It’s Not Just Hormones—Here’s What Could Be Causing Your Acne

Kelly Candela, MS, RD
Health Coach
Medically Reviewed
February 7, 2020

When you think about a face full of zits, you probably envision a hormonal teenager in the height of puberty. However, the reality is that fifty-four percent of adult women and 40 percent of adult men still report having some form of acne . While it’s true that hormonal acne is an issue for many adults, hormones aren’t the only thing that cause breakouts. And your dermatologist has probably never mentioned to you many of the underlying factors that can exacerbate acne.

So what causes acne, then? When you start looking more than skin deep, you might actually be able to find your personal pimple triggers and go from acne-prone to acne-free forever. Here’s how you can start approaching acne treatment differently in order to get long-lasting, blemish-free results.

Top acne causes

1. You’ve developed a food sensitivity.

Even if you don’t have digestive issues, persistent acne can still be an indicator that you’re eating something you’re sensitive to. Food sensitivities are tricky to nail down because contrary to the way we think about having a severe food allergy , food sensitivities can arise later in life and likely won’t produce a reaction as blatant as an anaphylactic response.

Instead, food sensitivities can cause delayed hypersensitivity reactions which take more than 12 hours and sometimes up to 48 to 72 hours to develop after exposure—often making food triggers extremely difficult to pinpoint. These reactions might look like a headache, joint pain, fatigue , bloating , diarrhea, or acne. They occur when your immune system mistakenly identifies certain foods as threats to the body and starts attacking them—fueling our body’s inflammation pathways. This cascade sends pro-inflammatory molecules throughout the body which can contribute to any number of the above symptoms.

The most common sensitivities we see at Parsley Health that cause acne include dairy , gluten , and eggs —just to name a few. However, there are countless foods that your unique immune system could react to that could contribute to breakouts.

The fix: To uncover any potential foods that cause acne, we encourage our Parsley Health members to do an elimination diet. Elimination diets work by removing common inflammatory foods from the diet for a minimum of 30 days. If acne resolves, restricted foods are then methodically reintroduced back into the diet to help pinpoint which ones may re-trigger breakouts. Our health coaches work closely with Parsley Health members to help guide the process and provide resources along the way.

If you are unable to pinpoint acne-causing foods triggers, your doctors may then recommend a food sensitivity test. This can help to provide a clearer understanding of a wider array of foods that may be responsible for causing immune-related inflammation outside of the typical suspects.

2. You’re constantly stressed out.

There’s a reason pimples seem to pop up when you’re worked up and stressed out. The inflammation caused by chronic stress has been linked to the aggravation of acne . This is in part because when you are constantly experiencing stress, your body begins to break down the barrier in the gut lining, allowing foreign antigens, microorganisms, and toxins from entering into the body’s bloodstream and spur inflammation, the major underlying acne cause.

The fix: In order to help manage stress, we encourage all of our Parsley Health members to employ daily stress management techniques to help keep skin clear. This can look like a meditation , gratitude journal, or yoga practice or perhaps something as simple as incorporating more walking, reading, painting, dancing, or stretching into your day. There is no right way to reduce stress. Rather, the goal is to intentionally incorporate specific activities into your routine that help promote a greater sense of calm and give your body—and gut lining—some much needed relief. The more regularly you engage in stress reduction and work to reframe a perpetually anxious mindset, the better off you’ll be at successfully warding off stress-induced blemishes.

3. You’re not eating enough healthy fats.

Despite the urge you may have to dry out oily skin in an attempt to treat acne, healthy fats and oils are actually your friend. Specifically, essential fatty acids like omega-3s and omega-6s help produce the skin’s natural oil barrier, keep skin hydrated, and ensure systemic inflammation is kept in check.

The ratio of omega-3 to omega-6 fatty acids that you consume is actually more important than the amount. The optimal ratio is 4:1, with ideally four times more omega-3 fatty acids. In reality, the standard American diet has a disproportionate and backward ratio closer to 25:1 of omega-6 to omega-3 fats. Researchers believe the proinflammatory effects of excess of omega-6 fats in the diet could be linked with increased acne .

The fix: Since this improper ratio is a common acne cause,rebalancing it to favor omega-3 fatty acids will help counteract omega 6’s inflammatory properties and have a therapeutic effect on breakouts. Swap out foods rich in omega-6 fatty acids such as processed foods and industrialized seed oils such as corn, soy, canola, and sunflower oils and opt for more anti-inflammatory omega-3 rich-foods such as walnuts, chia seeds, salmon, sardines, anchovies, pasture-raised eggs, and flax seeds. If you can’t get in enough of the above into your diet, consider talking with your doctor about supplementing with a high quality fish oil to help meet your needs.

4. Your diet is too high in sugar.

Does sugar really cause acne? If you have an insatiable sweet tooth, there’s a chance sugar might be what’s to blame for your pesky pimples. Eating too many high glycemic foods can overfeed the “bad” bacteria in your gut, contributing to dysbiosis or an imbalanced ecosystem in your gastrointestinal tract. When this community of microbes is out of whack, the overgrowth of bad bacteria and yeast can contribute to many issues, including acne .

The fix: Focus on consuming a varied, whole foods based diet rich in a balance of well-sourced proteins, healthy fats, and complex carbohydrates. Swap out high glycemic carbs from rice, pasta, cereal, and bread with fiber -filled carbohydrates from your favorite fruits, starchy vegetables, and whole grains which will help to promote a balanced gut microbiome and help treat acne.

5. You’re using too many products.

According to a survey conducted by the Environmental Working Group of 2,300 people, the average person uses nine personal care products each day with 126 unique ingredients, many have known endocrine disrupting properties . This can include anything from your favorite foundation to your special skincare serum.

For acne products specifically, topical treatments for breakouts don’t tend to work long-term because the inflammatory root of the acne is likely coming from inside, not outside, of the body. A new product might initially work to quell localized inflammation on the skin’s surface, but over time they tend to stop having the same effect as they strip the skin of its natural oil and leave the area dry, chapped, and even more susceptible to breakouts. In an attempt to protect itself, the skin will then produce more oil which contributes to the never-ending cycle.

Powerful pharmaceutical products, including topical antibiotics and retinoids, may also disrupt the acid-base balance of the skin and destroy the beneficial bacteria that live on your facial microbiome. This bacterial imbalance can actually cause more acne down the line as the ecosystem and immune system in place on the face is thrown out of equilibrium.

The fix: When it comes to skincare and fancy topicals, less is more. Try to limit how many products you’re using to best assess what’s working for you and what’s not. Be picky about your products and opt for formulas that include real, natural ingredients that you can recognize. Cross-check your next skincare purchase with The Environmental Working Group’s database Skin Deep which helps to compare safety ratings for various personal care products on the market. Sticking to a high quality, natural cleanser, moisturizer, and toner that you use once daily might be the simple trifecta you need to actually combat acne without making matters worse.

Kelly Candela, MS, RD
Health Coach

Kelly Candela is a registered Dietitian Nutritionist with six years of experience in the health and wellness field, four of which have been spent right here at Parsley Health supporting members with everything from gut issues and autoimmune disease to cardiometabolic health concerns and fertility. She holds a Master's of Science in Nutrition from one of the leading science-based natural medicine schools in the country, Bastyr University, and completed her dietetic internship at Sea Mar Community Health Center in Seattle, WA.

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