CLEAR SKINUNLOCKEDThe Ultimate Guide to Acne Freedom and Flawless Skin

Unlocked Series Stefani Ruper

 Clear Skin Unlocked:  

The Ultimate Guide to Acne Freedom  and Flawless Skin 

By Stefani Ruper

Copyright Stefani Ruper Enterprises LLC 2017

Contents 1 INTRODUCTION

5 HOW ACNE WORKS

70 INTERNAL HEALING MODULE 3:

Smart Supplementation

25 INTERNAL HEALING MODULE 1: Hormones and Acne

58 INTERNAL HEALING MODULE 2: Food and Acne

76 THE TOPICAL CARE SOLUTION

87 THE 4-WEEK JUMPSTART TO ACNE FREEDOM

95 FAQ

Introduction

66 INTERNAL HEALING MODULE 3:

Smart Supplementation

Introduction

I have never had particularly nice skin.

When I was 12 years old, I started using Clearasil. None of my friends needed it, but I did. And it did not make a difference. I regularly got cysts (especially around my mouth), bumps (a lot on my forehead), and what I now know were “blocked comedos” all over my chin.

It was, nevertheless, more or less manageable.

It wasn’t until I turned 22 years old that my skin was set on fire.

This was on a “good” day. I never summoned the courage to take a photo on a “bad” day.

No longer was managing my acne a matter of applying a simple dollop of salicylic acid and some foundation. Instead, my face was a war zone. Every morning I would wake up and run my tongue along the inside of my mouth. By the number of times I felt a stinging pain, I could count the emergence of new zits. Usually, there were six or seven. They were big. And they were painful. I’d get up and hesitantly sidle up to a mirror. Sometimes I’d cry. It hurt, physically, and it hurt, emotionally. I felt like I had no control, and I hated that.

It didn’t make any sense to me, either. I was doing everything right. I had already been eating “clean paleo” for years, and I followed the advice I found on paleohacks to a T. I cut carbs out of my diet. I started fasting. I focused on saturated fats and vegetables and organ meats. But I only ever got worse, and worse, and worse.

2 Introduction

Only after years of reading obsessively about nutrition did I finally learn the truth: I might have been eating by “paleo” or “healthy” rules, but that didn’t mean I was eating right for me, and definitely not for my skin.

In the end, I needed to gain weight, stop exercising as much, stop fasting, add carbs back into my diet, and eliminate soy and dairy products from my diet, in order to have clear skin. Topical probiotics, fermented foods, finding a new cleansing regimen, and red light therapy have all been a part of this journey, too.

They may be a part of yours. Or maybe you need something different. Whatever it is, I have provided the information here you need to figure it out and obtain it.

Now, I do not provide any silver bullets. The health of your skin is highly dependent upon a huge variety of factors, both internal and external. Your hormone balance matters, inflammation matters, nutrient status matters, food sensitivity matters, and the way you touch and treat your face matters. The secret to clear skin for you is solving the particular problem(s) underlying your acne. They will be different from mine and different from your neighbor’s and different from your sisters. But the information here in this guide is the most comprehensive of any acne guide I’ve ever encountered.

To that end, I spend several chapters describing how skin works, and the processes by which acne develops. I give a lot of space to hormonal factors in acne, because they are complex and they matter. But most of all what I give you is actionable advice. This book is full in equal parts of information that will empower you, and complementary practical advice that you can use to heal your skin. Along with information about the formation of acne, I provide supplement recommendations and topical care regimens, all of which I have personally studied, vetted, and used. Throughout the program I link to the Clear Skin Unlocked Resources Page, which is where I provide links to all of my favorite products. You, as an owner of this program, have exclusive access to this page. I haven’t shared this information anywhere else.

In the closing sections I provide what I call a four week jumpstart, which is a more structured set of principles to follow for the sake of your skin, to get you healing immediately and effectively. I do not promise perfect skin within four weeks--as the skin takes 90 days to regenerate itself--but I do know that four weeks of following these guidelines, all the while being smart and investigative about the internal health of your body, should yield significant benefits and set the foundation for a radiant and acne-free future.

Nowadays, I still wear a thin layer of foundation, but I don’t have to. My skin has this luminous glowing quality to it, and while I do still get small acne breakouts, I usually understand exactly which of my rules (no soy, no dairy, etc) I broke in order to get them. I never get a pimple

3 Introduction

without knowing exactly where it came from. This is precisely the kind of empowered knowledge and clear skin potential this program can give you.

I am eminently excited for you on your journey, and so happy to be able to be a part of your forthcoming dermatological triumphs. Thank you very much for the trust and the sisterhood.

With fire and love,

4 Introduction

How Acne Works

How Acne Works

Skin Quality = Genes + Hormones + Inflammation + Nutrient Status + Topical Care

Introduction

If you look for answers to your acne problem on the internet, you might end up a tad confused. When I first began digging into acne solutions, the answers I found ranged from clay face masks to cayenne pepper detox cleanses to giving up chocolate. And everything in between. Every wellness guru had a miracle trick that was going to work in just three days. If it didn’t work, I simply out of luck, and with emptier pockets to boot.

What was perhaps worse was when I tried to work with a dermatologist. The people I tried working with (and, to my understanding, most doctors and dermatologists) believed in something I now call the Standard Dermatological Wisdom. Despite how many people advocate for the SDW--and how professional and legitimate it seems--it’s still all kinds of wrong. It nearly destroyed my skin. It can destroy people’s health. It prevents millions of people from being happily acne-free every year.

What’s the problem with Standard Dermatological Wisdom?

The problem is that it doesn’t recognize the connection between health and the skin.

Standard Dermatological Wisdom says that when you have acne that’s just because of bad genetics, and too bad for you. According to this mindset, the only way to cure acne is to blitz your skin with chemicals or antibiotics, or to take potentially damaging medications such as Accutane. It says that the food you eat has nothing to do with the quality of your skin. It says that inflammation, nutrients, and hormones have nothing to do with your skin.

6 How Acne Works

I can’t tell you how many doctors I’ve seen in my life who told me that I needed to stop worrying about my diet and just buy the darn antibiotic lotion already. When I later told one dermatologist that the quality of my skin improved dramatically when I removed dairy from my diet, she scoffed and said surely it must have been a coincidence.

Of course, genes do matter. And there are bacteria on your skin. There are bacteria everywhere. But the question remains: how do dermatologists account for all of the people in the world who have the same skin genes as we do, and the same bacteria, but simply do not have acne?

Also, what about all the hunter-gatherer tribes and traditional cultures in which no one suffers from acne? What about the teenagers in traditional cultures that have never seen a pimple in their lives? Dermatologists do not, on average, appear to care. I may be exaggerating a tiny bit – but not by much. There are very many people in the world who could have acne or other skinconditions but don’t – and it’s precisely because of the diet and lifestyle conditions in their lives.

In order to best understand the recommendations that I make in this book, it will be helpful to understand exactly what goes on beneath the surface of your skin. To that end, in this section I give you everything you need know about the acne-formation process. This is not a short lesson – but it is a fascinating one that will help you both better appreciate your skin as well as learnbetter how to nourish it.

I’ll start with the mechanics of the skin. Then I’ll describe all the ways your body affects them partitioned into four categories : genes, hormones, inflammation, and nutrient status.

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Mechanics: How the Skin Works

The skin is the one component of the whole body that is responsible for protecting it from the outside world. The entire body. It keeps out toxic substances, and it lets through substances that are beneficial. It is a highly selective barrier, working day in and day out to make sure the body is safe from the outside world.

In order to be a good barrier, the skin has to be made of the right stuff, and it also requires a system to lubricate it and replenish itself.

There are three primary layers to the skin: the hypodermis (bottom layer), the dermis (middle layer), and the epidermis (top layer). The bottom layer connects the skin to blood and muscle tissue. The top layer is actually composed mostly of dead cells, debris, and oil – there’s nothing alive up there. The middle layer is where all the action happens.

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The middle layer of the skin, the dermis, has follicles that transverse it. These follicles connect the inner body to the outside air. In areas in which hair grows, hair comes out of these follicles. In areas where hair doesn’t grow, the follicles are somewhat empty. They are hollow grooves that connect the bottom layer of skin to the top.

Lining the walls of each of these grooves (the follicles where there isn’t hair) are sebaceous glands. Sebaceous glands produce an oil called sebum. In healthy skin, sebum moves up from the wall of the follicle to the surface of the skin. Once there, it spreads out, lubricates the skin, and helps keep toxins out. It sort of flushes out the follicle or pore. You read that right: oil can be a good thing. It’s all about context.

Another thing that moves up and out of follicles is dead skin cells. In healthy skin, when skin cells die they move up onto the surface of the skin and spread out evenly, adding to the protection the skin provides. In unhealthy skin, excess amounts of a certain kind of protein called keratin prevents the skin cells from separating properly when they die. Thus they end up dying in little clumps of skin cells, which can get stuck in follicles and block the healthy flow of cells and oil onto the surface of the skin.

This causes a mini-traffic jam up to the surface of the skin (it’s called a microcomedo) and clogs the pores. Because the follicle is clogged, the entire environment can’t get as much oxygen as it would otherwise. Acne-causing bacteria thrive in oxygen-poor environments, so they hang out in clogged follicles and feed on the sebum. As the bacteria multiply, they irritate the skin cells along the follicle walls. This causes inflammation.

At this point, there may still be a little bit of oxygen getting through the traffic jam for the microcomedo to access. In this case, a blackhead will form. If no oxygen can get through, however, a whitehead forms.

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What is a comedo? A comedo is that little hard circle in the images above. It can be either a blackhead or a whitehead. If you pop your pimples, the comedo is the thing you squeeze up and out. Sometimes this process can help reduce the severity of a cyst (I know! I am saying that sometimes it’s okay to pop! Just do it right.) because it eliminates the source of inflammation. More often than not, however, popping simply adds more dirt, friction, and inflammation to the whole area, making your skin more acne-prone in the long-run.

So this, in short, is how acne begins: Certain physiological processes lead to blockage in the follicles and pores of the skin. (These processes include 1) excessive keratin production, 2) rapid skin cell growth, and 3) excessive sebum production.)

The next step in acne formation is bacteria. But, believe it or not, everybody’s skin has the same “bad” bacteria on it. Dermatologists have been blaming “bacteria” for years… but even people with clear skin typically have bacteria on it, even the “acne-causing” bacteria! Bacteria are a link in the acne forming chain, but not the most important one. It actually turns out that some “good” bacteria can fight off the bad and reduce inflammation in the skin, so some varieties of topical probiotics can actually help reduce acne (I recommend Probiotic Action, which I link to here).

Antibiotics, on the other hand, are not the answer. Everybody’s skin has the same “bad” bacteria on it. Usually the best way to fix your acne is not to kill off this bacteria (because in that process you almost invariably do other damage to your skin or your body, including killing off the

10 How Acne Works

good bacteria), but rather to prevent the excess keratin, skin, and sebum production that fed the bad bacteria overgrowth in the first place.

Eventually, if infected, more debris, sebum (oil), and bacteria get added to the comedo than the body can handle, and the follicle ruptures. The whole immune system at this point sits up and takes notice. This is what causes a full-blown pimple. The pore becomes infected, and the immune system reacts. Red, painful, oily, scarring: the skin can’t help itself. It would rather be smooth and healthy, but with all of the blockage and inflammation going on in its pores, it simply doesn’t have a choice.

Different components of overall health play a role in each of these target processes. Genes of course are important. Most people with acne have a genetic predisposition to more sensitive skin. But then, more importantly, are the health factors of hormones, nutrient status, and inflammation. I give an overview of each of these in the following pages.

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Genes

Like all other health processes, genetics are important. Some people’s skin is just highly sensitive to both internal and external stimuli, and that’s that. For example, one landmark study of 458 pairs of identical twins and 1099 pairs of fraternal twins found that genes accounts for 81% of the amount of acne any of the people had. Only a tiny 19% was capable of being explained by diet and other lifestyle factors. Factors in the acne-formation process that are genetically influenced include rates of keratin production, the rates at which sebum (oil) oxidizes in your pores, and how sensitive your skin’s hormone receptors are. Fortunately, you can take good enough care of all of these different systems in your body that you can still be acne-free.

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Sex Hormones

I discuss in detail all of the different hormone conditions that can lead to poor skin health in the chapter on hormones. For now, for the sake of knowing how the skin works – the most important thing to know is that androgens – male sex hormones – cause the body to do two things: they make the body make more sebum than is normal, and they boosts skin cell growth rates (recall these are two factors I discussed as important for the development of acne in the previous section). In general, they tend to be pro-growth. Too much male hormone power in the blood means too much growth. When these growth processes occur with too much frequency or intensity, acne develops.

The hormones to blame

The most problematic hormones for your skin are the male sex hormones, called androgens as a group. The two most prominent ones are testosterone and DHEA-S. Testosterone is a male sex hormone that you’ve probably heard about. It’s produced in reproductive organs in everybody, though at much higher rates in men than in women. DHEA-S is not a sex hormone. It is produced by the stress glands (adrenal glands) in the body. But it resembles male sex hormones so much that it has androgenizing effects in the body.

The body has unusually high concentrations of androgen receptors in certain areas:

-around the mouth-the chin-the jaw-the forehead-the shoulders-upper back-glutes

Other hormones with skin effects

Estrogen has a balancing effect against testosterone and DHEA-S in the skin. This is great for women with a healthy balance of estrogen and testosterone or who have higher estrogen levels (for whatever reason). This is on the other hand not great news for women with low estrogen levels, such as those going through menopause or who have hypothalamic amenorrhea.

Progesterone is an important hormone, though its effect on skin is complex. Too much progesterone can sometimes cause inflammation and irritation in the skin. This is often a problem with progesterone creams or progesterone-dominant varieties of birth control. Yet

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usually the main problem with progesterone is having too little. Progesterone and estrogen need to be at sufficiently high levels and in good balance in order for skin to be clear. Progesterone also supports thyroid hormone production, and it is absolutely crucial to have healthy thyroid levels to have clear skin.

Metabolic hormones

When we hear the word “hormones” in our culture, we normally think of sex. But that’s actually a limited understanding of the body’s biology. The body’s hormone supply is actually quite large and diverse. There are dozens of hormones in it that are not related to sex at all. The scientific term “hormone” actually just means “messenger molecule.” There are hormones for just about every possible bodily function.

The body’s metabolism, in particular, is rife with hormones. Insulin is arguably the most important one for acne. Growth Hormone and Insulin-like growth factor 1 (IGF-1) are also very important for acne. These three hormones stimulate skin cell growth (get it – they are growth factors). They also enhance the sebum-producing effect of androgens. Insulin and related metabolic hormones directly stimulate cell growth and proliferation processes in the skin.

Additionally, these hormones have powerful indirect effects on the skin. For one example, insulin causes the ovaries to produce more testosterone, which causes excess oil production. For another, insulin and IGF-1 inhibit the body’s production of Sex Hormone Binding Globulin (SHBG), which binds to testosterone and can decrease its potency in the skin. For yet a third example, IGF-1 causes testosterone receptors in the skin to become more active. There’s a lot going on there. All of it indirectly stimulates acne.

Unfortunately, it is incredibly challenging, if not impossible, to directly influence growth hormone and IGF-1 levels in the body. (There is one thing you can do: eliminate dairy from your diet, which will help to some degree, since dairy is full of growth hormones.)

Insulin levels are different, though. These can be managed, and it is important that you do so.

Insulin secretion is constantly changing throughout the day and is directly impacted by the status of your health and the foods that you eat. If you manage to decrease your insulin levels, you will do two helpful things for your skin. First, you will decrease your IGF-1 levels, since insulin stimulates the liver to create more IGF-1. Second, and perhaps more importantly for women: it will decrease the amount of testosterone produced by your ovaries.

There are two main ways to reduce insulin levels in the body. The first is a short-cut, and not much of a long-term solution. It is to reduce carbohydrate consumption. The pancreas secretes insulin in order to clear sugar out of the bloodstream and deposit it into fat cells.

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How Acne WorksHow Acne Works

How Acne Works

Carbohydrates are basically different kinds of sugar in various forms. If you reduce your carbohydrate consumption, you will almost necessarily have less insulin floating around in your bloodstream.

However, the thing about insulin is that it isn’t problematic in short doses, especially in a healthy body. It only becomes problematic when your body becomes something called insulin resistant. “Insulin resistance” is the phrase for when your fat cells become resistant to insulin; they do not hear the signal that insulin is sending to them to open up and let the sugar molecules be deposited. Since the sugar is still hanging out in your bloodstream, and high levels of sugar in the blood are toxic, your body will continue to produce more and more insulin in order to shovel the sugar into your fat cells as quickly as possible. This results in a hyperinsulinemic environment (there is a lot of insulin). It also results in all sorts of problems for your skin, since insulin both directly and indirectly promotes the development of acne.

This leads us to the second, and more long-term, solution to insulin resistance. It is to focus more on the underlying problem. The underlying causes of insulin resistance tend to be more deeply rooted issues such as inflammation, gut permeability, and unhealthy gut flora populations. To that end, the best thing you can do for healing insulin resistance in the long-run is to focus on gut healing strategies such as consuming fermented foods, perhaps taking a probiotic supplement or a resistant starch supplement, and avoiding the potentially gut damaging foods such as grains and dairy. These are all strategies I discuss in other sections of this program. It is also worth working with a functional medicine practitioner if you suspect you have other digestive issues such as GERD or SIBO.

If you wish, you can undertake a low-carbohydrate diet (I do recommend refraining from lowering carbohydrate consumption below 100 grams a day) while simultaneously working on gut healing for a more long-term solution. Being sure to eat at least ~100 grams of carbs a day will also protect you (unless you have a very particular low carb need) from the potential long-term negative effects (such as, ironically, insulin resistance and acne) of eating a too low carbohydrate diet.

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Inflammation and Acne

Inflammation is an extremely important element of the acne formation process, and in various ways. For one, it has its own direct role when it inflames bacterial infections. For another, it also plays several indirect roles in the biochemical processes leading up to that moment. Some of these indirect roles include causing excess keratin to be produced, causing skin cell growth and oil production to accelerate, and causing squalene peroxidation.

This last topic, squalene peroxidation, is new. We have already discussed why keratin, skin, and oil production is problematic. But what is squalene peroxidation?

To understand squalene peroxidation we have to start with sebum (oil). There are many fatty acids involved in sebum production. Squalene is one of the most prominent ones (and one that has been discovered to be uniquely elevated in acne patients).

Squalene is an unsaturated fatty acid. This is important. Being unsaturated means that it is highly reactive, and unstable. Unsaturated fatty acids are easily oxidized. These stand in direct contrast with saturated fatty acids, which are stable because all of the possible bonding sites on the molecules are occupied (therefore why they are called saturated). These unsaturated squalene fatty acids however are not completely filled up, meaning that they are more susceptible to react with a wide variety of chemicals, including oxygen. These reactions are usually called oxidations because oxygen is involved in the reactive process.

Squalene is problematic because it is so easily oxidized. Two of the main causes of oxidation (for all unsaturated fatty acids) are light and heat. This means that sunlight, and specifically UV rays, are incredibly problematic for acne. They degrade squalene into its peroxide form.

Peroxidized squalene is highly inflammatory. The more the skin gets exposed to UV rays, the more peroxidized squalene the body produces. This makes the skin more and more inflamed.

Worse, the fact that squalene oxidizes so easily means that it steals the already limited oxygen stores in follicles. I mentioned earlier that bacteria in the skin thrive in oxygen-poor environments. Squalene peroxidation makes it easier for the acne-causing P Acnes bacteria to eat and reproduce.

UV Rays are just one of many environmental factors that cause squalene peroxidation. Others include air pollution, allergies, and damage to the skin barrier from harsh chemicals, heat, soaps, and other topical skin treatments.

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So squalene peroxidation is caused by environmental problems. Yet the problem with squalene does not stop at the environment. It also comes from the inside. In response to dietary triggers--and for sensitive skin they can even be very slight triggers--the immune system upregulates. If there is any amount of systemic inflammation in the body, the skin will become more inflamed than it might otherwise. If you have systemic inflammation, or some kind of immune reaction to foods such as grains or dairy, you will have a larger immune response to food, and therefore a greater chance of oxidizing squalene. This leads almost directly to acne formation.

