It’s been almost ten years since we last covered acne in this newsletter. Now, a new decade, a new generation… time to cover the subject again.

Now that some of us are “all grown up,” it’s easy to forget how bad acne was, how miserable, how awful, how flat-out tragic every pimple and blemish could be. But they were, and for the next generation, they are. Research now shows that even moderate acne is associated with levels of anxiety and depression normally seen in chronic, debilitating illness. Let’s take acne seriously!

So what is this scourge, exactly?

Your skin has thousands upon thousands of pores. Inside these pores are sebaceous glands that produce an oily substance called sebum, which helps keep the skin moist and protected. We get acne when the pores get clogged, the sebum can’t get out, and the whole thing swells up like a balloon ready to burst. (Testosterone, produced by both males and females, increases sebum production, which is why teenagers with those mythical “raging hormones” are usually the hardest hit). On top of that, clogged pores make an ideal home for the bacterium Propionibacterium acnes, which colonizes the pimple and causes the area to become inflamed. (All of us have P. acnes on our skins, but we don’t all have acne. The bacterium isn’t the problem so much as conditions which allow it to overgrow). The immune system, in turn, can respond to the infection and inflame the area further.

So, what to do?

Diet: Conventional wisdom says you are what you eat, and certainly nobody wants a face like a greasy, extra-cheesy, “meat lover’s” pizza. So folk wisdom says acne sufferers ought to eat a low fat diet. Research doesn’t necessarily agree. True, a number of studies have found a weak link between total fat intake and severity of acne. However, a number of other studies have found no link at all.

Unfortunately, none of the studies I’ve seen have explored different types of fat. What would we see if we separated the consumption of healthy fats from that of greasy fats? While we don’t actually know, I choose to believe that French fries, margarine, and aerosol cheese make acne worse; while avocados, wild salmon, and walnuts make it better.

Where the research is clear is in terms of dairy. There’s a growing body of solid evidence that dairy makes acne worse. Here as well, it’s tempting to wonder if we might distinguish between “healthy” and “unhealthy” dairy – raw, grass-fed milk vs. processed, industrially-raised and -processed greasy-cheeze. Unfortunately, however, it appears as though the issue is with dairy itself, not how the cow is raised or the milk is processed. Low fat, high fat, it doesn’t matter… An occasional glass of milk or slice of pizza won’t be the end of the world, but, generally, dairy should be minimized.

It also appears that high-glycemic foods make acne worse. High-glycemic foods are those that spike blood sugar, so basically foods high in refined starches and sugars, as well as fruit juices. So think lots of pasta, white rice, potatoes, white bread, cookies, cakes… And soda, of course. Soda is a killer.

Foods that are good for acne? Again, I can’t cite solid, definitive research, so let me just rattle off some opinions. Eat a diet rich in whole plant foods. Here “whole” means whole grain as opposed to refined. And to take it even further, intact vs. ground down into flour. And follow Michael Pollan’s maxim of eating “more leaves than seeds.”

Foods that should be especially helpful are those that are cleansing or nourishing to the liver. Think radishes (including daikon and horseradish, even wasabi), as well as burdock root, turmeric, artichoke, and fresh Mediterranean leaf herbs like basil, oregano, and thyme. Garlic and onions should be used liberally. A dish of steamed greens with olive oil, lemon juice, and garlic is a simple cleanser as well, and delicious.

Supplements: There’s a lot out there, but the big two for me are zinc and liver cleansing herbs.

Zinc helps the immune system fight off bacteria, is needed to process fats and oils in the body, and helps process testosterone. 13- and 14-year-olds have the lowest zinc levels of any age group, and acne sufferers are even worse off, with less zinc in their blood, hair, nails, and skin compared to others their own age. When you see this, and then remember how important zinc is for normal growth, wound healing, brain chemistry, and liver health, you’d probably want to take zinc acne or not.

And zinc should help acne, too, although, depending on how you look at the research, this is still controversial. On one hand, there are quite a few studies which show zinc to be just as effective as antibiotics in treating acne, with fewer side effects. But on the other hand, there are studies which show zinc not to be effective at all. Why the discrepancy? Well, earlier studies used poorly-absorbed zinc sulfate and showed little or no effect. More recent studies, however, have had much better results using the better-absorbed zinc gluconate or effervescent zinc sulfate (which chemically reacts in the fizzy drink to form zinc citrate and tartrate). Even better absorbed are zinc picolinate and zinc monomethionine (“Optizinc”).

I’d take 30 mg of zinc, twice a day. Zinc makes some people nauseous on an empty stomach, so take it with food. Also, zinc can displace copper from the system. If you drink tap water, which is copper-rich, you probably have copper to spare. Still, you might want to take a zinc-copper combo, just to be safe. Most people will notice a reduction in symptoms within two weeks.

Liver-cleansing herbs can also be a big boost for acne sufferers, and they work well together with zinc. Anything supportive of the liver should be helpful here, but what you’re really seeking out are the herbs that increase the production and flow of bile. Look for herbs like yellowdock and burdock, dandelion root, boldo, artichoke leaf, celandine and Oregon grape root. Planetary Herbals makes a nice combo product called Yellowdock Skin Cleanse. Rainbow Light’s Active Teen Multi is a good all-around multivitamin with a decent dose of live-cleansing herbs thrown in. Be aware that these can make acne a little worse for a week or two, before making it better.

Finally, vitamin B6 can help acne. A study dating back to 1942(!) gave B6 to 37 acne sufferers, and a placebo to 35. The B6 users started on 25 mg twice daily, but went up to 50 mg 5 times daily if the lower doses weren’t working. 24.3% of the B6 users showed “complete clearing” and 51.5% showed “definite improvement”; versus 0% and 20% respectively in the placebo group. B6 helps balance hormones levels, therefore it might be especially useful for women whose acne flares with monthly cycles.

Bodycare: keeping your face clean can be a big help. The problem is soaping, soaping, and soaping some more can leave your face dry, irritated, and flaky. Here, it’s especially important to use a non-soap cleanser. Cindy, who runs our bodycare department, recommends Himalaya Neem & Turmeric Face Wash, a gentle non-soap cleanser. Turmeric is a clarifying anti-inflammatory. Neem is a mild but effective antibacterial. She also speaks very highly of the MyChelle Clear Skin series, with sulfur and zinc, to unclog pores and calm blemishes. They have everything from cleansing pads to spot treatments.

While we’re on the subject of topical zinc, I should mention one of the best ways to get zinc on your face: diaper rash cream. The German company Weleda makes a Calendula Diaper Care which has been a store favorite for over 20 years (my grandmother, Beatrice Stark, never left home without it, and my mother carries on the tradition). Strange to think we’ve been around so long that we’re now selling the same product to teenagers that we did to their parents years ago…