Wednesday, October 1, 2008

Acne Anecdotes

Thanks for all the interesting comments on the last post. Here are some highlights:

I had bad acne as a teenager and although the worst of it did clear up for as I got older (this seems to be the pattern, so presumably there are hormones other than insulin involved,) I still had spotty skin into my 20s and 30s. When I went onto a Paleo diet my skin cleared up totally.
I am lucky enough to have reasonable skin already, but reducing carbs and vegetable oils has at the least coincided with a notable improvement
I used to get... 2-3 pimples most months. Since I have gone Paleo I have had not a single pimple in 8 months.
I had terrible acne that lasted from 9 yrs right up until 20 years - the same week I started the atkins diet. Then it stopped.
I see the skin as a barometer of health. A truly healthy person's skin is smooth, free of acne and has a gentle blush in the cheeks. Unhealthy skin is pale, puffy, pasty, dry, oily, or excessively red in the cheeks and face. It's no coincidence that what we perceive as attractive also happens to indicate health.

I'll add one more anecdote, from myself. In high school, my friends called me "the ghost" because my skin was so pale. I had mild but persistent acne and difficulty tanning. Over the past few years, as I've improved my diet, my skin has smoothed, I've regained the color in my cheeks, I've regained my ability to tan well and my acne has disappeared.


Debs said...

I've always had smooth skin, but at the beginning of college I noticed my skin seemed to be getting more sensitive. My forehead broke out easily, which I attributed to facial cleaning products or certain fabrics. This was also around the time my digestion was getting worse. I had just become a full vegetarian, but had been eating fish and chicken for a few years before that.

Now I eat a healthy diet with very little grains or sugar, and a lot of saturated fat, meat, fish and vegetables. A 21-year-old woman who gave facials professionally told me she envied my skin. She ate terribly.

Among youth I've worked with, I've also noticed a correlation between skin health and other aspects of wellness. When one such extremely visible organ is showing signs of poor health, something is likely wrong with other organs too.

Food Is Love

gunther gatherer said...

Hi Stephen,

I was wondering if you think "male pattern" baldness was also a disease of civilisation. Cordain says as much in his book too. I also notice in the Weston Price book that all the peoples he studied had no baldness, which he states at one point.

I have been a sufferer of this for the last ten or eleven years (it started out of nowhere at 26), and it seems to have stopped falling out now that I've been eating paleo foods. (Hasn't grown back, though it's only been a year with my new lifestyle.)

Thanks and great blog,

gunther gatherer said...

And if MPB is a disease of civilisation just like acne, can it also disappear like acne? Hmm...

David said...

nice hypothesis and all, but studies show that people with adolescent acne are less likely to get heart disease as adults...

Stephan Guyenet said...


Thanks for your perspective.


I don't know enough about MPB to decide whether or not it's part of the disease of civilization. I've seen Cordain bring it up a few times. I remember Price mentioning that the Australian Aborigines didn't go bald, but was that also true of the other cultures he studied?


I don't see that as a challenge to the hypothesis. A weak epidemiological association like that (0.89 relative risk of all-cause mortality) is nothing compared to the fact that healthy traditional cultures had no cardiovascular disease or acne, zero of either. Put them on modern foods and all of a sudden they look like Americans. The people with acne in that study were also more likely to be nonsmokers. That's the problem with these studies, they only detect associations.

AngloAmerikan said...

I have suffered from bad skin for over thirty years and recently discovered a medication that seemed to work very well, miraculously well in fact. Yet it occurs to me that at around the same time I started eating less fruit and almost no wheat or rice products while upping my fatty meat consumption as well as practising IF. The medication I used was a cream but thinking about it now I also used to get bad spots in my scalp which was embarrassing when I went for a haircut and I certainly don’t use the cream there yet these spots have completely gone too.

Anonymous said...

