Teenage Acne

June 10, 2017

The teenage years are often associated with the frustration of acne, which we’re here to help clear up. Listen in to learn what foods can cause inflammation which in turn often causes acne. We also share what a damaged intestinal tract has to do with acne, something that often surprises our clients.

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Carolyn: Welcome to Dishing Up Nutrition. I am Carolyn Hudson, Registered Dietitian Nutritionist and I’m co-hosting Dishing Up Nutrition today with Kara Carper. This show is brought to you by Nutritional Weight & Wellness, a company providing life-changing nutrition education and life-changing nutrition counseling.

Kara: Good morning, listeners! I’m Kara Carper, Licensed Nutritionist.

Today Carolyn and I are talking about teenage acne, it’s a very relevant topic to both of us.  

Carolyn: Yes, and very emotional. Let me ask you if you have ever had an acne breakout just before a special event?  I bet many of you can identify with that, I know Kara and I both have stories but before we tell you ours I want to know how did, or do you, feel when you have a breakout?  I know some of my clients tell me that they are so embarrassed that they just want to hide.

Kara: Yes, I can identify with that as well, in fact according to the American Academy of Dermatology over 50 million Americans suffer with Acne. Even more surprising is the fact that 95% of all people will experience acne at some time in their life! Acne is the most common skin condition. Not only does it physically affect you but also it can affect you emotionally which is what we just mentioned. When you have acne & pimples, whether it be face, neck, chest, it can be anywhere in the body, your self-esteem can be low because you believe you are not as attractive as you would like to be. Self-worth goes down, you feel self-conscious. Having acne can also cause depression and anxiety. I still remember the anxiety it caused me as a teenager and that was a long time ago, I still remember those feelings.

Carolyn: I can identify with that as well, lots of anxiety. As nutritionists, we know that acne is more than skin deep. While I was researching for this show I came across a great quote from the website, One Einstein and it goes like this “Sugar and spice and all things nice may be what little girls are made of. But we can equally say, milk and sugar and all things sweet, that’s what little pimples are made of.”

Kara: That is a perfect segue into what we’re talking about, the show is geared towards teenage acne. What we’re going to be talking about actually, if you’re an adult with acne, perk up your ears because it’s the same recommendations.  I’m sure parents and teens are asking, “How did this acne get started?  Why did I get that pimple? Why am I having these breakouts?”

Carolyn: I think the most important piece of understanding how acne starts is knowing how inflammation in the skin starts. Because really, it’s all about inflammation.

Kara: First, let’s talk about the skin itself. Our skin has glands that secrete an oily substance called the sebum. The sebum becomes inflamed causing the glands to go into overdrive and produce more of the sticky sebum that combines with dead skin cells, clogs up the pores and starts the acne breakouts. Research has shown that it’s the inflammation of sebum that triggers acne – not bacteria like we always hear about.  Bacteria adds to existing inflammation, but it doesn’t start the process.

Carolyn: So Kara, I think it is important to understand how inflammation of the sebum gets started.Believe it or not, it all boils down to sugar! I bet our long time listeners are not surprised at all to hear us blame sugar as a cause of acne.

Kara: Let me paint a picture for you. You get home from school grab a soda and a bag of chips, I hear about teens grabbing soda and chips. That type of a snack turns into sugar.

Carolyn: But what about things like pizza, pasta or bread?

Kara: Exactly Carolyn, so it’s not just soda and chips, the obvious forms of things that are sugary or turning into sugar. But it’s also things like pizza, pizza turns into a lot of sugar but it’s also pasta too. Believe it or not I think three cups of pasta turns into 25 teaspoons of sugar. And even a simple sandwich with two pieces of bread can easily turn into 10-12 teaspoons of sugar.

Carolyn:  That sugar, or glucose, in our blood stream triggers the release of insulin from our pancreas because our bodies don’t like to have sugar circulating in the blood. We need the insulin to help get the sugar into our cells for energy. But when we eat too much sugar it doesn’t all get into the cells for energy because there is too much. This left-over sugar in our blood is what causes the inflammation.

