Clear Up This Condition with the Paleo Diet and Saw Palmetto
TELL JOHN MCDOUGALL that acne has nothing to do with diet and be prepared to see him fighting mad. “Next time you hear that, ask for the evidence,” he says.
McDougall, medical director of the renowned McDougall Wellness Center in Santa Rosa, California, traces this wrongheaded information to a seriously flawed study by James Fulton, M.D., in the Journal of the American Medical Association way back in 1969. Fulton, aided by the Chocolate Manufacturers Association of America, tested thirty adolescents and thirty-five young adult male prisoners. He gave the subjects one of two sugar- and fat-loaded candy bars—one with and one without chocolate. Then, at the end of the study, he counted their pimples. The complexions of forty-six of the sixty-five subjects stayed the same, ten actually improved, and nine showed more acne. Based on this highly suspect and flawed study, the claim that “diet has nothing to do with acne” was born and remains the conventional wisdom to this day.
Opposing Forces Create Confusion
I hate to be cynical, but one reason that doctors and dermatologists say that diet doesn’t cause acne is because they can’t sell a healthy diet. In addition, they were trained to believe that there’s no connection between what you eat and what your face looks like. Plus, there’s constant pressure from the pharmaceutical industry to prescribe creams, drugs, and other “remedies.”
The problem is muddied further by the fact that there isn’t a perfect correlation between diet and acne—some people can eat crap all day long and have perfect skin and others can eat healthfully and still have outbreaks. “Acne sufferers are not a homogenous group,” says Richard Fried, M.D., Ph.D., author of Healing Adult Acne.
Two events conspire to create or aggravate most forms of acne. One is blockage, two is infection. Here’s how it works: Keratin is a fibrous protein that’s the main component of the outermost layer of the skin. Sebum is part of the oil found on the surface of the skin and is produced by the sebaceous glands, most of which open into a hair follicle. When either too much keratin or sebum is produced, it can block the skin pores. Those overstuffed pores then can become infected by bacteria, which literally eat up the sebum and thrive.
There is overwhelming evidence—both clinical and theoretical—that diet is a huge contributor to acne. Skeptical? Then ponder this: if diet has nothing to do with acne, why is the incidence of acne in underdeveloped countries where people eat natural, native diets almost zero while the incidence of acne in Western countries is in the double digits?
Eating Locally and Healthfully
The idea that the Western diet has nothing to do with acne should have been given its walking papers years ago. Back in 1971, O. Schaeffer published a report that acne was completely absent in the Inuit (Eskimo) population when they were eating and living in their traditional manner, but as soon as they adopted the Western way of eating, acne showed up.
Local physicians in Okinawa prior to World War II reported that “These people had no acne vulgaris.” According to one report, only 2.7 percent of almost 10,000 rural Brazilian school kids have acne. There’s far less acne in Kenya, Zambia, Malaysia, and rural Japan than is common in Western societies.
But if there was any doubt left about the diet-acne connection it should have been erased by the seminal research paper published in the Archives of Dermatology in 2002 by respected researcher Loren Cordain, Ph.D., of Colorado State University.
Cordain and his team studied two non-Westernized populations: the Kitavan Islanders of Papua New Guinea and the Ache hunter-gatherers of Paraguay. Are you ready for the number of cases of acne observed by these trained researchers?
None. Of 1,200 Kitavan subjects and 115 Ache subjects examined, not a single case of active acne was observed.
Tubers, fruit, fish, and coconut represent the dietary mainstays in Kitava and, according to Cordain, dietary habits are virtually uninfluenced by Western foods in most households. Similarly, the diet of the Ache of eastern Paraguay contains wild, foraged foods, locally grown foods, and only about 8 percent Western foods.
In other words, they were eating the diet of our hunter-gatherer ancestors: food you could hunt, gather, pluck, or fish, what Cordain, author of a well-respected book by the same name, calls The Paleo Diet. In another of his books, The Dietary Cure for Acne, he lays out some tasty options for a diet based on whole foods—salmon, sirloin, strawberries, walnuts, carrots, and the like—which may well be the cornerstone of a natural prescription for getting rid of acne. (The paleo diet is absent of grains and dairy and high in grass-fed meats, vegetables, fruits, and omega fats.)
Cordain hypothesizes that a diet that produces high levels of the hormone insulin is partly the culprit when it comes to acne. Here’s how it works: High-sugar foods (processed carbs and the like) produce higher levels of a hormone called insulin, which in turn elicits a rise in another hormone called IGF-1 (Insulin-like growth factor). IGF-1 has a high potential for stimulating growth in all tissues, including the follicles. Both insulin and IGF-1 stimulate more hormones in both ovarian and testicular tissues, meaning they stimulate more testosterone (in both men and women). And more testosterone—with its especially nasty metabolite DHT—may well be acne’s best friend. (More on the testosterone connection in a moment.)
