Friday, November 26, 2010

Acne, Depression, Omega 3, Vitamins, and Minerals

In 2008 some folks from a Beverly Hills skin clinic wrote up a short paper in Lipids in Health and Disease called Acne vulgaris, mental health and omega-3 fatty acids: a report of cases (free full text). The experiment itself was an open-label trial of a mineral/omega-3 supplement on five patients, so useful only as a reason to do further research. But a lot of interesting science tidbits on acne, omega-3s, and minerals are noted in the article, so it's worth a peek.

Acne is a disease of civilization which, like depression, has increased the last half century, especially in women. As we discussed in my blog post, Acne and Suicide, patients with acne are more likely to be depressed, angry, and suicidal. In fact, patients with acne struggle more with mental health issues than even patients with epilepsy or diabetes (according to a study comparing questionnaires between sufferers of acne and other general medical conditions).

Acne is accompanied by the overproduction of Sebum, a waxy oil, in addition to inflammation, hormonal shifts, and infection. Inflammation is one of the earliest manifestations of the disease, particularly mediated by a leukotriene called LTB4. This inflammatory chemical helps up-regulate sebum production, and you might be interested to know that the omega 6 fatty acid derivative arachidonic acid is made into LTB4, while the omega 3 fatty acid EPA (from fish) inhibits the conversion of arachidonic acid to LTB4. A study of 1000 teenagers in North Carolina showed lower incidence of pustules, acne cysts, and oily skin in those teenagers consuming the most fish. Another study showed that patients with acne ate low amounts of seafood. In my own clinical experience, young adults with acne have experienced a reduction in severity when they begin to supplement with fish oil (though it is not a complete cure, and doesn't seem to help everyone). However, many have a very noticeable improvement. There is a prescription drug, zileuton, that inhibits LTB4 and improves acne, but it would seem a fish prescription might be more practical.

Patients with acne, being in a state of systemic inflammation, also seem to have lower serum amounts of several vitamins and minerals, specifically zinc, vitamins A and C, and selenium. Studies of all these supplements, some administered topically, some orally, or both seemed to show some benefit. In addition, EGCG from green tea has been "suggested to be helpful in acne due to its well documented anti-inflammatory and antioxidant activity."

Acne is also worse in people with poor control of blood glucose, and the supplement chromium is known to have some minor benefit in that area. There was one open label trial of 400 mcg of chromium daily that seemed to help.

So in this experiment, five patients (three males and two females aged 18-23) were given a supplement with 1000 mg of EPA, EGCG 200mg, zinc gluconate 15 mg, selenium 200 mcg, and chromium 200 mcg to take daily. They didn't use any new topical treatments or change their diets in any way. The number of pimples and amount of inflammation was noted with a standardized acne scale at the beginning, and measured again at the end of two months. In addition, each patient took a before and after test measuring mental, emotional, and social well-being.

The results? Four of the five had improvement in number of lesions, and all seemed to have a reduction of general skin inflammation. Sense of well-being improved 24% (with a range in the five patients of 20-27%). The authors thought this improvement might be due to the EPA, but since EPA seems less important in the brain than its sister fish oil, DHA, I'm prone to be skeptical. I wonder if the improvement might be due to the generalized reduction in inflammation.

All told, this tiny little open-label trial can't allow us to draw too many conclusions. Without a control and some more data points, we can only tuck the information away as something to look at further. Now a healthy Paleolithic diet with organ meats and fish would provide the vitamins, minerals, and EPA (not sure about the EGCG). Especially in an active hunter-gatherer who would consume and burn more calories, and therefore more nutrients along the way. I feel saturated fat itself helps the skin (thinking of the adolescent Masai warriors, or the beautiful people of Thailand, and my own experience starting with a more Cordain-inspired lower fat paleo diet, and a few months later switching to a higher fat primal diet.) My skin is much less sensitive and I'm not prone to breakouts at all with the absence of gluten and the increase in saturated fat of my primal-style diet. In fact, one of the ways I know I've been slipping a little too much (a birthday party here, a wedding to go to there) is if a little spot pops up.

Everyone benefits from an improvement in looks. One of the fastest ways to improve mental health in my clinical experience is to help someone successfully get into fat-burning mode and clear the skin. Clinical experience and common scientific sense is one thing. Real controlled trials are something else. Bring them on.


