INFLAMMATION AND OXIDATIVE STRESS: THE CORE OF ACNE
It has become widely accepted that long-term inflammation is connected to virtually all chronic health conditions. Chronic inflammation is known to wreak havoc on the body, so it should be no surprise that it also affects the skin! Inflammation occurs early in the acne process, so it is important to identify the triggers of inflammation.[1]
Another cause of many chronic health conditions is oxidative stress, also called oxidation or free-radical damage. Free radicals can damage DNA, proteins, lipids, cell membranes, and more in the body. In the skin, oxidation promotes inflammation and can be another trigger for acne!
To reduce acne, we need to focus on reducing inflammation and oxidation. How can we do that?
How to reduce inflammation
Let’s talk about inflammation first. A major trigger in acne is elevated levels of inflammatory chemicals. To help with acne, we want to dampen the inflammatory cascade. The first step: reduce consumption of inflammatory foods. It is known that the production of certain inflammatory chemicals is highly dependent on the presence of a specific fatty acid called linoleic acid. Linoleic acid is the most heavily consumed Omega-6 fatty acid. It is beneficial in small amounts, but the problem is that our modern diet is excessive in linoleic acid (linoleic acid is high in safflower, soybean, sunflower and corn oils - meaning processed foods!).
It is extremely important to eliminate foods that cause inflammation. Although there could be many foods that cause inflammation, the foods below are linked to inflammation that can promote acne:
High glycemic foods.[2] Refined carbohydrates (chips, cookies, pastries, baked desserts, candy, most energy bars, fried foods, etc.) spike blood sugar, which can increase the hormones that stimulate oil production. Additionally, these hormones can change the skin composition, making it more prone to acne formation![3]
Dairy (skim cow’s milk in particular).[2] Milk contains the proteins whey and casein: whey increases insulin levels, which affect blood sugar regulation, while casein promotes the release of IGF-1. IGF-1 is a growth hormone that is needed in healthy amounts, but with excess it might fuel diseases like cancer or skin disorders like acne. Skim milk has more of these hormones added to make it taste less watery![3]
Omega-6 fats. One factor to look at is your Omega-3 and Omega-6 ratio; the goal is to reduce the consumption of omega-6 fatty acids, and increase omega-3s. Genetically, we have been accustomed to consuming these fats at a 1:1 ratio. Today, some people consume up to 20:1 ratio – meaning WAY too high in omega-6! A diet that is heavy in omega-6 oils promotes inflammation and oxidative stress.
Trans fats. Trans fats are added to processed foods to extend shelf stability. However, the body does not recognize them. Trans fats have been shown to be pro-inflammatory![4] Sources of trans fats include fried foods, commercial baked goods, fast food, and margarine.
Palmitic acid. This type of saturated fat is associated with inflammation. Palmitic acid, found in palm oil, interferes with an enzyme that breaks down an inflammatory chemical, therefore more of this chemical is available to cause inflammation.[5]
Once you have removed inflammatory foods from your diet, the next step is to consume anti-inflammatory foods. Omega-3 fatty acids are well known to be extremely anti-inflammatory - they diminish the activity of inflammatory chemicals.[5] The best source of omega-3 fatty acids is oily cold-water fish, e.g. salmon, sardines, mackerel, anchovies, and herring. Other foods with omega-3 fatty acids include walnuts, deep green leafy vegetables, and flaxseeds.
Here is a list of nutrients and food sources to reduce inflammation (these nutrients are particularly important for skin health!)[5],[6]:
Omega-3s (eicosapentaenoic acid (EPA)): fatty fish, walnuts, ground flax seeds, flax oil
Gamma linolenic acid (GLA): evening primrose oil, borage oil, black-currant oil
Curcumin: turmeric
Ginger
Epigallocatechin-3-gallate (EGCG) polyphenol: green tea, especially matcha
Zinc: oysters, lean meats, beans, nuts, seeds, oatmeal, whole grains
Probiotics: Orally consumed pre- and pro-biotics have been shown to reduce systemic markers of inflammation and oxidative stress[7]
I want to point out that some of the foods listed above could contribute to more inflammation if there is an underlying gut imbalance, for example a bacterial overgrowth. We will learn more about gut bacterial overgrowth in the upcoming blog post about SIBO.