Kara: So, inflammation causes acne, because it irritates the glands, causing more sebum to produce more sticky oil. That clogs the pores and gives us a breakout. It’s all starting with that inflammation that comes from sugar intake.   

Carolyn: Another thing, insulin growth factor-1, which is a hormone, has also been shown to increase acne. Elevated insulin levels from eating a lot of sugar are going to increase Insulin Growth Factor-1.  This is not a problem if you have a soda or donut once in a while, but it becomes a big issue if you frequently eat sugary foods.

Here’s an easy way to think about this. Sugar is sebum. Sebum is oil. So anytime you drink soda or eat a donut or chips, pizza or pasta or too much bread like we were talking about, you are adding sebum to your face which makes it more likely that you will get acne.

Kara: I wish someone would have told me that sugar is sebum, when my acne was really bad. You know, there is published research about Insulin Growth Factor hormone related to diet, specifically to dairy products. Dr. Loren Cordain from the University of Colorado has found a link between dairy and acne. He pointed out that dairy products cause the production of a hormone called Insulin Growth Factor which can result in acne. Dr. Cordain says “that there are a number of dermatologists who take their acne patients off dairy and it greatly helps clear up acne."

Carolyn: So Kara, another reason we get acne is because of our gut health.  As we mentioned before, sugar also feeds the bad bacteria in our gut. And when we have more bad bacteria in our gut and we eat too much sugar, that bad bacteria is fed by that sugar. And when we have more bad bacteria, guess what? We have more inflammation. Sounds like a vicious cycle, doesn’t it?

Kara: It really does. We’re going to break here in just a second and when we come back I’ll talk more about my story. But I sure wish I would have known about the sugar and diet connection to the sebum and acne, but also about the gut health connection to acne. And how do we take care of that? We’re talk more about this after break, but it’s about getting enough good bacteria to support our digestive tract.


Kara: We’re talking today about teenage acne and the diet connection to acne. Carolyn, is this a good time for me to share my story. People want to know that we understand where they’re coming from and as we said before it is a really emotional type of condition to have because it does affect our outer appearance so much. I started getting acne, a lot of people have it in high school, for me it was in college, I was about 19. So I first went to a dermatologist when I thought “Oh, this is getting really bad.” I’m sure I tried some over the counter things first, but then I started getting those harsh prescriptions, the Retin-A, when you use it and your face gets red and you can’t really be in the sun a lot, there’s a lot of peeling. You know, I didn’t have a lot of success with that and there were some nasty side effects from that as well. From there I kind of just kept going with some topical solutions and then it was recommended to me that I try antibiotics. Because, what do antibiotics do, well they kill off bad bacteria, they also kill off the good bacteria, which is not a good thing for our intestinal health and we’ll talk quite a bit more about that. I didn’t know that at the time and then that actually wasn’t working again either and then I’m not really familiar with the prescription I was giving but I know they said it’s also used for bladder infections. A sulfa type of a medication? I don’t know what the connection was with that, again, probably killing off good and bad bacteria. It didn’t work. So some of you may have heard of a product called Acutane, and that’s a really strong prescription. I realized the severity of how toxic this prescription was when I was asked to take a pregnancy test before I could go in each month and refill my prescription, because there is a chance of birth defects in a fetus. So I thought “What is this thing that I’m taking?” I had a little bit of success with that but my goodness it was so strong. In hindsight I would have done everything differently, but no one mentioned diet to me or asked “Gosh, what are you eating or drinking? Could that be effecting your skin?” My diet at the time was very not great, it was a very typical college diet, there was some beer involved, quite a bit of sugar in the forms of soda, eating sweets and pizza. I was in the ramen and we had a hot pot with ramen noodles and macaroni and cheese. That turns right into sugar. And a lot of pizza and eating out, sub sandwiches. Lots of bread, chips. Lots of bad fats and high carb sugar foods. Also, juice, I was a big juice drinker and cereal eater. It was a very emotional time for me. When I would have really bad breakouts, there were times I wouldn’t even want to go out with my friends for social events. If I had a presentation coming up, I would be so much more nervous than if I just had a presentation with clear skin, because all I could think about was my face. It effected my dating life, somebody would ask me out on a date and I would say no cause I would think what if I started dating this person and I get worse acne. Then they’ll see me.

