Acne – Using the Therapeutic Order

We all know the feeling too well… you wake up, look in the mirror, and BAM! There is a massive pimple right in the middle of your face on your nose. Of course today is the day where you wanted to talk to the cute person at work, have your photo ID picture taken, or just really did not want to deal with Acne.

Acne Vulgaris, is a skin condition that affects more than 80% of people between the ages of 12-21 y/o and is increasing in frequency with adults. Acne rates are lower in “non-Western” societies, which supports evidence that there is a diet/lifestyle factor at play. Some people have more mild versions, while others, the unlucky ones like myself, have what seems like a constant struggle between them and the pimple face. Typical ‘conventional’ treatments include harsh topical lotions, prescription drugs, and antibiotics. Don’t get me wrong, when I have a zit, I want it gone ASAP, but these treatments often leave my skin red, dry, scaly, and sensitive.

Doctors have Acne too! Morning wake up, make up free, no filter selfie! #loveyourself

Doctors have Acne too! Morning wake up, make free, no filter selfie! #loveyourself

Why does Acne happen?

While the cause of Acne is multifactorial (multiple factors contribute to getting it), studies have shown that hormone disruption and imbalance play a strong part. During times of hormonal imbalance there is…

  1. Increased production of sebum (oily lubricant that’s secreted through sebaceous glands to the skin and normally helps protect the skin from the elements). Overproduction, blocks pores and can lead a pimple.
  2. Overproduction of keratin (protein that has protective properties for the skin), which when increased, can block pores leading to pimples.
  3. Increased sebaceous gland creation, so there are more locations for acne to develop.

All of these factors and more can lead to pore blockage and possible infection, which results in increased bacteria and yeast growth. This leads to increased inflammation to the skin, which causes pustule formation and skin redness as well as cysts, nodules, and in bad cases scars!

Which hormones are to blame?

For males: testosterone as well as enzyme 5-alpha reductase which converts testosterone to DHT.

For Females: the male hormones as well as estrogen and progesterone.

The hormones involved with stress reactions also come into play especially in adult acne.

But I’m not an adolescent, why do I have acne?

There are many other reasons/causes for acne. Some other causes involved with hormone dysfunction are:

  • Pregnancy
  • Menses
  • Menopause
  • Medications: oral contraceptives
  • Increased emotional stress

There are also other related factors including genetics, nutritional deficiencies, food sensitivities, poor digestion, yeast overgrowth, and stress.

Lastly, another common related factor to acne is poor nutrition. Fat, sugar, and processed foods increase skin inflammation, which in turn can increase acne and other skin eruptions. They also can lead to constipation due to a variety of factors including lack of fiber in the diet. This can lead to a back up of toxins and waste in the body, which the body tries to expel in other routes, including the pores. Gross!

Natural Treatment Options!

There are many ways to treat acne. As a Naturopathic Doctor we typically start with the least invasive treatment and move up in intensity as needed. Today we are going to focus on the first step in the therapeutic order, removing obstacles to provide a cure and improving the external/internal environment for the body to heal itself.

Lifestyle Modifications


Wash your face! Remove make up, dirt, and other grim at night before you go to bed and in the AM when you wake up.

If you wear make up, try to use make up that does not contain harsh toxins. If you don’t want to change your make up routine, it is VITAL that you remove the make up at night before bed to allow your face and pores time to breath!


Fresh produce from the farmer's market yesterday. All this for $20! Increase your produce intake, improve your health.

Fresh produce from the farmer’s market yesterday. All this for $20! Increase your produce intake, improve your health.

Sample diet ideas:

Simple diet of basic, unprocessed foods is recommended! Ideal acne diet breakdown: 45% protein, 35% carbohydrates, 20% fat!

Ideal acne diet macronutrient breakdown!

Ideal acne diet micronutrients breakdown!

NERD OUT MOMENT: This diet will produce less 5-a-reduction of testosterone and enhance cytochrome P450 hydroxylation of estradiol (which are therapeutic goals of acne drug treatments). Essentially a diet lower in carbs will help balance hormones, specifically testosterone and estrogen. 

Also high carbohydrate diets lead to chronically high insulin levels, decreased levels of IGF-1, and increased inflammation. Decreased carbohydrate diets do the opposite!

