Thanks to modern technology and skincare advances across the board we have access to a plethora of acne-fighting products. Products that minimize pores, lighten hyper-pigmentation from old pimples, keep sebum production at bay, and give currently existing zits the boot.

Despite the myriad of potions and lotions promising clear, radiant skin, acne ranks as the most common skin condition in the U.S.^[1], with adult cases of acne on the rise,^[2] this according to the American Academy of Dermatology. What gives? While a perfectly tailored skincare routine plays a key role in enhancing the quality and integrity of the skin, you must also care for your skin from the inside out. Acne, like many skin issues, is a sign that something is out of balance in the body and to effectively treat it we need to identify the root cause, rather than just treating the symptom.

While most treatments fail to address the underlying causes of your acne, the good news is you can cure these body imbalances, and in turn your acne with a few lifestyle tweaks that don’t involve gut-wrecking antibiotics, hormone disrupting oral contraceptives, or liver damaging isotretinoin (aka Accutane®).

Keep reading to discover the underlying causes of acne and the most natural and effective ways to treat and cure it.

What Actually Causes Acne

Acne is one of the many subtle ways our bodies externally communicate internal disorders, imbalances, and other issues. Regardless of where it shows up, acne is the result of pores getting clogged with an excess of oil, dirt, and dead skin. That clog becomes a comedone (more commonly known as blackheads and whiteheads). If bacteria gets into the mix, the comedone can become inflamed and become a papule (a reddish pimple) or a pustule (papules that are filled with pus and look “poppable”). And then there are the most severe forms of acne, nodular and cystic pimples, which form below the surface of the skin and are more likely to leave scars.

All types of acne, including blackheads and whiteheads, no matter where they are on the body, are mainly caused by fluctuating hormones, an overproduction of sebum (skin oil), buildup of P. acne bacteria, and irregular shedding of skin cells. But what are the underlying causes of these imbalances, that is what factors contribute to these causal factors?

The Root Causes of Acne

1. Diet And Food Intolerances – Gut-Skin Axis

The connection between acne and food is real, and there is a direct correlation between the foods we eat, our complexion and our overall health.

This should really come as no surprise as your gut and your skin play similar roles. Both defend your body against pathogens, and both are covered in beneficial bacteria when in a healthy state.^[3] The more diverse the mix, the better.^[4] This also applies to your skin. Studies show that certain strains of bacteria found on your skin are associated with acne reduction, skin hydration, elasticity, and maintaining your skin’s overall health.^[5] Your gut’s job is to keep toxins, infections, and inflammation at bay. Your skin is the major detoxifier that helps eliminate the substances and waste created during this standoff. This connection and relationship is called the gut-skin axis.^[6]. When the gut is not functioning optimally, it can result in issues throughout the body, even to the point of autoimmune disease. The skin is often the first place to show the effects of an unhealthy gut.

Considering this, and the fact that our skin is our largest organ and one of the body’s primary detoxification pathways it seems fairly intuitive that our diet can impact the health of our skin both positively, and negatively.

2. Skin Inflammation From Insulin Resistance

The hormone insulin helps control the amount of sugar (glucose) in the blood. Insulin sensitivity or resistance describes how efficiently your body is able to get energy out of sugar and carbs. Sensitivity is good, insulin resistance means the body’s cells don’t respond normally preventing glucose from entering the cells. As a result, excess sugar and insulin stay in the bloodstream, causing inflammation and your glands to produce more oil, increasing your risks of acne.

If you eat a lot of sugar or foods that turn to sugar, things that are high on the glycemic index, they’re going to increase your blood sugar, which causes a spike in the hormone, insulin. That increase actually triggers excess sebum production, the oils in our skin, plus it increases androgen activity. That combination is one of the big triggers for acne.

Aside from insulin, too much sugar wrecks your gut, and a lot of skin problems originate in the gut. There’s no shortage of reasons to stop eating sugar.

