Acne is traditionally associated with hormonal changes during puberty and adolescence, but many women (and men) also suffer from this issue in adulthood, often with a hormonal origin but also influenced by lifestyle. Androgens (male sex hormones present in women as well) play a clear role in the onset of this problem, but do not explain 100% of cases. In the developed world, there is a true acne epidemic: around 85% of teenagers and up to 50% of young adults have it.
"No matter how prevalent or common it is, we should not normalize it, just as we cannot normalize that nearly 50% of adults are overweight or obese, or that there is childhood obesity," emphasized Gustavo Guillermo Garriga Martina, a specialist at the Gederma Clinic (Malaga), in a presentation on this condition at the congress of the Spanish Academy of Dermatology and Venereology (AEDV) held recently in Maspalomas (Gran Canaria).
The example could not be more relevant since, as dermatologists explained, acne and overweight are linked to the Western lifestyle. A study published in 1972 in the Archives of Dermatology already provided clues on the subject. Almudena Nuño González, a dermatologist at the Institute of Medicine and Advanced Dermatology in Madrid, recalled this in the same presentation: "The Eskimos have gone from living in igloos, using harpoons and dog sleds to living in heated houses, going to the supermarket, and using cars. And they go from not having acne to having it. From there, it was thought that lifestyle and diet could be influencing it."
While some people may have a genetic susceptibility to acne, there are modifications caused by the exposome (all non-genetic factors to which a person is exposed throughout their life), which includes almost everything we do and are exposed to.
According to some studies, the pilosebaceous unit (consisting of the pore, the hair that grows in it, and the sebaceous gland) could be the "brain" of the skin: it receives endocrine, immune, microbial, and environmental information. "In addition to diet, many other factors influence us, for example, pollution, which oxidizes the skin's lipids a lot and promotes inflammation; also heat and humidity, described for a long time along with UVA radiation (such as acne in Mallorca or tropical acne)," Nuño indicated, also mentioning the use of masks (in sectors like healthcare) or certain cosmetics that are not suitable for our skin. Not to mention smoking and hormonal imbalances associated with stress.
To address adult acne, in addition to following treatment guidelines, dermatologists suggest addressing these causal phenomena so that treatments are more effective and to prevent its reappearance upon discontinuation. Many women who go to the gym, take care of themselves, and supposedly eat well do not understand why they still have acne, but often our habits are not as healthy as we think. Here are five tips:
Mediterranean, Vegan, or Paleo Diet
Once again, the benefits of the Mediterranean diet come to the rescue for a health problem: a diet rich in vegetables and fruits, olive oil, quality fats, and proteins like fish or poultry "is associated with lower sugar spikes, less acne occurrence, and a better microbiota because everything is somewhat related," Nuño pointed out. The issue is that we have a diet rich in carbohydrates and processed foods that promote acne. How does it work?
"Acne is a pathology derived from a state of anabolism where androgen plays an important role, but where we must talk about metabolic and dietary factors that converge on a complex of proteins called mTOR, which is the key that opens the doors to anabolism in the body," Garriga explained. Anabolism involves protein synthesis, muscle mass gain, growth, lipid synthesis, muscle proliferation, or immune system activation, the specialist indicated, detailing that mTOR is mainly activated (and thus acne) by animal-derived proteins, both dairy and meat, and by foods with a high glycemic and insulin index.
Garriga emphasized that there are "two highways, and to activate mTOR, we must have both pathways activated at the same time. The first pathway is amino acid-dependent, while the second is mediated by glucose metabolism, insulin, IGF1 (insulin-like growth factor)." Acne appears when mTOR is activated above the physiological threshold, something that happens with Western diet patterns "where we overload on dairy, sugar, animal-derived foods...". Regarding the first pathway, caution must be taken with branched-chain amino acids (BCAA): leucine, isoleucine, and valine, which are mainly found in animal protein. "In practical terms, 100 grams of a steak are equivalent to the amount of leucine contained in 100 apples, so the difference is huge. Let's try to consume plant-based proteins, which have less leucine, and opt for fish over meat," Garriga advised.