Other diet suggestions:

Eat more dark-green or orange veggies (raw/lightly cooked to keep nutrients and fiber). The Carotenoids in these foods help to maintain and repair the skin


Garlicky collard greens #eattheleaf

Increase your fiber and drink lots of water to ensure proper elimination of food and waste! Try ground flaxseed (1/4 cup) with water (8 oz) every day to be more regular. If you need more help, drink a glass of water every 2 waking hours.

Increase your intake of essential fatty acids and vitamin E, both of which help to maintain beautiful skin! Do this by eating nuts & seeds (i.e. pumpkin, walnut, almonds, etc.).

Eat healthy protein like beans, peas, lentils, eggs, etc. as well as protein rich in omega-3 fatty acids like fresh cold-water fish (i.e. salmon, mackerel, herring, and sardines). You can still eat meat, but make sure it is antibiotic and hormone free.

Helpful Tip! If you are on antibiotics for your Acne try to eat live, unsweetened yogurt daily. This acts as a probiotic and will help reintroduce health bacteria back into your gut. Add some honey or fresh fruit to make the yogurt more palatable. 

Foods to Avoid:

These vary person-to-person, but are things to try! All the things listened below increase inflammation in the body. By avoiding all or any other these foods you can decrease overall inflammation and decrease acne flare-ups.

Bacon is still ok, because we all love bacon!

Bacon is still ok, because we all love bacon!

  • Junk food & processed food (i.e. refined grains, colas, candy, etc.)
  • Processed sugar & sugar substitutes like Saccharine & Aspartame. Sugar is my personal trigger, so I do periodic sugar cleanses (2-3 per year for 21 days each) to help decrease my overall inflammation levels. Every time I cleanse, my acne decreases/disappears. 
  • Saturated fats, hydrogenated fats, trans fatty acids, and high fat foods. Especially fried foods, solid fats,  margarine, lard, and vegetable shortening. These are hard to digest, increase inflammation, and disrupt sebaceous gland secretion.
  • Foods that create an acidic internal environment (alcohol, sugar, chocolate, fried foods, soda, and meat). No you do not have to give these up for life, but if they are your acne trigger, eliminating them or decreasing them in your diet may help your symptoms.
  • And this last one pains me to say, due to my own personal addiction, but coffee and other caffeinated beverages can cause problems for some. Try an herbal tea or decaffeinated coffee instead.
All the coffee for days!

All the coffee for days!

Food sensitivities

This will vary from person to person. If you have stubborn acne that will not go away, considered trying an elimination diet to see what your food sensitivities are. The most common culprits include dairy, wheat, sugar, chocolate, potatoes, and corn.

Physical Activity:

Exercise every day! People that exercise tend to have less overall inflammation. Also, exercise tends to lead to sweat, which can help expel toxins and build up in pores. Just DO NOT wear make up when you workout if at all possible, especially the thick stuff! Trust me your face will thank you!


Anything that reduces stress will help to improve acne, especially if it is stress based. Exercise, prayer, meditation, reading, yoga, and many other techniques can help to decrease stress. Sunlight can also help by decreasing bacterial growth. 15 minutes a day is recommended, but never let your skin burn!


Overall, Acne Vulgaris is a multifactorial condition that affects the majority of us throughout our lifetime. Genetics, hormones, stress, and diet are all factors that contribute to Acne and its severity. Lifestyle changes like diet, physical activity, hygiene, and stress reduction are treatment areas that can be easily modified to help decrease the severity of Acne and possibly eliminate it. Other areas of natural treatment include supplements like vitamins/minerals/botanicals, physical medicine, and topical treatments. We will come back and explore these other treatment options at a later time.

My name is Emma Petshow and I am a 3rd year naturopathic medical student at the National College of Natural Medicine in Portland, OR. For more about myself, check out my bio. This blog is intended for information about preventive health and lifestyle improvement. The information contained on this blog is not to be used as medical advice. For specific medical advice you should consult your physician.
Sugar cleanse update day #5
Sugar cleanse day #5 selfie! Feeling pretty good today. Yesterday I had a mild headache all day, but so far I am feeling more energized today.

Sugar cleanse day #5 selfie! Feeling pretty good today. Yesterday I had a mild headache all day, but so far I am feeling more energized today.


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