possible) of the toxic waste products that build up from the foods we ingest, the products we use, and the living that we do (like CO2 from breathing, or stool from the digestion process).

Our liver in particular plays an important role in metabolizing and excreting hormones, and as you just read above, hormones are super important in the path to clear skin – we want our hormones to be balanced, and part of this balance is contingent on the body’s ability to metabolize (break down) hormones and excrete them. A healthy liver supports this cycle. I don’t really advocate liver flushes or particular detoxes, but I think there is real value in eating for a healthy liver, and in drinking lots of water and hydrating beverages (to support your kidneys), in dry brushing (to support your lymphatic system), and in consuming sufficient fibre (for your gut and colon). In my experience, all of these practices support and promote healthier, clearer skin.

Root Cause #3. NUTRIENT DEFICIENCIES

Healthy, clear skin requires certain specific nutrients, including zinc, Vitamin A, Vitamin E, B Vitamins, and Omega 3 fatty acids

• If we have low stomach acid (see Stress), we may not be digesting our food and obtaining these nutrients properly.
• If we have compromised gut health (see Microbiome), we may not be absorbing these nutrients properly.
• And, of course, if we are eating diet that is rich in processed or refined foods and poor in fruits, vegetables, quality proteins, complex carbohydrates, etc, we may not be getting sufficient of these nutrients in the first place.

When we don’t have enough of these critical skin-supporting nutrients, acne prevention becomes very difficult. In addition, deficiencies in these key nutrients can prolong how long a pimple takes to heal, and contribute to slower healing from acne scars.

Root Cause #4. GUT DYSBIOSIS (ISSUES WITH THE MICROBIOME)

Your intestine is home to lots and lots of bacteria of all kinds – you can think of it like an invisible garden that resides within. As we study the microbiome, we’re learning more and more about its role in digestion, mood and mental health, immune health, hormone health, and yes, skin health including acne and your general glow. The gut also plays a role in helping the body manage inflammation, both in the gut locally and more widely throughout the body (see Inflammation, below). As it is, then, a healthy gut contributes to the healthy workings of the other body systems, and directly to the health of the skin (through the gut-skin axis).

Imbalances in the microbiome (commonly referred to as dysbiosis – when unfriendly or less positive bacteria dominate the friendly ones) can contribute to imbalances in those other body systems as well. In addition, certain microbes in the colon can produce wastes that increase toxicity (and therefore increase the load on the liver and kidneys – see Detoxification, above). Certain bacteria produce hormone-mimicking compounds that contribute to hormonal imbalance, like estrogen dominance (see Hormone Imbalance, above).

Here are some health factors that can negatively impact your microbiome:

• Antibiotics
• Dietary choices
• Too much sugar (can contribute to the growth of certain bacteria)
• Not enough sleep
• Too much stress
• Smoking
• Excessive alcohol consumption
• Pesticides/herbicides
• Chlorinated water

Remember that our microbiome has been evolving since birth, and how you were born (vaginally vs. C-section) may also have had implications for your microbiome. It’s a garden, right? Many individual factors contribute to its overall current status. For nutrition information on how to support your microbiome check out this acne and nutrition post, or this post on the microbiome and glowing skin.

Root Cause #5. DYSGLYCEMIA (BLOOD SUGAR IMBALANCES)

Acne is an inflammatory condition, but I’ve also heard it called “the diabetes of the skin.” That tells you that blood sugar is important. Here’s why:

• We need insulin to live – it’s the hormone that helps us store energy. When we eat a meal with carbohydrates, insulin is released to tell the body to store what we don’t immediately need of the carbohydrates (broken down into glucose by our digestive system) so that we have energy for later. Perfect!
• This system can go awry when we’re eating lots of refined carbobohyrates (usually in the form of sugary foods, foods with white floor, lots of processed foods) and we’re constantly releasing insulin to help manage our blood sugar.
• Chronically high insulin levels stimulate the release of something called IGF-1 (free insulin-like growth factor) which has been shown to increase sebum production, contribute to skin’s propensity to clog with dead cells, and to raise androgen levels, particularly levels of DHT (as noted above, that’s the potent, sebum-encouraging form of testosterone). All of these are huge components of acne.

