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Pills or Paleo? Preventing and Reversing Acne and Other Skin Problems

on June 21, 2016

by Chris Kresser

Acne and skin problems may not be life-threatening, but they’re associated with depression, anxiety, and social isolation. Conventional medicine has very little to offer for these conditions, but Paleo offers a safe and effective way to prevent and even reverse them.


Over 3,000 distinct types of skin disease have been identified, and skin diseases are extremely common in the industrialized world. Between 79–95 percent of adolescents and 40–54 percent of adults in western societies experience acne. Twenty-five percent have dermatitis, 11 percent have eczema, 5 percent have rosacea and 1 percent have psoriasis.

Yet while skin conditions may seem like a fact of life for those of us living in the industrialized world, anthropological studies have found that they are rare or virtually non-existent in hunter-gatherer cultures. (1) This suggests that most skin disorders are influenced primarily by environmental—rather than genetic—factors, and that changes in nutrition and lifestyle may be sufficient to prevent and even reverse them in many cases.

Acne and other skin problems got you down? Find out how to treat them naturally, without drugs or steroid creams.

The skin is influenced by other organs in the body, and this is especially true of the brain and the gut; scientists coined the term “gut-brain-skin axis” to describe the interconnection between these three systems. As far back as the 1930s, researchers had connected emotional states like anxiety and depression to changes in the gut microbiota, which they theorized promotes local and systemic inflammation and skin disease. (2) These pioneering early theories have been confirmed by modern studies showing strong associations between skin conditions (like acne, eczema and psoriasis) and both mental health problems and digestive disease. (3)

Unfortunately, the conventional approach to treating skin problems does not acknowledge the important role of diet, lifestyle, and digestive health. Instead, it is almost entirely focused on suppressing the symptoms.

With all of this in mind, let’s compare conventional treatment with a Paleo-type diet and lifestyle for the prevention and treatment of acne and other skin problems.

Conventional treatment for skin disorders

The most common treatments for acne include topical creams and gels like Retin-A, Differin, Renova, and Tazorac—which work by unclogging pores—and oral antibiotics, like doxycycline, tetracycline, minocycline, or erythromycin—which kills the bacteria that causes inflammation around the blocked pores. In teenage girls and young women, doctors might also use oral contraceptives as a means of attempting to regulate hormonal imbalances that can lead to acne. Finally, in the most severe cases of acne, doctors may prescribe a medication called isotretinoin, which was originally marketed as Accutane.

The effectiveness of these treatments varies. The creams and antibiotics help some quite a lot, while for others they have little effect. Oral contraceptives do seem to outperform placebo in the treatment of acne for teenage girls, but they must be taken for 3–6 months to have their maximal effect. Isotretinoin is a very powerful treatment for acne, which can even clear up severe, scarring breakouts that don’t respond to antibiotics, creams, or contraceptives.

But the potential side effects and risks of these treatments is often substantial, and in some cases, life-altering. For example:

  • Long-term use of antibiotics has a profoundly negative impact on gut health, one that we are only beginning to understand. Given that disturbances of the gut microbiota are associated with everything from anxiety and depression, to obesity and diabetes, to autoimmune disease, the consequences of taking antibiotics for months or years should not be underestimated. 
  • The list of side effects associated with oral contraceptives is so long I can’t even post it here. But it includes nausea, vomiting, constipation, acne, hair growth in unusual places, crushing chest pain or heaviness, extreme tiredness, coughing up blood, and swelling of the gums.
  • The side effects and complications for isotretinoin (aka Accutane) are downright scary. In fact, due to the number of adverse events reported (including severe fetal abnormalities in women taking Accutane during pregnancy) and an FDA-issued “black box” warning, Roche stopped manufacturing Accutane in 2009. Accutane has also been linked to inflammatory bowel diseases like ulcerative colitis and Crohn’s disease, as well as an increase in suicides. Many people who were harmed in these ways by taking Accutane have successfully sued Roche.