I doubt if fruit has anything to do with acne. Sugar and high fructose, maybe. Cordain argues against fruit as a cause of acne. This website says that cooked or frozen protein foods cause acne and that a diet of only raw meat, raw egg yolk, fruit, raw nuts shelled by hands, and oils (like EV olive) will cure acne, and cellulite 100%. There is more than one solution to most problems. Not everyone will be acne-free just by eating paleo or low-carb or getting "balanced" omega ratios.

Stephan Guyenet said...


Most healthy non-industrial cultures ate cooked meat and didn't suffer from acne. It was truly a rare culture that didn't cook any of their meat. Even the Inuit regularly ate cooked meat and fish.

Unknown said...

Now that people are baring their souls, I was wondering if people might consider sharing waht they eat.
I'm new to this way of eating. The diets posted for the OPtimal diet just don't seem very appetizing. I've previously eaten low carb, but with emphasis on protein and am interested inways to get more fat into my diet. I've eaten more eggs and started using butter again.


This is not a commercial- I have no involvement with these folks, but recently started ordering grass fed beef from US Wellness meats and it's the best I've eaten. They wet age their beef for 30 days. They also have great prepared foods- sausages, jerky, pemmican and headcheese and liverwurst and grass fed butter. They're great to deal with- very nice folks
Just a heads up

Stephan Guyenet said...


Feel free to recommend sources for healthy food any time. Have you had their pemmican?

I hear your need for recipes. That's something I haven't posted much about on the blog. You can find a few things on the blog if you search for "real food".

I find a good way to increase my fat is just to make the same dishes I usually make, but smother them in butter, lard, coconut oil or cream. It's not exactly hard on the tastebuds.

Las said...

I had persistent acne from age 12 until 21, when I went on Accutane. I had clear skin for about 4 years before I started breaking out again, but not as badly as before accutane. I went on the South Beach diet to lose a little bit of weight, and I noticed that my skin not only cleared up completely, but looked healthy in a way it never had before. I figured the combination of low-carb and lots of salmon was the reason, but being lazy I didn't keep up with it, and I started breaking out again (and choosing to control it with retin-a). I randomly came across some Weston Price information, did lots of digging and started reading so many informative blogs like this one, and now I'm once again acne free.

My diet is fairly low-carb. I rarely eat grains, not much starchy vegetables, and I've increased my saturated fat intake. I'm very fortunate in that I've never had any health or weight problems (just those 10 "vanity" pounds), so while I think that this way of eating is much healthier for everyone, I can't comment on that from a personal perspective; but the difference in my skin has been dramatic.

Pasi said...

Stephan and Gunther:

As far I know MPB is a stongly related to these "diseases of civilization". Two possible routes:
1) increased oxidative stress and glycation in hair roots microvessels
2) disturbed SHBG production in liver (causes (sex)hormone imbalance)

Scott Kustes said...

I'll throw my hat in the ring here. I never had much in the way of acne, but I did have dry skin up until about age 24. Not horrible, but I had to put lotion on my arms to keep them from being a bit flaky, kinda like mild dandruff on the arms.

Fewer grains, more fats, more saturated fats, no more dry skin. Further, I also couldn't get a tan to save my life. That change corresponded with a move to more saturated fats, specifically coconut and palm oils. I still don't get especially dark or maintain a tan for long, but I have my German-Irish heritage to thank for that. But I can be out in the sun and not get scorched.

Scott Kustes
Modern Forager

mess talker said...

