Diet and Acne

 

Does Diet Affect Acne? 

We have all been told in school that food does not cause acne. It's difficult to form a substantial conclusion about the subtle influences of diet on any disease. The average American diet contains so many different elements, and these elements work in so many complex combinations that isolating and testing any one factor on a human subject is nearly impossible.  The vast variety of chemicals that modern food processing has forced on our diets leaves us lost in a sea of dietary influences, most of which we know nothing about. We are finding out each day about new manufactured ingredients that are affecting our body but have been around for years.

 Iodine

"Excessive, long-term ingestion of iodide (also known as iodine), whether in drugs or in food, can induce acne. Once iodine enters the body and mixes into the bloodstream, excess is excreted through the oil glands.  As it is excreted, it irritates the pores and causes acne flare-ups  Iodine is especially irritating to the susceptible pores of acne-prone people, but in large enough amounts can induce acne in anyone.  In persons with existing acne, such eruptions occur much more rapidly and intensely than in non-acne-prone individuals and the flare-ups joins already diseased skin."

What Is Iodine In?

1) In Salt- Years ago nutritionists feared that average American diets lacked adequate iodine, particularly in the Midwest.  They wanted to reduce the incidence of goiter, an enlarged thyroid, which is a result of iodine deficiency. Therefore, iodine was added to table salt, and now in large amounts in processed food.

2) In Seafood- Not all seafood is high in iodine.  Kelp has the highest amount of iodine, followed by squid, crab, sole, and clams.

3) Fruits and Vegetables- It is best to say away from onions, asparagus, broccoli and wheat germ if you suffer from acne.  Where vegetables come from also is important.  Those grown in iodine rich soil, such as California and Florida, will have higher levels of iodine.

4) Milk- I don't recommend drinking milk in the first place, not even organic milk.  Milk does not naturally contain iodine, but researchers were surprised to find high levels of iodine in it.  Researchers found the source to be the cowlicks that contain salt and were finding their way into the milk.

5) Beef- Tests show even higher levels of iodine in beef and especially in the cow's liver.  The source again has to be the cowlick salt.

6) Drinking Water- It's now added into our bottled water.

7 Junk Foods and Processed Foods- Are too high in sodium and refined sugar.

8) Vitamins, Mineral Pills, and Food Supplements- Look to see if your vitamins or protein diet powders contain iodine or kelp.  If so, discontinue if you or someone you know suffers from acne.

Foods Containing Hormones

Any food containing high amounts of hormones or hormone-like substances could create a problem. Peanut oil, corn oil, and wheatgerm oil contain high amounts of testosterone and dihydrotestosterone. Milk, yogurt, cheese, and meat all contain hormones from another source.  Ingested male hormones can stimulate your sebaceous glands, as do the hormones your body produces naturally.

The Holy Grail Of Acne Information

Previous Blog Postings

In my last posts we discussed what causes retention hyperkeratosis  
and the the roll of p-acnes bacteria and biofilms on acne 

As I stated in my first blog on acne, My Journey To Fully Understanding Acne, I had no idea what some of these people were talking about on these message boards. My first question on the message board was a simple one about acne inflammatory responses.

 This was the first response I got

1. increased 5a reductase in the folicle.
2. abnormal stickiness in the keratinocytes.
3. deficiency of linoleic acid
4. elevated levels of interleukin-1a
5. MMP-8 elevated levels.
6. p. acnes bacteria

Some of these overlap. The abnormal stickiness is from a local deficiency of linoleic acid, p.acnes, and biofilm. Interleukin-1a is also known to increase proliferation of keratinocytes, another contributing factor. MMP-8 is released which breaks down the follicle and allows for the inflammatory process to occur.

5a reductase - in the pores of acne sufferers is 2-7 times higher than those who don't have acne. 