Signs of insulin resistance include negative effects from blood sugar fluctuation, increased thirst, feeling cranky in between meals, fatigue, even blurred vision.

Researchers have connected the dots between acne and insulin resistance,^[7][8] it’s a good idea to reduce your sugar and carbohydrate intake and see if this improves your acne.

3. Irritation From Harsh Skincare

While you might be tempted to go nuclear on it on your acne, and wind up buying the most drying, highest-strength acne fighting product on the shelf there are a few problems with this strategy.

First, your skin has its own microbiome, an ecosystem of microscopic organisms living on its surface. A healthy level of oil on your skin helps support beneficial microorganisms that keep your skin clear, calm, and happy. Many products work indescriminately, killing Propionibacterium acnes, the stain of microbes responsible for causing acne, as well as the beneficial microorganisms (which target and destroy P. acnes preserving a healthy balance) which allows the P. acnes to flourish.

Second, when your skin oils are in balance, your skin’s oil production is a supply and demand system. If it’s dry, you make more oil. Oily, you make less. Things like hormones, insulin, and toxins can disrupt the balance. If you intentionally (or inadvertently) dry out your skin, thinking that removing oil is good for you, your skin will respond by ramping up oil production which in turn will lead to more breakouts. If you’ve ever broken out after a really intense exfoliation regimen, you’ve experienced this effect. That’s your complexion trying to restore balance after disrupting the skin’s lipid barrier.

This applies to harsh chemicals. Your skin may react to products you use, giving you acne, or something that looks like acne but is actually irritation. Avoid heavy fragrances, strong astringents, allergens, and other irritants to keep skin smooth. We recommend Environ’s Focus Care Clarity+ Range of acne fighting skincare products. The line contains combinations of scientifically researched ingredients that assist in improving the appearance of breakout-prone skin.

4. Hormone Imbalances

Your acne may signal a hormone imbalance if:

• You get acne along your jawline, chin, or cheeks
• You’re a woman and you break out around the same time every month
• The acne is deep and inflamed

This type of acne can be caused by any type of hormonal imbalance (estrogen or androgen dominance, PCOS, adrenal fatigue, insulin resistance, etc.).

For this reason, the most commonly prescribed form of treatment for women is oral contraception however, we STRONGLY ADVISE AGAINST THIS. There are numerous side-affects associated with birth control which doesn’t actually balance your hormones, not to mention the havoc it causes on your body simply isn’t worth it!

Aside from birth control, spironolactone is another commonly prescribed option for managing jawline acne. Although this medication is normally prescribed to treat high blood pressure, it also blocks the production of androgens, or male hormones, which can contribute to the development of acne along the jawline, mouth and chin. Again we’d advise caution here and would recommend you first explore natural solutions for balancing your hormones outlined below.

With hormonal acne, an adjustment in diet and lifestyle is needed (do your best to eliminate dairy, wheat, conventionally-raised meat, sugar, white carbs, unhealthy fats, caffeine, alcohol and processed foods). You can take your time adjusting diet and lifestyle so it’s a pleasurable experience and one that allows you to create a sustainable lifestyle.

Sleep and exercise are also important. If you’re not getting enough sleep, you don’t give your body enough time to detoxify properly, in addition to disrupting hormones. Exercise is crucial because cystic acne is almost always also related to lymph stagnancy and if you’re not moving, the toxins aren’t either.

Additionally, supplementing with diindolylmethane (DIM), works to balance hormones by blocking the bad estrogen pathways, and strengthening the good. As an added bonus, DIM contributes to weight loss by balancing estrogen levels and by suppressing adipogenesis (the formation of new fat cells)^[9][10][11] and stimulating the use of fat for fuel.^[12][13]

5. Gut Health And Sluggish Detox Systems

Gut health is another root cause. Multiple factors can erode gut health, including food sensitivities, imbalanced gut flora, insufficient production of digestive enzymes, and regular exposure to inflammatory foods. These can lead to leaky gut, unhappy intestinal microbes, poor nutrient absorption, and inflammation.