  1. Thanks for the article! That study of 5 pations was interesting.

    Here are some other links I found very interesting:

    and especially this:

    I was something like 1,5 years on low carb but it didn't cure my (mild-moderate) acne. My low-carbing ended because I had some adrenal burnout symptoms and I noticed that my calculated calorie intake was something like 1000-1500kcal per day because I couldn't swallow any higher amounts of fatty foods because I got the feeling of satiety very quickly. I thought it's not healthy to eat such little food if I had stress-related symptoms too so I added some starch to my diet. I still don't know what caused that hypophagia on low-carb diet. Maybe it's some digestive enzyme insufficiency? Dunno, but at least noticed some time ago that I had stomach acid insufficiency and HCl supplementation helped me with insomnia (and waking up in middle of night), some annoying muscle feelings and it seems even to correlate negatively with acne symptoms as today my acne symptoms are very scarce.

    (Sorry for my English :P)

  2. Hi Emily.

    What do you think about the possible connection between lactose consumption, acne, and the other diseases that seem to be linked with acne?

    Maybe this is restricted to those who are lactose intolerant, although lactose intolerance at various levels seems more widespread than many people thing.

  3. Hi Valtsu - traditional low carb diets are often very high in dairy and omega 6, and thus would not be that terrific for acne. A paleo low carb diet should be good, as it combines the attributes of low inflammation, promoting good glucose control, and is less likely to have much dairy sugar or protein. Though you'd want to be careful about drowning yourself in bacon and poultry for the omega 6. However, as I mentioned, in my own case, wheat seems to cause a bit of a breakout, whereas dairy (I sometimes have a bit of cheese or a full fat yogurt, or sometimes even sour cream) doesn't seem to have an effect. I would guess each person's inflammatory signals are different. And we also have to consider maximizing immunity due to the infectious causes of acne. I don't know if moderate carb paleo would be better for immunity or not, especially on the skin.

  4. Hi Ned - I'm familiar with the large 2005 epidemiological study linking dairy consumption to acne, and also the connections between androgens of adolescence, PCOS, hyperinsulinemia, IGF-1, and acne. I know that dairy tends to stimulate IGF-1 but I've always blamed casein. I feel certain you are referring to another set of studies - throw me a link!

  5. It would be great if there were more interest in taking such suggestive little studies as starting points for more programmatic, controlled studies. I notice, too, that I only get pimples after cheat days that involve wheat and/or industrial oils. Like you, dairy does not seem to have any negative effect on my skin complexion or other markers of inflammation. I eat a lot of cheese (mostly raw), some full-fat greek yogurt, lots of butter (from grass-fed cows), and some whole raw milk in my coffee every morning. I've been back on a low carb primal diet the past few weeks to lean out and it's amazing how quickly it happens! But I have left dairy (mostly fermented) in rotation and feel and look great. It certainly seems that some people tolerate dairy very well while others do not.

    Now I'm off to have some sardines and Brazil nuts for breakfast.

  6. Thanks Emily. I was not referring to any particular study. Purely anecdotal; just keep hearing from people that acne follows dairy consumption, with exception of aged cheese. The latter is low on lactose, but otherwise a concentrated form of milk.

  7. Emily, in fact my diet was quite close to Kwasniewski OD, but there were some exceptions. I avoided grains and fatty pork (omega6) quite strictly and I also never could eat enough fat so my diet was also quite hypocaloric (though I didn't understand that until I started get some stress-related symptoms). I think a bit more likely explanation for acne problems isn't inflammation caused by dietary choises but maybe deficiency/malabsorbtion of minerals and protein because of my probably stress-related hypochlorhydria. Now I have had quite little acne symptoms for some weeks and it's not long since I started on quite large betaine HCl doses (4*520mg per meal) and occasional 15mg zinc doses. But I'm not really sure if my acne is almost cured, it's possible it's just gone for a while and will return again.

    That dairy thing is interesting. According to Staffan Lindeberg, lactose causes insulin resistance in calves and casein causes in rats. Relevant? :P

  8. Ned - aged cheese has the proteins broken down somewhat, I wonder if that makes a difference.

    Valtsu - there are so many variables! I tend to like the Perfect Health Diet approach, myself. Drs Jaminet seemed to have accounted for most of the variables. Though, to be honest, I'm not up to counting all my calories or separating my eggs from my egg whites...

  9. I have completely cleared my severe adult hormonal acne only by changing my diet to a strict paleo diet (with cheese and yogurt)

    It is absolutely incredible and I wouldn't have thought that you could do that with diet alone. I tried all of the things you mentioned. Zinc, fish oil etc. And none improved my acne noticeably but when I changed my diet the change was quick and incredibly dramatic. I feel better, and look fantastic as I dropped ten pounds and have beautiful skin! I am so grateful that I found out about paleo and I will never look back.

    Great Blog!

  10. Great Post !
    The brief information about acne has helped me a lot to take decision to which kind of treatment i should choose the Acne problem.

    Thanks for providing such information.

    obagi nu derm starter kit

    Alison Clarke


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