My Response                                                

I thought to myself 'WOW, what does this even mean'? So after my frustration fit was over, I decided to take it slow and research one thing at a time. And as you all know, with research, if you don't understand one thing it leads to something else, then to something else. This one message from a wonderful lady in Australia by the name of Jacine Greenwood, CEO of Roccoco Cosmetics, led me down a month long path of acne research and discovery.

 

Let's Break It Down

5a reductase is an enzyme responsible for the conversion of testosterone into DHT (dihidrotestosterone). There are 2 types of 5a reductase enzymes - type 1 and type 2. Type 2 predominates in the hair follicles and type 1 resides in the sebaceous glands.

5a reductase is the cause of hormonal mediated acne. So basically when you inhibit it you stop the effects of testosterone working in the sebaceous follicle.

MMP (Matrix Metalloproteinases) are enzymes that destroy collagen. Specifically MMP-8 is involved with acne. The follicular wall ruptures as a result of MMP-8 being released. This is what degrades the structure of the follicle wall. If you inhibit MMP-8 then you will get less inflammatory lesions.

Interleukin-1a is an inflammatory mediator. It has been shown to be present in high concentrations in the skin of acne sufferers. Interleukin-1a has also been shown to promote hyper Keratinization.

 

The Protocol

Some of you maybe saying "okay that's interesting what can I do to stop this." Well I am glad you asked. Here are a few ingredients that are know to help each one of these steps.  

1. 5a reductase inhibitors - green tea, resveratrol, saw palmetto, bellamcanda chinensis root, zinc, evening primrose oil, and linolenic acid.

2. linoleic acid deficiency - decrease oil flow through 5a reductase inhibitors and cleanser that is high in linoleic acid to correct the deficiency. Sunflower oil his high in linoleic acid.

3. Reduce interleukin-1a expression in the skin - Nettle extract, magnolia extract, black cumin oil.

4. kill p.acnes bacteria - type 1 and type 2. There are 2 types of p.acnes bacteria and tea tree oil only kills type 1( gram-positive), not type 2 (gram negative). For this I use black cumin oil, magnolia, chaulmoogra oil, Manuka oil. Licorice also has anti-bacterial and anti-inflammatory properties. Magnolia extract kills type 1 and 2 p acne.

5. mmp-8 - I inhibit this with pine needle extract which has a strong inhibition against mmp-8.

Jacine Greenwood CEO of Roccoco Cosmetics writes:
Everyone else focuses on exfoliation rather than preventing the cells getting sticky in the first place. I don't like benzoyl peroxide because of the free radical component and it also causes epidermal hyperplasia which contributes to follicular hyper keratinization. I exfoliate the skin with papain and bromelain. I also use desincrustation solutions to facilitate extraction.

I get them to prep with their products. The oil cleanser helps loosen impacted blackheads along with the serum packed with interleukin-1a inhibitors as well. They literally start to wiggle their way out easily. They also get a serum full of 5a reductase inhibitors.  
  
The difference between the non-inflammatory and inflammatory is simply the products I select.

I tend to focus on more 5a reductase inhibitors for the inflammatory and ingredients that have been shown to be highly anti-inflammatory such as licorice, green tea extract. This works very successfully.

With clients who have a lot of blackheads, etc. I ensure that they are using a proteolytic enzyme at home to eat the dead skin cells and keep the skin smooth, along with the 5a reductase inhibitor and a toner with a natural blend of fruit extracts in it. This is not an AHA but has a similar effect. 

 

In Conclusion

As I have stated, acne is an inflammatory skin disease.  It is because of the inflammation that a cascade of events occur. If you control the inflammation you control the breakdown of the follicle, bacteria, and hyperkeratosis in the follicle. Dead p.acnes bacteria still promote acne formation because they promote inflammation. So p.acnes are really only part of it. The problem is inflammation.

