5 Underlying Causes of Adult Acne

No matter what stage of life you're in, acne can be a nightmare and the effects of acne go well beyond physical symptoms, as I know from experience. Diet and lifestyle changes, along with nutritional supplementation, have been my skin’s saviour in my healing. So nothing gets me going quite like sharing my knowledge and experience with others currently struggling with rebellious skin. 
Several studies have confirmed that acne is often caused by hormonal imbalances, gut inflammation, food sensitivities, and nutritional deficiencies. This post dives into these underlying root causes and hopefully empowers you to take steps toward healing your skin. 

 

Rise in testosterone levels 

Testosterone is one of the hormones that cause acne. In women with elevated testosterone, dihydrotestosterone (DHT), a more potent androgen, converts more quickly, causing you to produce more sebum, clog your pores, and get acne. Two reasons why women may have elevated testosterone include oestrogen dominance and polycystic ovarian syndrome (PCOS):  

• Oestrogen dominance happens when oestrogen levels are too high compared to progesterone levels. Normally, progesterone blocks DHT, but when oestrogen is more dominant, progesterone doesn't work as well. As a result, DHT has a greater effect on the skin due to its ‘unopposed’ (1). In women with oestrogen dominance, acne tends to be more prominent during the luteal phase or second phase of their periods. Due to the increase in oestrogen-blocking progesterone during the second phase of the menstrual cycle, DHT causes acne to get worse. Oestrogen dominance can be caused by a lot of things including pesticides and pollution herbicides found in inorganic produce, environmental toxins found in tap water, BPA found in plastics, and chronic stress. Oestrogen dominance also varies in symptom and severity. Common symptoms include breast tenderness, fibroids, irregular periods, ovarian cysts, PMS symptoms, and of course, acne. 

• Polycystic ovarian syndrome (PCOS), is another common reason for high testosterone levels in women. Most women with PCOS, also have underlying causative factors like blood sugar dysregulation (insulin spikes) and chronic inflammation. are the underlying causative factors. This insulin surge signals the ovaries to produce excess testosterone. This excess testosterone prompts our sebaceous glands to overproduce sebum, which in turn causes acne (2).

Rise in Cortisol 

When we're stressed, our brain releases a hormone called corticotropin-releasing hormone (CRH), which signals our adrenals to release cortisol to deal with stress. In fact, every cell in your body has a CRH receptor. As a result, when we're stressed, CRH binds to its receptor on the skin cells, which promotes oil production, resulting in acne (3).  
According to a 2017 study, female medical students with heightened stress had worse acne. The study basically showed that stress and acne are strongly linked. Beyond psychological stress, physical stress such as environmental toxins, smoke, and UV radiation also creates a stress response, which can lead to acne and other skin conditions (4).  

Gut Imbalances  

In the last few years, there has been more and more evidence to show that our microbiome affects our hormones, specifically oestrogen. It turns out that our gut bacteria can actually secrete an enzyme called beta-glucuronidase, which causes oestrogen to recirculate in the body instead of being eliminated. When there's a microbial imbalance in the gut, some bacteria can produce more of this enzyme. When the gut has more beta-glucuronidase, hormones like oestrogen are excreted less. Recirculating oestrogen binds to oestrogen receptors and has a stronger oestrogenic effect on the body. Essentially, an imbalanced microbiome can lead to oestrogen dominance, which leads to acne.  

Food Sensitivities  

There are three main dietary triggers for acne: sugar, refined carbohydrate and dairy. Most cases of acne can be significantly improved by limiting these food groups.
A growing number of studies continue to show that sugar causes inflammation and insulin resistance, both of which are underlying factors in the pathway to acne. As the levels of insulin increase, the ovaries produce more testosterone, one of the hormones responsible for acne formation. In a 2017 study, researchers found that those with moderate to severe acne consumed more carbohydrates and showed greater insulin resistance compared to participants without acne (5). In another study in 2019, researchers found that drinking soda daily increased the risks of moderate to severe acne in adolescents, especially if they consumed more than 100 grams of sugar per day(9). Therefore it’s essential to limit not only refined sugar, but refined carbs as well. This includes foods like processed meals & snacks, white flours, pasta, cereals, pastries biscuits etc. 
Acne is also strongly linked to dairy, particularly cystic acne. In dairy products, there's a hormone called insulin-like growth factor-1 (IGF-1) and it’s found in cow, sheep, and goat. The name of the hormone reflects the fact that it has insulin-like actions in some of our tissues. For example,  the IGF-1 hormone can actually mimic the actions of our own insulin, and trigger our ovaries to produce testosterone. As a result, acne forms. Researchers evaluating the impact of dairy products on 78,529 individuals found that any dairy, such as milk, yogurt, and cheese was strongly linked to acne (6). 