There are many internal, dietary sources of inflammation, systemic or no. They include:

-a diet high in omega 6 fatsFats high in omega 6 fatty acids include seed, vegetable, and nut oils such canola oil, corn oil,vegetable oil, rapeseed oil, soybean oil, safflower oil, sunflower oil--and then nuts such asalmonds, peanuts (actually a legume), cashews, walnuts, pecans, hazelnuts, and the like. Theyare problematic for the same reason squalene is problematic: these fats are highly unstable andreactive in the body. They also happen to play pro-inflammatory roles in the immune system.This pro-inflammatory function can be healthy in small doses. However, Americans today eatfar, far more omega 6 fat than a healthy diet calls for.

-a diet high in fried and deep-fried foodsMost fried foods are not only cooked in vegetable oil, which is itself inflammatory, but are alsocooked at very high temperatures, which further oxidizes the fats.

-a diet that includes trans fatsTrans fats are highly inflammatory.

-a diet low in the omega 3 fats DHA and EPA relative to omega 6 in the diet.Omega 3 and omega 6 fats are similar in structure, but they perform very different roles in thebody. Omega 6 fats are pro-inflammatory but omega 3 fats are anti-inflammatory. Since bothkinds of these fats are unsaturated and have potential to be reactive, it’s important not toconsume too much of either of them. But it is important to make sure you do get more omega 3fats than omega 6s. I typically achieve this by avoiding vegetable oils (I can still get somehealthy omega 6 from animal products like beef and chicken), and eating a few servings of fattyfish such as sardines, wild Alaskan salmon, or trout a few times a week.

-a diet high in refined and added sugarsSuch as soda, desserts, and other processed foods.

-a diet high in foods that may be gut irritants, such as grains and dairy.

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How Acne Works

How Acne Works

The immune response to these foods varies by your health history and genetics. For some people these foods are incredibly problematic and for others not at all. The quality and type of these foods may also play a role (for example, raw dairy may be better for preventing acne than pasteurized).

-stress

-poor sleep

-antibiotics useAntibiotics can kill important gut flora that protect the body against inflammation.

-NSAID useNSAIDs are non-steroidal anti-inflammatory drugs such as ibuprofen, acetaminophen, naproxenand aspirin. NSAIDs can hurt flora and other restorative processes in the gut.

-poor nutrient status, particularly of vitamins D and A and zinc

How the body gets problematically, chronically inflamed

There are two primary biochemical pathways that contribute to inflammation in the skin. The first is by consuming foods with inflammatory molecules. This happens usually via a poor omega 6 / omega 3 balance in the diet, which was in the list of potential culprits above. Omega 6 and omega 3 fats are called Poly-Unsaturated Fatty Acids (PUFAs) and you absolutely must consume at least a little bit of each of them regularly in order to survive. The body does not produce these fatty acids on its own. They must be obtained from the diet.

The body needs these fats for help with immune modulation. Omega 6 fats are good and important in small amounts, precisely because omega 6 is inflammatory. Ordinarily, inflammation is a good thing. You need inflammation in order to heal. If you get a cut on your foot, for example, your body sends inflammatory molecules to the site which make it red and swollen (the same red and swollen that happens to your zits!), but which also heal it quickly. Without inflammation the wound would never heal. Then after the immediate immune response, in a healthy body, the body cools down with anti-inflammatory molecules. These are supported by the omega 3s. The body needs these to balance the inflammatory activity of the omega 6s.

So that inflammatory process is all well and good. But what happens if you eat 20 times the amount of omega 6 than your body is designed for? (This is a real possibility. Scientist’s best estimates are that Americans consume a ratio of omega 6s to omega 3s about 20 times the amount it should be.)

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Then the inflammatory response is way bigger than is healthy, and the cool-down is insufficient, and the body becomes chronically inflamed all of the time, rather than being inflamed in short, small doses like it should normally.

Why so much inflammation and omega 6? Americans eat so much omega 6 because it is the primary fat (in the form of soybean and other vegetable oils) used in processed foods, fried foods, and foods out at restaurants. This is such a potentially unhealthy thing it’s literally scary. High levels of systemic inflammation have been associated with just about every non-communicable disease or condition out there – from heart disease to cancer, to infertility, to acne.

One major solution for acne, then, is to reduce consumption of processed foods and other means by which you might consume these oils. They are also presents in nuts and seeds, so your consumption of those should be somewhat limited, too. You can also help with your inflammation levels by making sure you eat a few servings of fatty fish every week or by taking a fish oil supplement (I recommend Fermented Cod Liver Oil by Green Pastures). Be careful, however. High levels of omega 6 and omega 3 PUFAs combined are not awesome for your health. It is not wise to balance a high omega 6 intake with a lot of omega 3s. The best way to be as healthy and to have the healthiest immune response possible is to keep both omega 6 and omega 3 intake low. As I mentioned above, my personal favorite way to do it is to eat fish a few times a week and to never eat vegetable oils, and rarely nuts and seeds. The ideal balance is a 2:1 ratio of omega 6 to omega 3.

Another important dietary way to develop inflammation is via the health of your gut.

In fact, it’s crucial. Because the gut is literally a semi-permeable barrier between your bloodstream and the outside world, up to 70% of the immune system resides in the gut.

There are two major factors to consider here. One is gut bacteria. Believe it or not, trillions of bacteria live in your gut and regulate the breakdown of food into nutrients. These bacteria are, in a sense, like castle guards. As foods march through your digestive tract, these guards help keep order and promote healthy digestive processes. The more and higher quality of gut bacteria you have, the healthier your kingdom is. The fewer of them you have, the less protection your digestive system has, and the more vulnerable the rest of your body is to damage and disrepair. Having a healthy gut flora population is crucial for maintaining good overall health. It is also crucial for keeping inflammation and acne to a minimum.

Your gut flora is characterized by the type and amount of bacteria you have. The flora can be balanced toward good bacteria, which is a healthy situation, or toward bad bacteria, which is an unhealthy situation. Healthy gut bacteria perform a variety of important functions. Increasing healthy gut flora through diet or probiotic supplementation helps regulate blood sugar, improves

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insulin sensitivity, mitigates depression and other mental health disorders, minimizes inflammation and infection, promotes weight loss, and prevents allergies, asthma, and autoimmune disease. The reason gut bacteria can do all of these things is that they: -help break down food into forms that are more easily absorbed by the intestines-facilitate the absorption of nutrients into the body-convert neutral compounds into nutritional powerhouses (such as vitamin A)-stabilize immune function.-provide sufficient bulk in the intestines for comfortable and regular bowel movements.-crowd out unhealthy bacteria that try to sneak into the gut.-protect the body against toxins that might otherwise enter the bloodstream through inflamedintestinal walls.-promote healthy serotonin levels in the gut, supporting mental health.

Gut bacteria can also be balanced toward bad guys. This happens when you knock out healthy gut bacteria with antibiotics, as well as when you overfeed bad gut bacteria by consuming inordinate amounts of processed sugar. When bad bacteria chronically overpopulate your gut, the condition is called small intestinal bacterial overgrowth, or SIBO. SIBO is characterized by digestive discomfort, bloating, gas, loss of appetite, and irregular movement of the intestines, which can lead to both constipation and diarrhea. These symptoms make sense when you consider that bad bacteria impair your ability to digest food. They ferment food in ways that good bacteria don’t, creating and trapping gases throughout the small intestine.

Importantly, bad bacteria also prevent the absorption of nutrients and in doing so promote inflammation and damage the skin. Good bacteria help create nutrients; bad bacteria overproduce toxic by-products that can sneak into your bloodstream. Since the gut is one of the primary places in which the inside of your body makes contact with the outside, and since it is such a complex barrier, the immune system is highly sensitive to gut health and bacteria populations. Maintaining a healthy gut flora population is one of the most important things you can do to reduce inflammation and heal acne.

The second major factor to consider here is the integrity of your gut lining. In addition to gut bacteria, food interacts with the intestinal lining itself. Here, in a healthy body, important nutrients are selectively absorbed into the body and harmful toxins are selectively passed into the colon. If your gut integrity is compromised in any way, however, you may run into serious trouble.

Certain foods actively abrade the intestinal lining in many individuals (though not everybody--and this depends on a lot of different factors). These foods, which include grains and dairy, can be irritating, rough, and can make your gut lining permeable over time. Permeability in this context means exactly what you think it means: instead of staying outside your body, the contents of your intestines can pass through the damaged lining.

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In the wake of damage to your intestinal walls, toxic waste from the digestive process, large molecules that otherwise would pass right through your system and everything else your body wants to get rid of, can leach into your bloodstream. The body notices this, and it reacts intensely. The problem is that it activates the immune system in a big way. This can cause what we have been calling chronic inflammation, which is a source of acne and many other things besides, such as depression, anxiety, type II diabetes, and autoimmune diseases, which 20% of Americans have, even if unknowingly.

Keeping your gut healthy keeps inflammation to a minimum, and therefore is a huge step for eliminating acne. I have discussed treatment strategies to some length here already in this chapter; I discuss more specific foods to eat and steps to take in the sections on food, supplements, and the jumpstart.

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Nutrient Status

Nutrient status also plays various key roles for the quality of your skin. First, there are the actual health and integrity of the skin cells and sebum cells themselves. These are best supported by vitamins A, D, and K (both K1 and K2). These vitamins are unfortunately quite rare in the diet of most Americans.

As for vitamin A – most people probably think they get enough because they eat carrots, which are said to be “high in vitamin A.” Nothing could be further from the truth, however! Carrots and other orange foods like sweet potatoes and rutabagas actually have zero vitamin A in them. Instead, they have significant amounts of beta carotene. Beta carotene can be converted to vitamin A in your gut by gut bacteria, but that presupposes both that you have a healthy gut and also that you have the right bacteria for the job, and finally that you will absorb the vitamin A after conversion. If you have any sort of gut problem, you may not get the vitamin A you need. True vitamin A is really only abundant in animal products, particularly in liver, and also in high-quality grass-fed butter.

Vitamin D can be obtained via food to some extent – it is present in salmon and also in grass-fed butter and liver, for example. But that’s about it (unless you turn to fortified breakfast cereals, which is not a particularly healthful option).The best way to get vitamin D is via the sun. People with acne need to be careful about this, however, because exposing acne-prone skin to UV rays causes squalene peroxidation. The best way for acne-prone people to get sun is to always wear a hat outdoors. Depending on how fair your skin is (the more fair you are the less sun time you need) about 30 minutes of noon time sun each day is ideal. My personal preferred way to get vitamin D is to wear a hat to limit UV exposure to my face, but to keep my limbs bare to absorb the natural sunlight. Sun exposure is the most efficient and surefire way to get the vitamin D you need. If you cannot get that, you may wish to consider supplementing with vitamin D. I take about 1000 IUs of vitamin D every other day in the winter time. Most healthprofessionals recommend between 500-5000 IUs/day. It would be best probably to get testedfor what your own levels are before beginning a supplementation regimen; if not, start with a lowdose, as it’s important not to take too much.

Finally is the least well known of these skin-healing vitamins, vitamin K. Vitamin K1 is found heftily in greens like chard, kale, and spinach; Vitamin K2 is a little harder to come by. K2 is found primarily in grass-fed butter and grass-fed cow liver, and oddly enough in fermented soybeans, a dish called natto. Vitamin K is absolutely crucial for healthy skin – though many Americans don’t get any at all.

Vitamins A, D, and K are all fat soluble. They must be consumed with fat. In fact, the more fat present in a meal that contains these vitamins, the higher amounts of them the body absorbs.

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There is another important class of nutrients for your skin: antioxidants. Some of the most common ones are vitamin C, zinc, selenium, and N-Acetyl Cysteine.

Antioxidants are important for the skin because they fight inflammation. Antioxidants also help prevent the oxidation (get it? They are Anti-Oxidant) of molecules like squalene in the skin. Oxidation is a major part of the inflammation process. So the more antioxidants you have in your body and in your skin, the less inflamed you will be.

Certain studies have begun to show that the number of inflammatory pimples a person has is directly correlated with the ratio between inflammatory molecules and antioxidant activity in the body.

Antioxidants are some of the body’s best tools against inflammation. The more antioxidants people have, the less acne they have. It’s really that simple. In this study, people who supplemented either with NAC or with silymarin (both of which are antioxidants I cover in the supplementation section) experienced a whopping 50% reduction in acne after 8 weeks.

One powerful antioxidant for acne is vitamin E. Vitamin E is possibly the vitamin most likely to help prevent the skin against squalene peroxidation damage. Vitamin E is secreted in the skin in response to the oxidation of squalene. So sufficient vitamin E – which is in leafy greens, avocados, almonds, sweet potatoes, and asparagus – is great for acne. Vitamin E is fat soluble, so being sure to get a good dose of fat with vitamin E will help you absorb it. The body’s requirement for vitamin E also appears to increase in proportion to dietary omega 6 and omega 3 intake. That is—the more polyunsaturated fatty acids you consume, the more vitamin E your body needs. This is all the more reason to keep your consumption of vegetable oils (and nuts) to a reasonably low level.

Vitamin C is also excellent for the skin. This is because it is such a potent antioxidant. Vitamin C is high in leafy green vegetables and citrus fruits and berries… though really most fruits and vegetables are reasonably good in vitamin C. At least four servings of vegetables, and two of the leafy greens such as spinach, kale, chard, or broccoli, is a great way to make sure you meet this need every day.

Certain minerals also play a key role in antioxidant processes in the body. Zinc and selenium are two major players. Zinc is particularly concentrated in oysters, yet the best way to get zinc on a regular basis is simply to consume red meat and poultry (I recommend between 50-100 grams, or 0.5-1 pound, or 8-16 oz of protein daily). Selenium is available in seafood and seaweed, and is also found in great abundance in Brazil nuts. You can also supplement with these two minerals (find my preferences on the resources page), as well as with other antioxidant compounds available in supplemental form like N-Acetyl Cysteine.

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Note: acne prone skin uses up antioxidants at a high rate. This can further deplete antioxidant levels, making it even more crucial for people with acne-prone skin to eat nutritiously. The solution is to eat a diet rich in varied fruits and vegetables – with fat to make sure you absorb the vitamins – and also to focus on vitamins A, D, E, and K for truly, robustly, radiantly clear skin.

Acne = Genes + Hormones + Inflammation + Nutrient Status + Topical Care

So there you have it! I have just walked you through the process of acne formation and all of its various components. Acne starts with a genetic predisposition. But these genes only get triggered if there is excess sebum production due to hormonal factors, or excessive inflammation, or poor nutrient status due to a nutrient-poor diet. Gut health, immune system health, and the food you eat play major roles in all of that.

I know that it all may sound quite complicated – but it’s not, it’s not! I promise. Getting rid of your acne is all about reducing inflammation, enhancing your nutrient status, and balancing your hormones. It is, essentially, crafting a diet that is rich in natural powerhouse foods and that minimizes potentially toxic foods, with some keen insights specifically tailored to acne (such as moderating protein intake or steering clear of goji berries) along the way. With the help of evolutionary biology and cutting edge research on diet and health, you now have here in your hands a comprehensive plan for radiant skin.

And it works.

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Hormones and Acne Internal Healing Module 1

Internal Healing Module 1: Hormone Health

Having properly balanced hormones is absolutely crucial for clear skin.

Women suffer from acne at nearly 2x the rate of men (this statistic varies by age group). There’s no question as to why. It’s hormones, plain and simple. Men can exacerbate their acne problems with hormones, but it’s not very easy to do. In order for them to experience hormonally-driven acne they usually have to be on steroids, which increases testosterone out of healthy ranges, even for men.

Many women then wonder: is their acne hormonal? How do you know if your acne is hormonal or not? What do you do about it? Do not worry – I’ve had it all before, and I’ve researched it, and I’ve helped myself and literally thousands of others. In this section I tell you everything you need to know: first how to identify hormonal acne; second, what causes hormonal acne; and third, the steps you need to take to overcome hormonal acne.

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Hormonal Acne Part I: How to identify hormonal acne

Now – this is not a fool-proof identification system. Acne crops up in different places on different women for different reasons. Nevertheless, there are rough approximations we can make regarding location and type of acne.

The chin, around the mouth, the jaw:

This is the most common area for hormonal acne. The area around the mouth is where the highest concentration of testosterone receptors is found in the skin. If you have a hormone imbalance, you will likely see pimples in this area, ranging from very small to very, very large.

(This is the kind of acne I once had the worst; you can see an example in my photo in the introduction).

You may also see fluctuations in acne in this area in tune with your menstrual cycle (presuming you have one). Testosterone-related acne is usually greatest during ovulation (two weeks after the first day of your period). Testosterone-related acne can also crop up in the days immediately preceding or following the start of your period, as estrogen levels are quite low at this time. When estrogen levels drop and testosterone levels stay constant, the body interprets this as excess testosterone and develops symptoms such as acne. Facial hair growth, oily skin, and balding are other signs of high testosterone.

The forehead, upper back and glutes

Testosterone receptors are also found in these areas. They are not as potent as the ones around the mouth, but they are definitely real. Acne on the body, such as on the back and the buttocks, can become a real problem if you combine hormone imbalance with lots of sweat, dirty towels, dirty clothes, and the like.

Other areas on the face, like cheek, nose, neck, and ears

These areas are less common for hormonal acne, but it still happens here. Also, the worse the hormone imbalance and underlying health problems you have get, the more the acne will spread beyond the mouth and the jaw to areas like these.

When does hormonal acne show up?

For some of us, hormonal acne is a constant stream of frustration. Yet sometimes it comes in waves. This can help you identify the underlying cause of your acne.

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Throughout the course of the menstrual cycle, different hormone levels are dominant at different times. Testosterone spikes at ovulation (this is a 36 hour time period that usually takes place 14 days after the first day of bleeding). If you break out when you ovulate, it is likely that your testosterone levels are too high.

If you break out somewhere near the start of your period, this is because estrogen and progesterone levels are at their lowest point in the whole cycle. Female hormones help clear up your skin, so this is a possible sign that your estrogen and progesterone levels are too low.

If you break out in the week before your period, your estrogen levels may be too low, or your progesterone levels too high, as this is the more progesterone-dominant time of the cycle.

You also become more insulin resistant in the second half of your cycle, meaning that your acne may worsen due to greater insulin levels circulating in the bloodstream. Typically the increases in estrogen and progesterone at this time help adjust for this, but not always. If you have higher acne incidence in the second two weeks of your cycle, this could explain why. Focusing on healing the gut, while perhaps eating a lower carbohydrate diet during the final two weeks of your cycle, could help reduce this problem.

If your cycle is irregular, there is a decent chance you have PCOS, and that it is a part of your acne problem. I discuss PCOS at more length at this end of this section.

What does hormonal acne look and feel like?

The majority of hormonal acne is cystic.

Cystic means that the acne comes up from beneath the skin as a result of excess of oil. These sores are red (if you have white skin), and will usually have that white, pus-filled center. You can (though usually shouldn’t) pop these suckers. They can be small, or very, very large. They can be painful to the touch. When they are at their worst, they can even be felt without touching them, or felt from the inside of the mouth.

In addition to cysts, a hormone imbalance, particularly of stress hormones, can cause significant bumps (not always red, in fact, they are often neutral colored) to break out on the forehead and other parts the face.

Hormones can also contribute to making just about every other kind of sore and acne worse, so don’t rule hormones out completely if you don’t experience the two kinds of acne mentioned above, or even in the locations mentioned. These just so happen to be the most common and potent areas to address.

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Hormonal Acne Part II: The Hormone Breakdown

Here are the key hormones you need to know about, and how they affect your skin:

Testosterone: Testosterone is the most important hormone for acne. It is a sex hormone produced by the pituitary gland. It is a male sex hormone, but women still need testosterone for reproductive function. (Women only have about 10% the amount that men do.) Testosterone stimulates the skin to increase the amount of oil (sebum) it produces. This oil mixes with debris from the top layer of skin and clogs pores. The more testosterone you have, the more oil you make, and the more capacity you have to clog your pores (or develop oily skin).