P-Acne Bacteria & Acne Biofilms

In my last post we talked about retention hyperkeratosis being the cause for acne. Read here: Retention Hyperkeratosis 

 P-Acnes Bacteria

For the longest time it was believed that the Propionibacterium acnes (p-acnes bacteria) were the cause of acne. We know now that these bacteria exist in the pores of every human being, and do not dwell in greater numbers in acne-prone people. P- acne bacteria are anaerobic bacteria, which means they thrive without the presence of oxygen. So when the follicle swells and dead skin cells cover the opening of the follicle, the bacteria start to party.  The party starts by  the bacteria feeding off of triglycerides produced by our sebaceous glands.  They then excrete an enzyme called lipase to split the oil into fatty acids and glycerol.  They devour the glycerol portion, the part that they like, and discard the fatty acid byproducts.  The problem with the bacterial action is that the fatty acids, which the bacteria create and then discard as garbage, are quite irritating to the pores and aggravate acne.

These digestive enzymes also destabilize the layers of cells that form the wall of the follicle. The cellular damage, metabolic by-products, and bacterial debris produced by the rapid growth of p.acnes trigger inflammation.  When these digestive enzymes spiral out of control for too long, they destroy the follicle so much that it breaks, and leaks out infection into the other areas of the skin.  This is shown by the presence of cysts and nodules.  

There Are Two Forms of P-Acnes Bacteria

1) Gram-Positive Bacteria
2) Gram-Negative Bactera

The damage caused by P-acnes and the associated inflammation make the affected tissue more susceptible to colonization by opportunistic bacteria such as Staphylococcus Aureus.
Research shows that only healthy pores are colonized by P-acnes, while unhealthy ones universally include the nonpore-resistant Staphylococcus Epidermidis.

There are types of acne caused by gram negative bacteria.  Gram negative bacteria have the potential to secrete toxic byproducts which can cause intense inflammation and infection. Gram negative folliculitis is a bacterial infection present in pustules, cysts, and nodules. Unfortunately, gram-negative bacteria are resistant to most antibiotics. If you take antibiotics for too long, it causes bacterial interference.  The gram positive bacteria that proliferates in your nasal cavities and mucous membranes can turn into gram negative bacteria.

Tea tree oil only kills gram positive bacteria.  Mandelic acid kills gram negative bacteria along with licorice root, black cumin oil, and manuka oil.  Mangolia extract and mandelic acid kill both p acnes bacteria.

Symptomes & Appearance of Gram- Negative Folliculitis

 Sudden increase in the number and severity of acne lesions despite antibacterial treatment.  Sufferers who previously had whiteheads and blackheads will start developing numerous cysts, pustules, and nodules.  They will develop large clusters of nodules, cystic lesions that burrow and interconnect. Skin appears red, inflamed, irregular, and painful to touch.

Acne Biofilm

Part of the reason why cells stick together in the follicle is due to p-acne biofilm. Biofilms produce irritant fatty acids that promote inflammation and enhance p.acnes adhesion to the sebaceous follicle.

P- acne bacteria reside in the pilosebaceous unit in a biofilm, which means they live in a community that encases itself in an extra cellular lining to survive. Research is showing that the biofilm may explain the development of retention hyperkeratosis as they cause the keratinocytes to be very sticky. It may also explain the immunogenicity of the organism as well as the clinical course of the disease.  The biofilm is a new discovery.  We are not sure if it has always been there or is something that happened to resist antibiotics and other treatments. 

Do You Have An Acne Consultation Form?

How can we treat acne properly if you don't have a consultation form that is strictly in-depth acne questions?

Name__________________________________                                                         Sex-   M   or F

Age_______   Race________________________  Occupation __________________________

Address_________________________________________________________________________

Phone: ________________________________________    Email:_________________________________________

Family Acne History:

1) Circle any relatives who have (or had) acne:     None      Brother     Sister       Father       Mother     Grandparent          Aunt           Uncle      

2) Age acne began in above relatives  _________  

3) Elaborate on what type of acne they have or had__________________________________

___________________________________________________________________________

Your History

1) At what age did your acne begin? ________

2) Is your acne:     Worsening                   Improving                Staying The Same

Your Treatments                                                              Improvement                                                            Status

______________________           Worse,   Better,  No Improvement,   Same       

______________________           Worse,   Better,  No Improvement,   Same         

______________________            Worse,   Better,  No Improvement,   Same        

______________________             Worse,   Better,  No Improvement,   Same        

______________________             Worse,   Better,  No Improvement,   Same          

Notes

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Medically Supervised

1) Have you ever had your acne treated by a physician _______________

2) If yes, fill out the following treatment information by making a check beside any treatments below which have been tried on you.  Then rate its effectiveness as you did previously.