Add compromised detoxification pathways to the mix, and you have a recipe for skin problems.

If you have poor digestion and detoxification, it will show on your skin

Your sweat, digestion, urinary system, and especially liver all play a role in how your body deals with everyday toxin exposure. When one system slows down or gets overburdened, the other systems jump in to pick up the slack. It’s a beautiful arrangement when toxin levels are manageable and no system is severely compromised.

When other systems have too many toxins to deal with, or a major slowdown of other systems occurs (especially the liver), the extra toxins are eliminated through your skin. On the way out, these toxins (which include excess hormones) can cause damage and inflammation to surrounding cells, and that’s what you see as acne, rashes, and redness.

How To Treat Acne

As a major detox mechanism, your skin takes a beating from the inside out. As a defense mechanism from the elements, your skin also takes a beating from the outside in. So, that’s how to approach skincare. Address your inner systems that might not be working, while treating your skin topically.

Topical Acne Treatment: Sample Skincare Routine For Acne

Cleanse: Morning And Evening

Use a gentle cleanser that retains your skin’s moisture while washing away the elements. We recommend Osmosis Purify Enzyme Cleanser or Deep Clean Detox Cleanser, or  Environ Sebu-Wash.

Exfoliate: Daily, Then A Few Times Per Week

While you’re treating your acne, you’ll want to get rid of those layers of dead cells that aren’t turning over quickly enough to open up your pores.

Avoid harsh scrubs. Those can create micro-tears in your cells, which allow bacteria to spread inflaming your skin and making your acne worse.

• A retinol cream (Osmosis Clarify or  Envrion Concentrated Retinol Serum 1)
• A lotion or serum containing Lactic Acid (Osmosis Polish or Environ Sebu-Lac Lotion)

These gently slough off the old, damaged cells and make way for your pores to release the gunk that’s causing your acne. When things start to improve, you may choose to continue exfoliating daily, or you may back off to a few times per week.

Vitamin C Serum: 1-2 Applications Per Day After Cleansing Or Exfoliation

Vitamin C is a powerful antioxidant that fights free radical damage on the skin. The antioxidant action helps your skin in three ways. First, researchers have linked acne with a high proportion of free radicals,^[14] so vitamin C will snap them up at the source. Second, vitamin C reduces the appearance of scarring, dark spots and rough spots that acne may have left behind.

Since vitamin C serum reduces the signs of aging anyway, it makes sense to add it to your routine. Pick one that contains vitamin C, vitamin E, and ferulic acid. Vitamins C and E together have a good amount of research behind them, and ferulic acid stabilizes the mix.^[15][16][17] We recommend Osmosis Catalyst AC-11 or  Environ Sebu ACE Oil.

Moisturize: Morning And Evening After Exfoliation Or Serum

You might think that drying out your acne will get rid of it. As mentioned above, if you’re over-drying your skin, your skin will produce extra oil to compensate, and you’ll be worse off than you started.

You’ll see quick improvement with a good moisturizer. The most important quality of a moisturizer is that it’s non-toxic. Franken-creams can contain hormone disruptors that will make your acne worse.

You’ll also want to look for moisturizers containing lightweight non-comedogenic (not likely to clog pores) oils. Oily skin responds well to oils like olive, grapeseed, hazlenut, argan, and jojoba oils, among others. We recommend Osmosis Quench Nourishing Moisturizer or Environ Super Moisturizer+.

Since you’re not drinking water while you’re sleeping, you’ll want a heavier moisturizing cream at night to keep your skin cells hydrated until you take your first sip of water in the morning. we recommend Environ HA Intensive Hydrating Serum followed by Environ Super Mositurizer+.

Bentonite or Kaolin Clay Mask: Daily For 1-3 Days, Then 1-2 Times Per Week (After Cleansing, Before Serum)

Bentonite and Kaolin Clay are adsorbents meaning they draw substances into themselves. To adsorb a substance means the substance sticks to it.

