Acne is a common problem that gives too many people too much grief. Many conventional acne (or acne vulgaris) treatments—antibiotics, oral steroids, hormonal birth control pills, and isotretinoin (sold with brand name Accutane)—have serious, sometimes downright scary, side effects. There may be cases when these nuclear options are necessary, but I know many folks would prefer to try diet, lifestyle, and more natural interventions first.
The good news is that as common as skin issues like acne are today, they are not an inevitable part of the human condition. Grandfather of the ancestral health movement Loren Cordain asserts that acne is basically unheard of in traditional-living societies.1 This strongly suggests that modern lifestyle factors underlie much of what we see today. And if that’s the case, then there are steps we can take to cut acne down at the source.
I’ve always believed that there is a deep connection between skin health, gut health, and inflammation. I’m not surprised when people tell me that their acne, psoriasis, eczema, and other skin conditions are “miraculously” resolved after going Primal. The Primal Blueprint is designed to support a diverse, well-balanced microbiome, reduce chronic inflammation, and provide epigenetic signals that optimize health. It makes sense that clearer skin would be one of the benefits.
Some skin is finickier than others, though. I can’t promise that dropping grains and sugar, swapping out pro-inflammatory oils for better fats, and working on sleep hygiene is doing to solve the acne puzzle for everyone. If you’re struggling to “love the skin you’re in,” as the saying goes, here are some things to try.
What Causes Acne?
Acne doesn’t have a single root cause, which is one of the reasons it can be tricky to address. Sebum (oil) production, pore blockage, bacteria like Propionibacterium acnes (aka P. acnes), and inflammation each play a role. Androgens increase sebum production, and hormonal changes related to puberty, menstruation, pregnancy, PCOS, or menopause often lead to outbreaks.
Although many treatments target what’s happening on the surface, your skin’s appearance and condition are part and parcel of the body’s overall health. Systemically speaking, hormonal balance (or lack thereof) and associated nutrient levels strongly influence the production of oil, the skin’s vulnerability to invasive bacteria (and presence of “good” defensive bacteria), the natural production and turnover of skin cells, and, of course, underlying inflammation. It doesn’t help that we live a modern existence full of inflammation triggers: pollution in the air and water, harsh personal care products, chronic stress, and lack of sleep to name a few. There’s also a strong genetic component to acne, and some folks simply appear to be more vulnerable, unfortunately.
Acne sufferers frequently need to try a variety of dietary, lifestyle, and topical interventions before (hopefully) finding what works for them. Pharmaceuticals may become necessary, and I’m not looking down on anyone who goes this route. I know how much of a psychological toll chronic acne takes. But I’m strongly biased toward starting with more natural holistic approaches when possible.
How to Treat Acne Naturally
This is a non-exhaustive list of remedies that are backed by science and that members of the MDA community have told me worked for them.
Diet and Acne
This is where everyone should start, in my opinion, regardless of what else they’re trying concurrently. There’s absolutely no doubt that what you eat is reflected in your skin (although I’m happy to report that chocolate doesn’t seem to cause acne). You could go the route of doing a total elimination diet with systematic reintroduction to identify potential triggers, but that’s an onerous process, frankly. Instead, you can just try these first:
Of paramount importance is checking your carb intake. Both observational and experimental studies link greater intake of high-glycemic carbohydrates to more frequent and more severe acne symptoms. High-glycemic load diets probably promote acne through several metabolic pathways, including by stimulating insulin-like growth factor 1 (IGF-1) and androgen and causing inflammation.23 For some people, acne is significantly improved simply by lowering the glycemic load of their diet, and I’m sure that this is a big reason why going Primal helps so many. If high-carb foods, especially of the hyperprocessed, nutrient poor variety, have snuck their way back onto your plate, you know what to do.
Anecdotally, dairy seems to cause skin eruptions for many of you, an observation confirmed by a recent meta-analysis which reported that folks who drink more milk are more prone to acne.4 The American Academy of Dermatology also recommends that acne sufferers limit dairy intake.5
For what it’s worth, skim milk seems to be more problematic than whole milk. Also, in that meta-analysis, there was no significant relationship between acne and cheese or yogurt consumption. I hear all you cheese lovers rejoicing at that news, but hold up. I’d still recommend cutting out all dairy for at least a few weeks to see if it helps. If you notice your skin clearing up, continue the no-dairy experiment for a while longer. Then, if you wish, you can start adding back dairy a little at a time, starting with fermented dairy (yogurt, kefir) and cheese (fermented or unfermented).