The specialist noted that dairy products have two types of proteins: casein (80%) "and the famous whey proteins (the remaining 20%). Both casein and milk in general, as well as fermented dairy products, especially the combination of dairy and sugar, like ice cream, are a bomb for mTOR because they ultimately activate both pathways at once." Regarding the second pathway, mediated by sugar metabolism, insulin, etc., Garriga stressed the need to avoid generating too many insulin spikes through diet and recommended two types of diets to prevent excessive mTOR activation: the vegan diet and, less restrictive, the modified paleo diet, "which mimics what we ate about two million years ago, when agriculture was not yet developed: it avoids the consumption of cereals, legumes, dairy, sugar, and ultra-processed foods found in any supermarket today. You can consume meat, fish, eggs, fruit, vegetables, etc., but without overdoing animal-derived foods."
Take care of your gut microbiota
What we eat affects the intestinal microbiota (the bacteria living in our digestive system), which becomes imbalanced with ultra-processed foods, for example, leading to inflammation that travels to alter the skin's good bacteria - known as the gut-skin axis, connecting these two organs. All the inflammation that occurs in the intestine influences the Cutibacterium acnes bacteria (which lives on the skin and is harmless, but when there is imbalance or excess oil, it proliferates and causes acne).
"First of all, sending probiotics is useless if we don't eat well. That is, if we don't change our diet, the three months of probiotics we send may improve, but then it will return to its baseline microbiota based on how we eat, because what we have in the intestine is how we eat."
Oral Supplementation Yes, Protein Shakes...
Supplements taken in the gym when doing strength training to gain muscle, such as protein shakes, "are a machine to activate mTOR," emphasized Garriga, "and therefore acne." The dermatologist explained that whey protein supplements have different versions, but some, in addition to proteins, add carbohydrates and lactose, others have a higher insulin index, and some supplements contain BCAAs (leucine, isoleucine, and valine), the amino acids that most activate mTOR (and acne).
Regarding oral supplementation, Nuño pointed out that there is not enough scientific evidence, but there are supplements that have already shown to improve acne. This includes Omega 3 (reduces inflammation and lesions, modulates the gut-skin axis and microbiota, and can help reduce adverse effects of isotretinoin, a derivative of vitamin A considered the most effective treatment for severe acne), vitamin D3 (immunomodulatory and anti-inflammatory, can improve the response against Cutibacterium acnes), zinc (anti-inflammatory and antimicrobial, reduces inflammatory papules), and to a lesser extent, vitamin A, myo-inositol, or berberine.
Less Sedentary Lifestyle and More Exercise
Sedentary lifestyle is associated with acne, as key hormones like cortisol or insulin are altered. Especially being seated for more than four consecutive hours. "Moreover, it is associated with more severe acne, while moderate exercise reduces overall inflammation and is associated with less severe acne," Nuño explained. If one has a job that involves sitting for many hours, one can do movement snacks: small doses of exercise for a few minutes (if in an office, simply standing up every hour and climbing stairs or doing squats may be sufficient).
There are no studies on acne and exercise, but there are on a sedentary lifestyle, Nuño explained. However, using logic, it stands to reason that the benefits of exercise are also helpful for this condition, as they reduce inflammation, help eliminate toxins, and even improve acne lesions. "By moving for just 20 minutes a week—which is easy to do—we significantly reduce cardiovascular risk and the incidence of cancer. Ideally, it would be one or two hours a week or even more, but anything extra we do—as long as it's not extreme sports or activities that don't allow the body to rest—is beneficial," she concluded.
Going to bed before 11 p.m.
The dermatologist also mentioned adequate rest, "not so much the fact of sleeping for just a few hours, but going to bed late, after 11 p.m., because it disrupts the circadian rhythm. The hormone corticotropin [which activates the stress response] is disrupted, and we may experience changes in cortisol levels, leading to a hormonal imbalance and inflammation that can contribute to hyperseborrhea—that is, increased sebum production and the onset of acne," according to Nuño.