We’ll talk about this in the nutrition post, but studies have shown the a low-glycemic diet (i.e. one that keeps your blood sugar nice and stable) helps reduce acne. It does this by keeping your overall blood insulin levels lower and more balanced.

Root Cause #6. STRESS

What doesn’t stress do? In the case of acne, it has a significant impact and actually might be the hardest ‘root cause’ to manage (I find it to be!). Here’s a quick rundown: 

• Stress increases the production of cortisol, our stress hormone. Cortisol and progesterone share the same building blocks and pathway, so more cortisol ultimately means less progesterone (called progesterone steal). This can contribute to low progesterone (see Hormonal Imbalances above), which impacts acne.
• Cortisol also influences our blood sugar, which indirectly links to increased sebum production. Here’s how: The release of cortisol in our bodies corresponds to a release of glucose into the bloodstream. Sugar in our bloodstream requires the insulin to manage it, and (see BLOOD SUGAR, below) insulin promotes sebum production.
• Stress also impacts digestion.  We need to digest food properly to get key nutrients for skin health, and we need stomach acid for that – stress shuts down digestion (don’t need to digest when you’re outrunning a tiger!) and that includes the production of stomach acid.
• Stress is also linked to altered gut flora (see the Microbiome section above).

Root Cause #7. INFLAMMATION

I’ve saved this one for last because we’ve kind of been leading up to it – it’s where the root causes converge into one big root cause. Recall that acne is an inflammatory condition. Studies are discovering the role of inflammation at the level of the skin (the pain and swelling and redness of the pimples themselves) and the role of inflammation as a general condition in the body. A few key points:

• Inflammation in the body is typically a good thing and a natural bodily process. Think about an injury or cut – you see swelling, heat, redness, and you feel pain, and all of these are the body’s way of bringing blood, nutrients, immune cells, and other healing agents – including inflammatory compounds – to the affected site. Once the situation is under control, the inflammation subsides and the body returns to a normal state. This is called acute (or short-lived) inflammation.
• In today’s world, many people experience chronic inflammation, or, inflammation that never goes away. There are constant “insults” happening in the body, and the inflammatory compounds that are normally part of the healing process are instead sent to act in places where their activities start to harm (they might attack healthy tissues, for example). Chronic inflammation can contribute to a vast array of diseases including autoimmune conditions, arthritis and joint conditions, and more – many theories suggest chronic inflammation is in fact at the heart of ALL disease.
• What things contribute to inflammation in the body? Many of the root causes above. Stress is a big one, along with smoking, heavy alcohol consumption, and obesity. Dysbiosis (an imbalanced gut microbiome), hormonal imbalance, and dysglycemia (blood sugar imbalances) can also contribute to inflammation, as does diet rich in inflammatory foods (like sugar, alcohol, trans fats, conventional meat and dairy, gluten, processed foods, etc).

So how does this impact acne? Consider in the case of chronic inflammation you have inflammatory compounds in your body always at the ready – any blocked pore will easily be able to invoke a significant inflammatory response, resulting in the redness, swelling, and pain that are so frustrating.

What’s more, studies have also suggested that inflammation contributes to oxidized (or damaged) sebum, which, in turn contributes to more inflammation and which may contribute to acne even before the pore gets blocked and the bacteria multiply. So in other words, it all starts with inflammation.

To Sum It Up:

At first glimpse, the number of different root causes of acne can seem really dejecting – it might seem to you that it’s an overwhelming amount of health stuff to manage and to understand, and you might already feel that dealing with your acne is a full-time job. I get that.

But there is a silver lining here as well: the connected nature of the body’s different organs and systems means that helping one area of your body often automatically helps another: Balancing blood sugar helps with hormone balance; smart supplementation helps directly with skin health, but also helps blood sugar, hormones, the body’s ability to handle stress, and the microbiome. Helping the microbiome helps hormones and blood sugar, and so on.

It’s a domino effect! Little changes anywhere can help make positive changes everywhere!!

In the next post – Holistic Nutrition for Clear Skin – Part 4: Nutrition for Acne – we’ll look in-depth about the nutrition choices that directly address the root causes of acne and also nourish and promote healthy skin.

© Emily Joldersma, R.H.N. Eat Well, Live Vibrantly