I love the pemmican from the us wellness. Love it. We order the packaged bars for convenient lunches. It says to keep frozen but they taste best after sitting around for a while in your pocket. Moist and delicious. Boy do I get some looks as I squeeze my meat (ha). It's like a meat push-up or popsicle. We order a lot with the cherries and honey but after reading Vilhjalmur Stefansson's great book on pemmican I've realized that's not the preferred method but one for special occasions or for guests "whites".
The bars are pretty optimal with 20gP 40gFat. All grass fed beef. We also order a lot of kidney and heart from them and it's awesome. Plus the breakfast sausages. We call it the Jack Palance sausage cause it tastes cowboy real.
As far as the rest of my diet goes, little potato, and honey round out my carbs (plus the veggies my wife makes me eat), yogurt and fresh sausages from the optimal deli. Was eating a lot of coconut milk for while mixed with cocoa and honey. Still trying to lose about 15lbs. Just stopped drinking and will hopefully keep that at bay for a while while I'm about a month in at crossfit.
Oh and I get some back acne still and little pink dots. Seem to have "cured" my lifelong (really from the womb) dandruff with weekly topical treatment of Braggs Apple Cider vinegar.
thanks stephan for all your work.

Stephan Guyenet said...


The tanning thing is really interesting to me. I'm glad to hear you had the same effect. I wonder why it happens?

Mess talker,

My mouth is watering right now! Did Stefansson write about pemmican?? I should get my hands on that. I'm going to get some suet from the market tomorrow and make me some pemmican. I can get grass-fed suet for $2/lb.

mess talker said...

Fat of the Land: Not by bread alone is a wonderfully written book. It's pretty much a love letter to pemmican.

Unknown said...

It's interesting what you mention about being able to tan after ditching the grains/embracing the fats--come to think of it, the same has happened to me since adopting that way of eating. I've always been pretty fair and would usually just turn pink then quickly fade back to pale after being in the sun. The past two summers, though, I've been able to get nice and tan. I hadn't really made the connection to diet; I thought it was just from being outside more often after jumping on the fitness bandwagon. But now that you mention it, I bet it's at least partially because of what I eat--and don't eat.


Pass the porkfat, please!!!

ItsTheWooo said...

Hey gunther, about the MPB thing, it's definitely related to high insulin and metabolic syndrome... it's part of a syndrome that is "male PCOS".

In female PCOS, too much insulin, glucose, lower dopamine causes imbalances in the body which affect levels of LH (much too high) and FSH (relatively too low). LH tells your gonads to make hormone precursors; FSH tells them to make sex cells (sperm or eggs). So what you have in PCOS is way too many hormone precursors being made, but not enough follicle/egg maturation. The immature egg and follicle make precursors to estrogen under direction of LH, which are androgenic.

The end result of this is that the PCOS woman has high hormones, especially high androgens, and infertility/anovulation.

Now, male PCOS is much more inconspicuous because slight excess estrogen does not profoundly alter appearance or mood of a man the way slight excess testosterone would in a woman. Also, male PCOS does not cause overt infertility, but it does cause reduced fertility.

The symptoms (physical) of male PCOS are lower sperm count, hair loss, abdominal obesity, and female-pattern fat distribution (man boobs and a slightly puffy/thicker look to the face and body under direction of estrogen). If it onset in childhood, he may be prematurely shorter than family members without it.
These symptoms are not only non-specific but they are mild and common so obviously male PCOS is ignored and not even classified as anything at all.

Going low carb and fixing insulin/glucose will cure male and female syndromes... but some of the damage is permanent. Hair loss is permanent.

Hair loss occurs when testosterone is broken down into DHT. Both men and women with the syndrome have high levels of all hormones, and that produces a lot of DHT. DHT kills hair follicles, they don't grow back.

Further hair loss should be slowed or stopped but what is already lost will stay lost if it is male pattern baldness...

ItsTheWooo said...

In summary...

MPB basically correlates with "too high testosterone", and the number one reason for that is insulin-glucose driven syndrome of infertility (female this is named PCOS but there is a similar syndrome in males that is unidentified because it is inconspicuous).

Having MPB does not mean this is the reason you have MPB. Anyone with lots of testosterone is going to get some degree of MPB. I want to mention more testosterone is not better; men tend to hear that and think "oh so that means I'm really manly". It's true testosterone is higher in healthy males, but a lot of the time there is a pathological reason for excessive testosterone (especially if there are signs of poor health in other ways).