Treatment                                                          Improvement                                                                    Status

1) Vitamin A acid - Retin-A                         Worse,  Better,   Improved,   None         

2) Benzoyl Peroxide                                     Worse,  Better,   Improved,   None             

3) Drying Lotion- sulfur, salicylic...             Worse,  Better,   Improved,   None              

4) Oral Antibiotics                                         Worse,  Better,   Improved,   None            

5) Topical Antibiotics                                    Worse,  Better,   Improved,   None           

6) Special Diets                                             Worse,  Better,   Improved,   None           

7) Chemical Peels                                          Worse,  Better,   Improved,   None            

8) Injections into Cysts                                  Worse,  Better,   Improved,   None             

9) Special Soaps and Scrubs                         Worse,  Better,   Improved,   None              

Others

______________________                     Worse,  Better,   Improved,   None                   

______________________                     Worse,  Better,   Improved,   None                   

______________________                     Worse,  Better,   Improved,   None                     

For Women

1) Do your acne flare-ups follow a month pattern?        Yes        No       

If so, when does the flare-ups occur?  During menstrual period       Mid Point of Cycle        Week before periods

2) Have you ever taken birth-control pills?       Yes    No   List Brand Name _________________________

3) Did birth-control pills make your condition     Better      Worse      No Effect

4) If you have ever been pregnant, did pregnancy flare up your acne condition?    Yes    No

What I Use On My Face

List all skin care products or cosmetics currently used on your face.  Start with cleansers or soaps, continue with everything that touches your face (astringents, toners, makeup, blushes, powders, moisturizers, spf lotions). ________________________________________________________________

________________________________________________________________

Other Factors

1) Do you find that your acne is related to stress         Yes      No 

If yes, why do you believe so _____________________________________________________________

2) Does your acne seem related to amount of sleep     Yes    No

3) How many hours of sleep do you get on average a night? ____________________________

Time you usually go to bed_______________   Time you wakeup ____________________

4) Do you work around any chemicals, oils, humid or hot conditions?    Yes          No

5) Do you play sports?     Yes    No

6) Do you notice flare-ups or clearing when you go to a different climates?     Yes         No

7) Does sunlight seem to affect your acne?        Yes     No    How__________________________________

8) Circle any of the following that regularly touches your face, back, or any other area affected by acne.  Headband      Tight hat      Chin Strap    Tight Clothes   Backpack   Glasses   Hands on face    Cell Phone

Picking Habits

1) Do you squeeze , pop, or manipulate your pimples?   BE HONEST!   Yes    No

2) If yes, do you squeeze or pick?    Everyday       Once or twice a week      Once a month     Other

3) Explain how you squeeze ( fingers, scratch with nails, open with a needle) _________________________________________________________________________

4) When you squeeze do you ?   Usually get contents out easily      or   Seldom get anything out

5) Do you pick at lesions deliberately in front of a mirror? _____  or  

 Do you pick unconsciously _____

State of Health

1) List any seriously illness _______________________________________________________________

_______________________________________________________________

2) List any Allergies _________________________________________________________________

3) Are you taking medications for any of the above conditions? _________________________________________________________________

_________________________________________________________________

4) Are you on any special diet requirements or restrictions? __________________________________________________________________

___________________________________________________________________

5) Do you take vitamins or minerals? ____________________________________________________________________

6) Are you currently on a diet to loose weight? Describe ____________________________________________________________________

