PCOS & Hormonal Acne: A Natural & Nutritional Approach to Treatment

I struggled with acne for years. Throughout my teens and well into my 20s. I tried all the creams, all the cleansers, I saw a Dermatologist and I tried taking the OCP (I lasted a year before I stopped because I didn't like how I felt on it). I remember my Mum telling me my acne would just go away as I got older, but it never did. In fact, in my early 20s when I was diagnosed with PCOS, my acne became much worse.

Having hormonal acne was the PCOS symptom I struggled with most. It affected my mental and emotional health and it impacted my self confidence and self worth. Healing my acne took time and I honestly had days that I thought I would never experience clear beautiful skin. But I was wrong, and today I enjoy rarely wearing makeup because I feel grateful for my skin.

If you're on the path of healing hormonal &/or PCOS acne, I want to give you hope and tell you not to give up. But I also want you to know you're beautiful now. Just as you are.

What is Acne

Acne isn't truly a skin problem. Yes of course the actual acne lesions (pimples, blackheads, whiteheads, cysts) is caused by the skin's hair follicles/pores becoming blocked with sebum (oil) and bacteria, and becoming inflamed. 

But the skin is ultimately a reflection of what is going on inside. It's your body signalling to you that something isn't 100%. The question we need to ask is 'why' is the skin becoming blocked and inflamed?

Acne is complex and multifactorial, involving genetic, metabolic, and hormonal factors. If you have acne, you're most likely going to have inflammation, hormonal imbalances, blood sugar dysregulation, and gut issues.

PCOS Acne

It is understood that PCOS acne is caused by elevated androgens that we see in PCOS women. Androgens, specifically testosterone, converts to DHT (dihydrotestosterone) via an enzyme called 5α-reductase. DHT increases oil production in the skin, and the trapped oil, dead skin cells and bacteria beneath the hair follicles cause cystic-like lesions, which can appear on the face, jawline, neck, upper back and chest. Testosterone peaks mid-cycle around ovulation, so many PCOS women will notice skin breakouts or worsening acne just after ovulation.

The Link Between our Hormones, Inflammation & Acne

Acne is known as a chronic inflammatory condition.

Yes high androgens cause excess oil production in the skin. But its inflammation that causes an excessive turnover of keratin (a skin protein), which changes the sebum composition and creates more dead skin cells that can block pores. This provides a breeding ground for bacteria, which can cause more inflammation and worsen acne.

Blood sugar dysregulation is a big factor that can impact acne as it causes spikes in insulin and cortisol, both which drive excess androgen production and are pro-inflammatory.

A lot of women find they experience breakouts or worsening acne in the week leading up to their period and this is due to changes in hormones. Progesterone is high during this phase and this leads to a more insulin resistant state and more difficulty keeping blood sugar levels stable (also why you experience cravings and feel more stressed!) - this is where diet and movement can help to manage blood sugar levels.

The Link Between our Gut Health & Acne

To add another layer to this, our gut health plays a major role in acne and skin health. Through the gut-skin axis, the gut microbiota (bacteria in the gut) modulates the inflammatory immune response that causes acne. When gut dysbiosis (imbalance of or overgrowth of certain bacteria) exists, there can be an imbalance of skin homeostasis, that is the skin functioning as normal.

A Natural & Nutritional Approach to Acne

There are a number of dietary strategies, supplements and lifestyle practices you can implement to treat acne naturally and nutritionally by targeting the root causes. These are the top key things to focus on:

