Case Study - Acne

Sofia came to me looking for help with acne which had been present on and off for four years, mainly occurring on her forehead, cheeks, and chest. She told me that the issue had worsened over the past 12 months which coincided with a stressful period and a shift towards eating a predominantly plant-based diet.

The conventional treatment from her doctor, which consisted of a prescribed antibiotic cream, left her skin with scarring and was not a safe long-term solution.

Sofia had tried various dietary changes to try and improve her condition, but nothing had made a major impact. She had tried a 30-day sugar and refined carb elimination but was still consuming fruit, honey and chocolate. Dairy intake was already very low except for occasional consumption of Greek Yoghurt.

I was impressed that she had already made the connection between sugar and dairy as being two likely culprits for acne. Cow’s dairy can trigger acne in some individuals. The main proteins in milk are whey and casein. Whey increases blood insulin levels, while casein increases IGF-1. These proteins may trigger an acne breakout.

Sugar and excess carbohydrates may also lead to a breakout in the skin. When blood sugar spikes, it causes inflammation throughout the body. These spikes also cause the body to make more sebum, an oily substance on the skin. Both inflammation and excess sebum can lead to acne.

Over the past 9 months, Sofia had made some positive changes to her diet and lifestyle. Namely, intermittent fasting, meditation and reducing her alcohol consumption. This brought about significant improvements to her digestion and mental health.

After taking a solid case history from Sofia, where I assessed her medical history, various body systems as well as her diet and lifestyle, there were a few contributing factors that stood out to me.

Her diet consisted mainly of plant-based foods, and she had avoided meat for the past few years. Fish and seafood had also been missing from her diet for just under 12 months, as she had given these up for ethical reasons after watching ‘Seaspiracy’ on Netflix.

Two key nutrients that are needed for healthy skin are Vitamin A and Zinc. A deficiency of either of these nutrients is a risk factor for developing acne. The body primarily uses Retinol (Vitamin A) which is only found in animal foods like liver, eggs and dairy. Beta-Carotene is the plant version of Vitamin A which is found in orange foods like carrots and green leafy vegetables. Sofia had not been consuming many orange foods but ate some green leafy vegetables.

Conversion from beta-carotene to retinol is heavily dependent on genetics and absorption. If someone has genetic variations in the enzymes that convert beta-carotene to retinol, then the risk of a Vitamin A deficiency is more likely, especially when not consuming preformed retinol from animal foods. A study by researchers from Newcastle University showed that individuals who carry the T allele of rs7501331 have a 32% reduction in enzyme activity while individuals who carried T allele for both rs7501331 and rs12934922 had a 69% reduction in enzyme activity.

Zinc is abundant in meat and seafood and although it is present in plant foods like pumpkin seeds, it is less bioavailable due to nutrient inhibitors such as phytic acid. Interestingly, zinc is also necessary for virtually every step in Vitamin A metabolism, including its transport in the blood.

I also considered other factors in Sofia’s diet such as fatty acid deficiency due to the lack of omega 3 oils from her avoidance of fish and arachidonic acid deficiency due to low animal protein consumption. Her antibiotic cream may have also been a contributing factor as this can disrupt the delicate eco system of bugs on the skin and in the gut leading to chronic microbial imbalances which drive inflammation.

She didn’t have the budget to do any functional lab testing, so I jumped right in and suggested a simple protocol to address Retinol (Vitamin A) and Zinc. Although I like to use foods to correct deficiencies whenever possible, in this case we had to use high quality supplements as Sofia was not open to eating liver to obtain retinol or eating significant amounts of meat or seafood to obtain zinc.

I suggested a Zinc/Copper supplement by Jarrow called Zinc Balance to obtain zinc and Rosita Cod Liver oil which naturally contains 100% of the RDA for Retinol. As a side note, most Cod Liver Oil supplements do not contain natural retinol but instead have added synthetic Vitamin A (retinyl palmitate) which is fat soluble and remains stored in the body’s fatty tissues. For this reason, it can build up to too-high levels, causing toxicity and liver disease.

I head from Sofia again after about two months. Success! Amazingly, her skin had cleared up after implementing the suggested protocol. She had also reintroduced small amounts of meat and seafood back into her diet. The ‘before and after’ photos of Sofia’s skin say it all! Her overall physical and mental health had also improved, and she was keen to stick with a more rounded diet going forward.