Carolyn: Ah, well stress, as we know is hard on our bodies too and then top it off with eating poorly.

Kara: I won’t go on anymore, but I wanted to share my story. We help people that have similar situations with their skin, so if you feel that a consultation would benefit you or you’re struggling with acne, our office number is 651-699-3438.

Carolyn: Yes, we work with a lot of teenage clients on their skin. And as Kara was telling her story I was thinking, oh my gosh I have three or four clients who have come to me recently because either they’re on antibiotics for the acne, or the Acutane. And one of them had the where with all, I think it was a Mom actually who is an avid listener, said, “Oh, maybe before you start taking that you should have a consultation.” So I was really happy to see her. Before we went to break we were talking about good bacteria. Some of that good bacteria like acidophilis and -bifido bacteria. These are really good probiotics. We can get them from fermented foods or supplements. We will talk about that more a bit later.

Kara:  So far we’ve talked about the sugar connection, we’ve talked about the poor gut health connection to acne. Another factor that people might not be aware of or even think about is constipation. Constipation, which is having less than one bowel movement a day, that’s an indicator of poor gut health.

Carolyn: Maybe think about it this way, if we don’t have regular bowel movements we are not eliminating waste products from our bodies.

Kara: When I am working with a client who suffers from constipation, I always look at what they are eating but I also frequently recommend magnesium. Most people do really well with our Mixed Magnesium, made up of magnesium glycinate and magnesium citrate. It really can help people’s constipation.

Carolyn: Magnesium is a mineral that about three out of four people don’t get enough from our food. It’s a relaxing and calming mineral. If you are constipated, it can help to relax your muscles and works as a mild stool softener. I take mine before bed because it also helps me get a good night’s sleep!

Kara: Me too, I take 400 mg before bed and it also keeps me regular as well.

Carolyn: When people have a conversation about acne, they usually talk about what sort of cream or medication they are going to try next. We are here today to let you know, that creams are not the solution. “Lotions, potions, and creams don’t fix the problem they are just a band aid treatment. The real cure for acne is at the end of your fork, not from a prescription pad.”

Kara: I can really relate to that statement! Even into my twenties I was still struggling with acne, because I had not heard about that connection. At that point I was using things like Proactiv through the mail, which got kind of expensive. I wish one doctor, dermatologist, or esthetician would have mentioned this diet connection. It was all about masking the problem.

It looks like it’s time for us to go for our second break. We’ll talk more about inflammation and acne when we come back.


Kara: We had started talking before break about food solutions, because for you listeners what you’re putting in your mouth or what your teenagers are putting in their mouth, that’s the real culprit for acne breakouts. So you’re probably wondering, what should we be eating?

Carolyn: So far in today’s show, we have shared how things like sugar and soda increase inflammation in the body, which can lead to more acne. But it’s not just cake and cookies and soda causing problems – lots of other foods turn into just as much sugar as a piece of cake.

Kara:  I remember seeing a study in The Journal of the Academy of Nutrition and Dietetics, in 2012 that grabbed my attention. Researchers found that three out of four foods in supermarkets had hidden sugars and were considered high-sugar foods. Many so-called healthy foods have as much sugar as candy bars. If you eat cold cereal for breakfast, did you know that two cups of cereal contain 15 teaspoons of sugar? That's more sugar than most candy bars. 

Carolyn: Some of my high school clients still grab for a lot of convenience foods that are high in sugar. Some examples I hear about are bars and smoothies. Everyone thinks Clif bars are healthy but they have around 13 teaspoons of sugar and are soy-based. Research has found soy is not a good protein source if someone has inflammation or acne. 

Kara: If you order a small Banana Berry Jamba Juice Smoothie, it has about 15 teaspoons of sugar. That’s in the small size, that’s something that could certainly be causing acne.

Carolyn:  That sugar adds up so quickly! I just heard a podcast about sugar, and some parents might remember reading or watching the Laura Ingalls Wilder series Little House on the Prairie. Sugar was so scarce and expensive in the 1800s. In the year 1820, the average American ate two tsp per day. So Laura Ingalls Wilder would get a piece of candy at Christmas and for a birthday. One piece or two pieces of candy per year. I bet her face was not covered in acne.