Bentonite and Kaolin Clay have strong negative charges, which means they will pull out positively charged ions. Impurities on the skin tend to have positive charges, so if you smear on a simple Bentonite or Kaolin Clay Mask, they will draw out and bind impurities as they dry. We recommend Environ Sebu-Clear Mask.

Professional Facial: One Per Month

Our highly trained estheticians are acne specialist and are 100-percent committed to improving skin on a cellular level using a holistic approach combined with advanced technology, with your health in mind. They will create a custom tailored solution to fit your unique skincare needs. Our facial treatments use medical-grade cosmeceuticals, corrective products and tools to produce glowing results. Our advanced facial treatments help to cleanse, exfoliate and promote a clearer, well-hydrated, radiant complexion.

Monthly professional treatments such as our purifying facial will deliver the results you’re looking for helping to purify, soothe, and balance oily, problematic skin, while shrinking pores and improving your skin’s complexion. Deep cleansing combined with professional extraction serves to unblock pores and remove dead skin cells, Blue Light Therapy is used to purify the skin, stabilize oil secreting glands and combat the bacteria associated with acne. If required a custom peel can be added to further enhance the elimination of surface oils and the promotion of new healthy skin cells and accelerating the recovery of your beautiful complexion.

Treating Acne From The Inside Out

1. Fix Your Gut

One of the primary causes behind acne has to do with the gut, the gut microbiome, and increased intestinal permeability (aka leaky gut). We recommend addressing imbalances and healing the gut as a first step in treating acne that create problems in your whole body, the most noticeable place being the skin.

Here are some ways to address your gut microbiome…

2. Diet

Focusing on food is the first and best place to start. Keep two key factors in mind when curating an anti-acne diet: Make it anti-inflammatory and low glycemic. Luckily, foods that fight inflammation and foods that keep blood sugar stable are often one and the same.

When your blood sugar rises quickly, it causes the body to release a hormone called insulin. Having excess insulin in your blood can cause your oil glands to produce more oil, increasing your risks of acne.

Some foods that trigger spikes in insulin include:

• pasta
• white rice
• white bread
• sugar

Because of their insulin-producing effects, these foods are considered “high-glycemic” carbohydrates. That means they’re made of simple sugars.

Other researchers have studied the connections between a so-called “Western diet” or “standard American diet” and acne. This kind of diet is based heavily on:

• high-glycemic carbohydrates
• dairy
• saturated fats
• trans fats

According to research reported in the Journal of Clinical, Cosmetic and Investigational Dermatology, these kinds of foods stimulate the production of hormones that can cause excess oil to be created and secreted by oil glands.

They’ve also found that a Western diet is linked to greater inflammation, which can also contribute to acne problems.

Finally, there’s a great deal of research linking dairy consumption and acne.^[18][19] Researchers have found a high correlation between dairy consumption, especially skim milk, and teenage acne.^[20][21] One reason why is that conventional dairy products contain enough hormones to have an effect on your body.^[22] You can see the effects of excess hormones on your skin.

EAT: Plenty of FIBER from vegetables, chia seeds, flax seed, almonds, etc. Quality protein such as Organic Chicken and Grass Fed Beef (and Finished) (ButcherBox is a quality supplier we recommend), Wild Caught Fish (Vital Choice is a quality supplier we recommend) squash, cucumbers, celery, carrots, cabbage, beet tops, dandelions, aloe vera, mulberry leaf, lettuce, low glycemic fruits with high antioxidant levels such as; raspberries and blueberries, as well as alfalfa sprouts, and split peas.

Other things to try include taking a high quality probiotic and getting lots of supergreens. If you’re not up for eating a pound of veggies a day (which is ideal because it crowds all the worse food off your plate) then try spirulina, chlorella or a supergreens supplement. Keeping the body more alkaline by increasing the intake of green vegetables, as well as reducing meat and dairy can help combat acne.