Nutritional Deficiencies  

Nutrients like vitamin A, vitamin D, omega-3 & 6 essential fatty acids and zinc; as well as antioxidant as vital for skin health. A lack of any or all of these can lead to acne (7)(8).  

• You need vitamin A to support skin regeneration. Cod liver oil and orange-coloured vegetables like sweet potatoes, pumpkins, and squash are excellent sources of vitamin A.

• Vitamin D helps tame inflammation. Since acne has an inflammatory component, vitamin D is crucial for reducing this inflammation. Vitamin D is most readily absorbed through the skin. It is recommended to spend at least 15-30 minutes outside, though factors such as latitude and skin tone can impact vitamin D absorption.

• Essential fatty acids. The health of our skin’s structure depends on the health of its cells. Omega-3 & 6 essential fatty acids help to maintain cell membrane elasticity and structural health. They also happen to be precursors in molecules that are involved in signalling the resolution of inflammation. So without these omega 3 & 6 fatty acids in our diet, we have reduced capacity to resolve inflammation. Our body actually cannot make these essential fatty acids by itself therefore we need to get them through our diet or supplementation, regularly. Walnuts, hemp seeds, chia seeds, salmon, sardines, mackerel, and anchovies are excellent sources.

• Zinc is a crucial mineral for skin health as it protects against oxidative damage, as well as enhances vitamin A activity, which results in a more youthful appearance. Zinc is found most abundantly in oysters, clams, red meat, and poultry. Plant sources of zinc are available but are not readily bioavailable compared to animal sources of zinc.

• Antioxidants protect tissues from damage against reactive oxygen species and other free radicals and prevent unwanted inflammatory responses in the first place (9). Dark green, red, and purple fruit and veg, legumes & pulses, and seeds & nuts are great sources of natural antioxidants.

For more on this topic stay tuned!



Sources: 

1. Aggarwal S, Thareja S, Bhardwaj TR, Kumar M. Self-organizing molecular field analysis on pregnane derivatives as human steroidal 5alpha-reductase inhibitors. Steroids. 2010;75(6):411-8. 
2. Ju Q, Tao T, Hu T, Karadağ AS, Al-khuzaei S, Chen W. Sex hormones and acne. Clin Dermatol. 2017;35(2):130-137.
3. Ganceviciene R, Graziene V, Fimmel S, Zouboulis CC. Involvement of the corticotropin-releasing hormone system in the pathogenesis of acne vulgaris. Br J Dermatol. 2009;160(2):345-52.
4. Puri P, Nandar SK, Kathuria S, Ramesh V. Effects of air pollution on the skin: A review. Indian J Dermatol Venereol Leprol. 2017;83(4):415-423. 
5. Burris J, Rietkerk W, Shikany JM, Woolf K. Differences in Dietary Glycemic Load and Hormones in New York City Adults with No and Moderate/Severe Acne. J Acad Nutr Diet. 2017;117(9):1375-1383.
6. Juhl CR, Bergholdt HKM, Miller IM, Jemec GBE, Kanters JK, Ellervik C. Dairy Intake and Acne Vulgaris: A Systematic Review and Meta-Analysis of 78,529 Children, Adolescents, and Young Adults. Nutrients. 2018;10(8).
7. Siniavskiĭ IuA, Tsoĭ NO. [Influence of nutritional patterns on the severity of acne in young adults]. Vopr Pitan. 2014;83(1):41-7.
8. Logan AC. Omega-3 fatty acids and acne. Arch Dermatol. 2003;139(7):941-2.
9. Arulselvan P, Fard MT, Tan WS, Gothai S, Fakurazi S, Norhaizan ME, Kumar SS. Role of Antioxidants and Natural Products in Inflammation. Oxid Med Cell Longev. 2016; 2016: 5276130.