Kara:  Fast forward to 2017. Sugar is cheap, it’s easy to come by, it’s hard to avoid. The average American eats over 60 teaspoons of sugar per day. Now that’s an average, some people are eating more, some are eating less. Just a piece of candy here and there, sugar is pretty much everywhere.

Carolyn: So what should we be eating to help clear up acne breakouts? Instead of cereal and milk for breakfast, which is something I bet you had in college.

Kara: I did! I had Cheerio’s because I thought they were healthy and it wasn’t like Fruit Loops. I didn’t know that two cups has 15 tsp of sugar.

Carolyn: So I recommend, instead of that cereal and milk, have either hard boiled eggs, or our turkey breakfast sausage recipe that's on the website. Add a small piece of fruit, and handful of nuts, which is that healthy fat. To save time I make up a whole dozen hard-boiled eggs at once so they are easy to grab in the morning.

Kara: Great suggestion and then you know, the turkey sausage patties for breakfast those can be made up in advance as well. We had a request to give ideas for dairy free meals and snacks because, because remember dairy can aggravate acne in some people. On our website, weightandwellness.com you can find our protein shake recipe, our dairy-free version that skips the yogurt and adds extra protein powder and extra full-fat canned coconut milk. I make this dairy free smoothie every day and love it – it's so easy and delicious.

Carolyn: Our smoothie recipe is SO different from many other smoothies. Things like Jamba Juice or fruit juice smoothies are really full of sugar and will cause more breakouts.  Our shake recipe has protein, we call it a protein shake for a reason, it has a healthy fat, and a very small amount of fruit – so it's low in sugar and it’s not going to cause that inflammation.

Kara: Another recipe I really like and I think a lot of teenagers would enjoy this. This is something that would replace the Clif or granola bar that would be high in sugar, is our Oatmeal Almond Ball recipe. With rolled oats, protein powder, and almond butter and a little maple syrup. All in all these are very low sugar and ends up to be the perfect grab and go snack for busy teens. They are best kept in a cooler or lunch bag with an ice pack.

Carolyn:  Another dairy free snack could be nitrate free beef or turkey sticks, cut up veggies, and Wholly Guacamole packets. That’s nice, easy and convenient.

Kara: Avocado is a wonderful, healthy source of fat. Carolyn, you mentioned earlier in the show how dairy products like milk, cheese, yogurt, cottage cheese, and ice cream; cause an increase in the Insulin Growth Factor hormone which makes acne worse. As a nutritionist, if your teen is struggling with acne – I recommend that you have them take the four to six week dairy-free challenge. If they eat dairy-free, if they commit to that for at least one month that means getting rid of milk, cheese, yogurt, cottage cheese and ice cream – and they also need to reduce their sugar intake – we are fairly certain that they would see an improvement in their skin.

Carolyn: For clear skin we should reduce our sugar intake, try a dairy free diet and drinking lots of water. Water increases cell growth and cell regeneration. Plus, it helps the body get rid of toxins. And keep the bowels regular – being constipated can lead to toxic buildup and breakouts. So wow, I think we’re ready for our last break.


Kara: We had just started talking about how important water is when it comes to having clear skin. It’s a really big topic! We have radio shows all about water. Most tap water has a lot of chemicals and substances we don’t want in our bodies. We feel that some sort of purification system is a good idea to reduce chemicals. 

Carolyn: Listeners, have you been reading about how unsafe some of the tap water is in many communities? On May 2nd, the Natural Resources Defense Council released a report that if you live in the United States, there’s one in four chances your water is contaminated.  Remember the Flint, Michigan story? That was really very recent and I think they’re still struggling out there. Their water supply had lead, nitrates, arsenic and other contaminants harmful to health. So, water is an important issue to consider. Filtered and purified is the safest kind of water to drink.

Kara: Water helps keep our skin well-hydrated. We should all be drinking about half our body weight in ounces every day for healthy skin. Working with clients we know that not everyone is there. So if you’re drinking three glasses of water and a bunch of coffee and soda and juice you need to gradually increase that water intake.