DHEA-S: DHEA-S is not well known, but that doesn’t stop it from being an important player in acne formation. DHEA-S is a stress hormone produced by the adrenal glands. The body makes it when it is stressed. Yet because DHEA-S is also classified as an androgen – a male sex hormone – it has a similar effect as testosterone in the skin. It increases oil production, which causes cystic and other types of acne. Perhaps worse is the fact that when the body makes DHEA-S, it decreases its production of estrogen and progesterone.

Progesterone: Progesterone is a female sex hormone produced by the pituitary gland and reproductive organs, and also found in all birth control pills. Progesterone is absolutely necessary for healthy thyroid function and hormone balance, yet excessive synthetic progesterone (such as different kinds of progesterone called progestins found in birth control pills) can cause inflammation, which actually makes skin worse. Your body’s natural progesterone likely has a calming effect on your skin, so long that it does not overpower estrogen; synthetic progestins made in the lab may have an opposite effect, depending entirely upon which type of synthetic progesterone and your personal biochemistry.

Estrogen: Estrogen is a female sex hormone produced by the pituitary gland, reproductive organs, and fat cells. It is also found in some but not all birth control pills. Estrogen is the hormonal skin savior, especially when it’s well balanced with progesterone. It acts as a counterweight to testosterone and helps the skin be sparkly and radiantly clear.

Thyroid hormones:

There are three primary thyroid hormones that I’ll talk about in this section of Clear Skin Unlocked: Thyroid Stimulating Hormone (TSH), T4, and T3. TSH is a hormone produced by the pituitary gland that stimulates the thyroid gland to produce T4. T4 is a reserve molecule that is

29 Hormones and Acne

inactive in cells. T3 is the form of the hormone that is actually active in the body, and the body converts T4 to T3 on a case-by-case basis, striving its hardest to maintain balance. Insufficient T3 causes all hormone--and specifically female hormone--production to suffer. It also causes skin maintenance processes to slow. Keeping the thyroid system healthy is crucial for clear skin.

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Hormonal Acne Part III: Causes of Hormone imbalance and how to overcome them

1. Insulin Resistance

Being diabetic, pre-diabetic, or insulin resistant in any sense is one of the primary causes of “hormonal” acne. I put hormonal in quotes because many people wouldn’t traditionally think of this kind of acne as hormonal. Insulin is not a sex hormone, so it is typically classified in other ways. But technically it is still a hormone.

The means by which insulin causes acne is quite simple. Insulin has a direct, stimulatory effect on skin cell growth processes. This causes acne in and of itself. It also causes the ovaries to produce testosterone, which can lead to severe hormonal acne (and this time, in the sex hormone sense) for women.

Now, this phenomenon has far reaching implications for health. The insulin-testosterone link is one of the leading causes of Polycystic Ovarian Syndrome (more on which at the end of this section). It can make you infertile. It can cause facial hair growth. It can cause balding. It can rob you of your sex drive.

The solution?

The severity of insulin problems women may have varies greatly. On one end of the spectrum is full-blown type I or even type II diabetes (though type II may be managed or even overcome with diet). On the other end of the spectrum is a simple overabundance of insulin in the blood, often referred to as “pre-diabetes” or “insulin resistance.”

Type I diabetes is a complex issue that requires insulin injections and its own treatment protocol. For type II diabetes, pre-diabetes and more moderate insulin resistance, however, significant improvements in insulin levels can be made with diet and lifestyle changes.

The solution involves many different possibilities and steps, all of which I believe should be taken:

1. Get fasting insulin levels tested to gauge your level of insulin resistance. If you wish tobe really diligent, you could purchase a blood sugar monitor to monitor how quicklyyour body clears blood sugar out of your blood after a meal. If your blood sugar levelsspike and then take a long time to come back down, you know that you may have someinsulin issues to work through. A great guide for going through this process is RobbWolf’s Wired to Eat.

2. Get tested for elevated testosterone levels with a simple blood or saliva test. Your doctorwill be able to tell you if your testosterone levels are also elevated because of insulindysregulation or not.

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3. Focus on gut healing. New research indicates that a healthy gut is crucial for maintaininghealthy insulin levels. You can focus on gut healing...

a. By eating a nutrient-dense diet (described in the sections on food and thejumpstart),

b. By consuming fermented foods such as kimchi, kombucha, sauerkraut, coconutyogurt, or kvass on a regular basis (see my favorite fermented foods here, andan even longer list on this page),

c. by considering a probiotic supplement (I recommend Prescript Assist) which willhelp support gut flora,

d. by regularly consuming foods that healthy gut flora populations love to eat(called prebiotics) such as Jerusalem artichokes, onions and leeks,

e. by supplementing with a bit of resistant starch (I recommend Gut Garden) on adaily or semi-daily basis. Resistant starch is a kind of starch that resists thedigestive process all the way until the end of the digestive process, in the colon,at which point it is a favorite food of good gut bacteria. It has been shown to helpsharpen insulin sensitivity.

f. by eliminating foods that may be irritating your gut such as grain products anddairy (dairy is highly insulinogenic and may be a major factor in your hormonalacne anyway).

g. by reducing stress as much as possible, since stress seriously disrupts gut florahealth.

2. Eat a diet high in greens (at least two cups of greens such as kale, chard, spinach,arugula, or broccoli a day), which contain the enzyme cytochrome P450 that helps boosthormone detox in the liver3. Moderate carbohydrate intake. Insulin levels can be managed by keeping carbohydrateintake on the lower end. Begin with 100 grams of starchy carbohydrate or fruit every day(this is in addition to your regular vegetable consumption which should be as plentiful as youchoose). 100 grams is the equivalent of 2 cups of cooked white rice or four apples. You caneat a bit less than that, or more, but 100 is a great place to begin experimenting.5. Practice the two best kinds of exercise for sharpening insulin sensitivity: weight lifting,and high-intensity sprinting. In general, a great place to start with this is two weight-liftingexercise periods and two sprinting exercise periods each week. The level of lifting orsprinting you do should vary based on your level of athleticism and experience. The generalrule is to lift weights that feel significantly heavy.

The more muscle you have, the more insulin sensitive you will be. You will add more muscle (though not become manly if that is a concern of yours) if you lift heavier weights in smaller amounts (eg, 5 to 10 repetitions of a 20 lb dumbbell) than lighter weights in higher amounts (eg, 30 repetitions of a 5 lb dumbbell). Work at least a few muscle groups each time you exercise, and make sure to do it until your muscles feel tired and used.

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As for sprinting. The trick is simple: go as fast as you can running, biking, swimming, jumping rope, or doing simple body exercises like burpees that really get your heart pumping for as long as you can. Try doing 30 second sprints with 90-120 seconds of rest in between. Over time, you will find it pretty easy toincrease the length of your sprints. You can get strong and fast much morequickly than you might think – which will be great for both your insulin sensitivityand your overall health.Importantly, however, you do not want to overtax yourself, as this can causeyour body to produce stress hormones such as DHEA-S which cause acne. Ifyou are overworked, over-tired, or have a history of exercising a lot, then it isprobably best that you err on the side of caution and refrain from increasing yourexercise regimen. In fact, if you are very stressed out it may be wise to decreaseit. And for all women, it is important to refuel after your workouts. If you do not eatat least a couple hundred calories of carbs and/or protein an hour or so after anintense workout, your testosterone levels will remain high and cause a long-termacne problem.

2. Stress

Perhaps it goes without saying, but stress has a powerful effect on hormone levels.

This effect is very real, and has been documented in numerous studies. Approximately 10% of women experience impaired fertility and irregular menstrual cycles due to stress alone at some point in their lifetimes. It even happens for our primate cousins. In one study of cynomolgus monkeys, those at the lower end of the social hierarchy experienced impaired fertility and had irregular menstrual cycles but their more popular peers did not. These monkeys all ate the exact same diet and did the same activities. The only thing that was different for them was the amount of emotional distress they experienced.

Psychological stress, whether from work, family, relationships, money, or anything else, is one of the many signals the body takes as a sign that it should put the brakes on reproductive activity. Out in the wild, millions of years ago, it was incredibly important that women be in safe conditions before becoming pregnant. If they became pregnant in a time of war, disease, famine, scarcity, or unrest, they were putting both their babies and their own selves at significant risk.

In order to prevent pregnancy in stressful times, the female body developed the power to shut down pregnancy. Ancestral females experienced reproductive shut down whenever they felt significantly stressed out. It saved their lives. Today we experience the same shut down, even though it’s not as necessary as it was in history.

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Reproductive shutdown results in a decrease in pituitary gland activity, a decrease in estrogen production, a decrease in thyroid activity, and, perhaps worse of all, an increase in adrenal activity.

The adrenal glands, when supercharged, produce DHEA-S, which causes oil production and acne. In order to make this happen they also steal the molecules that would ordinarily go toward progesterone and estrogen production. They use up all of the body’s hormonal resources--the ones that normally fight acne!--for the sake of producing DHEA-S, which is an acne powerhouse. (This is sometimes called “pregnenolone steal” and I’ve written about it on the blog, here).

That’s a two-in-one sucker punch. The more stressed you are, the fewer female sex hormones you make and the more male sex hormones you make. This is a potent way to cause hormone imbalance.

The solution

The solution to stress is not simple. I have written many thousands of words on it in various documents over time. Unfortunately I do not have the space to delve into it here. Re-thinking your priorities, learning how to say no to overwhelming responsibilities, eliminating stressful people and activities from your life, finding ample time to sleep and rest, taking some minutes alone for yourself, and learning how to find strength and solace in the people around you are all very important steps to consider. Therapy could be very important, too. Noelle Tarr and I also talk about this at great length in the Paleo Women podcast.

3. Starving

I just described how important it was for our female ancestors to be in calm, safe environments in order to reproduce. Imagine what would happen to a woman, then, if on top of being stressed out, she were also starving?

Famine was a very real threat to women in ancestral history. If food ran out while a woman was pregnant, her body would not be able to meet the increased energy demands it had from the pregnancy. Both the fetus and the mother would be at significant risk. The woman would, in all likelihood, die as a result of her body attempting to sustain the life of the child.

The body’s “starvation response” as such is roughly the same as the psychological stress response: It shuts down female sex hormone production, shuts down thyroid production, and increases adrenal production. Additionally, it causes the hippocampus in the brain to do two key things: it’ll keep you awake at night, and it’ll make your acuity for spatial navigation better. This has been demonstrated extensively in both rodent and in human studies.

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Basically, your brain will try its best to keep you awake and to make you a better hunter. When it thinks you are starving, it doesn’t want you to sleep or to rest – it wants you to go find food. All the while it decreases libido, decreases estrogen levels, increases stress hormone levels, and makes acne a nightmare.

So even more potent than the need for a woman to be calm is her need to be fed.

The female body has not changed since the ancestral days. It is still highly sensitive to starvation. Unfortunately, instead of starvation being the number one thing that we avoid at all costs, women in today’s world deliberately starve themselves on a day to day basis. We live in a world in which starvation is kind of a cool thing to do. Because, body image?

Here are the things women commonly do that cause their bodies to enact the starvation response:

Calorie restriction Carbohydrate restriction (Usually less than 100g a day though this varies) Excessive exercise (Intense exercise--usually more than 3-4 times a week, but it depends on the individual--worsened when not adequately re-fed afterwards) Very low body fat percentage (Less than 18 percent for all, sometimes higher, such as 25 percent for women with different genetics, such as me) Intermittent fasting (done many different ways) Dramatic weight loss

The point at which these different phenomena begin to have a negative effect on each woman varies significantly. Some women can fast healthfully and easily throughout their whole lives. Others can do it for a month or so before they start to see symptoms crop up. Others still yet cannot go a day or two without experiencing negative side effects. I personally start to get bumps on my forehead after about six hours of starting to feel hungry.

It depends entirely on your genetics, on how stressed you are, on the general health and robustness of your body, on how well you sleep at night, on the degree to which you do these things, and for how long you’ve done them. The longer and harder your exposure to starvation behaviors is, the worse your condition will be.

But how do you know if you are doing any of these things? Perhaps you don’t think you exercise all that much. Or perhaps you fast but you think it’s okay. Perhaps you don’t know if you are fasting at all. All of those things are okay.

Like I mentioned before, it’s all a matter of degrees.

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Hormones and Acne

Hormones and Acne

The starvation response is sort of like an equation (read this if you’re into math; skip it if you’re not). Basically, every single possible contributing factor is a part of the equation, and then if you do or have one more extremely than others, it will cause acne. If another factor increases, then the acne will worsen. If you happen to enjoy math, I wrote an acne equation. For example, let X, Y, and Z equal Calorie restriction, carbohydrate restriction, and excessive exercise, for example. Say you have 1 unit of calorie restriction, two of carbohydrate restriction, and zero of exercise.

Then you could have Severity of acne = 1X + 2Y + 0Z...

Which equals the total amount of starvation response you experience. If this amount is more than your pituitary gland can handle, then it’s too much of either X, Y, or Z for you. If it’s not, then you’re probably okay. At least for now.

In all cases, simply pay attention to your body as you move forward. At the very least make sure that you are on the lookout for any symptoms that might crop up.

In addition to acne, other signs you may be taxing your body’s starvation response are:

-feelings of hunger throughout the day that are ignored-“pushing through” hunger to your next meal-intermittent fasting even though it feels unnatural to you-if you uncontrollably overeat sometimes (as this is a common result of restriction)-feeling very tired-making yourself exercise even if you don’t feel like it-low libido-light and/or infrequent and/or absent menstrual cycles-low body fat percentage-decreased body fat percentage-insomnia-anxiety, depression or mood swings

One final way in which your body can perceive itself as being “starved” is if you have lost a significant amount of weight relative to what you weighed when you began menstruating. So far as scientists can best tell, the body has a body fat set-point that’s affected by a number of factors. One prominent factor is your weight status while going through puberty.

If you go below this set-point, your body might panic. Yet what if you have been overweight for a very long time, and now believe that you are at a much healthier weight? I simply advise you to go a bit more slowly. Your body’s fat cells produce a hormone called leptin. Leptin tells your brain how much body fat you have. When you lose weight, your leptin levels fall. This can

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Hormones and Acne

Hormones and Acne

confuse your brain, but with patience and a healthy, anti-inflammatory diet, your brain may become more sensitive to the amount of leptin you have in your body, and will hopefully restore hormone balance. Also, high levels of the body’s appetite-stimulating hormones (which your body produces when you are hungry) actively inhibit pituitary activity. So if you’ve lost a lot of weight while dieting or restricting food intake, then this may be a factor. Remediating it is as simple as eating when you are hungry. Of course – these methods work best when you are still a relatively healthy weight. It does not work if you simply have too low a body fat percentage.

The Solution

Above all, the number one thing to keep in mind for this kind of stress is a mantra I try to permanently implant into my clients’ heads:

When in doubt, eat more rather than less.

As a society, we tend to think that eating less is better. But it’s not, and definitely not for women who are recovering from this kind of starvation, like I was.

Food is your friend. It could also very well be your acne cure.

For specifics, this is what I recommend:

-No fasting. When you are hungry, eat. If you are busy, make the time. If you do let yourself gohungry, only do it occasionally. Your body needs to be fed.-Eat breakfast within an hour of waking.-Feel free to snack, especially if you are hungry.-Do not count calories.-If you insist on counting calories, make it at least 2000 a day.-Cut the amount of workouts you do in half. If you can’t do that, reduce their severity.-Be sure to always refuel with carbohydrate and protein after a workout, at least 200 calories ofthe two combined.-Eat at very minimum 100 grams of starchy carbs or fruit every day. If you are an athlete, bumpthat up to 150 grams at very minimum.

4. Fasting after exercise

During the course of any kind of strenuous activity, the body burns through its glycogen stores. Glycogen, in essence, is a form of sugar that’s stored in the muscles. It’s one of the body’s favorite fuel sources for exercise.

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Fitness specialists recommend that after a workout that depletes muscle glycogen (so after about one hour of higher intensity), you eat a meal composed of a ratio of 3:1 for carbohydrate:protein. If you do so, testosterone levels fall. If you do not eat after exercising, however, testosterone levels do not fall. If this behavior persists over a significant period of time, it can cause excess testosterone, hormone imbalance, and acne.

The solution

The solution to this one is simple. Within 45 minutes of a workout, eat at very minimum 200 calories of carbohydrate and protein (in a ratio of at least 2:1, if not 3:1 carb:protein). Good protein possibilities are meat, eggs, and fish, and if you’re on the run, canned fish, jerky, nuts, or nut butters. Good carbohydrate choices are potatoes, sweet potatoes, rice, bananas, other fruits, or dried fruits if you’re on the run. Any food will work for you, really, so long as there is some protein and carbohydrate in it.

It is also important when you exercise to ramp down stress and return to a relaxed, parasympathetic state. Consider stretching or yoga for ten minutes afterward. If you are pressed for time, simply taking ten deep breaths before your meal can go a long way towards increasing your relaxation, your ability to digest food, and your ability to keep your metabolism running smoothly.

5. Hormonal Birth Control

For better or for worse, the vast majority of women opt to use hormonal birth control. This is by and large because of the options available to them. Non-hormonal options like the copper IUD are few and far between and come with their own risks and drawbacks. In the United States, 98% of women have used hormonal birth control at some point in their lives. Currently, 62% of women of reproductive age are on the pill. I do not necessarily recommend it; birth control pill usage has been associated with a wide variety of nutrient deficiencies (see more on my blog here). But I understand that we all have to make a choice about what’s best.

One of the biggest problems with IUDs is the expense. They carry a hefty (sometimes 1k-1.5k) initial cost. Another is copper toxicity. The copper IUD can cause copper toxicity which has a wide variety of mental and physiological health symptoms. Fortunately this toxicity can be prevented by supplementing with zinc and magnesium, as they help offset the excess copper (and the zinc in particular). The copper IUD is also associated with heavier periods and greater pain while bleeding; if you struggle with these issues in your normal period, it may be best to refrain from using the copper IUD.

Hormonal birth control itself comes in many different varieties. The two most important categories to consider are progestin-only versus progestin-estrogen combination methods.

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(“Progestin” is the word for “progesterone-like.” These compounds are synthetic and not identical to what your body produces, unless labeled ‘bio-identical’.) These can come in the form of pills, but there are also patches, implants, rings, and shots.

So the amounts of estrogen and progestin vary in every pill that is proscribed. Most women are on a variety of the pill that contains both estrogen and progestin – but the estrogen is added only because it has been shown to help many women achieve better hormone balance and reduce symptoms of being on the pill. In reality, only progestin is necessary to prevent pregnancy.

Pills can cause acne in two ways. One is by throwing off the estrogen-progesterone balance. If you already have low estrogen levels, or a predisposition to be sensitive to low estrogen, a progestin-only option could reduce estrogenic activity in the body, thereby worsening acne.

The other way--and more important way--is via the type of progestin used in the pills. That’s right. There are different progestin options, and they all have different effects on the body.

There are, broadly, three primary classes of progestin from the lab. They are estrogenic, progestational, or androgenic. Each three of these types behave more likes estrogen, behave more like progesterone, or behave more like androgens (male sex hormones).

The more androgenic the variety of progestin in a pill, the more likely women are to experience acne as a side effect. They are still utilized by pharmaceutical companies however because they can help control for other side effects and have lower risks of causing clotting, strokes or other cardiovascular issues than pills with highly estrogenic effects. It is all a matter of choosing which pill has the best outcome--or least amount of risks and side effects--for each woman depending on her own physiology. This is why doctors will often say that you need to experiment for a while before you find the “right” pill for you.

In order to help you better discern which variety is for you (if you choose to be on hormonal birth control), here is a list of progestins that are androgenic and should probably be avoided if acne is a concern.

Note that these are not the names of pills, but rather progestins used in pills. (The different varieties of pills are discussed in the section “the solution” below.) The number in parentheses lists the amount of androgenic activity compared to other varieties of progestin.