It’s not just a high-carb diet that’s responsible for the surge in insulin and its resulting effect on acne. The Kitavan Islanders ate a diet of almost 70 percent carbohydrates—but they never saw a Twinkie or a processed breakfast cereal. Their carbs came from tubers, fruits, and vegetables, which are considered a low-glycemic, or low-sugar, diet.
Although no one has investigated this directly, factory-farmed meat and chicken contain hormones and hormone-like compounds that can affect the body’s hormonal balance and could certainly be part of the problem. Meat eaten in the native cultures where acne is virtually absent comes from wild game and pasture-fed (grass-fed) animals, not from factory farms where cows are routinely given large doses of hormones.
One study in the Journal of the American Academy of Dermatology investigated the relationship between diet and teenage acne and found a significant positive association between acne and milk (skim and whole). The researchers hypothesized that the association may be because of the “presence of hormones and bioactive molecules in milk.”
Although no one is claiming that diet is the only cause of acne, no responsible nutritionist or health practitioner should deny the overwhelming evidence that a bad diet makes matters much worse. There are probably genetic factors that make one susceptible to excess keratin and sebum production and to the inflammation and infection that can contribute to acne. But eating in a way that produces excessive amounts of hormones that do the same thing may “turn on” those genes; eating a natural, traditional diet lower in sugar and processed foods does not.
Acne is also promoted by a diet low in the antioxidants found in abundance in vegetables and fruits. “Acne may be the best angle you will ever use to sell a healthy diet to your teenage children,” says McDougall. “After all, millions of people living in Papua New Guinea, Paraguay, and rural Africa and Asia who eat a plant-based diet are acne-free throughout their lives—so why can’t you also be acne-free, if you behave like they do?”
A diet rich in plant foods provides huge amounts of antioxidants and natural anti-inflammatory agents. Whole foods are also high in fiber and low in sugar, and do not raise insulin to any levels that are likely to be problematic. Research going back to 1977 suggested that patients with acne may not metabolize sugar very well. Back in 1959, researchers writing in the Journal of the Canadian Medical Association went so far as to refer to acne as “skin diabetes.” It appears they were on to something.
One of the main factors that drives the overproduction of either sebum or keratin is hormones. According to Michael Murray, N.D., acne is considered a “male hormone dependent condition” because the male hormone testosterone fuels the growth of keratin and causes the sebaceous glands to enlarge and overproduce sebum. (Don’t forget—females also have testosterone, just not as much as we guys.) But it’s not just the amount of testosterone you have that causes the problem. It’s how your body metabolizes it.
Testosterone converts in the body to a nasty little compound called DHT—dihydrotestosterone—which stimulates the sebaceous glands to produce even higher levels of sebum. To complicate things further, a high glycemic diet accelerates the conversion of testosterone to DHT, one reason the low-sugar paleo diet works so well
When eating meat, grass-fed, hormone-free choices are less likely to contribute to the problem of acne because they don’t add hormones to the diet. According to Robert Ivker, D.O., a diet of 45 percent protein appears to restrict the conversion of testosterone to DHT. My guess is simply reducing sugar and processed carbs—even if they weren’t replaced with protein—would accomplish the same thing. The take-away message is that the processed foods that are rampant in the Western diet create a hormonal situation that is likely to seriously aggravate acne or even, in some cases, actually cause it.
Saw palmetto is an herb with a documented ability to prevent some of that conversion of testosterone to DHT. The question is, what role exactly does DHT play in acne? How much of hormone-driven acne is due to testosterone and how much is due to its metabolite DHT (which I like to call “son of testosterone”) no one is quite sure. But it’s very possible that DHT plays a substantial role, and if so, limiting the conversion of testosterone to DHT—which saw palmetto can clearly do—would be a boon for acne sufferers.
Fried, of my “go-to” guys for skin problems, explains it this way: “There are people who, through God, bad luck, or genes, are just susceptible to the effects of testosterone and DHT. The cells that line the hair follicle over-respond to this hormonal stimulation.”
When this happens, the oil glands produce too much oil, which in turn clogs the follicles and creates a welcome environment for bacteria. “The immune system mounts an attack against that bacteria, which leads to inflammation, which is why a pimple can turn into a nasty, red cyst that can scar both physically and emotionally,” Fried says. The theory—and it remains a theory—is that by downsizing the conversion of testosterone to DHT, saw palmetto can make a big difference.
Opinion is divided on saw palmetto as a natural cure for acne. Though as of this writing there aren’t any solid research studies on acne and saw palmetto, there is a lot of anecdotal evidence from a growing number of people who’ve had good luck with it. It makes good common sense that it might be a terrific adjunct to the Paleolithic diet in a natural prescription for acne.