In the case of other skin disorders like psoriasis and eczema, treatment often involves oral and topical steroids. Talk about a laundry list of side effects and risks! These include:

  • Weight gain
  • Acne
  • Mood changes, including aggression
  • Thinning skin
  • Muscle weakness
  • Cushing’s syndrome (stretch marks across the body, acne, fatty deposits in the face)
  • Osteoporosis (even at a young age)
  • Diabetes
  • High blood pressure
  • Glaucoma and cataracts
  • Increased risk of infection

I don’t discount the psychological suffering that acne and other skin conditions can cause, but when dietary and lifestyle changes can often mostly or completely resolve the condition, it’s difficult to make an argument for putting patients at risk with these medications.

A Paleo-type diet for skin disorders

As I said in the beginning of the article, acne and skin disorders are shockingly common in the industrialized world, but nearly unheard of in hunter-gatherer cultures. That should tell us that there is something about our modern diet and lifestyle that is contributing to skin disease. It also suggests that returning to a way of eating and living that more closely mimics are ancestral template could be an effective means of preventing and treating skin problems.

The most important thing to understand about virtually all skin disorders is that, like all other “diseases of civilization”, they are inflammatory in nature. So they key to addressing them is to follow an anti-inflammatory diet and lifestyle. That’s what Paleo is all about. For example:

  • Paleo eliminates the highly processed modern foods that provoke inflammation, such as refined flour, excess sugar, and industrial seed oils.
  • Paleo encourages regular physical activity, which reduces inflammation and strengthens immune function.
  • Paleo promotes getting adequate sleep, which has also been shown to reduce inflammation and support healthy immune function.

Another common cause of skin disorders in the modern world is nutrient deficiency. In the industrialized world we are overfed, but undernourished. In fact, more than half of Americans are deficient in zinc, calcium, magnesium, vitamin A, vitamin B6; and about one-third are also deficient in riboflavin (B2), thiamine (B1), folate (B9) vitamin C, and iron. (4)

In addition to reducing inflammation, Paleo works well for skin conditions because it’s so nutrient dense. Studies have shown that the meat, fish, vegetables, fruits, nuts, seeds, and starchy tubers featured in the Paleo diet are the most nutrient-dense foods we can eat. (5)

Finally, Paleo is a very gut-friendly diet, which is important given the strong connection between the gut and the skin. For more on this subject, see this previous article I wrote on ChrisKresser.com about the gut-skin connection.

But just how effective is Paleo for reversing skin problems? I see fantastic results in my work with patients every day, and I’ve also received hundreds of success stories from readers, like this one from Malori Mayor (note the connection we’ve discussed here between gut and skin!):

My skin problems (eczema and acne) started over 10 years ago, when I was 16. The eczema got so bad at that time that I got a cortisone shot. My stomach problems started over 5 years ago, beginning with lactose intolerance, discovering by personal trial that I was gluten intolerant a little over 2 years ago, and eventually receiving a diagnosis of lymphocytic colitis and mild small intestinal inflammation 6 months ago. I have also experienced chronic joint pain all over but especially in my hands.

My GI doctor prescribed me Uceris for the colitis but I chose to be non-compliant and never got the prescription filled. Despite the nurse telling me that “there is no natural remedy for colitis” I was determined that there was. I also knew that skin issues and stomach disorders are closely related, as I’m a nutrition nerd that loves reading and studying on my own.

I had been kinda-sorta doing Paleo (gluten free, sugar free and mostly dairy free), but at the end of May I decided to do a 30-day reset, as Chris talks about in Your Personal Paleo Code. I even blogged about it to keep myself on track! I followed the Autoimmune Protocol (AIP), and about halfway through, I realized that my joints did not hurt AT ALL. My GI symptoms were almost non-existent, the awful eczema patches on my hands disappeared after the 30 days, and my acne flare-ups stopped. It was totally amazing!! 🙂

Now I don’t adhere to a strict AIP diet – I can tolerate white rice, goat dairy, and nuts in moderation – but I try to avoid nightshades, seeds, and eggs for the most part, as I notice joint pain and skin issues flare up when I eat those things too much. As for my stomach? Gas and bloating used to be a daily thing for me, but now it’s only occasional.

So what will it be for your patients? Pills, or Paleo?

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