The five most androgenic progestins are:

A. Methyltestosterone (50)

B. Gestodene (8.6)

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C. Levonorgestrel (8.3)

D. dl-Norgestrel (4.2)

E. Desogestrel (3.4)

The least androgenic progestins are:

A. Pregnane Progestin (0)

B. Norethynodrel (0)

C. Ethynodiol Diacetate (0.6)

D. Norethindrone (1.0)

E. Ortho Tri-Cyclen (Norgestimate) (0.15)

F. Ortho-cept or Desogen (Desogestrel) (0.17)

G. Modicon (Norethindrone) (0.17)

(Source)

There are also certain formulations of the pill that contain a variety of progestin that is actively anti-androgenic, called drospirenone, which is known to help improve acne in women who suffer from testosterone-related acne. Drospirenone is used in the pills are Gianvi, Yasmin, Yaz, and Zarah.

However, these drospirenone-containing varieties of the pill come with a very big warning. They can cause a potassium-overload in the blood, which can lead to sudden death. They can also cause many other unpleasant symptoms, which I was personally a victim of for several years.

These varieties of the pill cause the kidneys to retain potassium while flushing fluid out of the body. This can dehydrate you. It can also cause a potassium excess, which will cause your heart to beat irregularly, cause anxiety, and cause insomnia. It can, in extreme cases, then cause muscle weakness, shortness of breath, heart palpitations, and sudden death. This is, in fact, why I once had to check myself into the ER. Not only could I barely make it up a flight of stairs without my legs cramping up, but my heart was also racing incredibly fast.

The trick to being safe about this is regularly testing your potassium levels and making sure they are in safe ranges, eating a diet lower in potassium (greens, broccoli, avocados, melons, dates, tomatoes, salmon, and bananas are some of the highest potassium foods), and keeping an eye out for any symptoms so that you can stop taking it right away if you must. In the end, after all,

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one of these pills may actually be a great help to you. It simply depends on your own body, and its specific physiological needs.

One final significant health risk to be aware of is inherent to birth control methods with high amounts of estrogen in them. Excessive estrogen from pills has been shown to cause blood clotting and stroke. This side effect is rare, but if you are concerned about your cardiovascular health then it may be wise for you to opt for a low-estrogen option.

In summary, therefore:

-Hormonal birth control most commonly causes acne if…-It is a progestin-only pill (or ring, implant, etc like the copper IUD)-It contains an androgenic type of progestin

-Hormonal birth control has been shown to reduce acne to at least some degree withlow-androgen and drospirenone-containing varieties. They may come with their own seriousrisks.

-The safest form of hormonal birth control is none. You may wish to investigate fertility tracking(check out Taking Charge of your Fertility on the resources page), and invest someprophylactics, which are my preferred ways of mitigating pregnancy and STI risk. On the otherhand, some women find that their acne really improves if they go on an estrogen-containing pill.Your decision is entirely up to you.

The solution

If you’d like to stay on the pill, you may wish to consider reducing your dosage. There are two classifications of pills--”low dose” and “ultra-low dose”--which therefore may be of interest to you.

“Ultra low dose” birth control pills are those that contain 0.02 mg of estrogen. 0.02 mg of estrogen is the lowest possible dose. Many people opt for higher doses because a higher dose of estrogen can help more with the side effects of spotting and breakthrough bleeding. If these are not a concern for you however then the low dose varieties may work just fine.

There are two ultra low dose varieties: Alesse (Aviane, Lessina, Lutera, Sronyx)

– contains 0.02 mg ethinyl estradiol and 0.1 mg levonorgestrel (a kind ofprogestin mentioned above)

Mircette -contains 0.02 mg ethinyl estradiol and 0.15 mg desogestrel (a kind of progestin)

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There are five low dose pills. Pills containing 0.02 mg- 0.035 mg of estrogen fall into this category. They have a lower incidence of spotting and breakthrough bleeding. Low dose birth control pills include: LoOvral

-contains 0.03 mg ethinyl estradiol and and 0.3 mg norgestrel (progestin)Nordette

-contains 0.03 mg ethinyl estradiol and 0.15 mg levognorgestrelOrtho-Cept (Reclipsen, Solia)

-contains 0.03 mg ethinyl estradiol and 0.15 mg desogestrelDesogen

-contains 0.03 mg ethinyl estradiol and 0.15 mg desogestrelLevlen 21

-contains 0.03 mg of ethinyl estradiol and 0.15 mg of levonorgestrelSeasonale/Seasonique

-contain 0.03mg of ethinyl estradiol and 0.15 mg of levonorgestrelOther popular low dose pills are those which are “tri-phasic,” which more closely approximate the hormonal fluctuations a women normally experiences. They also tend to be a bit better than average for weight maintenance and even weight loss. These include: Cyclessa

-Phase 1: ethinyl estradiol 0.025 mg and desogestrel (a kind of progestin) 0.1 mg-Phase 2: ethinyl estradiol 0.025 mg and desogestrel 0.125 mg-Phase 3: ethinyl estradiol 0.025 mg and desogestrel 0.15 mg

Ortho Tricyclen Lo -Phase 1: 0.025 mg ethinyl estradiol and 0.180 mg of norgestimate-Phase 2: 0.025 mg of ethinyl estradiol and 0.215 mg norgestimate-Phase 3: 0.025 mg of ethinyl estradiol and 0.250 mg of norgestimate

(Ortho Tricyclen and Ortho-Cyclen, each with 0.035 mg of ethinyl estradiol, contain slightly higher amounts of estrogen in each type of pill than Ortho Tricyclen Lo)

If you’d like to come off of the pill, great! Some ways you can support your body while you do so are by

-eating at least two daily servings of leafy greens, which have a unique enzyme (cytochromeP450) in them that helps the liver detox hormones-keeping your gut as healthy as possible by the methods described in the sections on food andthe jumpstart-eating at least 100 grams of carbs and 50 grams of fat from the right sources every day tosupport healthy hormone production-exercising regularly, but not to excess, 2-4 intense workouts per week

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-Reducing stress-taking magnesium + cofactors (boron, B6, vitamin C)

Know also that as you come off of the birth control pill, your body may go through a period of adjustment. When on the pill, the body becomes reliant on the external source of hormones. This means that it may have some difficulty kicking back into proper hormone detox and production. This may result in some skin quality changes, weight changes, mood changes, PMS changes, and irregular periods or spotting.

6. Phytoestrogen intake

“Phytoestrogen” means “plant estrogen.” We may not talk about it all that often, but almost all plants contain plant forms of estrogen, to some degree or another. The most potent phytoestrogens are soy and flax. Beans, legumes, nuts, and yams are also phytoestrogenic, though to a far lesser degree.

The question of the health effects of consuming these compounds is a complex one for women. Does consuming these kinds of foods help hormone balance, or hurt it? Do they increase estrogen levels, or decrease them?

Doctors and other health specialists differ widely in their opinions on this issue. Some say yes! Eat phytoestrogens daily! And others say No! Never eat phytoestrogens!

I personally believe the truth is more complicated than that.

Here is what’s complicated about it: there are several different types of phytoestrogens, and they are each present in different foods in different amounts.

There are also, in the female body, two primary different types of estrogen receptors: estrogen receptor alpha, and estrogen receptor beta. Receptors are where all the estrogenic activity happens. They are where the body detects estrogen in the bloodstream, and where the estrogen actually gets put to good use. When estrogen locks in at a receptor site, the receptor becomes active and carries out an estrogenic function. For example, the skin has estrogen receptors in it. When the bloodstream has estrogen in it, the estrogen will act like a key in the phytoestrogenic lock, and the receptor will become estrogenically active. More likely than not, because this receptor is in the skin and its natural estrogen, skin quality will improve.

The problem with phytoestrogens and estrogen receptors is that different phytoestrogens fit differently at different receptor sites. If this sounds a bit overly-complicated, that’s because it is. No one ever said biochemistry was easy.

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But this is what it boils down to: the phytoestrogens available in soy and flax and most other foods are not well suited to the estrogen receptors in the skin. They may be well-suited to estrogen receptors in other tissues, and therefore help with different symptoms, like low libido, but they are not well-suited to the skin. They appear to actually decrease estrogenic activity in the skin, rather than increase it.

Now, for most women this issue doesn’t matter. The amount of phytoestrogen in foods is minimal compared to that which their bodies produce. But if you have a delicate hormonal system or if you have delicate skin, this may be a real concern for you. To that end, even though I make varying recommendations for phytoestrogen intake based on age and weight (for more on which, see my program Weight Loss Unlocked), when acne is a concern I generally recommend avoiding phytoestrogens. It is possible that they will not hurt you and may even help you--so these foods are worth experimenting with--but there is a good chance they are actually harmful for your skin and should be avoided.

The Solution

Eliminate soy and flax from your diet, and reduce the amount of nuts and legumes to 1-2 servings a day. Take at least a month to evaluate if it makes a difference. You should be able to tell within two weeks if they affect your skin. If they do not, feel free to add them back in! However, soy and flax may not be all that great for your health anyway, so even though consuming them occasionally or in small amounts is fine, they probably shouldn’t be the backbone of your diet.

7. Hypothyroidism

The thyroid gland is the part of the body responsible for delivering energy to cells. It gives organs life. It is absolutely crucial for a healthy metabolism, for having energy, and for being healthy with a robust immune system. Without healthy thyroid activity, cells slow down until they actually stop working, and die.

Poor thyroid function is an epidemic among women, affecting at least ten million women in the United States alone. An even scarier statistic is that an equal number of women may suffer from hypothyroidism but don’t even know it.

Do you suffer from hypothyroidism? The only way to really know for sure is to get tested, but getting acquainted with the signs and symptoms can help you figure out if you need to get tested in the first place. Here is a list of the most common hypothyroid-related symptoms:

-Fatigue-Poor energy even with sufficient sleep

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-Brain fog-Chronically feeling cold-Cold hands and feet-Constipation-Brittle hair and nails-Thinning of the eyebrows-Hoarse voice-Swollen neck-Depression-Weight gain or difficulty maintaining weight-Low libido-Dry, acne-prone skin

There are two primary ways in which the thyroid gland is crucial for healthy skin. First, skin cells need energy in order to replenish themselves and to thrive. Second, hormone production suffers when thyroid production suffers, which decreases the body’s ability to properly lubricate and care for its skin.

This is how the thyroid gland works:

It receives its first signal from the pituitary gland. This signal comes in the form of the hormone thyroid stimulating hormone (TSH). TSH is the “green light” that the thyroid gland receives from the pituitary gland. Then, if the thyroid gland is healthy, it produces T4. T4 floats around in the bloodstream as a “reserve” molecule. The body converts T4 to T3 – the form of thyroid hormone that your cells actually need and use as fuel – as it discerns a need to. When T3 levels fall, more T4 is converted to T3. Then the thyroid gland synthesizes more T4.

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(It can also make Reverse T3, which competes with T3 and makes it harder for the cells to make energy. Reverse T3 is made often as a result of stress or undereating.)

Hypothyroidism is the condition of not getting enough T3 to your cells. Unfortunately there are many complicated ways in which this supply chain can malfunction. Fortunately, we can narrow our discussion down to two of them, since they comprise the vast majority of cases. (If you believe you struggle with hypothyroidism but from neither of these specific problems, or if your test results are normal, you may wish to consult Stop the Thyroid Madness by Janie A. Bowthorpe or Why do I still have Thyroid Symptoms When My Lab Tests are Normal by Dr. Datis Kharrazian -- linked here).

First, your thyroid gland itself may be weak, as a result of autoimmune disease. This is the case with a full 90% of hypothyroidism cases. This sickness to which I refer is called “Hashimoto’s Thyroiditis” and it is an autoimmune condition. In Hashimoto’s Thyroiditis, the immune system, as a result of a intestinal permeability, accidentally attacks the thyroid gland. It mistakes thyroid cells for pathogens, and destroys the body’s own thyroid cells. When this is the case, lab results will show that T4 levels are low. TSH levels will probably be quite high, since the pituitary gland keeps trying to signal to the thyroid gland to produce more T4, but production fails due to the deterioration of the thyroid gland. T3 levels are also often lowered, depending on the severity of the Hashimoto’s.

The other primary possibility for hypothyroidism is simple thyroid sluggishness (this is not a medical term!). This is what happens: the thyroid gland slows down along with the pituitary gland and other hormonal systems. Whenever you are stressed, whenever you over-exercise, whenever you undersleep, and whenever you undereat, your thyroid gland slows down. This is a part of the female mechanism that attempts to protect itself in times of stress and starvation. The female body doesn’t want to burn through its resources faster than it can replenish them. So if it thinks it is being seriously stressed, it slows down its metabolism.

A slowed down thyroid gland, either from Hashimoto’s or from various stressors, can cause reproductive function to slow down, too. Hypothyroidism often results in Poly Cystic Ovarian Syndrome (an infertility condition I discuss below) and reduced levels of estrogen, progesterone, and LH and FSH (other hormones made by the pituitary gland).

The Solution

Get tested. A blood test for TSH, T4, T3, and TPO (antibodies which fairly reliably indicate if you have Hashimoto’s or not) should give you and your doctor what you need in order to adequately assess the state of your thyroid gland. Be sure to get all four of these hormones tested. Some doctors will only test for TSH or for T4, but it is entirely possible to have a different thyroid hormone profile and still need treatment. For example, many women with the

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sluggishness problem or who eat low calorie diets will have reasonably normal levels of TSH and T4 but have reduced levels of T3. Only a full blood panel will reveal if that is the case.

For Hashimoto’s, if you do discover that you have it, you will in all likelihood need to eat an autoimmune-protocol diet such as that described by Sarah Ballantyne in The Paleo Approach (linked here), in order to heal the inflammation that is causing your body to attack its own thyroid gland. Depending on the amount of damage that has been done to your thyroid, you may also need to supplement with thyroid hormone (T4 or T3, depending on your physician’s orders). Once the thyroid gland has been damaged by Hashimoto’s it does not re-grow itself. Thus, supplementation may be necessary.

The solution to sluggishness is simply to reduce your stressful or restrictive behaviors. Make sure you eat enough. Abundantly. 2000 calories a day, minimum. Eat when you are hungry. Eat fat, eat carbs. Don’t do intermittent fasting.

Additionally, you can support your thyroid gland with proper nutrition. Get sufficient iodine and selenium (two minerals crucial for thyroid health) in your diet by consuming seaweed at least once a week, and by consuming about 10 Brazil nuts every week. Seaweed is an excellent source of iodine, and Brazil Nuts are a great source of selenium. Fish and seafood in general are good sources of both of these minerals, so my earlier recommendation to consume wild-caught fatty fish a few times a week will be helpful in this regard, too. Be careful to make sure you get both iodine and selenium in your diet, as they need each other for proper thyroid health.

8. Menopause

Many women, after spending decades with crystal clear skin, begin breaking out during menopause and perimenopause. Why?

During menopause, the ovaries stop making estrogen and progesterone. This causes an imbalance with other hormones.

DHEA-S is produced by the adrenal glands. Its production does not slow during menopause. So when estrogen and progesterone levels fall during menopause, DHEA-S levels can end up being too high, and causing acne.

Testosterone is also a potential problem, as levels do fall a bit during menopause, but often not as much as estrogen and progesterone. This is especially true if you have any degree of insulin resistance, since insulin stimulates testosterone production in the ovaries.

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It is therefore highly likely that you are at risk for acne during menopause if you live with a significant amount of stress (as this stimulates DHEA-S), if you over-exercise or undereat (as this reduces estrogen and progesterone production in the ovaries while at the same time stimulating DHEA-S), or if you suffer from insulin resistance (as this stimulates testosterone production).

Skin is not the least of most women’s worries during menopause, unfortunately. There are many other symptoms of hormone imbalance at this time, and for even the healthiest woman they can be hard to avoid. Sleep can worsen, fat can get stored in the abdomen, fat loss can get more difficult, sex drive can plummet, hot flashes can disrupt your everyday life, and mood can become imbalanced.

The solution

Acne in menopause can be a challenge to overcome, but it is not impossible. The trick is to limit testosterone and DHEA-S and to enhance estrogen and progesterone as much as possible.

Limit testosterone by following the steps to reduce insulin resistance discussed in the section above on metabolic hormones as well as by making sure to refuel after workouts.

Limit DHEA-S by reducing stress and sleeping well.

Enhance estrogen and progesterone by reducing stress, eating a diet that is at least 30% fat (fat helps your body make hormones), and by focusing that fat intake on fat from animals such as beef, pork, and fish, which is saturated (even better for hormone production), and which has some natural, healthy hormones already in it. You may also wish to consider eating foods rich in vitamin E such as avocados and kiwis, which has been shown to help progesterone production. Vitamin D from regular exposure to sunlight is also very important for both estrogen and progesterone production. Low estrogen has been associated with low vitamin D.

Phytoestrogens are also a viable possibility for boosting estrogen levels during menopause. Even while phytoestrogens may not have the best relationship with estrogen receptors in the skin as discussed above, they still may be better for the skin than having no estrogen at all. To that end, it is worthwhile experimenting with their place in your diet to see if it helps. If you suspect you have a sensitive hormone system, consider adding one bowl of a mild phytoestrogen-containing food such as chickpeas or black beans to your daily food intake. Within two weeks you should be able to tell if it makes a hormonal difference. If you see no difference you could then add a regular serving of soy to your daily diet. Effects vary in this regard, so they could be positive for you or negative. If positive, you have found yourself a solution! If negative, you may need to focus on other aspects of hormone balance, such as

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reducing stress and insulin levels, exercising regularly, and sleeping as long and deeply as possible.

You may also be considering hormone-replacement therapy. Hormone replacement therapy with bioidentical hormones is not a terrible idea. It can be helpful, and it most certainly has been for many women. I won’t tell you not to do it. It does, however, come with its own set of risks. HRT involves supplementation with estrogen and progesterone synthesized out of natural compounds such plant animal estrogen in a laboratory (very much like hormonal birth control) or from animals with bioidentical hormones. It is effective at raising hormone levels back up to premenopausal levels. This can be quite helpful for easing menopause symptoms like acne, hot flashes, mood swings, and possibly even abdominal fat.

Yet there may be a relationship between HRT and breast cancer. Unnaturally elevated estrogen levels have raised some red flags for researchers, who see a potential link between these high levels and incidence of female cancers. If considering HRT, work with a practitioner who is committed to giving you the lowest dose possible and who is aware of the risks of HRT. It is also best to use HRT on a short-term basis, if at all. It is still unclear just how much HRT (and which kinds of HRT) increases the risk for female-specific cancers like breast cancer. It is only known that there is risk involved—so much so that studies on women undergoing HRT (importantly, however, with synthetic and not bio-identical hormones) who have had breast cancer in the past have been stopped mid-study because the study was deemed too dangerous to continue.

9. Pregnancy

Many women experience acne during pregnancy. This is because hormone levels really intensify. It has been reported in multiple instances that women who suffer from acne linked to their menstrual cycles are more susceptible to acne during pregnancy. This is presumably because their skin is sensitive to hormonal changes and balances between testosterone, estrogen, and progesterone.

Acne during pregnancy is most common during the first and second trimesters, when testosterone and other androgens have increased alongside the increasing estrogen and progesterone levels. The body may also be more sensitive to insulin fluctuations, in large part due to the sensitivity of these hormone systems.

Solution

While there are many nuances to acne that women suffer during pregnancy, these changes are typically impermanent, and reside after the baby has been born.

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In the meantime, the most important things to do are focus on stress reduction and to manage blood sugar and insulin levels (so focusing on gut healing, as well as on avoiding refined sugar). These two things will keep androgen levels to a minimum, and help the skin benefit from the glowy, radiant effects of progesterone and estrogen that are possible during pregnancy.

It is also important to steer clear of intense acne treatments such as Retinol or Accutane at this time, as they may be harmful for your baby. Before undertaking any kind of skincare efforts--whether in pill form or topical--it is best to consult your doctor.