Oxidative stress
Oxidative stress damages the skin. What can we do to reduce oxidative damage? In addition to avoiding external free radicals (for example UV rays from the sun, pollution, x-rays, cigarette smoking, industrial chemicals), we want to consume antioxidant-rich foods. Antioxidants defend us against free radicals and prevent their formation. We have antioxidants that our body can make, but we also need dietary nutrients to build them and make them effective.
It is particularly important for acne sufferers to consume higher amounts of antioxidants. Research shows that acne sufferers may be under increased local and systemic oxidative stress. They have lower levels of antioxidants and anti-inflammatory nutrients in their blood – this could be an indication that there is an increased demand of both antioxidants and nutrients for those who suffer with acne.[6]
Below is a list of nutrients and food sources that are particularly helpful to address oxidative stress in acne sufferers[5],[6]:
Vitamin A: cod liver oil
Carotenoids: sweet potatoes, orange and yellow fruits and vegetables, spinach
Vitamin E: nuts and seeds (especially almonds, sunflower seeds)
Selenium: whole grains, nuts, seafood, salmon, halibut
Epigallocatechin-3-gallate (EGCG) polyphenol: green tea, especially matcha
Zinc: oysters, lean meats, beans, nuts, seeds, oatmeal, whole grains
Curcumin: turmeric
Anthocyanins: blueberries, dark cherries, purple carrots, pomegranates, acai, purple sweet potatoes, purple cauliflower, black grapes, beets
Want an easy way to reference the best foods for acne? Click here to download an eBook that lists the nutrients and foods to reduce inflammation and oxidative stress to help your acne.
In addition, prebiotics and probiotics taken orally can reduce both oxidative stress and inflammation. Because acne sufferers undergo oxidative stress, the use of oral probiotics may be helpful[8]. However, as I mentioned above, it is important to make sure there is not dysbiosis in the gut, since the probiotics may be benefiting the wrong microbes.[9]
Now that we’ve learned about inflammation and oxidation, it is crucial to point out that food is not always the magic bullet. No amount of anti-inflammatory and antioxidant-rich foods can reduce inflammation until the root cause of the inflammation is addressed!
Let’s dive deeper into the 1st source of inflammation that originates in the gut: Small Intestinal Bacterial Overgrowth (SIBO). SIBO results in an imbalance in the microbiome, nutrient malabsorption, injury to the cells in the small intestine and a compromised gut lining – all of which set the stage for widespread inflammation that is both systemic and local to the skin.[3] In our next blog post, we can assess if SIBO could be the trigger for your acne!
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REFERENCES
[1] Rubin MG, Kim K, Logan AC. Acne vulgaris, mental health and omega-3 fatty acids: a report of cases. Lipids Health Dis. 2008;7:36. Published 2008 Oct 13. doi:10.1186/1476-511X-7-36 [2] Zeichner JA, Baldwin HE, Cook-Bolden FE, Eichenfield LF, Fallon-Friedlander S, Rodriguez DA. Emerging Issues in Adult Female Acne. J Clin Aesthet Dermatol. 2017;10(1):37-46. [3] Bowe W, Loberg K. Dirty Looks: the Secret to Beautiful Skin. New York: Little, Brown Spark; 2019. [4] Hadj Ahmed S, Kharroubi W, Kaoubaa N, Zarrouk A, Batbout F, Gamra H, Najjar MF, Lizard G, Hininger-Favier I, Hammami M. Correlation of trans fatty acids with the severity of coronary artery disease lesions. Lipids Health Dis. 2018 Mar 15;17(1):52. doi: 10.1186/s12944-018-0699-3. PMID: 29544473; PMCID: PMC5856295. [5] Logan A C. The Clear Skin Diet. Nashville, Tennessee: Cumberland House Publishing; 2007. [6] Rubin MG, Kim K, Logan AC. Acne vulgaris, mental health and omega-3 fatty acids: a report of cases. Lipids Health Dis. 2008;7:36. Published 2008 Oct 13. doi:10.1186/1476-511X-7-36 [7] Clark AK, Haas KN, Sivamani RK. Edible Plants and Their Influence on the Gut Microbiome and Acne. Int J Mol Sci. 2017;18(5):1070. Published 2017 May 17. doi:10.3390/ijms18051070 [8] Bowe W, Patel NB, Logan AC. Acne vulgaris, probiotics and the gut-brain-skin axis: from anecdote to translational medicine. Benef Microbes. 2014;5(2):185-199. doi:10.3920/BM2012.0060 [9] Lipski E. Digestive Wellness : Strengthen the Immune System and Prevent Disease through Healthy Digestion. Mcgraw-Hill; 2020.