Carolyn: So today it’s going to be like 100 degrees I heard. Most people think oh, that’s when I really need to drink more water, but really, on a day like today you’re probably going to have to drink more water than usual. So if you weigh 120 pounds you should be drinking about 60 ounces of water every day. That’s about a half of gallon of water every day. My clients go “Oh my gosh, I don’t drink anywhere near that amount.” Many teens are drinking soda, energy drinks, sports drinks, and milk; but very little water. Make sure your teen has a portable bottle they like using – remind them to keep it filled with water and take with them to school and other activities.

Kara: I remember meeting with a client, it was parents that came in with a pre-teen and we were talking about water. And they decided that at the end of the appointment that they were going to go to Target and have this gal pick out a water bottle. She’s like “There’s nothing that I really like that’s in the house.” So that’s a good idea, have them pick it out, something they can see themselves using every day. Carolyn, you talked about gut health and the relationship with poor gut health and acne. What can people do to fix their gut health and heal acne?

Carolyn:  A great way to add in good bacteria, or probiotics, to the diet, you can take some supplements if you don't think you will be eating fermented foods on a daily basis, it's a good idea to take a supplement. I know I take both Bifido Balance and Acidophulus almost daily.

Kara:  I do too, I do too. We take it as a prevention and because it’s good for the immune system and good for basically everything, but particularly, if you have acne, you want to get a good quality probiotic. Not all probiotics are going to work. I have seen clients who buy probiotics at their drugstore or grocery store, and many times they are the wrong strains in the wrong amounts, and sometimes we can tell it’s just poor quality. We have very high quality products and you can also ask your chiropractor or naturopath, they often have practitioner brand supplements. Some health food stores have higher quality probiotics as well.

Carolyn: If your teen has been on antibiotics for acne, it's a must for them to take a probiotic supplement to off-set the damage to the gut that is done from antibiotics.

Kara: There was a client of mine, I just want to share this story because it sticks in my head. This was a male teenager, I met with a couple years ago, his parents brought him in for an appointment. The reason for the appointment was that he was losing weight because he could hardly eat anything – he had acquired a food sensitivity to just about everything and was having terrible diarrhea and stomach pain.

Carolyn:  Was this the person you were telling me about who took all of those antibiotics for acne?

Kara:  Yes, that’s the same person. What happened was his dermatologist prescribed strong antibiotics for acne, long-term. The antibiotics killed off bad bacteria and at the same time, killed off all his good bacteria. Without enough good bacteria he could barely digest any foods. It actually took a long time to heal. He took lots of probiotics and ate gluten-free, dairy-free, sugar-free, a real restrictive diet. We had to reintroduce foods slowly to make sure his gut could tolerate the foods.

Carolyn: I can’t tell you how many clients come to see me with gut problems that came from antibiotics that they had to take. It is important to understand that sometimes you will need the antibiotic if you are sick but you also need to replenish the good bacteria in your gut.

Kara: Besides Bifido and Acidophilus, there are other supplements that are really helpful for acne. We know that acne is inflammation of the skin. Omega 3 fatty acids are very anti-inflammatory and they are greatly missing from the average diet. You may know Omega 3 fatty acids as fish oil and we recommend three soft gels per day for reducing inflammation.

Carolyn: Another one that’s missing from our diets is called GLA.  It comes from plants such as Borage Seed Oil or Evening Primrose Oil. But we got to remember that hydrating lotions, potions and creams are probably not going to be the answer. It’s food that’s the answer.

So let’s recap, what did we talk about today? We talked about some of the things that cause acne like sugar, soda, cereal, pasta because they often lead to inflammation of the skin. We also talked about damaged intestinal tract can cause acne. If you can get rid of your constipation and too much of that bad bacteria in your gut, that will help improve your skin.

Kara: We gave some dairy-free solutions, eggs for breakfast with some fruit and nuts, our dairy-free protein shake or our favorite Oatmeal Almond Balls and drinking a lot of water especially in place of soda or energy drinks, is going to be so important for healthy skin.

Carolyn: Our goal at Nutritional Weight & Wellness is to help each and every person experience better health through eating real food. It’s a simple, yet powerful message.

Eating real food is life- changing.

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