Two Common Conditions

If you suffer from some of the causes of acne I just talked about, such as insulin resistance, stress, starving, or hypothyroidism, there is a decent chance you have been diagnosed with one or both of the following conditions: Hypothalamic Amenorrhea or Polycystic Ovarian Syndrome (PCOS).

Now, the way to overcome each of those conditions depends upon your personal physiology. That’s why I went through each of the causes individually above. A PCOS diagnosis doesn’t necessarily tell you what you need to do in order to recover. PCOS means infertility and it means hormone imbalance – but which kind? How was it caused? How can you address it? You cannot overcome the “condition” with which you were diagnosed until you know specifically the kind of hormone imbalance you have and how to overcome it. Of course, you can also posit a reasonably intelligent guess about the causes. That’s fine, too. My whole point is this: the best way to overcome your hormone imbalance is to identify the cause, then to correct it.

PCOS and HA are flexible diagnoses. My own life is an excellent example of that fact.

I was diagnosed with PCOS in 2009. I had acne, no libido, and no menstrual period. So far as I could tell from talking with my doctor and doing research online, the thing I needed to do to overcome PCOS was to lose weight. This is what just about everybody and their grandmother was saying about PCOS at the time.

But I weighed 104 pounds! There was no way that weight loss was the answer for me. To lose weight would be seriously unhealthy, maybe even fatal. So I got curious, and I started digging deep into medical journals.

I learned that even though for perhaps 60% of PCOS patients weight loss is an important piece of the puzzle, that’s only for women with PCOS who have higher body fat percentages. Many women who have PCOS are overweight and insulin resistant. But not all women with PCOS are, like I had been led to believe.

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I ended up being one of these “different” cases.

Instead of causing my testosterone levels to rise sharply with insulin--which is the “typical” way women develop PCOS--I caused them to rise a by working out on an empty stomach. I also caused my DHEA-S levels to rise due to undereating and to stress. So my male sex hormones were elevated. Ordinarily that might not have been enough to cause PCOS in someone else, but I had also had very, low, pretty much non-existent, levels of estrogen and progesterone. My estrogen and progesterone levels were dangerously low because I was so thin, exercised so much, and ate so little.

I had PCOS, but I also technically had hypothalamic amenorrhea, which is the medical term for women whose hormone levels are low (and who stop menstruating) due to stress. This includes all kinds of stress. Psychological stress from work, relationships, and life are a significant part of hypothalamic amenorrhea. They cause the pituitary gland to shut down. Physical stress from a restrictive diet, low-body-weight, excess exercise, low calorie intake, low carbohydrate intake, and the like are also highly relevant, and also causes the pituitary gland to shut down. Both psychological and physical stressors need to be addressed in order to overcome hypothalamic amenorrhea.

Hypothalamic amenorrhea has also been called female athletic triad syndrome – because the triad of 1) low body weight, 2) excess exercise, and 3) low calorie intake is so common in young women. HA happens most often for younger women and especially those who are athletes in activities that “require” low body fat percentages such as gymnastics, dance, or running.

The hypothalamus is the part of the brain that detects stress and starvation. As soon as it detects these states, as it did in me, it forces the pituitary gland to shut down sex hormone (and particularly female sex hormone) production.

It is possible to have both HA and PCOS (and if you have these you almost always have at least a little bit of hypothyroidism, too).

I had PCOS, but my solution was way different than the answer medical professionals normally give women about testosterone and insulin. Instead of losing weight, I needed to gain it. Instead of eating fewer carbohydrates, I needed to eat more. Instead of exercising more, I needed to exercise less. I bring this up because I want to be very clear that being diagnosed with PCOS doesn’t necessarily mean that you need to follow the same advice as other people with PCOS. Your best bet is to do something specifically tailored to your own personal type of PCOS.

In order to be diagnosed with PCOS, 2 of the following 3 things are required:

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-Elevated testosterone and other male sex hormone levels-Irregular or absent menstrual periods-Multiple cysts on the ovaries, as demonstrated via ultrasound

Classically, PCOS occurs because...

Testosterone levels become elevated due to insulin resistance. This results in cystic acne, facial hair growth, balding, low libido, irregular menstrual cycles, and infertility for many women.

But you can also have PCOS…

And suffer from cystic acne, facial hair growth, balding, low libido, irregular menstrual cycles, and infertility...

...as a result of many other hormone imbalance issues. PCOS can happen as a result of low estrogen and/or progesterone, as a result of hypothyroidism, as an imbalance after pregnancy, as an imbalance due to having been on the birth control pill, as an imbalance due to excessive soy and flax consumption, as a result of hypothalamic amenorrhea and low body weight or excessive exercise, or as a result of simple stress.

PCOS is about imbalance first and foremost. It’s about high testosterone and DHEA-S relative to estrogen, progesterone, and other female sex hormones. You can cause it with insulin resistance, but you can also cause it with everything else I just mentioned. The thing about PCOS is that it cannot be treated with a one-size-fits-all solution. You cannot be plugged into a cookie cutter mold. You need your own cookie cutter shape, designed just for you!

(I happen to do precisely this in my program for overcoming PCOS, PCOS Unlocked: The Manual, should you be interested.)

All in all, I share this information with you about PCOS and HA to help you figure out the best way to approach your acne. If either HA or PCOS sound like they may fit for you, it may be good for your skin to dig deep into those conditions and what they mean. Again, I address both at length in the Paleo for Women blog and PCOS in the manual linked above. You may also wish to consult a doctor about getting tests done (or order a saliva panel on your own).

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Condition and hormone testing

If you have been diagnosed with PCOS, HA, or hypothyroidism, or if you have not but suspect you may need to be, the best thing you can do is get your blood or saliva tested for specific hormones to help you figure out more specifically what your problem is. The more you know about your hormone profile, the more you can narrow down the possibilities of what is causing your hormone imbalance.

For example, if you find out that most hormone levels are normal but your progesterone is low, then you know that the problem you most likely need to address is stress (since progesterone is uniquely linked to stress). If you find out you have Hashimoto’s thyroiditis, then you need to eat an autoimmune protocol to help your PCOS. Each woman’s step forward is different.

The best way to do testing for hormones is saliva testing over the course of a whole month. This way, you get to see precisely your hormone levels at all times of the month. Zrtlab.com is a great resource for this, as is directlabs.com.

You can also do a simple blood test at your doctor’s office. This works well, but you need to do this test mindful of what time of the month it is for you. This way, you can compare your test results to normal ranges for that time of the cycle. In the luteal phase, the follicular phase, and at ovulation, hormone levels will all be different. So you’ve got to compare blood test results to normal ranges for the proper time.

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These are the hormones I recommend testing for to assess your hormonal health and balance:

Male sex hormones: Testosterone (Free) DHEA-S

Female sex hormones: Estradiol Estrone (These are two different types of estrogen; estradiol is produced by the ovaries and estrone by fat cells; there is a third kind, called estriol, but it is only produced during pregnancy) Progesterone

Pituitary signalling hormones (an imbalance can indicate PCOS): Luteneizing Hormone (LH) Follicle Stimulating Hormone (FSH)

Thyroid hormones: TSH T3 T4 TPO (thyroid peroxidase antibodies)

Fasting insulin

If testosterone is elevated, then there is a good chance you will want to look at insulin resistance as a potential health issue to work on. This suspicion can be confirmed with a fasting insulin test. Also be sure to refuel properly after workouts.

If DHEA-S is elevated, then stress of all sorts is the monster for you. Assess your life, your relationships, your job, your priorities, and your responsibilities. Get rid of the responsibilities you can afford to, and troubleshoot or come to terms with the responsibilities you cannot afford to. Rejecting negative stressors and reprioritizing the remaining ones in your life is one of the best things you can do for your health and happiness. You will also want to look at physical stressors: over-exercise, under-eating, a low-carbohydrate diet, intermittent fasting, and fasting after workouts should all be abandoned for a more nourishing, calorie-rich, and relaxing daily regimen.

If estrogen is high, this may be because you have a higher body fat percentage (since estrogen is produced by fat cells) or are experiencing estrogen dominance. Estrogen

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dominance is a result of many different factors (but they typically do not cause skin problems unless progesterone is low, so I have not discussed them here in any depth. If you are interested in learning more about estrogen dominance, you can check out this post on my website.)

If estrogen is low, this may be because you are experiencing menopause, or because your body is too psychologically or physically stressed. Low estrogen may also be indicative of low vitamin D.

Note that the estrogen produced by your ovaries is called estradiol. This is the one you most want to keep up in the healthy ranges especially if you are of reproductive age. It indicates robust ovary and pituitary health. If this is low, it means that your stress level is high.

Estrone is the form of estrogen produced mostly by fat cells, and is the most prominent type of estrogen in menopausal women.

There is a third kind of estrogen called Estriol, but this is mainly produced during pregnancy, and not at other times.

If progesterone is low, stress reduction – of both the mental and the physical sort – should be a primary concern. Eating sufficient calories is also important. It has furthermore been suggested that vitamin E intake boosts progesterone production.

LH and FSH are hormones the pituitary gland uses to send signals about the time of the month. They should ordinarily be in a ratio of 1 to 2. In PCOS, however, the ratio is often inverted to 3 to 1. That is almost always the case for PCOS caused by insulin and testosterone problems--a type of PCO I call “type 1 PCOS”. Sometimes for PCOS that is more like hypothalamic amenorrhea and caused by stress (something I call “type 2 PCOS”), LH and FSH levels are both very low. (In hypothalamic amenorrhea, almost all hormone levels are low, depending on the severity of the HA.)

If TSH is high, this may mean you have Hashimoto’s thyroiditis. A TPO test for antibodies specific to Hashimoto’s can (likely) confirm that suspicion.

If TSH is low, this may mean your pituitary activity is decreased, probably due to stress.

If T3 is low but T4 and TSH are fine, then this may be an indicator that you need to decrease stress and specifically to eat more carbohydrates. The body needs carbohydrate (and vitamin A) to convert T4 into T3 in the liver. So make sure you eat at least 100 grams of starchy carbohydrate or fruit every day, and hopefully a combination of both. Also be sure to get some

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vitamin A, in the form of liver or egg yolks. Carbs and vitamin A are crucial for healthy T3 production – and you need T3 in order to have healthy hormones and healthy skin.

If you believe you struggle with hypothyroidism but cannot find a diagnosis that fits, or if your test results are normal, you may wish to consult Stop the Thyroid Madness by Janie A. Bowthorpe or Why do I still have Thyroid Symptoms When My Lab Tests are Normal by Dr. Datis Kharrazian (here).

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Food and Acne Internal Healing Module 2

Internal Healing Module 2: Food and Acne

Below is a list of foods to avoid, and foods to focus on including in your diet. Some foods may be problematic. In fact, if you have a problem with acne, the chances of them being problematic are reasonably high. They are grains, dairy, vegetable oils, refined sugar, and (probably) soy. Now, they probably are not all problems, and this is important to bear in mind. You will not need to avoid all of them forever. The point here is to eliminate all of the potential problems (in the Jumpstart, I recommend that you do so for a full four weeks), and get your skin as clear as possible. Later, once you’ve got a good baseline going, based off of the benefits you’ve experienced from removing these foods from your diet completely, you can begin to experiment with bringing potentially problematic foods back in.

Importantly, even though I list the jumpstart as taking four weeks, the skin takes much longer to regenerate itself. If you get to the end of four weeks and experience healing but not as much as you’d like, it may be best to keep going for another month or so before re-evaluating what your next steps are and trying to add any of these foods back into your diet. Ultimately though, you will be able to carefully bring one category of food back into your diet at a time to see if it has an impact on your acne. When you do so, I recommend that you have a few servings of this kind of food for at least three days. At the end of three days, if your skin has not worsened, you may be all right. I cannot reiterate enough, however, how important it is to get a reasonably good baseline on your skin--that is, to heal it as much as possible, before experimenting with bringing potentially harmful foods back into your diet.

Importantly, what you include in your diet is just as relevant as what you exclude. Foods rich in vitamins and minerals will be great for your skin, particularly vitamins A, C, D, E, and K, and also zinc, selenium, collagen, and probiotic foods. I describe each and their skin-healing benefits below.

Grains

The most common grains include millet, corn, sorghum, barley, rye, oats, rice, spelt, teff, triticale, wheat, buckwheat, amaranth, chia, and quinoa. These can be found in a vast and diverse number of food products, including dietary staples. Breads, breakfast cereals, bagels, desserts, and various pastas are all very high in grain content. Many sauces are also made with the flour from grains. Note moreover that there is gluten in soy sauce.

Dairy

Dairy is anything that is derived from, or contains milk (from any animal). There are many different kinds of dairy, meaning that while some kinds of dairy may be problematic for you (such as milk), other kinds (such as butter or ghee) may not. For the purposes of a trial

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Food and Acne

elimination, it is important to eliminate all dairy from your diet. This includes ghee, butter, yogurt, cream, cheese, and milk.

Over time, you can test different kinds of dairy to see how they affect you. In general, there are two main components of dairy that may be problematic. The first component of dairy that could be contributing to your acne is its fat--or more specifically, the hormones in its fat. Dairy fat contains high amounts of insulin-like growth factors and other growth-oriented hormones. These molecules can cause acne in some people, particularly those with very sensitive skin or who have hormone balance issues. If you find through careful experimentation the fat is an issue for you, then probably all kinds of dairy will be problematic for you.

Another component of dairy that can be problematic is its proteins. Dairy proteins casein and whey can be irritating to the gut lining for some people. As they do so, they cause inflammation. Fortunately, if you are in this group, you will probably be able to consume ghee (clarified butter), butter, and cream without much problem. You may however find that yogurt, cheese, and milk are still problematic, as they often contain high amounts of dairy proteins.

Vegetable Oil

I have discussed vegetable oils at length already in the section on how acne works. It is important to keep vegetable oils (a list of which is below) to a minimum for the sake of clearing your skin.

Refined Sugar

Sugar can also be a big problem for people with acne. This is for many reasons. For one, the body produces insulin in response to sugar (and all carbohydrate) intake. The insulin response to refined sugar is worse than in whole foods because it has been stripped of the accompanying vitamins and fiber that help you digest sugar and blunt the insulin response. This can directly cause skin cell growth and proliferation; it can also cause testosterone production in the ovaries. For another, while the body processes sugar it consumes high amounts of water and vitamins. This means that sugar is both dehydrated and nutrient-depleting. It actually makes it harder for your body to be healthy, heal itself, and repair the skin in the long run. For this reason, it is probably best to keep sugar to a minimum as much as possible. Natural carbohydrates such as fruits and starches and even honey have vitamins in them that help the body digest the sugar. Refined sugar does not.

Soy

Soy and flaxseed may be problematic for the skin because they contain high amounts of plant estrogens. You might think that this could heal the skin, since I’ve talked so much about

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estrogens healing powers, but it’s more complicated than that. These estrogenic-compounds in plants are not quite the same as the kind your body makes naturally (as I pointed out in the section on hormones). These slightly-different estrogen-compounds interact with different estrogen receptors and tissues in the body differently. This means that in some instances they can increase estrogenic activity; in the skin, they tend to decrease it. It’s probably best then to try eliminating soy and flaxseed to see if they help with your acne. When I really struggled with acne, eliminating soy was one of the most important things I did to help clear my skin.

Grains:

Wheat Millet Corn Sorghum Barley Rye Oats Rice Spelt Teff Triticale Buckwheat Amaranth Quinoa

Dairy:

Butter Cream Yogurt Cheese Milk Whey Protein

Vegetable oils:

Canola oil Palm kernel oil Peanut oil Soybean oil Rapeseed oil Corn oil

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Cottonseed oil Grapeseed oil Safflower oil Sesame oil Sunflower oil Rice bran oil Hydrogenated or partially hydrogenated oils Margarine Vegetable shortening Vegetable oil spreads

Some of the names for sugar”

Agave nectar Barley malt Beet sugar Brown rice syrup Brown sugar Buttered syrup Cane juice crystals Cane sugar Coconut sugar Corn syrup Confectioner's sugar Date sugar Dehydrated cane juice Dextrose Evaporated cane juice Fructose Glucose Grape sugar High-fructose corn syrup Invert sugar Lactose Malt syrup Maltose Muscovado sugar Palm sugar Panela sugar Raw sugar Rice syrup

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Sucrose Sorghum syrup Sucanat Treacle sugar Turbinado sugar

Soy products: Tofu Edamame beans Soybean oil

-Focus on skin-enriching foods

Vegetables

Vegetables are rich in antioxidants and vitamins. I don’t need to tell you this, but the endorsement bears repeating: vegetables are awesome. In fact, vegetable-rich diets have repeatedly been linked to many health benefits, including clear skin. Vegetables are anti-inflammatory, largely because they are rich sources of antioxidants such as vitamin C, vitamin E, and beta carotene. Broccoli and other leafy greens are particularly rich in vitamin C. Avocadoes, asparagus, almonds, kiwis, and sweet potatoes are rich in vitamin E.

Eating vegetables won’t get you a hearty antioxidant punch without a solid dose of fat to go along with them. Many of the vitamins found in vegetables are fat soluble. They can only be absorbed into your bloodstream when there’s fat in your meal. This is partly why fat is such an important part of this diet. Eat your vegetables with fat, and your skin cells with thank you.

If you eat a lot of vegetables and have a delicate gut, it may be important to remove the skins of vegetables with thick skins (such as squash), and also to cook your vegetables thoroughly. The skins contain insoluble fiber which can be abrasive to a delicate gut. If you cook your vegetables you may better neutralize the insoluble fiber and make it easier to digest.

Starches: potatoes, sweet potatoes, and more

Starches such as potatoes, sweet potatoes, yams, yucca root, taro, and cassava are generally classed as vegetables, but they deserve their own mention. Why? Because they contain significant amounts of carbohydrate, starch, and soluble fiber. Carbohydrates are important for the health of your skin. If you eat too low carb your skin may dry out as a result. The “complex” starch in these foods makes their blood sugar and insulin response typically lower than other common carbohydrate-containing foods such as rice. And the fiber is great for feeding your gut

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flora, which are important for reducing inflammation, restoring the integrity of the gut lining, and keeping your skin pimple-free.

Fruit

Fruit is rich in fiber, antioxidants, and vitamins and is a dense source of carbohydrate. It is another excellent way to meet carbohydrate needs, as well as to satisfy your sweet tooth.

Much like starches, fruit has natural properties that make it less susceptible to blood sugar problems the way processed foods never can be. First, fruit is typically made up of more fructose—as opposed to glucose—than other carbohydrates found in the wild, such as starchy vegetables. Glucose and fructose are digested differently. Whereas glucose goes into the bloodstream and immediately becomes blood sugar, fructose must first be processed by the liver, which prevents blood sugar levels from spiking precipitously. Second, fruit contains not just fiber but a host of vitamins and antioxidants, the most important being vitamin C. These vitamins help insulin metabolism run smoothly and prevent blood sugar from becoming a problem when fruit is consumed in moderation.

To buy organic or not?

The answer to this question, is, as always, “if you can.” Yes, organic produce may be more nutritious than traditional produce, and free of problematic pesticides and the like. But if you cannot afford it, conventional produce will do just fine. For fruits and vegetables that have skins, it may be best to peel them to reduce chemical exposure, and it is always wise to wash them thoroughly in simple water, or with an organic soap designed for produce.

Beef and meat from other four-legged critters

Contrary to popular opinion, beef, lamb, pork, and other ruminant (the technical term for four-legged animals) products are some of the most healthful foods available--and particularly if from grass-fed, pasture-raised sources. They also contain complete protein, which helps provides high quality protein to help build the structure of your skin. Beef products are rich in zinc which is great for your skin, and also selenium, iron, copper, manganese, and more. I do later in this program caution against eating high amounts of saturated fat and especially that of animals raised on conventional feedlots, but if you stick to grass-fed products you should be fine. You may wish to experiment with leaner cuts of meat and see if they help with your acne for the time being.

