acne

The Gut-Brain-Skin Axis
03/11/2011 - 21:38

 When I was a child I was obsessed with several things, but two of them were Motown Oldies and aliens. I also had a bad habit of hearing things rather strangely. A good example would be the song "It's in his kiss" by Betty Everett. For quite some time I thought it was actually "It's in his skin." Since I was also into aliens I kept thinking about would would be in his skin besides baby aliens? I must have seen that scene from Alien when my mother wasn't looking...

Today I found a paper that is about how your skin isn't just a reflection of whether or not aliens are gestating within you, but whether you have a healthy gut. This paper has almost all of the real food/paleo blogospheres interests: probiotics, cod liver oil, leaky gut, acne, stomach flora, depression, and aliens. Just kidding about the aliens. Unless you consider our gut flora aliens...who knows?

Acne vulgaris, probiotics and the gut-brain-skin axis - back to the future?

Either way, the authors have put together many interesting puzzle pieces to lend support to the idea that the bacteria in your gut are connected to the condition of your skin and your mood. 

So first there is the association. I bet you are thinking that "of course people with acne aren't happy because acne sucks." But there are a lot of other medical conditions that probably suck more like epilepsy and diabetes. Mental health impairment scores, a measurement of distress, are higher for acne sufferers than from people with these conditions and many other unpleasant illnesses. The gut connection has also been documented, for example in a student of 13,000 adolescents that found that people with acne were more likely to experience stomach problems, in particular abdominal bloating. These and other studies are shining a light on this connection, but it has been theorized for a very long time. The authors of this paper particularly pay homage to a 1930 paper by dermatologists John H. Stokes and Donald M. Pillsbury that contained this hypothesis. 

I would like to get ahold of this paper and have requested it at school. One of the main reasons is it apparently contains evidence that many people with acne have low stomach acid AKA hypochlorhydria. The idea that many people have a sub-clinical form of condition is popular in alternative health circles and I've looked for evidence for some time and it seems to be poorly studied. 

Also, 80 years ago these dermatologists were thinking about stress altering gut bacteria and this leading to leaky gut (abnormal intestinal permeability)!! Whoa. These doctors were ahead of their time.

The lack of research into stomach acid in otherwise "healthy" people is unfortunate, but the growth of heartburn in America has given us some research that we can make some inferences with. For example, half of people on proton pump inhibitors, a heartburn medicine that gives you low stomach acid on purpose, have small intestinal bacterial overgrowth. Wow, I'm so glad I got off those...SIBO is connected with leaky gut pretty well in the medical literature.

 SIBO has also been connected with depression. Most research needs to be done on specifically connecting acne to SIBO, but it's clearly something to investigate. 

Studies found that people with acne have circulating endotoxins from gut bacteria in their blood, which healthy controls did not have. These endotoxins belong in the gut, not in the blood and it's likely they got there through abnormal intestinal permeability. Eventually the body develops reactions to these toxins, which have been connected to depression and anxiety. 

 There is also evidence that decreased digestive transit time can be caused by stress and this increased time can lead to bacterial overgrowth as well. Constipation has been connected to acne in several studies. Other studies showed that people suffering from constipation have low levels of good bacteria. 

So what did they do about this issue in 1930? Their prescription was for fermented milk and cod liver oil...sounds kind of Weston A. Price-ish huh? But wait! Doesn't dairy CAUSE acne? Well Cordain and other paleo authors who have made that connection have rightfully said that dairy contains IGF-1, which IS connected to acne. BUT fermentation reduces this 4-fold. And studies on dairy and acne show the connection doesn't hold for fermented dairy. Dairy also contains the anti-inflammatory protein lactoferrin, which has shown to decrease acne. 

A Russian study showed that drinking milk fermented with lactobactillus reduced acne and an Italian study showed that a probiotic with freeze-dried L. acidophilus and B. bifidum did the same. Saccharomyces cerevisiae has been found to improve both acne and constipation, as well as to improve the integrity of the gut lining. Surely more studies need to be done, but it sounds promising. 