1. Diet

• A whole food anti-inflammatory diet has positive impacts on skin health and clearing acne. Prioritise lots of omega 3s (salmon, sardines, mackerel, chia seeds, flaxseed, walnuts), monounsaturated fats from extra virgin olive oil and avocado, and antioxidant rich vegetables and fruits.
• Blood sugar balance is vital - so limiting refined carbs, opting for quality low GI carbs (vegetables, fruit, wholegrains, sweet potato, quinoa), and most importantly, always pairing carbs with protein, fats and fibre. This slows digestion and slows the release of sugar (from carbs) into the bloodstream to keep blood sugars stable and insulin and cortisol low.
• Avoid cow's dairy until acne has cleared (then trial a reintroduction). Studies show cow's dairy can exacerbate and trigger acne in those susceptible, due to the dairy proteins and that it stimulates IGF-1 and insulin.
• Reduction of gluten. Gluten increases the release of zonulin in the gut, which causes increase intestinal permeability ("leaky gut"). This allows endotoxins from bacteria in the gut to pass into the bloodstream, causing an immune inflammatory response. We've learnt already how inflammation can worsen acne.
• Reduce / avoid ultra-processed foods - which contain inflammatory seed oils, preservatives and additives. 

2. Gut support

• This can be through the diet and through probiotic supplementation (work with a practitioner for the right strains and dosage for you).
• Focus on increasing fibre (vegetables, fruit, nuts, seeds, some wholegrains) to improve the gut microbiome and detoxification elimination pathways. Prebiotic (onion, garlic, asparagus, legumes, lentils) and probiotic foods (fermented foods) are beneficial for supporting a healthy gut microbiome to reduce inflammation and support skin healing through the gut-skin axis.
• Bone broth and collagen are very healing for the gut lining to reduce intestinal permeability and  inflammation.

3. Stress management

Stress plays a huge role in acne and skin breakouts, and this has been shown in studies. Chronic stressors cause cortisol release which leads to blood sugar dysregulation. High cortisol also increases androgen production, and cortisol disrupts digestive function and the gut microbiome, leading to more inflammation and worsening of acne. Everything is so very connected in our bodies!

Some practices that may help you reduce stress - breathwork, meditation, journalling, exercise, walking, reading, massage therapy.

4. Exercise

Any movement and type of exercise that makes you feel great is perfect. Exercise reduces stress, improves insulin sensitivity and blood sugar balance, supports detoxification and elimination, all to help improve your skin health.

5. Reduce environmental toxin exposure

Everyday we are exposed to so many environmental chemicals and toxins that we eat, inhale or absorb through our skin. Our liver has to deal with these toxins and detoxify and eliminate them. But the liver is also involved in a magnitude of other processes, including hormone production and detoxification. So when the liver is over burdened due to our environment, this can cause hormonal imbalances and inflammation. A majority of these exposures are known EDCs - endocrine disrupting chemicals - which mimic, block, and interfere with our body's hormones.

As much as possible, begin to reduce your exposure by swapping to low tox skincare, haircare, makeup, toothpaste, household cleaning products, sanitary products and a big one - deodorant! And consider a water filter for your drinking water and shower.

6. Supplements

There are a number of supplements that can help with treating acne and the root causes. As always, work with a practitioner on what is going to be the most effective and safe ones for you to take as you certainly don't need to be taking all of these. *Please note these are evidence-based suggestions, but should not be taken as medical or healthcare advice. Some supplements are not suitable to take with certain medications.

• Gut health - probiotics, collagen
• Anti-androgens - zinc, saw palmetto, spearmint tea
• Reduce inflammation - cod liver oil / fish oil, NAC, antioxidants
• Lower insulin - inositol, NAC, berberine

I encourage you to consider taking 30-60 minutes out of your day to start implementing some new changes and practices into your nutrition and lifestyle to improve your skin and overall health. And if you need any further guidance, please feel free to reach out.

Tris x

Join The Blood Sugar Reset online workshop to learn how to eat for blood sugar balance so you gain vibrant energy, glowing skin, stress-free cycles and reach a healthy weight.

The workshop is live on Wednesday 15th Feb 2023, 7pm AEDT and will run for approx. 90 mins. The recording will be available if you can't make it live. You'll also receive a BONUS 2 week blood sugar reset meal plan (valued at $99). Tickets are only $49 for a limited time. For details and to sign up click here.