For genetic reasons some people have hair follicles which are abnormally sensitive to DHT, these people get MPB even if healthy with normal hormones.

So, basically, MPB correlates with insulin/glucose fubary but it isn't always true.

gunther gatherer said...

Hi itsthewooo,

Thanks for that information. I had suspected for a long time, even before reading Cordain's theories, that MBP was a disease of civilisation. We hear all these theories about "genetics" being the reason, but what they really want me to do is give up and spring for hair transplants or propecia, etc.

Your explanation of the pathway towards male PCOS from diet makes total sense. But I have to disagree about the "dying follicles" thing. The process of MBP, from a physical standpoint, is that the follicles SHRINK, they don't really die. They just make thin, weak hairs that fall out before they reach a length and thickness that is visible. This gets worse over time until you get a "bald spot", depending on the length of time and severity of the male PCOS you describe.

I know this because I can clearly see all the fuzzy, thin, blonde hairs that USED to be long, thick brown hairs on this "bald spot". They cover the whole spot, so the follicles are alive, and even working, just not optimally. ;-)

So if proper hormone levels (DHT) can be restored, acne cleared up (also hormonally caused), pre-diabetic blood profiles corrected, and in general, one's whole appearance changed, I'm wondering if proper diet can't wake these little guys up again...


Jeff said...


I post what I eat and how I exercise on my blog daily. Please feel free to take a look and provide comments. I have made a huge dietary and fitness change 8 months ago and am still learning, but the results on what I have been doing have been fantastic. If anyone else has any suggestions, please let me know.

I am going to a farm tomorrow to buy pastured, grass fed beef. Looking forward to it.

On the same topic, I sure as heck would love to see a daily log of Stephan's diet. :-)


Puutyöläinen said...

But why oh why do I still get spots?!

I'm doing everything right nutritionally. I've been lowcarbing for years (I'm 30), and it's stopped the problem with dry skin and oily skin (and body lotion addiction). But I still get spots weekly. I eat a high fat, high protein, animal based diet, the few carbs coming from potatoes and rice mostly. Completely gluten free for two months now, has made no difference. I've started on vitamin D and zinc recently like Cordain suggests in his Acne book. No difference.

So is it excess androgens as Itsthewoo says? If so, how is that possible? I lift weights but I'm no uberman by any means. And if so, I'll have to accept being spotty forever, cause I'm not about to start drinking soy milk to lower my androgens either.

Also, is there a difference between different places to have spots? I most often have mine in the area from the corner of mouth down to the jaw.

Stephan Guyenet said...


I wish I had an answer for you. All I can think of is increasing your vitamin A intake (liver, cod liver oil). Anyone else have suggestions?

ItsTheWooo said...

Belmondo -
First, may I ask if going low carb made any difference in your acne? This offers valuable clues to the origin of the acne. If it is mediated by insulin-driven androgen excesses, then an improvment in acne should be observed when going low carb.

Second, how low carb do you eat? The definition of low carb varies widely, it's common for people to say they do "low carb" when what they really mean is that they are eating less carbs than they were (but still pretty high carb). It may be that you are not eating low enough carb (especially if you are eating rice and potatoes). I eat 60 grams per day, if I try to go up to even 100 I start getting insulin-driven acne spots.

Third, do you eat dairy? Dairy has hormones activators in it, insulin-mimetic and other nasty things which can make acne flair up for vulnerable people. I do tend to get spots if I drink milk. I avoid dairy except for cheeses and yogurt, which I consume small amounts of.

There's also evidence that omega 3 fatty acids can reduce inflammation that can contribute to acne (whereas omega 6 exacerbate it).

mess talker said...

I was getting some weird rash around my mouth and it went away when I stopped using Mint toothpaste. Years late.

Puutyöläinen said...

Thanks for the comments!


Low carb I think has made a slight difference on amy acne, but only a slight. Ten years ago as a high carb vegetarian my skin was quite horrible, (I tried Roaccutane for a while as well) but then I was practically a teenager still.