AVOID: Conventional raised Chicken and Beef, as well as dairy products all of which contain hormones (that throw off your bodies natural hormone balance) as well as antibiotics (which damage your microbiota by killing the beneficial bacteria, leading to an overgrow of bad bacteria and yeasts both of which produce toxins and contribute to increased intestinal permeability, aka leaky gut), grains and gluten, excess caffeine (which causes your skin to become dehydrated leading to the over-production of sebum), alcohol (alcohol itself is a toxin and one that dehydrates our skin, it’s typically combined with sugary mixers), sugar (a food source for bad bacteria and candida yeast in your digestive track but also contributes to inflammation and hormonal imbalances), excessive table salt, chocolate, sodas, hydrogenated oils, and fatty / fried / processed foods

3. Address Hormone Imbalances

With hormonal acne, an adjustment in diet and lifestyle is needed (do your best to eliminate the foods mentioned above). You can take your time adjusting diet and lifestyle so it’s a pleasurable experience and one that allows you to create a sustainable lifestyle.

Sleep and exercise are also important. If you’re not getting enough sleep, you don’t give your body enough time to detoxify properly, in addition to disrupting hormones. Exercise is crucial because cystic acne is almost always also related to lymph stagnancy and if you’re not moving, the toxins aren’t either.

Additionally, supplementing with diindolylmethane (DIM), works to balance hormones by blocking the bad estrogen pathways, and strengthening the good. As an added bonus, DIM contributes to weight loss by balancing estrogen levels and by suppressing adipogenesis (the formation of new fat cells)^[23][24][25] and stimulating the use of fat for fuel.^[26][27]

There are many causes of estrogen dominance and other endocrine imbalances, and if these recommended strategies don’t alleviate your acne, you’ll want to work with a functional medicine doctor on this one. Functional medicine aims to uncover the root cause of a problem, while conventional medicine most often treats symptoms.

Hormones are complicated business, so you should dig as deep as you and your doctor can to address the chain reaction that leads to hormone problems and hormonal acne.

4. Boost Your Detoxification Pathways

The liver is the body’s main organ of detoxification. In the first phase of detoxification, toxins (including used-up hormones) are shuttled to the liver to be broken down. In phase two, the liver sends these broken-down toxins back out into the body to be eliminated. Elimination happens in one of three ways: through sweat, urine, and the bowels. You can optimize the detox process at every step of the way. Eating cruciferous vegetables (the broccoli and cauliflower family, for example) of supplementing with Pure Encapsulations Detox Pure Pack is one of the best ways to support liver function; getting regular exercise or making use of other sweat therapies (like infrared sauna) boosts sweat; staying hydrated keeps the bladder moving, and a high-fiber diet does the same for the bowels.

5. Light Therapy

The onset of acne breakouts begin because of bacteria in the pores of our skin. Blue Light Therapy at 415nm is predominantly used for its anti-bacterial properties and in the treatment of acne. The blue light emitted from the device is absorbed by porphyrin. The bacteria responsible for causing acne, Propionibacterium Acnes (P. Acnes)^{[28][29][30][31]} contains abundant amounts of porphyrin and when the blue light is absorbed an oxygen free-radical is created which is released into the bacteria and results in bacterial reduction. In addition, infrared light at 830nm reduces the size of oil-secreting glands^[32][33] that contain the bacteria. Blue light also has anti-inflammatory characteristics although the best results are seen when combining red and blue light for its additional skin rejuvenation and wound healing benefits. Red Light Therapy at 630nm reduces the activity of acne vulgaris by accelerating wound healing and reducing the inflammatory response.^[34]

Blue–Red Light uses low-level light therapy in both Blue (415nm) and Red (630nm) wavelengths. Multiple studies have shown it is well tolerated and effective through a reduction in inflammatory and non-inflammatory acne lesions and is superior to blue light alone.^[35] The mechanism is thought to be synergistic in applying the antibacterial and anti-inflammatory actions of both wavelengths of light acting at different depths within the skin.