Emotional State

1) Has acne affected you emotionally or socially?        Yes         No

2) Make a check beside any statement below that applies to you

____ Acne causes me to feel depressed quite often

___ _ Acne causes me to feel depressed occasionally

____ I don't date or socialize because of my acne

____ I sometimes call off social engagements when I'm flared up

____ Even though my acne makes me self-conscious, I never cancel social plans

____ I do not avoid people because of may acne

____ I have trouble looking people in the eye when I talk to them because of my acne

____  I act cheerful and outgoing so people will notice my acne less

____ I don't believe my acne affects my social relationships at all

____ I get upset when people tease or question me about my acne

____ I joke about my own acne in front of my friends

____ I feel that people stare at me because of my acne

____ I have learned to live with my acne.  It doesn't bother me

____ I hate to look in the mirror

Other comments about your acne emotional effects. ___________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

_____________________________________________________________

__________________  __________________________________________

Products

Name of Product __________________________________________

Percentage of ingredients

How many hours or min did you leave it on

How often did you apply it

Did you experience a burning sensation

Circle any other affects :  Itching      Redness    Soreness    Flaking    Peeling

How many days did you wear it before you began to notice flaking or peeling

Did any of the above go away after time?   Yes    No

Did you experience clearing  from the product

If so, how long did it take before you noticed clearing? _____________________

Products

Name of Product __________________________________________

Percentage of ingredients

How many hours or min did you leave it on

How often did you apply it

Did you experience a burning sensation

Circle any other affects :  Itching      Redness    Soreness    Flaking    Peeling

How many days did you wear it before you began to notice flaking or peeling

Did any of the above go away after time?   Yes    No

Did you experience clearing  from the product

If so, how long did it take before you noticed clearing? _____________________

If you would like for me to send you a word document or PDF of this, please feel free to email me at www.advancedskinacademy@gmail.com

What Causes Retention Hyperkeratosis ?

In my last post we talked about What Is Acne
This is where I discussed that acne was a inflammatory skin disease and not a skin condition.

What Happens Differently In Acne

As I have discussed Retention hyperkeratosis is at the very heart and soul of acne, and it is the process you must interfere with in order to outfox the disease. The stratum corneum sloughs off a layer of cells each day very easily, but not very well inside the pore.  The dead cells begin to stick together and form a mass (impaction) down inside the follicle. The chemical compisition of our sebum is not sticky, the sticky part is the dead skin cells in the follicle brought on by Acne Bio-Film (we will get to that in the next article).  So acne is the renention of dead skin cells and the mad proliferation of additional cells to make matters worse in the pores of acne-susceptible families.

What Cause Retention Hyperkeratosis?

There are lamellar granules present in the the skin which produce an enzyme to break down the ‘glue’ between skin cells in order for them to be sloughed off in a normal manner.  This leads to congestion in the follicles.  There are many of these granules down in a healthy pore where the layer is normal and thin, but if you look onto an acne-affected follicle with it's thicker layer, there are few granules.

A popular misconception about acne is that the oil hardens and plugs up the pore opening.  This in not true. The oil plays only a minor part in the acne impaction. It is the retained cells, not sebum, that produces the mass itself. In fact, as the lesion develops, the sebaceous glands become smaller, and whatever oil they continue to produce is not actually trapped. Studies show that a clear channel is always maintained between the sebaceous gland and the surface. The channel appears to be kept open by protein- digestive enzymes that gradually digest the dead skin cells in the center of a lesion.  This explains why an acne impaction often reaches a certain size then appears to stop growing. Even though more cells are rapidly being produced by the follicular wall, the lesion does not enlarge because the cells next to the bacteria on the inside are being digested about as rapidly as new cells are being dumped into the impaction. This happens in the mildest form of acne Grade 1.  The white heads and blackheads reach a certain size but do not burst into inflamed acne.

Stay tuned for my next post where we will talk about P-acne bacteria and Acne Bio Film