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.