6. Targeted Nutritional Supplementation

Optimizing levels of carotenoids; vitamins B, C, E and D; omega-3 fatty acids; and zinc, selenium, collagen protein, L-glutamine, and probiotics can help clear the skin (specifically probiotic supplements containing Lactobacillus Rhamnosus SP1 or GG, strains that has been linked to a reduction in adult acne^[36] ). Essential fatty acids such as those in fish, flaxseeds, evening primrose and borage oils can be helpful. Work with a trusted healthcare practitioner if you want to add supplements to your acne-fighting regimen. Remember, too, that even if you’re taking in a lot of high-quality supplements or whole-foods sources of these micronutrients, it doesn’t always mean that your body is absorbing them. If you suspect poor absorption is a problem for you, consult your practitioner.

Berberine has antimicrobial action and it helps stabilize blood sugar, so it helps fight breakouts on two fronts. Pure Encapsulations Metabolic Xtra includes Berberine, and three other powerful ingredients that help support insulin receptor function and healthy glucose metabolism.

7. Sunscreen Daily For Protection

You need to protect your skin from ultraviolet (UV) ray damage with a daily sunscreen.

With acne, you want to normalize your skin, which is the main barrier between you and the outside world. Protecting that barrier involves moisturizing it and protecting it from the sun. Sunscreen is a very effective way to do that. Look for an oil-free, broad-spectrum sunscreen with SPF of 25 or higher, noncomedogenic formula (so it won’t worsen their acne). Apply sunscreen daily in the morning and reapply throughout the day as needed.

What Not To Do For Acne

1. Do Not Pop Your Pimples

Just don’t. Your zits will look ten times more noticeable after you’ve messed with them.

2. Do Not Take Antibiotics As A First Line Of Action

If you’re looking into prescriptions, you’re probably pretty frustrated with your acne at this point. When you consider antibiotics, you have to weigh the pros with the cons to see if antibiotics are worth it. Is it a short-term solution, and will you have to keep repeating antibiotics? Is it worth wrecking your gut, knowing that there’s an intricate relationship between your skin (as well as your overall health) and your gut?

You can opt for topical antibiotics, which are certainly better than oral antibiotics, but keep in mind that your skin has a microbiome that antibiotics will disrupt.

It takes patience, but a better option is to support your immune system and address imbalances first.

3. Do Not Take An Isotretinoin Prescription Without Trying Everything Else First (Everything)

Sure, desperate times call for desperate measures. But medicines containing isotretinoin not only mask the true issue — they can cause serious lifelong side effects like:

• Crohn’s disease
• Depression and suicide^{[37][38][39][40][41][42]}
• Anxiety
• Severe birth defects if you take it while pregnant

The most well-known isotretinoin brand, Accutane®, is no longer available, but doctors still prescribe other isotretinoin brands with the same set of risks.

Isotretinoin permanently affects the communication lines in your hypothalamic-pituitary-adrenal axis^[43] which is “mission control” for your stress response, among countless other functions.

This is one of those times when even if your doctor extensively counsels you on this medication, you probably still will not cover the magnitude of long-term damage it can cause. Tread lightly. Get a second, third, and fourth opinion if you have to.

Pimples aren’t simply a skin condition. They’re a signal that something else is going on in your body. Keep asking your dermatologist and/or esthetician, “what caused that?” until you have a handle on the root cause of your acne. If you treat the symptom (ie. your acne) without treating the source, it won’t go away.

A synergistic hormonal acne protocol of topical skin care products, dietary modifications including supplements, lifestyle adjustments, and monthly clinical skincare treatments will deliver the results you’re looking for, allowing you to recover your beautiful complexion in as little as a month!

You’re not vain for wanting clear skin. Your appearance affects your job, your relationships and interactions, as well as your self confidence. More importantly, your skin indicates how your body is working and your overall health and wellness. Look at your skin as a main line of communication between the inside and the outside of your body.