I now cycle my carbs, around 20 grams 6 days a week, on sundays I eat liberally of the "sefer" carbs I mentioned. This translates to a weekly average of about 60 grams per day.

I eat dairy, but don't drink it - except whey protein shakes 2-3/week, so those could contribute? I use butter and cream liberally and some cheese and yogurt. Sports supplements such as creatine and leucine made me break out, so those are out, only whey now. I live in scandinavia where there's no hormones given to cattle.

I'm pretty sure my omegas are in balance, as I supplement with fish oil/cod liver oil, eat fish, very little nuts and only use EVOO of the vegetable oils. My spots don't usually get inflamed any more(the painful ones).

As to vit A, I usually try to eat liver every week, I take cod liver oil in the winter, and use plenty of vitamin A-rich foods such as butter. I could get more A. Right now my wife is pregnant so I'm just a bit cautious at cooking us liver each and every week.

Stephan Guyenet said...


Sounds like you have a good diet. The dairy could be a problem, as much as I hate to admit it. It might be worthwhile to cut it out for a while and see how your face reacts.

Scott Kustes said...

I'm betting that the greater stability of the saturated fats confers some kind of additional resistance to the sun's effects to the skin. Perhaps the saturated fats are giving additional resistance to oxidation when they are incorporated into cell walls. Otherwise, ya got me!

Scott Kustes
Modern Forager

Stephan Guyenet said...


I'd be interested to see if the fatty acid composition of skin changes with diet.

AngloAmerikan said...


I recommend trying a product with Benzoyl Peroxide in it. I suffered from eruptions on my chin and jaw too and this chemical cleared them up after thirty years of suffering. It's possible that my change in diet away from wheat helped as well yet the change in my skin after two weeks of twice daily application was dramatic. I was very surprised that an off the shelf product was so effective that I did a bit of googling and discovered that many others had the same experience:

Puutyöläinen said...

Thanks Angloamerikan, will try. All though I feel like it's almost cheating, since I believe acne to be dietary, but what the heck. ;D

Half Navajo said...

hey belmado,

i used the benzoyle peroxide treatment the suggests...and it works well...but i felt like i was cheating and started eating high fat like everyone else and i didn't have to use it anymore...and i also started to sunbathe in the middle of the day, which dermotologists don't recommend and my skin got really nice! I read somewhere that getting sun from 1 to 3 in the day is the only time your body can convert sunlight into vitamin d...and not to worry about skin diseases or melanoma if you don't burn. Another thing i did was switch to a plain organic soap that was unscented, and use a nice coconut oil mixed with aloe vera gel. maybe this will help.

t r o y

Half Navajo said...

correction on that 11 to 3 for quality sunlight...i accidently didn't type in another one...another thing might be allergic to something your eating...check out for more info on allergins.

Unknown said...

Hi Belmondo

You might wanna try cutting out the whey protein shakes. Just a guess, but it's been pointed out (Cordain mentioned it) that milk has its insulinogenic effect probably because of something contained in the *whey protein*. So if you avoid drinking milk, but still have a whey protein intake via the shakes ... you may still be getting the problem dietary ingredient that contributes to insulin spikes.

Just a guess. Try it and see.

AngloAmerikan said...

Acne is probably a symptom of many underlying conditions. Diet may well have an influence and the low to no incidence of it in non-industrialized societies implies this. Once adulthood has been reached and bad skin persists despite a clean diet the cause can be bacterial. If anti-biotics clear up the skin then bacteria is the culprit and Benzoyl Peroxide should be very effective. Using modern medicines is no more cheating then using tools to crack nuts or fire to cook food. Hunter-gatherers are especially prone to parasitic organisms and no amount of good diet will protect you from them. In these cases medicine is required. Insisting on avoiding modern medicine has on many occasions proven to be unwise or even fatal.

Anonymous said...