Poultry

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Poultry is a good source of protein. Chicken is a rich source of vitamin B3, or niacin, as well as the trace mineral selenium--which is great for the skin. Turkey is also a dense source of B vitamins. However, both chicken and turkey contain smaller amounts of most of the minerals found in animal products—such as iron and zinc—than beef. Poultry also has higher concentrations of omega 6 fat than beef does, which makes it a less-optimal source of protein than beef, pork, bison, lamb, and other ruminants. If however you cannot get your hands on grass-fed or locally-raised animal products, going for lean cuts of chicken and turkey--indeed, of any animal--may be the safest option both for your health and your skin. You can supplement these lean cuts with bountiful plant fats such as coconut, avocado, and olive oil, or with high quality ghee or butter products if you find you tolerate them well.

Organ meat

I eat liver regularly not only because I find it delicious, but also because it is possibly the most nutrient-dense food. Liver is packed with enough vitamin A to nourish a family of five for a month. This is huge for your skin. In fact, it provides so much vitamin A that you have to be careful not to eat too much.

Liver also contains vitamin D, vitamin K1, and vitamin K2. Importantly, K2 is only found in the grass-fed versions of liver and other animal products (notably butter!), so if you can find grass-fed liver, it could be really helpful. If you cannot find grass-fed versions of organ meats and other animal products, you may wish to supplement with a vitamin K supplement that has bountiful K2 in it. I recommend one on the resources page.

If you notice that you get some acne when eating liver, it may be because of the high B12 content. Vitamin B12 is incredibly good for you. It only sometimes play a role in acne because certain bacteria in the skin make their own B12. When they are inundated with abundant B12 from the diet, they may switch off their B12 production and instead make a slightly inflammatory by-product. In this case, it is important to note. Helpfully, topical probiotics may help alleviate this risk, and enable you to consume all the enriching, vitamin A, D, K1 and K2 dense liver you want. Since it is important to not eat too much, about ¼ pound of liver every week is a great dose.

Liver is the most nutrient-dense organ meat, though heart and kidneys are also powerful options. Any part of the animal, really, is fair game. And nearly any part of the animal that is not simple muscle tissue is going to have more or at least unique nutrition in it. This makes basic biological sense: more nutrition resides in organ and essential tissues because they perform complex functions that are essential to life.

More detail on animal fats and industrialization

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The differences between industrial and truly natural animal products can be striking. For virtually all of Earth’s history, animals have eaten and existed off of their natural food sources. Cows ate grass, not soy, corn, grain, or Snickers bars (this is not a joke; it happened in 2012 during a corn shortage). Chickens ate insects and grasses. Fish ate plankton, algae, and krill.

Deviations from these natural diets have caused real problems in the modern world. Cows, pigs, chickens, fish, and other farmed animals are raised on the cheapest foods manufacturers can get their hands on: grain, soy, corn, and edible leftovers from farming processes. Animals raised on these products are often sick because these foods aren’t a part of their natural diets. This means that they need to be pumped full of antibiotics in order to stay disease free. Their being sick, aside from being unpleasant and sad in and of itself, does not spell good things for the level of nutrition available in their meat. There are three important effects of poor diet on industrially raised animals: 1) the vitamin and mineral content is decreased, 2) the toxin load is increased, and 3) fat profiles are skewed toward inflammatory omega 6 and away from anti-inflammatory omega 3. Better for the animals and better for you, eating meat from local farms, if you can, is an excellent way to promote wellness.

Vitamin K is an often underappreciated vitamin that promotes the growth of strong bones, helps blood clot effectively, prevents calcification of arteries, and provides possible protection against liver disease, in addition to supporting healthy skin. It comes in two forms, both of which are crucial for health. Vitamin K1 is available in kale, spinach, broccoli, and all other leafy greens. Vitamin K1 can be converted to vitamin K2, but at a low rate. Vitamin K2 is available in natto, fermented or aged cheeses, egg yolks, grass-fed butter, and grass-fed chicken and meat livers.

Fish and seafood

Fish and seafood are some of the healthiest sources of dietary protein and fat. Wild-caught Alaskan Salmon (the salmon most likely to be free of toxins from the sea or irresponsible fish farming) is a particularly vitamin-rich food and contains high levels of vitamin D as well as vitamin A, all the B vitamins, potassium, phosphorus, calcium, magnesium, and selenium.

One of the primary reasons seafood is so good for the body is that seafood is the richest source of omega 3 fat. You’ll recall from the section on vegetable oils that omega 3 fat is important because it acts as a counterbalance against omega 6 fat. Omega 3 fat is explicitly anti-inflammatory and has been demonstrated to have enormous health benefits across a wide variety of health conditions, including healing the skin.

Since it is ideal to maintain relatively low levels of unsaturated fat in the diet as a whole, the best way to achieve healthy omega 3 / omega 6 balance is to avoid vegetable oils, consume healthy ruminant and poultry products, and consume 3-4 servings of sardines or wild-caught salmon, trout, or other large fatty fish every week.

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Oysters are also incredibly high in zinc, and may help nourish the body’s zinc stores if consumed once a week.

Eggs

Eggs are supremely healthful foods and great sources of protein and fat. Eggs contain all of the nutrients necessary to build a whole organism, so they contain plenty of trace elements and minerals that are rare in other foods. These include powerful skin-healing molecules such as selenium, zinc, the B vitamins, and, importantly, vitamins A, D, E, and K. Importantly, the vast majority of nutrition from eggs is contained in the yolk. Some people with gut issues may be sensitive to egg whites, so if you are concerned about that, you may wish to just consume the yolks. You may also find that eggs are too high in a few things if you eat a lot of them: 1) vitamin B12, 2) phytoestrogens (if the chickens are fed soy, which they typically are if they are listed as having “protein” in their diet, or 3) saturated fat. In this case eggs may play a role in your acne, though only if you are really sensitive to one of the above three issues. All in all, given how nutrient dense they are, it is probably prudent for most women to consume up to two eggs every day, and at least half a dozen a week.

Healthy plant fats: olive, avocado, and coconut

Why these plant fats and not others? These fats come from plants but do not contain the same amounts of the highly reactive unsaturated fats I’ve discussed elsewhere. Olive oil is mostly monounsaturated fat, and avocados are also composed primarily of monounsaturated fat (monounsaturated means they only have one area that isn’t saturated, polyunsaturated on the other hand means many areas aren’t saturated, which is why polyunsaturated fats are more reactive). Both olive oil and avocado contain antioxidants, specifically vitamin E, which helps prevent oxidative damage and can protect all sorts of tissues, including the skin.

Coconut oil and other coconut products are composed of saturated fat, but that does not make them inherently unhealthful. In fact, coconut oil is a special kind of saturated fat called a medium-chain fatty acid, and it has unique anti-microbial and anti-inflammatory properties.

Select nuts in moderation

Nuts and seeds are natural foods that are tolerated well by many people. More often than not, however, they are composed primarily of omega 6 fat, so it’s best to limit them in your diet.

Nonetheless, nuts are fairly nutrient dense, and some of them are uniquely healthful. My favorites for supporting healthy skin are almonds, macadamia nuts, and Brazil nuts. Almonds are rich in vitamin E, magnesium, phosphorus, calcium, and zinc, and while they contain a

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significant amount of omega 6, it is balanced by a fair amount of monounsaturated fat. Macadamia nuts are arguably the most healthful of all nuts and have the highest proportion of monounsaturated fat. Though Brazil nuts are composed primarily of omega 6 fat, they are the richest natural source of selenium; eating just two a day is equivalent to taking a selenium supplement.

If you are going to eat nuts, it is important to buy them fresh, not baked in any kind of oil or roasted. As with the liquid omega 6 fat in seed oils, heat can turn nuts rancid, and eating rancid foods destroys tissue and causes oxidative damage in the skin.

Fermented foods

One of the most powerful things you can do for your skin is to improve the health of your gut flora. You can do this two ways: 1) taking probiotic supplements, which introduce certain strains of healthy bacteria to your gut, and 2) consuming foods that have been fermented and still contain live bacterial cultures (yogurt, for example, has been fermented and still has live bacteria cultures in it; beer and wine, on the other hand, have been fermented but no longer contain live bacteria).

Supplements can be very helpful. But they are limited in that gut bacteria are nearly infinitely diverse, and a truly healthy gut may require different bacteria than the ones available in the particular supplement you choose to take. You may of course try a high quality, diversely-populated probiotic such as Prescript Assist, here.

Fortunately, you can cultivate a wide variety of bacterial strains in your gut by consuming a wide variety of bacteria-containing foods. These are all of the fermented foods, and they include sauerkraut, kimchi, natural, unpasteurized, full-fat yogurt, kefir, natto, kombucha (fermented tea), and other fruits and vegetables that have undergone fermentation processes. I list several of my favorites here.

Your gut flora population will also thrive if you feed it the types of fiber it loves to eat (called prebiotics) such as Jerusalem artichokes, onions, and leeks a few times a week.

For the sake of healing your skin and your gut, I recommend at least one serving of a fermented food every day.

Bone broth

When parts from pasture-raised animals like bone, marrow, tendons, cartilage and ligaments are simmered in water, they release several healing compounds, including glutamine and collagen which have specific gut healing qualities. Collagen also, notably, has a powerful impact on the maintenance of healthy skin.

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Depending on the needs of your body, it’s best to consume homemade bone broth on a daily basis while in healing mode. Drink 4-6 oz of warm broth during the day, or use it when making soups and stews. You can also add collagen to your diet by supplementing with grass-fed beef gelatin or collagen peptides, which are both in powder form (I link to a collagen peptide powder I personally use here). You can add these collagen powders to stocks that are not “bone” made (say, if you purchased a chicken stock from the store), to salad dressings, or, as they are (mostly) flavorless, to coffee and tea.

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Smart Supplementation Internal Healing Module 3

Internal Healing Module 3: Smart Supplementation

While I really do believe that everything you need for a healthy body is available in whole, natural foods, sometimes smart supplementation can help you with a particular deficiency or problem you have, especially if digestion is compromised. All of us have accrued some amount of damage to our bodies due to life in one way or another. Supplements can help us out. Some supplements have even been shown to have pretty remarkable effects on acne in studies.

All of these supplements can be easily checked out and purchased on this page.

Here are the best ones out there:

Zinc

Zinc helps support the skin in a number of different ways. Perhaps most importantly, it is a powerful antioxidant. It helps reduce insulin levels and sharpen insulin sensitivity. It boosts the immune system, and thus can support a healthy immune response. And it is crucial for the utilization of vitamin A, another crucial element for your skin.

The best way to get zinc is to eat plenty of red meat and poultry on a regular basis. Oysters have also been shown to be an excellent source of zinc, so including these in your diet can be a great help, too. Zinc is also available in greens like spinach, kale, and chard, and also in seeds, particularly sunflower seeds and almonds (though because these are high in omega 6 you should keep your consumption within reasonable limits).

Adding a zinc supplement to your regimen may be a great help to your acne – just be careful. You need the right dose for you, as too much zinc can cause an imbalance with copper and end up negatively affecting the immune system and the metabolism in the long run (as well as cause many unpleasant symptoms). Most studies of zinc and acne use 10-30 mg of zinc daily. 30 is near the upper limit, so it may perhaps be best to start with 10-20 mg, depending on your size. Zinc in an “organic” (by this I mean the scientific “carbon-containing” meaning of organic, not “free of pesticides) or “chelated” form is the most natural and best for your body. Look for forms of zinc that have “ate” at the end like zinc picolinate or gluconate.

Selenium

Selenium is another powerful antioxidant. It plays a crucial role in the body’s methylation and detox processes. The more you can support this process, the healthier you will be, and your skin will definitely be clearer for it. The methylation pathway is crucial for lowering inflammation and enabling antioxidants to do their work.

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Supplementation

Seafood, in particular salmon, sardines, halibut, cod, and tuna, and Brazil nuts are the best dietary sources of selenium (1-2 Brazil nuts a day is equivalent to a selenium supplement). Red meat and eggs are also good sources of selenium.

Selenium supplements have also been shown to be quite helpful for acne. For the sake of acne, meeting the Recommended Daily Dose of 50 micrograms a day might be a good place to start. You can feel free to go up to 100 or 150 micrograms, but I’d caution against going much higher as selenium toxicity is also a possibility. As always, chelated “ate” forms of selenium like sodium selenate are best (or the methionine variant I list).

N-Acetyl Cysteine (NAC)

NAC is yet another antioxidant. This one doesn’t ordinarily come from foods but is instead synthesized by the body. It plays a critical role in the methylation pathway (it is a precursor to glutathione, the Big Kahuna of detox molecules that neutralizes free radicals and other inflammatory molecules) and is excellent for liver health, detox, and anti-inflammatory processes.

Most studies have patients take 1200 mg or so of NAC daily, 600 in the morning and 600 at night. As always, if a small human being, try a smaller dose first. It is possible that NAC has a negative effect on gut flora and motility, and it may also elevate histamine levels, which can cause adverse and allergic-like reactions in some people. Most people do not experience these side effects. For this reason it may be wise to start with a lower dose and evaluate before increasing your dosage.

Silymarin (Milk thistle)

Another potent antioxidant, silymarin has been shown to be just about equal in effectiveness to NAC for combatting inflammation and acne simultaneously. For this, take up to 70 mg after each meal, which rounds the dose out to approximately 200 mg each day.

A note in case you struggle with hormone imbalances – silymarin is a phytoestrogen. It has been shown to reduce testosterone levels in rodents, and may help with hormone balance. It may also, however, have a different effect on you personally than on the rodents, so be wary in your usage and watch for hormonal symptoms to crop up.

Fermented Cod Liver Oil

This is a long-time favorite of many health advocates, especially in the paleo scene. The reasons it has received such acclaim are many:

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Supplementation

1) Cod liver oil is a rich source of EPA and DHA, the two anti-inflammatory omega 3molecules your body needs to cool down inflammation2) Being fermented means that the oil doesn’t go “rancid.” Rancid fats are not good for you. Infact, they are quite bad. Does this make you wonder whether the fish oil you see on grocerystore shelves is rancid? It should – because there’s a very good chance it is. Fermented isdefinitely the way to go.3) Cod liver oil is a rich source of the fat soluble vitamins A and D.4) If you think that you tolerate butter well, you may be well served to purchase a variety offermented cod liver oil that has butter oil added. When you do this, you round out the vitamins Aand D in the cod liver oil with vitamins K1 and K2 in the butter oil. This combination of vitaminsis powerful, as they work in synergy. (I list both the regular cod liver oil and the butter oil addedvarieties on the resources page.)

However, in recent years questions have been raised about the quality of these supplements, as well as the safety of consuming vitamin A, D, and K in these ratios and quantities. So far as I can tell, there is no harm to taking these supplements, and many people have professed to seeing great benefits. It may be worth trying. When you do so, be aware of your vitamin D intake and levels. One of the potential drawbacks of these supplements is imbalancing your system towards more A and K and away from D. If you make sure to get a lot of sunlight or also supplement with a little bit of vitamin D, that problem can be accounted for.

All in all, if possible, it may be best to get your vitamin A, D, and K from dietary sources such as egg yolks, liver, and grass-fed ghee or butter. If however that is not possible or you are unsure of your ability to do so regularly, taking a fermented cod liver oil supplement with butter oil added OR a fermented cod liver oil supplement with an independent vitamin K1 and K2 could be a great help for your skin, and other symptoms you suffer besides.

Vitamin D

Vitamin D is crucial for healthy skin. You should be able to get all of the vitamin D you need from daily exposure to noontime sun (at least 20 minutes of it on as much of your body as possible, but not your face!). If you cannot get that much because of work or the weather, then a supplement may be in order. An emulsified form of vitamin D is probably best, to aid absorption. I recommend Bio-D Mulsion Forte by Biotics Research.

Resistant Starch

Resistant starch is a kind of starch that resists the digestive process until the end of the digestive process, in the colon, at which point it is a favorite food of good gut bacteria. It has been shown to help sharpen insulin sensitivity greatly. You can get resistant starch from an interesting variety of sources: green bananas or plantains for example contain a high amount of

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Supplementation

resistant starch and in my opinion are the fastest and easiest way to get it. Raw potatoes are also an easy method. Rice after it has been cooked and cooled also contains resistant starch (and it must be eaten cool). You can also get it in supplement form. I recommend Gut Garden.

If you wish to consume high quantities of resistant starch, you may wish to move slowly at first. Resistant starch jumpstarts fermentation activity in the colon (in the long run this is a good thing). But in the short term it can cause gas and bloating. Just a teaspoon or tablespoon of a resistant starch food a day to start is great.

Probiotics

Probiotic supplements are a good option (indeed, perhaps a crucial one) if you choose not to eat gut healing foods such as fermented foods (kimchi, sauerkraut, kefir, kombucha, and all other foods that naturally contain bacteria in them) or resistant starch.

The best probiotics to take are ones that have acidophilus and/or bifidobacterium in them, since these strains of bacteria have been demonstrated to be particularly helpful for good gut health. Yet it is also important to have variety in your gut flora – so a supplement that contains one or both of these strains plus others is probably best. One of my favorite probiotic supplements is Prescript Assist.

Gelatin or bone broth

Bone broth, as I mention in the section on food, is incredibly good for your skin. If you can make that on a daily basis (and aided by collagen peptides if you so need), that’s great. If not, you can take a collagen supplement (in powder form, and add it to soups and teas and salad dressings) such as the one I recommend on the resources page.

Green tea

Green tea is a powerful antioxidant and great for the skin. It works great both from the inside--from drinking tea--and also great from the outside, in topical form. This is because green tea is both an antioxidant and also has other health benefits: green tea has a powerhouse molecule called epigallocatechin-3-gallate (EGCG) in it, which blocks androgen receptors in the skin. It also may help sharpen insulin sensitivity. In fact, EGCG is thought to be 25-100 times more potent for helping with acne than vitamins C or E. Green tea – both drinking high quality, fully caffeinated green tea – as well as applying it topically in the form of creams, appears to reduce acne incidence by 50%.

So how much green tea should you drink? Most studies have been conducted on the consumption of 3-6 cups of high quality, fully brewed and caffeinated tea. If you drink decaf or

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purchase your tea flavored or from some company pre-brewed, there’s a decent chance it won’t be as potent, so either change to caffeinated tea leaves or increase your dose.

And how do we make good, acne-fighting tea? Brew your own from high quality leaves. Bring the water to a boil, add a bit of sugar to speed absorption, then let steep for at least 4 minutes, It also helps if you drink the tea on an empty stomach, so right upon waking might be wise. Drinking tea in this way will give you the best odds for increasing your insulin sensitivity, your antioxidant activity, and your skin quality.

On the resources page, I link to a high quality green as well as a serum that contains green tea.

Supplements in sum

There’s no saying you have to go out and buy all of these and do them at all once. In fact, usually just one of them significantly helps reduce acne, sometimes by as much as 50% in just a few weeks. Perhaps try one or two at a time and monitor your results. This way, you can collect data about what works best for you. A time period of ~4 weeks may be necessary to witness an effect of any of these supplements on your skin – both because your body needs time to adjust to the higher intake, and also because the skin takes months to replenish healthfully. Of course, the only way to truly be sure you get the nutrition you need is to get it from high quality food sources and making sure your gut is healthy enough to absorb their nutrients. When not possible, however, or when you’re looking for some extra help, supplements can go a long way toward helping you with your skin.

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Smart Supplementation The Topical Care Solution

The Topical Care Solution

Topical care is an interesting issue. According to most dermatologists and Google searches, what you do to the surface of your skin is the most important factor in acne.

I disagree. When I was in the throes of my worst skin nightmares, topical care did almost nothing to help me. I changed my pillowcases; I slept on top of towels; I tried ten different cleansers… and still the zits kept coming.

Of course, topical care still matters. If done wrong, it can really wreck your skin. But if done right, it can really help. But it has to happen on top of a solid foundation of good nutrition and lifestyle choices. That’s what most of this program has been about.

This section is all about what I would call the icing on the dermatological cake. This is it, the topical stuff.