Interestingly probiotics might also help with depression. One study found that depression patients had low levels of lactobactillus. Some other studies have shown depression can respond positively to probiotic treatment. Why? They have been found to increase tryptophan levels, alter serotonin and dopamine turnover (those are the neurotransmitters that antidepressants alter), decrease negative response to stress, increase omega-3 tissue levels, decrease internal lipid oxidation and other good stuff. Unfortunately some of these studies were on mice, so we need more human studies. But there have been a few studies in humans and they have shown positive effects. 

The authors of the paper make a valuable point which is that in many folk health theories there is a focus on things rotting in the gut which causes constipation which causes all manner of problems. Usually the thing they blame is meat. This has led to way too much focus on what ends up being a symptom which is ironically caused by things not rotting in your gut. But rotting is kind of a mean term for the valuable services that gut bacteria perform. They will rot your body, but that happens AFTER you die...

This research is especially important because common treatments for acne include some seriously harsh drugs with terrible side effects, as well as antibiotics, which might end up making other problems worse since they decrease all bacteria instead of improving the gut ecology. 

Isn't it crazy that little tiny weird bacteria can affect your appearance and mood so much? Maybe I was right about the aliens...

 

Comment?: 0
A Pox Upon Thy House: Vague and Annoying Sources of Symptoms
11/19/2010 - 23:48

A commenter writes in:

I have been wanting to increase my [carbs] and veggies as its pretty much zero right now, I have never felt better(though the current state is less than perfect) but meat is not cheap and I want to have a more diverse diet. But it seems that every time I eat something plant based I start getting acne, rashes, asthma, dry skin and other minor annoyances again, lately I tried to eat potatoes and I immediately noticed a minor shortness of breath and it didn't take more than a couple of days before my face was glowing red and I started getting dry flaking skin. You say you eat rice - brown rice?

Yes, this is a real problem. Many of us started paleo because of sensitivities and diversifying our diets can be frustrating. I don't think this was a problem for humans in the old days, but modern humans have a different immunological milleu. What causes it? A major hypothesis is that it's caused by too-clean environment in childhood, which we can't exactly undo now.

Before I started messing around with my diet and going veg*n and then paleo, I never had acne. But since I went vegetarian I've had it occasionally and while paleo has lessened it, it still appears occasionally, usually alongside scalp issues and keratosis pilaris. Today was one of these days.

My diet before vegetarianism was absolutely atrocious, but I almost never ate vegetables and it was fairly bland. Unfortunately, now that I have discovered the deliciousness of hot peppers, I realize they are the probable cause of my skin issues. I also have problems with many members of the cabbage family.

If you are having a frustrating problem like this, I highly recommend checking out the failsafe diet (the site used to have a more awesome name: Plant Poisons and Other Nasty Stuff). The best strategy is probably to introduce families of plants into your diet gradually until you figure out what is making you sick. The author of that site notes that once she identified some problem foods and avoided them for awhile, she was eventually able to add some back in. Interestingly, she also discovered she had thyroid disease.

For me, it seems the reaction is quite complex. I can eat hot peppers sometimes, but if I eat them in the last week of my menstrual cycle that's when they really wreck my skin.

As far as starches, poatoes are known to be a problem for many people because they are in the nightshade family and contain solanine and some potent glycoalkaloids. Yams are much better tolerated and another rec would be cassava, which is prized for its hypoallergenic qualities. Brown rice is full of stuff that can be a problem, white rice much less so.

Comment?: 7
Keratosis Pilaris- Cured
04/18/2010 - 15:10

Wouldn't it be nice if avoiding gluten, sugar, and other foods you are sensitive to cured EVERYTHING? It can make a difference in the quality of your life, but it's not magical.

The very minor bane of my paleo years has been keratosis pilaris, which I've had on my upper arms and thighs for as long as I can remember. Actually, 40% of adults have it and women are most commonly affected. It manifests as small red knobby bumps, which are caused by the body producing excess keratin. Since I am very light skinned, it always looked kind of stark on me and my first boyfriend often remarked how rough my skin was.

Going paleo seemed to make it slightly better, probably because of increased retinol and DHA in my diet, but it still affected me. I decided to think about what a paleolithic woman would have done to her skin. We don't know exactly- it's possible women used minerals, fats, and herbs on their skin, as plenty of modern hunter-gatherers do. There is even some evidence neanderthals wore "makeup."

But what can we infer about paleolithic woman's skin treatment?

