Acne is the most common skin condition in the United States. It affects between seventeen and forty-five million people. It is a condition that affects the skin over areas of the body with large oil glands, causing clogged pores and lesions. (2) These lesions can take the form of whiteheads, blackheads, pimples, and cysts. Whiteheads are caused by bulging follicle heads, while blackheads are plugs composed of oil and dead skin cells that are open to the surface. Pimples are infected, inflamed raised red spots with white centers, and cysts are caused by blockages and inflammation deep inside of the hair follicles.(3,14)
Acne lesions form due to an overproduction of sebum, irritation of hair follicles due to irregular shedding of skin cells, and an overgrowth of bacteria. However, the exact cause of acne is not known. There are many conditions that are thought to influence the overproduction of sebum. In teens, androgens are mainly involved in the activation of the sebaceous glands and overproduction of sebum. Family history of acne and contact with oils and grease are also important. In adults, hormonal imbalances (e.g. cessation of oral contraceptives), and some medications are recognized as additional important factors.(3,14,18)
Acne is not considered to be a serious health threat (2,20). However, severe acne can cause permanent damage to the skin, leaving the patient both physically and emotionally scarred. Furthermore, the most common conventional allopathic treatments, which employ the use of both topical and oral medications such as antibiotics and isotretinoin, can be the source of further grief because of their potentially serious side effects. (2,8,10,11,13,14)
Even though scientists admit that there is no cure for acne and the reasons why acne develop cannot be fully explained, many insist that diet does not play a role.(3,4,14,15,17) This is despite the fact that patients are generally advised to stop eating specific foods that aggravates the condition.(4,15,17) In addition, a recent study suggests that the typical western diet, which is high is refined carbohydrates, causes a permanent increase in insulin that leads to an increase in hormone levels. These increased hormone levels stimulate sebaceous secretions and in turn causes clogged pores, the growth of bacteria, and the formation of acne.(17)
In Traditional Chinese Medicine (TCM) there are at least six different patterns that can cause acne. The most basic or common would be toxic heat, and clearing heat from the appropriate channel or organ can provide relief for some patients, but not all. Identifying the correct pattern is the key to providing individualized treatments.(11,12,16,18)
Although acne is mainly treated with herbal medicine in TCM, dietary imbalances are thought to play a role both in its etiology and treatment.(1,11,17) Lifestyle advice, including dietary recommendations, are given when treating a patient with acne. Treatments focus on the root of the problem, not just the branch. When using TCM properly, not only can the condition be treated effectively, but also side effects can be kept to a minimum and the overall health of the patient can be improved.
General Dietary Recommendations
Dietary Recommendations for acne sufferers include eating a healthy diet with plenty of fruits and vegetables, supplementation with certain vitamins and minerals, drinking sufficient amounts of water, and staying away from foods which may exacerbate the condition. A general TCM dietary approach includes foods that drain dampness and are cooling in nature.
A vegetarian diet is a good place to start for many acne patients. Androgens are thought to be responsible for the production of sebum. When hormones are out of balance as a result of eating meat which also contains hormones and other similar substances, acne may develop.(5) Whole foods, fiber, fresh vegetables and fruits are preferred. Vegetables in include those that are rich in beta-carotene such as carrots, winter squash and pumpkin. The provitamin A and beta-carotene foods are thought to be especially beneficial if there is inflammation.(7,12)
Greens such as dandelion greens, beet greens, spinach, kale, chard, celery, and watercress are beneficial for individuals with acne. In addition, wild blue-green and spirulina (both micro-algae) are helpful. Seaweeds are cooling and detoxifying, and are therefore also recommended. These greens are rich in chlorophyll, which is thought to purify the blood and therefore reduce the toxins that cause acne lesions.(12) Other foods that can be freely added to the diet include mung beans, adzuki beans, and unpeeled cucumber slices. These drain dampness and clear heat.(12)
A diet free of processed and refined foods is also recommended. Acne sufferers should avoid refined sugar, spicy, fatty, fried foods, margarine, and other foods containing hydrogenated vegetable oils. Chocolate, caffeine, soda, iodine-rich foods, citrus fruits, oysters, herring, and shrimp, milk and milk products and/or wheat can aggravate acne conditions in some people. If milk products are needed in the diet, those from goat’s milk are considered the best choice for those with skin diseases. In addition, drinking plenty of water can help keep the skin sufficiently hydrated and help maintain bowel regularity.(6,7,12,20)
Deficiencies in essential fatty acids and faulty metabolism of fats have been linked to acne in cases of hormone-related acne. This is the reason why fried foods and hydrogenated oils should be avoided, and also why fish such as salmon and sardines, flax and sunflower seeds, which are good sources of essential fatty acids, should be added to the diet.(5,12,20) Omega-3 fatty acids in particular are thought to reduce inflammation.(8) When using oil for cooking or for salads, unrefined sesame oil is best.(12)
Vitamins and Minerals
People with severe forms of acne have been shown to have low serum levels of Vitamin A, a fat-soluble vitamin that is needed to maintain hormonal balance, and which may also therefore help lower the production of sebum. High doses of Vitamin A can have toxic side-effects, including birth defects, so intake should be carefully monitored. Since Vitamin E, beta-carotene and Zinc are all needed for the formation of Vitamin A, these should also be added to the diet. Absorption of Vitamin A can be increased by eating a healthy diet that is free of unhealthy fats like margarine, hydrogenated oils, and processed food. Vitamin A is found in carrots, green leafy vegetables, and yellow/orange fruits.(5,20)
Vitamin B6 is particularly effective in acne cases.(5) Vitamin B6 may help improve acne associated with menses. This is because it is the proper metabolism of steroid hormones requires adequate amounts of B6. Vitamin B6 can also make the skin less sensitive to the effects of testosterone.(20)
Zinc in the form of zinc gluconate or zinc sulfate is associated with improved complexion in acne sufferers. Zinc may help prevent acne, help heal acne lesions, reduce inflammation, and decrease the effects of androgens on the skin. It is thought that low levels of zinc, lead to an increase in the production of androgens. Zinc can be found in whole grains, brazil nuts, pumpkin seeds, and brewer’s yeast.(5,20)
As simple carbohydrates are consumed, levels of chromium decrease. It is estimated that 90% of the population is deficient in chromium. Supplementation with chromium in such people has been shown to improve acne conditions.(5)
Selenium is a trace element has been shown to improve acne conditions and the associated scarring when coupled with vitamins A and E.(5)
Acne is the most common skin condition in the United States. Its cause cannot be explained clearly by western science, and treatments with conventional pharmaceuticals can have deleterious side-effects. Such treatments should be employed as a last resort. It is not only the prudent but also the ethical choice to seek out other ways of treating acne. An individualized treatment approach that includes dietary recommendations may be just as effective as pharmaceuticals and should be explored first.
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