Naturopathic Newsletter December 2009: ACNE

December 2009

Our office will be closed as of December 23rd, reopening January 5th. We will reply to all phone and email messages upon our return.

For supplement renewals, please contact Line by phone or email this week, allowing for enough time before the holidays.

I'd like to wish all of you and your families the very best for the holiday season with much happiness and health for the New Year!

At one point or another, many individuals have experienced skin blemishes, known as acne, to some degree. For most individuals, this occurs during adolescence, corresponding with the hormonal changes of puberty. For others, their experience may continue or even begin well into their adult life. In these cases, hormones, as well as other potential factors, may play a role in skin changes.

Acne vulgaris is characterized by the presence of papules, comedones, pustules, and nodules on one's face, upper chest, and back, which for the layman, translates into black heads, white heads, pimples, and cysts.

This skin condition is seen as changes occurring in hair follicles and their associated sebaceous glands.These skin structures are most densely populated in the face, chest and back, corresponding to the most common sites of acne development.

The changes in these sebaceous structures often share the following characteristics:

hormonal influence,

inflammation, 

bacterial infection, and

pus formation

As a result of these shared characteristics, the conventional approach to treating acne usually entails:

antibiotics, oral or topical, to kill the bacteria,

hormonal treatment, such as birth control pills, and

decreasing inflammation with such treatments as accutane, which is believed to work by decreasing the secretion of oils from the sebaceous glands

The remainder of the newsletter will explore the naturopathic approach to acne vulgaris. Similar to the conventional medical model, the naturopathic understanding of acne includes possible hormonal imbalance, local inflammation, and bacterial infection. However, it approaches these possibilities by trying to assess and address the underlying causes that may be contributing factors for the individual patient.

I titled this newsletter Acne: More than just SKIN DEEP to reflect the naturopathic understanding that skin conditions often go much deeper than the surface. As described above, the conventional approach is to focus on the imbalances that are occurring at the level of the skin, including hormonal affects to the sebaceous structure, and local bacterial infections at the site of these structures.

The naturopathic approach does not negate that these physiological occurrences are true, but rather attempts to dig a bit deeper to understand WHY these local changes are happening in the given individual patient. 

Considering that the skin is the largest organ of the body, as well as a major organ of elimination, the manifestation of skin conditions is likely an indication that something beneath the surface is going on.

Although testosterone is the main problematic hormone acting at the level of the sebaceous structure, this reflects a possible imbalance with other hormones, including estrogen, progesterone, cortisol ("stress" hormone), and insulin ("sugar" hormone).

These imbalances can be seen in certain patients with acne who report the following experiences:

premenstrual "break-outs", principally in the chin area, which corresponds to the ovaries in the Chinese medical model,

worsening of acne during  stressful periods with inadequate sleep, and

correlation between insulin and testosterone imbalances, as seen in patients with PCOS

Aside from trying to identify and target which hormones may be involved, a key hormonal balancer that cannot be neglected is the liver. One of the principal functions of the liver is to convert hormones into an excretable form. If the liver is unable to do this effectively, then this leads to a relative excess of circulating hormone levels. 

Modern lifestyles and practices have been blamed for "bogging down" the liver, rendering it "sluggish", and thus unable to properly fulfill it's duties. As a result, most naturopathic acne protocols will include support to the liver's 2 phases of detoxification. Speak to your lcoal ND or herbalist for more information.

Both the media and conventional medicine have quoted studies that conclude that food does not influence acne. 

As a naturopathic doctor who works with numerous patients suffering from a variety of skin conditions, including acne, I can safely say that I disagree, for the most part, with this statement. Again, don't forget that the naturopathic approach is INIDIVIDUALIZED, meaning that there is rarely 1 solution for all individuals experiencing the same condition. However, I have seen a great number of patients suffering from acne at all ages (infant, adolescent, and adult) improve SIGNIFICANTLY from dietary changes.

One of the most significant dietary interventions is the identification of possible food intolerances. Food intolerances are NOT the typical, quick onset, allergies seen in response to such foods as peanuts and shrimp. Intolerances are foods that we often consume on a daily basis without realizing that they are contributing to a low grade inflammatory response in the gut, which can either manifest itself as or aggravate a skin condition, including acne. The most common food intolerances are dairy (including milk, cheese, yogurt, and cream), eggs (both the white and the yellow), and wheat, if not all gluten containing grains (including spelt, kamut, rye, and barley). To investigate further, you can either COMPLETELY eliminate these foods from your diet for a minimum of 4 weeks, or you can discuss a food intolerance test with your local ND.

As my patients know, I expect full description and details of their bowel movements for the simple reason that what comes out is an indication of what is going on inside. As a principal organ of elimination, the skin has to compensate for the inadequate clearance of toxins from a constipated colon. First and foremost of importance is for the reader to understand what is meant by constipation. Very often I ask a patient if they are constipated, and they reply "No, I go every couple of days.". NEWS FLASH .... this is constipation. I want to see my patients having a healthy, effortless, banana size and shaped bowel movement at LEAST once daily, with little non-odorous gas, and the absence of bloating. 

Not only does constipation push the elimination of excess toxins through the skin, it also contributes to a COMMON factor involved in many chronic ailments, known as dysbiosis: a general term referring to the imbalance in the good bacteria and other potential critters living in the gut. This imbalance can refer to insufficient probiotics (good bacteria, which are significantly diminished by antibiotics, steroid based medications and poor food quality), or it can refer to the presence of "critters", such as yeast/candida, bad bacteria, and parasites. 

Many people think of yeast/candida only in terms of vaginal health, which is a gross understatement. The overriding presence of yeast/candida can be seen in virtually any organ system, including the skin with regards to acne.

Many people also think that "bad" bacteria and parasites are problems that plague less developed countries with tainted water and food supplies. This is NOT the case. My years of practice has taught me that whether you are a seasoned traveller or a visitor of balconville, bad bacteria and parasites can be found ANYWHERE and must be considered in trying to understand the underlying cause of health ailments. To discuss more on the possibilities of stool testing, speak to your local ND.

As with many chronic health conditions, there exists the possibility that the individual is suffering from nutrient insufficiencies. Unlike a deficiency,an insufficiency does not directly cause a disease state, but rather it contributes to suboptimal function.

Insufficiencies of the following nutrients can contribute to suboptimal function that manifests in the skin as acne:

zinc

vitamin A

vitamin E

omega 3 fish oils

vitamin D

To discuss matters further and to identify possible nutrient insufficiencies, consult your local ND.

Water: 1.5 L daily (avoid plastic bottles; use glass or stainless steel)

Avoid deep fried foods, refined grains, non organic animal products, white sugar, soft drinks

Eat wild, top-feeding, small fish al least twice weekly

Ensure daily bowel movement

Sleep at least 7-8 hours per night

Incorporate stress management techniques into your daily routine

Exercise to maintain microcirculation and elimination of toxins

Dry skin brushing 2-3 times per weekly to support elimination of toxins, improve the health of your skin, and to stimulate lymphatic drainage

Use non-toxic skin products (www.cosmeticdatabase.com)

Discuss with your local ND the possibility of nutrient supplementation

Discuss with your local ND the possibility of food intolerances and dysbiosis