Image Source: Adriano Russo
When I tell you how I finally cleared up my hormonal acne, it is going to sound so painstakingly obvious that it might even seem . . . annoying. To make a long story short: I met with a doctor who helped me balance my hormones and improve my gut health, and my skin has never looked better.
At the start of Spring, I booked an appointment with Dr. Keith Berkowitz, an MD (internist) located in NYC who worked with Dr. Robert C. Atkins (as in the Atkins diet) for six years and now specialises in how eating affects health. He gave me a glucose test, took my blood, analysed the lab results, and diagnosed me with reactive hypoglycemia. The latter means I process sugar unusually quickly, so I can't eat much of it (even fruit!). I learned I had high testosterone levels and was iodine deficient.
According to the American Thyroid Association, iodine is an element (not made by the body) needed for the production of the thyroid hormone. You get iodine from your diet and various foods, and if you do not have enough of it, you can't make the thyroid hormone, which regulates your metabolism as well as heart and digestive function, muscle control, brain development, and bone maintenance.
I have not changed my skincare routine or received any new spa treatments.
"Women today are struggling with increased hormonal imbalance causing oestrogen dominance, low levels of progesterone, and high levels of testosterone and DHEA [an endogenous steroid hormone]," Dr. Berkowitz told me via email. "This is complicated by the overall decrease in hormone levels as we age. It leads to women having dull, dry skin; a rush of wrinkles; increased pigmentation; and increased acne."
So I began on a journey to balance out what was going on internally by changing my diet and taking supplements. When it came to eating, I had previously spent a year living off of morning smoothies and eliminating gluten and dairy. Though it was technically "healthy," I was eating way too much fruit and spiking my blood sugar.
Dr. Berkowitz tweaked my diet so that I was eating more balanced, portion-controlled meals and snacks that include carbohydrates (including vegetables and fruits) with high-fibre foods and lean protein or healthy fats (like avocado). "It is important that you eat three meals and one snack every day," he explained of his general diet philosophy. "Eating balanced meals will minimize fluctuations in blood sugar and increases in insulin levels."
Image Source: POPSUGAR Photography / Jae Payne
He immediately added bread back into my regime, but only low-carb (Alvarado Street Bakery Sprouted Flax Seed Bread), and I can have just one piece at a time to ensure I am not carb-loading. I was permitted low-lactose dairy, such as goat cheese, since it is a great source of protein. In addition, I eat a lot of organic chicken and salmon, eggs, salads dressed with olive oil and lemon (rather than sugary dressing), and low-carb Wasa crackers topped with hummus and avocado. My smoothies were tweaked: instead of blending in four fruits, I can have one (usually low-sugar, antioxidant-rich berries). Any time I do eat fruit, I can have half the amount (such as half a pear) and mix it with protein, such as a spoon of almond butter. Eating this way has stabilised my blood sugar (I no longer get 3 p.m. sugar cravings), and I feel less restless overall.
I expected to debloat (I did!) and lose a few pounds (check!), but what I did not see coming was how these tweaks would significantly affect my skin. Pre-Dr. Berkowitz, I had combination skin, meaning I would occasionally get pimples in places I am greasier (usually my cheeks and chin). And every month a few days before my period, I got a few "lurkers" (below-the-skin pimples) around my chin. These are typically caused by hormones and can't be cured by creams — they have to go away on their own.
After a Summer spent travelling as far as Greece and Prague, wearing tons of gooey sunscreen, and straight-up sweating, I expected to see my usual cluster of whiteheads on my cheeks. I have also waited each month for the arrival of those chin lurkers. But for the past three months, my skin has been completely and totally clear. I have no dryness and no oiliness. The lines on my forehead are naturally smoothing out and the redness around my nose fading. I have not changed my skincare routine or received any new spa treatments.
What had changed was my gut health. "Tiny bacteria in the gut are one of the major control systems in the body," Dr. Berkowitz explained. "These bacteria have a direct role in helping maintain the health of the skin. They help your absorb nutrients needed to protect and repair itself. They protect the integrity of the gut lining. The gut lining helps protect against inflammation (which ages skin), and it protects the skin environmental toxin damage."
He also told me that gut in the bacteria can cause acne, because that area produces something called substance P. This affects sebum production (the cause of oily skin).
My gut bacteria wasn't all that had been regulated after three months of sticking to Dr. Berkowitz's plan: my hormones tested more balanced, my iodine levels were better, and my glucose more stable.
"The gut lining helps protect against inflammation (which ages skin), and it protects the skin environmental toxin damage."
"Your eating plan led to your hormones being better balanced — lowering DHEA and testosterone — and having better balance with progesterone and oestrogen," Dr. Berkowitz told me when I asked how this could have affected my skin. "The lifestyle also leads to lower levels of cortisol [a hormone that regulates stress, metabolism, and inflammation] and insulin [the hormone that regulates metabolism and gives your cells energy]." He noted that when these hormones are high, it can cause drier skin and premature aging. This is because there is a connection between stress and the deterioration of cells, and skin is made up of cells.
A hormone imbalance can also cause discolouration of the skin. "Oestrogen and progesterone can trigger the melasma, which are brown or light grey patches of pigmentation that most commonly appear on the face," he said. "It usually appears between the ages of 20-50 and is most common in pregnant women or those on an oral contraceptive pill."
In addition, he shared that low oestrogen can lead to decreased collagen production and more wrinkling of the skin. Low levels of progesterone are associated with decreased skin elasticity. And a deficiency in DHEA is problematic, because it helps control oil production. DHEA also increases collagen production, which you want for youthful-looking skin.
When it comes to testosterone, having too much can lead to acne through an increased sebum production. So that explains why decreasing my testosterone levels eliminated my breakouts.
Though my situation was very specific, others can benefit from getting their blood tested and tweaking in specific ways that make sense for them (as instructed by a professional MD). While we are in no way telling you to run out and try a bunch of supplements to balance all of this out (please talk to your doctor first!), regulating your hormones and improving your gut health can directly give you clearer skin with better tone and texture. It happened to me!
If you get the OK from your doctor, here is a list of supplements (from Dr. Berkowitz) and what they do:
- Alpha lipoic acid: helps stop the stiffening of collagen fibres.
- Antioxidants: stop free radical production. For example, vitamins A, C, and E help to better hydrate the skin.
- Hydrolysed collagen: reduces wrinkles.
- Hyaluronic acid: hydrates skin. (Yes, you can take the popular skincare ingredient as a supplement, as well!)
- Astaxanthin: fights free radicals and prevents damage from the sun and other environmental toxins.
Here are specific supplements for acne:
- Zinc: helps accelerate the development of new clear skin cells and reduce the inflammatory response to bacteria.
- Probiotic: promotes healthy or good bacteria and thus decreases the inflammatory response that damages skin.
- Coconut oil: helps replace the protective acid layer that keeps skin healthy and reduces inflammation.
He also shared an anti-inflammatory eating plan:
- Avoid refined carbohydrates, which increase insulin and inflammation.
- Avoid gluten, cow's milk dairy, processed foods, and excessive amounts of omega-6, which are all pro-inflammatory.
- Increase use of spices: turmeric, cinnamon, garlic, and parsley all have anti-inflammatory effects to help keep the skin healthy and slow down the ageing process.