"Most healthy non-industrial cultures ate cooked meat and didn't suffer from acne. It was truly a rare culture that didn't cook any of their meat. Even the Inuit regularly ate cooked meat and fish."

They also didn't have pollution, stress, vaccines, mercury dental fillings, etc. Many people can't get rid of acne simply by eating paleo, low-carb, or balanced omega ratios, if they are cooking their foods. They can if they eat the food raw. Maybe this is a consequence of our modern degeneration and poisoning, but it's a reality nonetheless. Eating raw meat has helped many people overcome a lot of serious health problems, whereas the low-carb cooked diet seems to be a stop-gap solution at best. Many seem to degenerate to the extent that they have to eat zero-carbs, for ex. If they were eating raw or rare meat, this might not occur. Whether primitives did something or not isn't particularly relevant. We have to adapt that information based on the world we live in. for ex, I don't think it would be healthy to eat a diet like the primitive Eskimos if you lived in a polluted city like Los Angeles.

Anonymous said...

We need a theory that can explain all of the facts. If some people eating a paleo diet have acne, then there must be other factors. If people limiting omega-6 fats and eating more omega-3 have acne, there must be other factors. If someone eating a low-carb whole foods diet has acne, we need to look at other ideas.

I think there are various factors behind diseases. Didn't Cordain do a study, and fail to achieve 100% cure of acne by his diet alone? If you can't get a 100% cure of acne, your theory is wrong IMO. Let's see if there are any other diets that DO give 100% cures. I've tried many extreme diets and none of them gave me perfectly clear skin. What works for one person is often useless for another.

Looking at what primitives do is helpful as a rough guide to a healthy lifestyle, But we can't extrapolate from their life to our own. Stephan said that the Eskimo cooked most of their meat, but how do we know for sure? Someone reported it. They might have lied, afterall.

Some people believe that Stefansson lied about how much raw meat the Eskimos ate, because he knew people wouldn't take him seriously if he told the truth. We can't assume that everything Weston Price said was the whole truth, either. Maybe Price ignored (or failed to find) some healthy tribes that didn't support his theories. You can't assume that everything written by anyone is true/complete.

It's a fallacy to say that modern people wouldn't have acne if they ate low-carb, paleo, or some other diet. Where are the randomized controlled studies that had a 100% cure of acne with diet? They do not exist. Eliminating acne is a lofty goal, and there's no evidence that paleo diets offer a 100% cure rate. I suspect that a raw paleo diet would cure more people of acne than a cooked paleo diet. There are some people who could get by with a less extreme approach, but then maybe they're harming themselves long term. We need to be skeptical and open-minded.

Stephan Guyenet said...


Human fat has a half-life of about 2 years. So if you have a bunch of n-6 in your fat stores, it might take 4-6 years of paleo eating to deplete it.

Also, who knows what the developmental effects of the modern diet are. It's possible that some people get permanent metabolic disturbances that nothing will improve. For example, if you are a type I diabetic, eating paleo isn't going to bring your beta cells back.

So the fact that there are a minority of people who haven't seen improvements eating paleo doesn't bother me too much.

Unknown said...

This is a belated comment to this 2008 thread. But many with non-cystic acne, such as closed comedone whiteheads that hare harded sebum and skin-cell bumps under the skin have sebum that is deficient in linoleic acid. WHY they have this deficiency is unknown and complex. In part it is genetic. Topical application of linoleic rich oils (must do homework and not buy oils off grocery shelf) such as HIGH linoleic safflower, grapeseed or sunflower oil or HEMP oil will change the sebum content of skin from oleic-heavy to linoleic and after several, very patient months, will unclog the skin. It is slow going. Also I found a study that said that people who have damaged the bifidobacerium population in the gut from antibiotic use at any time in life (or NSAID abuse, Chemical birth control, etc...steroids-all damage the gut lining and contribute to gut disbiosis) can't metabolize fatty acids very well and get them into the lipid layers of the skin where they are needed to produce and regulate healthy sebum content.