Unlike many people in the natural health blogging sphere, I personally do not like to use DIY beauty products. This is because, for one reason, they can take a lot of time to make. For another, I have not found that they ever out-perform products that I purchase either from mainstream cosmetics companies (such as Cetaphil or Palmers), or from grassroots companies which specialize in naturalistic skin care (such as Primal Life Organics or Dragonfly Traditions). I also happen to personally know the women who design these products and run companies such as PLO and DT. They are incredibly talented, and I have found that it really shows in the products of theirs I have tried. All of these products, from Palmers to Dragonfly Traditions, can be accessed on the resources page. I have included both “conventional” and naturalistic options I trust below, as I know that many people prefer one or the other.

To that end, I here share with you general instructions on how to topically care for your face, as well as make recommendations for my preferred products.

General sanitation and upkeep

As a general rule, it is important to keep your skin as far away from bacteria and potential toxins as possible. Some of the most important ways to do this are to sleep with clean pillowcases, replace washcloths frequently (once weekly is good if you can), use sanitary make-up applicators (or clean fingers), refrain from using make-up more than 6 months old, gently wash your face after workouts or any kind of activity or environment that causes you to sweat, and refrain from touching your face unnecessarily.

This last point is important: many different kinds of dirt and bacteria hang out on your hands and fingertips. If you read with your chin in your hands or often touch the side of your face while you’re working or driving, you may need to kick the habit. I have personally found that this is a

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big factor in my acne. I broke my habit of putting my hand near my mouth, and that helped with acne in that area. But I later realized I still lean the side of my face on my hand while I work at my computer, and this is the spot of my face now most likely to develop zits.

It is also important to keep your skin well moisturized. I will cover moisturizing practices in terms of how you apply product to your face below, but it is also important to pay attention to your environment. In the wintertime, most environments become more dry. In the summertime, air conditioning can also dry out the air at work and at home. On airplanes, the air tends to be really dry. Now you can’t bring a humidifier on an airplane, but you can moisturize well before and after. And you also can’t change your work. But you can, at least in the bedroom in which you sleep, get a simple humidifier. This could work wonders for your skin, as it will assist your body in keeping the surface of your skin smooth and moist. I recommend the the Taltronics Whisper Soft Humidifier linked here.

Water, and especially hot water, can strip the skin of its moisture, often to devastating effect. To that end, when you bathe or shower, it may be wise to skip on overexposing your face to the water. Only get it wet when necessary.

How to cleanse

Many skincare experts recommend washing your face twice every day; I prefer to take a more gentle approach. Over-washing your skin has the potential to strip it of its own nutrients and lubricating oil. When you do this, you may actually encourage your skin to become oily, because it sometimes produces even more oil in response to the feeling of dryness. Over-washing can make you either too dry or too oily, and almost never just the right amount of lubricated.

So I personally have found that washing my face just once a day--before I go to bed--is the best routine for the moisture level of my skin. This means that I usually shower before bed, and then when I wake up in the morning I simply either do nothing or apply a light coat of foundation (with SPF if I will be outside for a while) and walk out the door.

If you shower in the morning, it is probably best for you to still wash your face at night, especially if you wear make-up throughout the day. This means you’ll be cleansing and moisturizing twice daily. If this feels like too much washing for you and you need a break, try taking a lukewarm shower without exposing your face to the water. This could really help remediate the over-drying issue.

I recommend one of two primary methods for cleansing. One is my personal choice--to use no cleanser at all. Instead of a cleanser, I use warm water and a clean washcloth. I simply wet my face, then wet a washcloth, and then gently scrub my face with the washcloth. Usually if I have worn make-up throughout the day I can see it come off on the washcloth. I then run the

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washcloth under the water to rinse the foundation off of it, and bring it back up to my face to resume washing. The warm water helps loosen and pull the dirt and oil off of my skin; the washcloth exfoliates. This means that I am exfoliating my skin on a regular basis. Because I use a simple, gentle washcloth with warm water, however, I am not doing damage to my skin. This has been somewhat important for me as my skin does not usually tolerate the chemicals found in cleansers very well.

The other method of course is to use a cleanser. Wet your face, apply a dime-sized dollop of cleanser to your hands, and apply gently to your face, rubbing in small circles. A good cleanser will have elements in it that break up the dirt and oil on your skin. As you proceed to rinse off the cleanser (and be sure to rinse it off thoroughly!), it should take the dirt and oil with it, without over-drying your skin.

(A third method is called “oil cleansing” and I address it on its own below.)

Recommended cleansers

Bentonite cleanser by probiotic action. This cleanser is made with a special clay I actually once studied while on a geology field trip in Wyoming that has unique chemical softening properties. I have personally used this cleanser and, with all my intensely sensitive skin, found it to be very cleansing and softening at the same time. I really enjoyed the experience.

Cetaphil. This is a standard easy-on-the-skin cleanser recommended by dermatologists.

(None). Try a set of inexpensive, simple washcloths (rotate once weekly or bi-weekly), such as the Talprit Bamboo washcloths on the resources page.

(All here.)

How to moisturize

It is best to moisturize after every wash (and when your face is clean). Simply squirt a dime-sized dollop onto your fingertips and apply evenly over your face. Importantly, it is ideal to use moisturizers that squirt out of a bottle of some sort, rather than a pot that you dip your fingers in. When you use pots, you run the risk of getting dirt and bacteria in the pot from your own fingers over time. Plus, if you’re using an antioxidant moisturizer (and that would be ideal), using pots oxidizes the antioxidants and makes them quite useless.

Tip: Be sure to also moisturize your neck, as moisturizing helps combat tissue damage and wrinkles.

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Recommended Moisturizers

Moisturizers come in many different varieties these days.

There are several variations sold in terms of how thick or thin a moisturizer is. In general, people say that thicker, richer moisturizers are for more dry skin types. However, as I noted above, sometimes oiliness is a result of over-drying in the first place, so I have actually found that medium-weight moisturizers tend to serve most people best. The ones that I recommend below should suit all ‘oily’ or ‘dry’ skin types.

It is also possible to purchase moisturizers with acids in them, designed to help exfoliate the outer layer of dead skin cells and dry up excess oil. In my opinion and experience, this is a superfluous function if you cleanse your face well, or especially if you choose to wash with a washcloth on occasion (or regularly, like I do). These acids are called alpha hydroxy acids (AHAs for short) and beta hydroxy acids (BHAs). Examples include citric acid, hydroxycapric acid, and hydroxycaprylic acid. The most common one is salicylic acid. They all tend to be quite drying on the skin, and can be irritating to those with sensitive skin. They make the skin more porous, which can be good if you apply a high quality anti-aging or antioxidant serum later in the day, but bad if you expose your skin to dirt, pollution, sweat, oil, and even the sun, which more easily burns skin treated with AHA or BHA. I have included a vitamin C serum with hylauronic acid in it on the resources page if you have more oily skin and think an acid may be helpful for the time being. Acidic moisturizers, in my opinion, however, are more of a short term fix than a long term solution.

My favorite moisturizers are designed for sensitive skin and are rich in antioxidants. The antioxidants commonly found in moisturizers are vitamin E, vitamin C, vitamin D, B vitamins, lycopene, green tea, reservatrol, and retinol (related to vitamin A). Retinol can be harsh on the skin and while vitamin A has been shown to really help the skin, for sensitive skin it may do more harm than good. I have linked a retinol containing night cream that has worked well for me on the resources page.

I personally use the highly cost effective, simple, vitamin E-rich cocoa butter formula by Palmer’s (on the resources page here). Really, I love it, for my whole body, including my face.

When I am home visiting my mother I use her Go Pure Vitamin C moisturizer and I love that, too.

I have heard many paleo experts swear by the vitamins A, D, and K found in Green Pasture’s beauty balm (linked here).

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If you choose not to apply topical probiotics as a spray (listed below), you could also try a probiotic moisturizer such as Eminence’s.

Topical probiotics

While “bad” bacteria P Acnes causes inflammation and zits, “good” bacteria can actually help remediate inflammation and reduce the occurrence, often by a significant margin. I have personally experienced marked improvements from applying topical probiotics to my face, as have many in the Paleo for Women community.

I have for a long time recommended the topical probiotics made by the company Probiotic Action. Recently the founder of the company reached out to me and told me that many people in my audience who first purchased their probiotic spray years ago are still regularly purchasing it to this day. This is a strong indicator that it has worked for them and become a regular part of their skincare routine. I have found that my initial application helped a lot with my own skin, and then in later months when I noticed my acne worsen I would use it again, and it would have the same anti-inflammatory, healing effect. Over time, as my hormones and internal inflammation has healed, I have needed topical probiotics less and less. I will never forget how much they helped when I really needed them, however.

To apply topical probiotics, simply spray them on after washing the face as directed. For the first few days of using the topical probiotics it is best to try to be make-up free, but if you cannot do that, that’s okay too.

I personally use Probiotic Action’s Sprayable Probiotics (on the resources page).

You may also enjoy the probiotic moisturizer by Eminence I mentioned above and which is also listed here.

Topical antioxidants

You may also wish to supplement your skincare routine with more antioxidants. If you already use an antioxidant-rich moisturizer, this may be unnecessary. But if you use a moisturizer with vitamin E and wish to get more diversity in your antioxidant application and use a vitamin C serum, this could be actually helpful.

There are two very powerful serums made by two of my favorite companies that I could not recommend more highly.

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There is the B5 serum by Dragonfly Traditions, which emphasizes B5. It smooths, softens, and makes the skin more radiant. I personally still have this one on my shelf and cherish it.

There is also the vitamin C serum by Primal Life Organics. Vitamin C has been shown to actually reduce aging in the skin.

If you’re looking for a lower ticket vitamin C serum that also feels and works great (and which both I and my mother use), you may want to try out the Go Pure vitamin C serum.

You can see the resources page for links to all serums.

Oil Cleansing

Oil cleansing is an interesting--and effective--way natural health practitioners have found to cleanse the skin. From Katie the Wellness Mama to Liz Wolfe to Noelle Tarr, many brilliant women I know who now have radiant skin swear by it. Oil cleansing involves, simply, applying oil to the face, letting this oil bind with the oil (and dirt attached to it) already on your face, and rinsing it all off together. It’s sort of like basic washing with a cleanser but more naturalistic, and meant to help keep your skin well-moisturized and soft.

With oil cleansing, acne may worsen for about a week, but then it gets much better, supposedly because toxins and debris are being pulled and flushed from the skin, or perhaps the oil producing glands are adjusting to the new input. You may also have to experiment to find the best oil, and the best ratio of oils as you may need to combine them, that works for you. Basically what you will need to decide is how “astringent” your oil mixture should be. I recommend starting with low astringency and calibrating from there.

Castor oil is the most commonly used oil for the ‘astringent part’ of oil pulling, as it is somewhat astringent. Since I mentioned earlier that I’m not a huge fan of astringents as they tend to be drying, I prefer to mix castor oil with at least three parts olive oil. It should never be used with less than two parts olive oil (so, one third castor oil and two thirds olive oil), given its astringent properties. You could use 100% olive oil if you so choose, or 100% with a small dollop of castor. Importantly, you can swap out olive oil with avocado oil. You can also use hazelnut oil in place of castor oil, if you so wish.

You only need a small amount of oil to do your whole face, so one teaspoon of castor oil or hazelnut oil with a tablespoon of olive or avocado oil could be a really nice place for you to start. This will last you approximately four washes.

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Then, over the sink or in the shower, take about a quarter of what you’ve made and massage it onto the skin of your face--without washing it first! This should be smooth and gentle, and done thoroughly, so for about a minute. Get the oil well and good into your skin (pro tip! This takes makeup off, too!). Leave this on for a few minutes if you’ve got the time and want a deeper clean.

Soak a clean washcloth in really hot water, wring it out, and then lay it on top of your face. Let the washcloth touch your skin and absorb the oil into it. This is almost all you need to do! You’re almost done! Let it rest for a minute. Wipe gently if you need, and flip over the washcloth to absorb from the other side if that’s necessary too.

Your face should be all clean now, and well moisturized too! Just in case it’s not, you’re more than welcome to apply moisturizer afterward. It totally depends on your experience, on how astringent you made your oil mix. If you find the “right” balance of astringent to “other” oil for your skin, you likely will not need to moisturize after.

Popping

The vast majority of skincare guides you will find in the world forbid popping your pimples. They say it is the worst thing you can do, because you will create more inflammation, expose the surrounding skin to oil and dirt from your fingers, and do more damage to your pores in the long run.

Yes, it is true that the ultimately healthiest thing for your skin is to refrain from popping. However, if you pop well, you can minimize damage while reducing some of the stinging or irritation you experience from the zits. This also comes in handy, of course, if you’ve got a hot date or some other occasion for which you’re really invested in having clear skin.

First things first, you can only pop a pimple if it has some sort of whitehead visible for you to pop. The only exception to this rule is if you cannot see it yet, but you can feel it beneath the surface of your skin. There must be some sort of build up that is “ready” in some sense to come out.

Eg:

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For what it’s worth, given their small size and delicate appearance I would likely use the “soft whitehead” method on these pimples. I may use the “actual pop” on the whitehead on the right,

however, depending on how hard it feels to the touch.

There are two main popping methods, and the appropriate one depends on the quality of the zit with which you are dealing.

First is a soft whitehead. This will look--on a person with light skin--like a small white center in the middle of a red sore. But it is distinct from a hard whitehead in that that there isn’t enough fluid or tension in the area to be able to squeeze it out. It is a soft, malleable whitehead.

In this case, if you really want the white head to go away, you can sterilize the head of a pin with antibacterial soap and/or an open flame (such as from a gas stove or a lighter). Then, very, very delicately, pierce the surface of the skin right on top of the whitehead. This should create a small opening in the skin above the whitehead, so that it can either leak out on its own or dissolve under the gentle press of your finger wrapped in a tissue.

The second option is the actual pop. This is for a comedo that feels harder to the touch. In this case, you’re going to want to wash your hands first (or place a tissue between the skin on your fingers and the skin on your face). Then, place one finger from each hand a distance from the pimple on opposite sides. They should be in somewhat of a straight line, with the pimple in the center, and far enough away (up to about a centimeter) so that pressure applied towards each other and the zit squeezes the zit from the bottom up. I personally prefer to use my pinky fingers, actually, as if I push them together side-by-side (as opposed to dead-on) they provide a nice amount of torque and stiffness to the zit, increasing the amount of force I can apply to the area.

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Then, simply, press your fingers in against your skin and towards each other, and with a bit of an upward angle, sort of like you are attempting to slide whatever is stuck in your pore out from the bottom towards the surface. You may find that after applying pressure in one spot that you benefit from rotating your hands and squeezing from another angle. If the zit is hard and you apply the right amount of pressure, you will be able to get everything you need out of the zit. It takes some practice, but done right can actually speed the healing of zits. If you begin to see blood, stop squeezing. This itself can take some time to heal. When you are done, blot the area with a tissue. If it feels inflamed, you could cool it down with some ice, or simply leave it alone and let it heal.

Red light

If you’re looking for a one-time expense (that’s not altogether cheap, admittedly) that could work some real magic on your face in terms of inflammation (and aging), the best bet is a new, emerging technology called Red Light Therapy. I have written about this at great length on my blog here, as my personal experience has been revolutionary. Unfortunately, since I began using the red light after I had healed most of my acne, I cannot attest to its acne-reducing effects. I have spoken with the co-founder of the company Joovv at great length and he has told me he has piles of testimonies from women who have seen their acne improve. The biological effects of red wavelength light were first discovered on a NASA spaceship in which red wavelength light was found to make plants grow faster. The gist of red light therapy is that it stimulates the production of collagen and the production of cellular ATP, and therefore encourages healthy cell regeneration in the skin. Check out the blog post I linked above if you’re interested. It’s not the cheapest method for clearing and smoothing your skin, but the effect it’s had on the quality of my own skin has turned me into kind of a fanatic.

Choosing

The amount of options for topical skincare are a bit overwhelming. This is why I have refrained from providing you will the whole plethora of options out there. There are too many. Instead I opted to share only my favorite techniques and favorite products. I readily admit that there are products out there that are great that I have not listed here; if you find something that works for you or that seems particularly nice, go for it. You know what works better for you than I do.

That being said, I have provided a list of products only that I have personally tested as well as thoroughly vetted through reading customer reviews, dermatological assessments, and ingredient lists at length, something I’ve actually never done with my audience before.

Do you need to take every one of these steps? No. There are only two essential steps: cleansing at the end of the day, and moisturizing afterward (or, if you so choose, oil pulling

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only). The rest is sauce intended to help you tinker with different methods of healing if you feel so inclined.

My personal routine these days includes washcloth cleansing, Palmer’s vitamin E lotion, daily red light therapy, and the occasional B5 or C serum. There was once a time where I used topical probiotics and they were very important. I oil pull on occasion but rarely make the time. I remember liking how soft it made my face, but again, so do the other steps I use.

You may be best served starting with cleansing and moisturizing as a baseline, and adding in either a topical probiotic or antioxidant serum as you see fit to experiment. You could also alternate days of applying a topical probiotic and an antibiotic serum, in order to benefit from both. Red light therapy is compatible with all regimens.

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Topical Care

The Topical Care Solution To Acne Freedom The Four Week Jumpstart

The Four Week Jumpstart to Acne Freedom

There has been a lot of information laced throughout these pages. Moving forward, it may be helpful for you to start with a four week jumpstart. To that end, I here provide you with a summary of the most important points and strategies moving forward. For four weeks, if you follow the given advice, you will most likely be able to see improvement in the quality of your skin. Skin takes longer to heal than four weeks--so it will not be perfect by then (and would not by any acne treatment, even the dreaded Accutane). It would be ideal to implement these strategies for longer, say, 12 weeks.

But four weeks is enough time to give you a good ballpark idea of how the strategies you’ve undertaken have worked for you. Then, and this part is important, you can re-assess, and begin testing new diet, supplement, or topical strategies. The point is to give you a solid foundation of reduced inflammation, better internal health, and better topical care that will heal your skin deeply, and have you well on your way towards soft, clear, and dewy skin for the rest of your life. Four weeks isn’t enough for perfect skin, but it’s a fantastic amount of time for a jumpstart.

1. Assess your health

There is no doubt about it, every case of acne has an underlying cause. You can fix this cause. Or rather, you can fix your causes.

Unfortunately since there is such a wide variety of possible causes, I cannot provide you with one simple solution that will work for everybody. Or even one simple solution that will work for you.

For some people, overcoming acne may be as simple as following the food recommendation guidelines that I list below. It may mean eliminating gluten, or soy, or fast food from their diets. For other people it takes more time and troubleshooting. There may be different hormone or nutrient or stress problems underlying your acne, all of which require their own addressing. But nevertheless, I persist in believing: you can overcome your acne.

If you have an underlying health condition, it is quite likely that you have symptoms other than acne. So the first thing you need to do to overcome your acne permanently and radiantly is to take stock of your health. What other problems do you encounter? Headaches? Joint pain? Digestive distress? Mood swings? Menstrual irregularities? You could be helped enormously by truly understanding the total state of your body and what might be going on for you. Other symptoms are clues to what your underlying conditions may be. PCOS, HA, hypothyroidism, autoimmune conditions, insulin resistance and diabetes are the most common ones associated with acne. Of course, it is not necessary for you to have an underlying health condition to have acne—you could simply have some food sensitivities or topical care needs, or need some

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probiotics. But it is important for people who have other incalcitrant symptoms to at least consider how they may intersect with acne.

Assess your health and symptoms when you start your four week program, and assess again once a week moving forward. What changes do you notice in your overall health? What changes do you notice in your skin? Taking regular photographs (even daily) could be a great help.

2. Research; get tested; work with functional medicine docs; solve underlying issues

Once you have a list of symptoms, do some research. I’ve provided you with a hefty amount of information to get you started. There are many common hormonal possibilities I have listed in the section on hormones. Do you fit the criteria for PCOS or hypothalamic amenorrhea, hypothyroidism, or birth control issues? Or do you suspect that you may have insulin resistance or diabetes? Perhaps given your symptoms you suspect that you have an underlying problem with the integrity of your gut lining, inflammation, and gut permeability.

