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Insight into Acne. Dairy, Sugar and mTOR.
If you suffer acne, or treat acne, then 2012 was an important year. That was when this ground-breaking paper came out of Germany: ‘Diet in Acne: Further Evidence for the Role of Nutrient Signalling in Acne Pathogenesis’. The full paper is here. One sentence from the abstract says it all:
“Acne should be regarded as an mTOR-driven disease of civilization, like obesity, type 2 diabetes and cancer induced by Western diet.”
What is mTOR?
Don’t be intimidated by the biochemist-speak. In layman’s terms, mTOR is a sensor of nutrient status. When you consume high energy foods (high sugar, high dairy), then you will have high insulin and high IGF-1 hormone. These hormones activate an enzyme called mTOR, which, in turn, activates different parts of your physiology, including – in the case of acne – sebum, keratin and inflammation.
mTOR is not all bad. It is only bad when it is over-activated, as it is with our modern diet. Over-activated mTOR also leads to diabetes, PCOS, cardiovascular disease and cancer. Acne is the ‘early warning signal’ of metabolic dysfunction. It makes sense that our modern insulin-surging, inflammatory diet is the problem. Acne was unheard of in traditional hunter-gatherer societies.
Good dairy – Bad dairy. Does casein also play a role?
IGF-1 and mTOR are the proposed mechanism for why dairy causes acne (1, 2), but there may be more to the story. Many acne-sufferers improve off dairy, but some do not. There are other factors at play such as intestinal permeability, inflammation, zinc status and casein. A1 casein (from Holstein cow milk). is inflammatory, but only for some people. Perhaps the problem is casein-inflammation coupled with mTOR activation. That would explain why the A2 casein in goat, sheep and Jersey seems to be OK in many cases of acne. If you can tolerate A2 casein, then you will get the benefit of whey, saturated fat, and lactoferrin (discussed below). In my clinical experience, high-fat dairy (like butter and cream) is less likely to cause acne than low fat. This makes sense because high-fat dairy contains less sugar and less casein.
When patients stop normal milk and stop sugar, their skin usually clears within 3-4 months. That is the research, and that is my overwhelming experience in clinic. I say usually, because like all things in the real world, it is not always that simple. Some people need a little more help.
Other strategies for acne:
1) Zinc. Hands down, zinc is the most helpful acne supplement. It reduces keratin production, so it keeps pores open. Zinc kills bacteria, and reduces inflammation. Zinc is also essential for healthy ovulation, which increases estrogen, and reduces testosterone in women.
2) Berberine. During my 18 year career, I have consistently prescribed berberine-containing herbs (Goldenseal, barberry, phellodendron) for acne, and have usually had good results. I gave it because it reduces intestinal permeability (and thereby reduces inflammation), and it is also a natural anti-microbial. I now understand that berberine is doing something else. Berberine improves sensitivity to insulin, thereby lowering insulin and IGF-1. It also directly inhibits mTOR. A recent clinical study found that just 4 weeks on berberine improved acne by 45%. I recommend that berberine not be used for more than 8 weeks continuous, because it is anti-microbial and may damage intestinal bacteria in the long term.
3) Lactoferrin is a dairy protein that is anti-inflammatory and anti-microbial. It has shown promise for acne. Lactoferrin is included in some probiotic formulas, and follows nicely after berberine.
4) Reduce stress. Stress worsens acne because it disrupts insulin and female hormones, and because it causes inflammation.
5) For women: Estrogen reduces sebum production. That’s what the Pill’s synthetic estrogens do, but that’s what your own estradiol could do just as well (once your mTOR inflammation is down). The only way to get a good level of estradiol is to have a healthy ovulation.
Acne is not trivial. As a doctor, I take it very seriously. Acne can damage someone’s self-esteem and happiness, but not only that. Acne leads to harmful medications such the Pill, Spironolactone, and the most frightening of all: Accutane (isotretinoin).
Accutane.
The drug’s mechanism of action is DNA damage, which means that it targets the deepest level your core biology. Accutane also damages the hippocampus, which may be why it causes depression, and is linked to inflammatory bowel disease and osteoporosis.
One of my patients intuitively said this about Accutane: “I felt its side-effects at my soul-level.”
I beg you not to take it.
Yours in Health, Lara Briden
About the Author
Lara Briden, ND, before qualifying as a Naturopathic Doctor, studied evolutionary biology at University of Calgary. She then went on to graduate from the Canadian College of Naturopathic Medicine (CCNM) in 1997. Her love of science and the natural world has informed the way she practices medicine. Seeing the body as a pragmatic, regenerative system. The body wants to be healthy. So often, the best thing that we can do for health is to remove the obstacles that get in its way. In her 18 years as a Naturopathic Doctor, thousands of patients have entrusted her with their hormone stories. Every story was unique. Here is what she has learned: Some things really work for hormone balance. The rest are just theories. With this blog, she strives to assemble some health truths, and to dispel some health myths. Some Truths: Coffee has merits; the Pill is chemical castration; and antibiotics are bad for hormones. Another Truth: Wheat, sugar and vegetable oil are not suitable food for humans (or for any creature). That is not new information, but it is a truth that has recently been made sexy by the Paleo hipsters. Follow her on her blog and on Facebook.