  • Lots of sunlight
  • Probably bathed in cold water and probably didn't bath every day

I first linked it these things when I worked on a farm where we didn't have hot water, except for if you wanted to build a fire a boil it yourself. Not surprisingly, I bathed pretty sparingly, mostly just using a wash cloth. We also had a sauna that we used sometimes. I can definitely understand why people invented saunas- it's much less work than bathing in hot water because it uses relatively little water, just as steam. If you are hauling water yourself, you aren't going to want to use it liberally. Also, being on a farm I was out in the sun all the time.

No, I didn't smell bad, and yes, my skin looked and felt awesome.

How can I apply this to the real world? I've tried all kinds of skin creams and they haven't worked. Unfortunately, I've always LOVED really hot showers and this has been a hard habit to break. I'm now taking lukewarm showers that I do not enjoy, but my skin looks much better. I'm also sun bathing, which also isn't fun in the cold.

I think the lesson here is that there are three factors we have to take into account: cultural, environmental, and biological. Most people doing the paleo diet do their best to have a biologically appropriate diet and exercise regimen, but I live in a culture where I must be clothed most of the time and an environment where we have hot showers and spend our days in dark offices. I can only do so much to change these things, but by questioning them, I can more effectively apply evolutionary thinking to improving my well-being.

UPDATED POST HERE

Comment?: 11
Diet Delusions
03/21/2010 - 13:24

 I meet them all the time- people who tell me that they would never try the paleo diet because their diet makes them feel awesome. Maybe they don't realize that a face covered with acne and a spare tire around their waist aren't exactly markers of feeling awesome. 

I thought of that when reading this NYT article about Alicia Silverstone where she eats a meal presumably loaded with inflammatory omega-6 fatty acids

She settled on nachos and onion rings to start, and mulled beer selections with two girlfriends who had seen her show that night. This was no dive bar that the trio had chosen for a post-performance meal; it was Candle 79, a cozy Upper East Side restaurant that specializes in organic and vegan cuisine. The nachos came slathered in refried pinto beans, tofu sour cream and chili-grilled seitan, a wheat-based meat substitute.

If you are at a vegan restaurant, be sure to avoid fried things. Unless Candle 79 is bucking the trend, they are using canola, safflower, and soy oils, which are rich in omega-6, which to boot is also sensitive to eat. Alicia's fried food was probably loaded with rancid inflammatory fats. I was sad when I realized my favorite veggie-friendly restaurant, Souen, uses such oils to fry in. I LOVED their fried oysters, but I can't order them again. 

But she claims she feels awesome

The karma of turning vegan is amazing. And then to get this sudden weight loss, and my skin is glowing and my nails are strong and my eyes are white — it was wonderful.

But if you google Alicia Silverstone and acne, you can find pictures of her without makeup showing off her not-exactly glowing skin. It's not a surprise: gluten and rancid omega-6s are a nasty combination. It's not veganism that's the real problem here though, it's the idea that veganism is THE PERFECT diet and as long as you don't touch those nasty animal products you are AOK. The truth is that acne is usually caused by things like gluten, sugar, and omega-6 oils. It's hard to avoid these as a vegan...or anyone who eats one, but worth it for everyone!

Last year I had some issues with acne. I realized it was because of my "cheat meal" at the Swedish pub, which was a burger with mayo. The burger bun and the oil in the mayo=bad news for my skin. I have delicate skin and what I eat really does show up, for some lucky people it doesn't, but maybe they aren't so lucky because they don't get that visual indicator. Either way, so many women I know accept acne as normal! If you are 25 and still have acne, that's the sign of a problem. 

I was reading this excellent interview with an ex-vegan this morning and she also talks about her "veganism as perfect diet" blinders:

 

Did you feel better or worse as a vegan? 

I felt better for the first four months and then progressively worse for the next seven years.

But did you tell people you felt better?

While I was vegan I worked as a manager in a health food store.  I always told myself and others that I felt much better as a vegan (deep down I knew I didn’t).  I think I was actually trying to convince myself that I felt better.  “I’m thinner, so I MUST feel better.” 

If you do the paleo diet you have to be conscious of blinders too. If you are having a problem, admit it and look for solutions. It's very much possible to have a diet that causes problems, but is technically paleo. 

 

Comment?: 8
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