Talk with your doctor. Consider finding a functional medicine practitioner. Do some research in medical textbooks and with online sources you trust. Troubleshoot your underlying issues. This is crucial for overcoming acne. I have given you what you need to help you get started. All that is up to you now is getting acquainted with your body, committing yourself to your health journey, and digging in for answers.

3. Zero in on parts of previous sections that seem relevant to you

There have been a lot of important tidbits laced throughout this program. For example, I mentioned that as healthy as liver is to eat, high B12 intake can exacerbate acne. If you eat a lot of liver or take a B supplement, take note of this. Apply all of the information I have supplied, specifically as it may pertain to your own needs. I know it is a lot of information, but I had to share all of it to make sure your problem didn’t fall through the cracks. Ingest as much of the information from this program as you can, and take note specifically of the sections and steps that are the most relevant to you.

4. Avoid the “avoid” foods and focus on the skin nourishing foods

Avoid grains, dairy, vegetable oils, refined sugar, and soy.

Consume weekly: -¼ pound of liver-3-4 servings of fatty fish such as sardines, trout, or wild-caught Alaskan salmonAt least once a day (on average) consume:

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-two servings of leafy greens-one egg yolk, if not two-one serving of a fermented food-one serving (if possible) of bone broth or collagen powder.

5. Eat enough calories

Many people think that the secret to overcoming acne is to go on some sort of cleanse. They think that they need to starve the body to “reset” it or “eliminate toxins.”

This could not be further from the truth.

I know that sometimes it’s hard to eat when you struggle with acne because you can’t figure out which foods are “clean” or “good” for you or not. But it’s really, really important to make sure you don’t undereat. Undereating is a huge cause of stress for many women’s bodies. Plus, if you stop eating, your body will not be able to get the nutrients it needs to heal itself. Your body already has its own really powerful detox capabilities. They occur mostly in the liver. Don’t fall into the trap of trying to starve yourself out of acne. You’d only be making it worse.

Eat when you are hungry. Don’t let yourself feel hungry for very long. Stop eating only once you feel full. This may mean you are eating more than you are used to. But that’s the point. This is the kind of change you may need to really soothe your system, heal your body, and heal your skin.

6. Eat enough of every macronutrient

Many people also think that they need to eliminate carbs or fat from their diets in order to overcome acne. While there may be some bits of truth in these ideas, what’s actually happening is much more complex.

For the people who think they need to eliminate carbs, they are probably thinking that a low carb diet will reduce their insulin levels, which will help reduce acne. Yes, this can be helpful as a short term fix. If you reduce your carb intake, in the short term, your insulin levels will drop, simply because you’re not eating carbs. But in the long run, a low carb diet can actually cause more insulin resistance, making it harder for your body to manage carbs as a whole. That would make you stuck on a low carb diet for life. Plus, this is only really a quick fix. It’s like putting a band aid over a wound. It might cover up the symptoms and make life manageable, but it’s not healing the underlying problem.

The real way to heal the underlying problem of insulin resistance is to heal the integrity of the gut and reduce inflammation. This is achieved through eating a diet rich in nutrient-dense foods

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(listed in the section on food), eliminating potential gut irritants (grains and dairy, listed in the section on food), and consuming gut-bacteria-enriching fermented foods (some of my favorites are here). This is a more permanent fix for gut health.

Since carbohydrates play an important role in nourishing the natural moisturizer in the skin, it is best not to eliminate them completely no matter how much you’d like your quick fix. I recommend starting with eating at least 100 grams of carbohydrate every day. This is the equivalent of 4 pieces of fruit, or two large sweet potatoes. This way, if you want to keep your carbs low, you can do so while still taking care of your skin’s needs. If you eat this many carbs for a few weeks and feel like fewer would be better for you, feel free to experiment. Just keep an eye out for potential symptoms that may crop up such as menstrual cycle irregularities, mood swings, and insomnia.

(Importantly, if you really find that going lower than 100 grams of carbs a day helps your acne, due to diabetes or whatever specific issue you have, by all means, if it doesn’t cause other health problems, do it. Just be cautious.)

There are other people who think it’s important to eliminate fat in order to overcome acne. There is some truth to this, too. Saturated fat can be somewhat pro-inflammatory in the body, and especially if it comes from animals that were raised on conventional feedlots. The fats in these animals are often full of toxins and inflammatory fats. Fat also is the backbone of hormones produced in the body, so if you have a hormone balance that is highly skewed towards male sex hormones, fat (and especially saturated fat, given its slightly more inflammatory potential) will in all likelihood exacerbate the balance.

That being said, fat is an important part of skin health, both because it helps build the tissue of the skin, as well as helps the body absorb nutrients that are important for skin health such as vitamins A, D, E, and K. Without fat in your diet, your body may not be able to truly heal its skin.

To that end, I recommend eating a minimum amount of 50 grams of fat every day. This is the equivalent of about four tablespoons of oil, or two medium sized avocados. For people who are worried about having too much saturated fat because of their hormone levels or because they don’t have access to high quality, wild-caught fish or grass-fed animal products, this will get enough fat in your diet while preserving your health and the quality of your skin. For people who are not worried about skewed hormones or just love fat, feel free to eat as much of it as you want, up to hundreds of grams a day. 50 is an absolute minimum bar, and ideally it should always be at least some more than that. In the long run, as your body heals from inflammation and develops better nutrient status, potential drawbacks of fat for acne fall away.

7. Moderate saturated fat (and/or make sure it’s high quality)

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As I mentioned above, saturated fat intake is perfectly healthy, but for women with highly sensitive, hormonal acne, it can contribute to the severity of acne. This is especially the case if it comes from conventionally-raised animal products on industrial feedlots. Be sure that the saturated fat you consume is high quality. If you cannot get high quality animal products--eggs, meat, fish--it may be wise to err on the side of less saturated fat rather than more. If you have a severe hormone imbalance, for the time being (though not for the long run) it could help your skin to reduce your saturated fat intake and instead focus on leaner meats and avocado, olive, and coconut (a medium chain fat) oils.

8. Moderate protein intake

Finally there is protein. Eating too much protein can lead to too much growth activity in the skin (and other tissues besides), and eating too little is quite bad for your health, so it’s best to stick with consuming an average amount of protein. I recommend somewhere between 50 and 100 grams, depending on your activity level. I typically eat about 80 grams a day. The more active you are the more you will need. If you are an athlete, consume about 100 grams a day, perhaps 120. If you are a larger person you may also need more; if you are of shorter stature and do not exercise much then 50 grams could work quite well. There are 25 grams of protein in a serving of meat about the size of a can of tuna. 2-4 serving sizes that big daily is a great place to start.

9. Exercise according to energy level

It is really important for women with acne to refrain from putting too much stress on the body. When you do so, you cause the body to produce a lot of DHEA-S, which is pro-inflammatory and a big cause of acne. If you’re underslept, stressed out, and feeling down, it may be best to sit a workout out.

I recommend no more than a few periods of intense training every week (2-4), and as much gentle or recreational activity as you like. This of course varies by your own personal needs. If you have a history of dieting, undereating, and overexercising, you may need to stop working out altogether. Be real with yourself while assessing what might be best for your body.

I personally had to give up exercise and accept gaining 15 pounds in order to heal my skin. It wasn’t easy, but it was necessary. There was no slick, silver bullet that enabled me to starve myself thin and have clear skin at the same time. Remember: estrogen is a powerful skin healing tool, and it’s produced both in fat cells and also when the body is not over-stressed. Sometimes the best thing women can do to heal their skin is learn to relax about their go-getter fitness routines and strict body image standards.

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It is also important to re-fuel reasonably soon after workouts. Testosterone levels rise during exercise. If the female body doesn’t get some food after an intense workout (the ideal amount is 200-300 calories of carbs and protein in a ratio of 3:1), its testosterone levels remain elevated. If you eat, your testosterone levels fall back down to average levels. This is really important for women who struggle with exercise and stress related acne. Re-fuel after workouts.

10. Always gently cleanse after workouts and the end of the day

Cleaning your skin after periods of dirtying it (such as going about your day!) matters. Be sure to moisturize well afterwards. If you prefer, use the oil pulling method instead.

11. Consider topical probiotic or antioxidant serum

Choose either a topical probiotic or an antioxidant serum for your acne. If you wish, choose both and alternate their use every other day, or use them at different times of the day. This method may be ideal, if it fits in your budget. You could also apply the topical probiotics throughout the day and then an antioxidant serum when you go to sleep at night.

12. Consider a supplement or two of your choosing

I listed many different supplemental options. Some are more natural than others, intended to replace types of food if you cannot get them in your diet. If you cannot consume bone broth, a gelatin supplement could help you get that collagen dose, and if you cannot consume a daily serving of fermented foods, a probiotic supplement could work wonders.

One method I like is to choose one supplement oriented towards gut healing (eg, resistant starch, probiotics, collagen peptides), and one supplement oriented towards antioxidant supplementation (eg, zinc, milk thistle, selenium, or NAC). You can always add more in good time. Start with ten supplements if you like, though two may work just as well and is a lot more simple to figure out which supplement has which specific effect on you. I personally believe that less can sometimes be more, especially when it comes to supplements. Step carefully, and pick the ones that seem most appropriate for you.

It is usually wise to supplement with vitamin D, and a glass of high quality green tea daily (if you tolerate caffeine) would never hurt.

13) Sleep and reduce stress as much as possible!

Important healing processes take place while you sleep, as does a significant bulk of your daily hormone production. I never have nicer skin than when I sleep well.

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I’ve already talked about the importance of reducing stress. Acne-causing stress hormones are produced when you’re stressed; acne-fighting hormones such as estrogen and progesterone are produced when you are not.

Sleep as well as you can in a dark room; eliminate or remediate the sources of stress in your life as well as possible. But, importantly, don’t stress about it!

In sum

Four weeks is not a ton of time for your skin, but it’s a good chunk to get you started. This is why I call it a “jumpstart.” You will almost inevitably learn more about your skin as you go through the four weeks, and even after. Heck, it’s been years and I’m still learning little bits here and there about mine.

Get started with these recommendations and pay attention to what goes on in your body, in your skin and otherwise. The more closely you do so, the more quickly will come your healing and your freedom from acne. Yet it is also important to have patience for your skin. Remember: it’s doing everything it can to be healthy. You just haven’t yet been able to give it just what it needs to so do. This is what I am here for, and how the jumpstart and rest of this program can help you.

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To Acne Freedom FAQ’s

FAQ

Where do I find all the stuff you’ve talked about?

All of the products I have mentioned as vetted, personal favorites I have shared (for the first time ever!) on a resources page hosted on my website, here at http://paleoforwomen.com/skin-resources. At that link you can find all the best supplements for acne, including resistant starch, collagen peptides, and my favorite fermented foods, as well as all of my favorite skincare products.

I have (or think I may have) an MTHFR mutation. Could this contribute to my acne?

Yes. People who have one or multiple gene mutations related to the MTHFR processes tend to have acne more frequently than others. This is presumably because the body’s main detox ability (called the methylation pathway) is hampered by the mutations. This leads to excess toxic build up in the bloodstream. One example toxic elevation in MTHFR is that homocysteine levels become elevated. Elevated homocysteine is associated with inflammation and therefore with acne (Reducing protein intake may help manage homocysteine levels in the short term, as homocysteine is a byproduct of protein metabolism). Unfortunately MTHFR deserves its own volumes of work to be explained, and I do not have space or expertise to do so in this program.

Generally speaking, the first important step to take regarding treating MTHFR is to get tested (23andme.com, e.g.). This will teach you precisely about which of the several possible MTHFR mutations you may have. The second is to begin doing research. There is not much out there, though Dr Amy Yasko has written extensively online regarding the mutations and how to treat them. I encourage exercising caution, however, because this science is so nascent. I personally suffer from 8 methylation mutations. But I have never treated any of them specifically. I have only worked on my acne in terms of reducing inflammation generally, balancing hormones and improving my nutrient status (and, perhaps relevant to MTHFR, reducing protein intake). This has been sufficient to overcome the MTHFR problems regarding my skin. Of course, your MTHFR issues may be more severe than mine. In that case, a functional medicine doctor who specializes in this sort of thing (there are not many) or doing lots of careful research before embarking on your treatment is perhaps the best path forward.

What if I still have acne after four weeks?

This is to be expected. With the diet, lifestyle, and topical choices I here describe, you should experience improvements in your acne. Do not anticipate fully-fledged clear skin. In fact, it takes 90 days for skin to regenerate itself completely. 90 days. This means that even if you solved your acne problem and immediately made your internal and external environments perfect, it

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would still take up to 90 days for your skin to become the most clear and healed and lovely that it could.

Importantly, too, it takes time for not just your skin but also the underlying health processes that affect your skin to heal. Most studies conducted on the effects of supplements such as Zinc on the skin occur over the course of 6-12 weeks. Nutrient replenishment, hormone-rebalancing, and inflammation reduction all take serious amounts of time.

If you have chronically dieted or restricted your food intake, it may take a while for your hormone levels to re-balance. Of course, they will re-balance more quickly if they have more reassurance from you in the form of abundant eating. Please consider the possibility that you simply, still, are not eating enough, or are exercising too much.

What if my acne has not improved at all in four weeks?

If your acne has not improved at all over the course of four weeks,

-be very serious about making sure you’re eating enough calories, carbs, fat, and protein-try shifting your macronutrient ratio towards either a higher carb diet or a higher fat diet-shift your carb intake away from starchy carbs and towards fruit (which has a lower glycemicindex and therefore elevates blood sugar and insulin levels less)-consider getting testing done for autoimmune diseases, gluten sensitivity, and inflammatoryblood markers such as C-reactive protein-consider seriously potential underlying health conditions, especially: PCOS, Hashimoto’sthyroiditis, diabetes and insulin resistance, all autoimmune conditions-consider getting genetic testing done to learn about whether you have an MTHFR genemutation. See the above question for more information on this.-have patience

For certain underlying health conditions, especially autoimmune conditions, it can take a long time to recover.

What if my acne never gets perfect, or only improves moderately?

There are many factors that go into acne. Sometimes you manage to heal a few of them but one or two are still left unfinished. Getting through the rest of this journey takes patience and tinkering.

There are a few possibilities for food sensitivities that are worth investigating if after several weeks of eating the diet and lifestyle tactics I here proscribe your acne does not improve: -nightshade vegetables

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These are a class of vegetables that can sometimes be inflammatory, especially for people with autoimmune conditions. These include tomatoes, tomatillos, eggplant, potatoes (regular, not sweet), peppers, and goji berries (I personally get terrible acne from goji berries).

-high B12 foodsI mentioned at various points throughout this program that high B12 foods and supplements can contribute to acne because of the metabolism of bacteria on the skin. When you eat hefty amounts of B12, they shut off their own production and instead make a pro-inflammatory compound. High B12 foods include eggs, liver, shellfish, tuna. I personally still get small breakouts from these foods if I eat too many of them too many days in a row.

-chocolateStudies have actually demonstrated that chocolate can cause acne. And it’s not because of the dairy in most chocolate products, but the cocoa itself.

-egg whitesSome people don’t tolerate egg whites well, which leads to inflammation in the gut.

-imbalance of vitamins A, D, KIf you’re taking a cod liver oil supplement, a vitamin D supplement, or a K supplement, you may find that your balance of A, D, and K becomes skewed. If you haven’t seen any improvement with these supplements to date, consider lowering your dose or discontinuing and waiting for two weeks to see if there is any improvement.

What if my acne gets worse?

If your acne worsens when on this plan, what has happened for you is highly contextual and I cannot give you a certain answer about what that is or what to do about it.

The change depends a lot on what you were doing beforehand, and the changes you are currently undergoing. I will share a few of the more common possibilities.

If you made a big change in your diet and especially if your are losing weight, your body may be working overtime to clear toxins out of your fat tissue and blood.

If you used to eat a very low fat vegetarian diet, that may have caused your acne because of nutrient deficiencies. But once you switch to a more holistically nourishing plan such as the one I describe here, you’ve got a lot more fat in your system, and fat is the backbone for hormones. (Don’t forget that saturated fat is especially suspect, and can in some cases be pro-inflammatory.) So you may find yourself stumbling into pro-inflammatory processes on your way towards a more well-nourished body.

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Another possibility is that you have been on a very low carbohydrate diet for some time. When adding carbohydrates back in for the first time, your body may not be ready, since the body develops non-pathological insulin resistance (this means: insulin resistance that isn’t necessarily a health problem) while undergoing a low carb diet. So you may cause your insulin levels to rise when you introduce carbohydrates at first. With time and especially while focusing on gut healing, carbohydrates can result is much more robust and radiant skin in the long run. If you try eating carbohydrates with a healthy gut for two weeks and you do not see any improvement, take the carbs out and focus on gut healing before trying to add them back in again.

If you were once on the pill and went off of it, this is a big change that will take some time for your body to adjust to. I listed strategies for helping your body with this transition in the chapter on hormone balance.

My acne got worse on paleo - are you sure this will work for me?

While I cannot say 100% for certain yes, I will say that most likely, yes, this program will help you more than typical “paleo.”

This is because “paleo” is done differently by its varying advocates, and most do not focus on acne, nor on women’s acne specifically. There are various insights about acne and the effects typical “paleo” foods (such as liver, or saturated fat) can have on acne in various circumstances. I wrote this guide specifically because there is a dearth of this kind of information out there. There is “paleo,” but then there is high quality acne science that happens to coincide really well with food choices often made by paleo advocates and dieters.

For what it’s worth, typical problems that people encounter on paleo that cause acne are from adding nuts or high omega 6 animal fats (such as chicken skin) to their diets, from shifting their diets towards a lot of fat and specifically saturated fat, from consuming higher quantities of insoluble fiber (think: nuts, vegetable skins) which can be a bit rough on the gut, from eating more foods that they may have a sensitivity to such as nightshade vegetables or egg whites, from not eating enough, from working out too much or not refueling properly after workouts, or from having too high a protein intake.

What do I do after the four weeks?

Have patience and keep tinkering! In my opinion, the best thing to do for your skin is to stick with what you know works, and keep experimenting with what you are unsure may work or not. This means that if you experience great skin gains while eating really “clean” as I recommend here, you would be well served by continuing to eat “clean” and experimenting very carefully with the foods that you’ve been avoiding (such as bread or milk). Moving forward, you will then be able to figure out which foods you handle well and which you do not.

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If you experience moderate success with the advice I’ve given you here, have patience and keep going. Persist with the “clean” diet, for example, and add a zinc supplement and/or a probiotic spray. Play with both internal and external factors. Think deeply about your health history, your health conditions, how they may affect your skin, and what you can do about them. Meditate on how you can better nourish your skin, both on the inside and the outside. Then act on it. Experiment. Find what works. There is something that works. I have given you all that I can here to get you on your path, and armed with up-to-date, rigorously scientific knowledge. Now all that’s left is for you to figure out what your skin needs, and feed it.

I know that acne can be a frustrating journey. It took me years of intense pain, shame, and anxiety to finally figure out the science behind it. But once I did -- and I’ve shared everything I know with you here -- I was able to blast through my own skin problems, as well as those of the tens of thousands of people who come to my website every month seeking acne advice. My hope in sharing this program with you is simply to arm you with everything you need. I am eminently excited for this part of your journey. Remember to have patience for yourself and love your skin no matter what it looks like. It’s doing its best to heal for you. All you have to do is nourish it and use the principles shared in this book to heal.

For further reading, you can consult my blog at http://paleoforwomen.com/acne, and all of my blog posts on acne at http://paleoforwomen.com/acne-blog-roll. Remember that all of the resources I talked about in this guide, from books to washcloths to moisturizers to supplements to fermented foods, are listed on this page. I have even more paleo resources such as kitchen appliances and snacks listed on this page. I have two other Unlocked programs available for related health issues: PCOS Unlocked: The Manual, for Polycystic Ovarian Syndrome, and Weight Loss Unlocked: The Paleo Woman’s Solution, for weight loss. And as ever, please feel free to be in touch on all of the social media platforms: Facebook, Twitter, Instagram, Pinterest. I and the rest of my team would love to hear from you.

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