Other food sensitivities
I can’t tell you how many readers have confided they struggled for years, even decades, with acne before switching to a Primal diet and finally getting relief. Many of them traced the root of their problem to gluten. Others were particularly affected by dairy, soy, or eggs. Occasionally, random food sensitivities were the issue.
Consider keeping a food journal to see if you can spot any patterns between what you’re eating and your acne flare-ups. When you identify likely culprits, try cutting them out for a few weeks and see what happens with your skin.
Beyond the power of a clean, anti-inflammatory diet, I suggest adding a good comprehensive supplement as well as extra zinc,6 vitamin B complex (especially vitamin B3),7 vitamin A, and vitamin D to assist with regulating oil production and further boosting the skin’s natural repair abilities. Research has especially supported the role of zinc deficiency in acne. Women who are pregnant, nursing, or have recently weaned are particularly at risk because of higher need for zinc.
Also make sure you get plenty of omega-3s through small, oily fish or supplementation.8 Some folks report good experiences with adding evening primrose, an anti-inflammatory omega-6 as well.
Finally, a good probiotic can help your body (and skin) balance its own “good” bacterial defenses.9 Various Lactobaccilus and Bifidobacterium strains have been shown to improve skin health.10
Speaking of probiotics, if you want healthy skin, you need a healthy gut. There is a strong gut-skin connection, and skin problems like acne, rosacea, and psoriasis are often the outward manifestation of gut dysbiosis or intestinal permeability (“leaky gut”).11 You have nothing to lose by adding sauerkraut, kimchi, and other foods containing probiotics and prebiotics to your meals. If you’re not sensitive to dairy, try kefir, one of my favorite sources of probiotics. You can even try doing a yogurt mask since topical probiotic treatments could be beneficial.
Stress and Sleep
Stress causes a cascade of hormonal actions that, over time, deplete essential nutrient stores, especially minerals like zinc. We can’t always control the stressors in our lives, but most people, if they’re being honest, could put more effort into getting better sleep. Consider it an investment in your appearance as well as overall health. They don’t call it beauty sleep for nothing! Additionally, take up stress management methods that bolster the parasympathetic relaxation response to further support hormonal balance.
Finally, work on your skin’s surface. Don’t be discouraged if finding the products that make your skin happy takes a process of trial and error. What works for one person’s skin will aggravate the next. Here are some places to start.
Nicotinamide:Aka niacinamide, this topical form of vitamin B3 can reduce inflammation and help acne and improve skin’s overall condition.12
Willow bark: Contains a compound called salicin, which the body converts to salicylic acid. Aspirin works in the same way, so you can make a paste out of crushed up aspirin (the plain white pills, not the coated capsules) to use as a spot treatment or face mask. Or, of course, you can purchase creams and toners that contain salicylic acid, just watch for other gnarly ingredients.
Essential oils: Certain essential oils are particularly good for clearing up acne. Tea tree oil and thyme oil are two.1314 Always dilute them appropriately in a non-comedogenic carrier oil. Jojoba oil is a good one.
Other botanicalslike calendula and feverfew: Can be soaked and spread over the face with a cotton ball after washing in order to calm skin.
Apple cider vinegar: Diluted so as not to burn skin, exerts anti-bacterial and pH-balancing effects.
Zinc creams: For fungal acne specifically. Look for zinc pyrithione on the label (the same active ingredient in many dandruff shampoos).
Steaming: Visit the steam room at the gym or lean over a bowl of hot water with a towel draped around your face to open pores for a good cleansing, natural oil extraction, or absorption of botanical agents. Don’t scald yourself, obviously.
Pure water: Those with the worst skin conditions like severe acne or rosacea can benefit from rinsing with distilled rather than tap water.
Skin disorders are complex. The idea here is to take a holistic approach to supporting healthy skin. Although these suggestions might not serve as a cure-all, they are the best way to get at the root causes of the physiological imbalances behind acne. Furthermore, the natural topical options can support your lifestyle efforts without depleting skin of its natural moisture or defenses.
The remedies I mentioned here are not the only ones you might try, and severe or prolonged cases may respond best to a combination of treatments, including medications. Even if it takes a while to find your clear skin solution, the upside is that everyone benefits from cleaning up their diets, building a healthy gut, sleeping well, and reducing stress even if your skin issues are especially stubborn. No matter what your specific challenge, the following are always good practice:
Practice practical prevention: Avoid touching your face as much as possible and frequently wash items that touch your face (pillowcases, helmets, etc.).
What say you, MDA community? I know I just scratched the tip of the iceberg here. Tell me about your personal successes and challenges. What’s your secret for healthy skin? Maybe your advice can help someone else.
Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.