Clear Skin from the Inside Out: Root Cause Solutions for Acne
Acne is one of the most common skin conditions, affecting millions of people worldwide. While it may seem like a surface-level issue, acne is almost always a reflection of deeper imbalances within the body. If you struggle with acne, know that your skin is the way your body is trying to get your attention of those deeper areas that need supported in order to look and feel your best.
Clear skin is 100% possible, and understanding your acne root causes can help you address the underlying factors contributing to breakouts in the most effective way. In this blog post, we'll explore the primary root causes of acne I see in my clients.
Poor Cellular Health
Cellular health refers to the state of the body’s cells and how well they are functioning. Poor cellular health can contribute to acne in various ways.
Cellular Turnover and Skin Health
The skin naturally sheds dead skin cells to make way for new ones in a process called cellular turnover. However, when this process is sluggish, dead skin cells can accumulate on the surface of the skin, mixing with excess sebum and blocking pores. Poor cellular turnover is often linked to nutrient deficiencies, dehydration, and oxidative stress.
Metabolic Dysfunction
Mitochondria, the powerhouses of the cells, are responsible for producing energy (aka metabolism). Mitochondrial dysfunction can lead to poor cellular function and lower energy levels, which can manifest in a variety of health problems, including acne. Inadequate energy production impairs the body's ability to repair itself, including the skin’s ability to heal and regenerate.
Supporting your metabolism and mitochondrial health through proper nutrition, hydration, and avoiding environmental toxins is essential for overall health and clear skin.
Stress and Blood Sugar Imbalances
Stress is a significant contributor to acne. When we experience stress, our body releases hormones like cortisol and adrenaline, triggering a series of physiological responses. One of the most concerning is the way stress affects blood sugar levels.
How Stress Affects Blood Sugar
When cortisol is elevated due to stress, it signals the liver to release glucose into the bloodstream, leading to higher blood sugar levels. This makes the pancreas work harder to produce insulin, the hormone responsible for helping cells absorb glucose. Chronically elevated blood sugar levels can lead to insulin resistance, where the cells become less responsive to insulin’s effects.
Insulin resistance can increase the production of androgens, a group of hormones that includes testosterone. Androgens stimulate the oil glands in the skin, leading to increased oil production, which can clog pores and provide a breeding ground for acne-causing bacteria. This combination of higher insulin levels, increased oil production, and clogged pores contributes significantly to acne breakouts.
The Role of Diet
A diet high in refined carbohydrates and sugars, such as white bread, pasta, and sweets, can exacerbate this problem. Foods with a high glycemic index (GI) cause rapid spikes in blood sugar, leading to more insulin production. In turn, this triggers inflammation and increased sebum production, leading to the perfect storm for acne development. Adequate protein intake can help to keep blood sugars more stable throughout the day and most women need to be eating 100+ grams of protein daily.
Vitamin and Mineral Deficiencies
Nutrient deficiencies can play a significant role in the development and persistence of acne. Vitamins and minerals are essential for many biological processes, including skin repair, cell regeneration, immune function, and inflammation management. When the body is deficient in key nutrients, it can struggle to maintain skin health, leading to breakouts and other skin issues. I commonly see vitamin A, vitamin E, zinc, potassium, and magnesium deficiencies contribute to acne.
Vitamin A: Supports skin cell turnover and reduces sebum production. Found in beef liver, cod liver oil, and eggs.
Vitamin E: Acts as an antioxidant and protects skin cells from free radical damage. Found in almonds, sunflower seeds, and spinach.
Zinc: Regulates sebum production and reduces inflammation. Found in oysters, pumpkin seeds, and beef.
Magnesium: Lowers stress, balances hormones, and reduces inflammation. Found in leafy greens, nuts, seeds, and avocados.
Potassium: Supports cellular hydration and thyroid hormone uptake. Found in bananas, avocados, potatoes, and coconut water.
Hormonal Imbalances
Imbalances in estrogen and progesterone and high levels of testosterone can increase oil production within the hair follicle and increase bacterial buildup in your pores. Other hormones such as insulin, cortisol, and DHEAS can also trigger acne, which is why it’s important to do proper testing.
Androgens and Acne
Androgens are hormones that can cause the sebaceous (aka oil) glands to enlarge and produce more sebum. Androgens, especially testosterone and DHEAS, are directly linked to the development of acne because of this increase in oil production. The excess sebum mixes with dead skin cells and bacteria, blocking pores and leading to inflammation and breakouts.
Hormonal Acne in Adults
Hormonal imbalances also explain why some women continue to struggle with acne well into adulthood, particularly around their menstrual cycles. Fluctuations in estrogen and progesterone can lead to an increase in androgens right before menstruation, which explains the premenstrual flare-ups many women experience.
Conditions such as polycystic ovary syndrome (PCOS) can cause a prolonged imbalance in androgens, leading to persistent acne. Medications like spironolactone and hormonal birth control are often prescribed to help regulate these hormones, but understanding and addressing the root cause of the hormonal imbalance is key to long-term skin health.
Low progesterone is another very common cause of pre-period breakouts. You can learn more about the relationship between estrogen and progesterone HERE.
Hormonal acne is often cystic and typically located on the chin and jawline. It can be cyclical or present all month long, depending on which hormones are imbalanced.
It's important to know that if hormones are triggering acne for you, they aren't actually the deepest root cause. Hormones are just responding to other things in the body like poor metabolic health, blood sugar imbalances, stress, and gut issues. When we address those things, your hormonal acne will become a thing of the past.
Inflammation and Infections
Inflammation is a key component of acne, but it's often a symptom of deeper systemic imbalances rather than the root cause itself.
Chronic Inflammation
Acne is considered an inflammatory skin condition. The body’s immune response to clogged pores, bacterial overgrowth, and excess oil production results in the redness, swelling, and discomfort commonly associated with breakouts. While inflammation in small amounts is a healthy response to infection or injury, chronic inflammation can exacerbate acne.
Chronic low-grade inflammation can stem from poor diet, stress, or gut imbalances and can lead to a cascade of skin issues, including acne.
Infections: The Role of C. acnes
Cutibacterium acnes (C. acnes), a type of bacteria naturally found on the skin, plays a role in acne development. In healthy skin, this bacteria is in balance with other microbes on the skin's surface. However, when pores become clogged with excess oil and dead skin cells, C. acnes multiplies within the blocked follicle, leading to infection and the formation of pus-filled lesions. The immune system responds to this infection by sending inflammatory cells to the area, which worsens the redness and swelling.
Oxidative Stress and Inflammation
Oxidative stress, caused by an excess of free radicals in the body, can worsen inflammation and trigger acne. Free radicals are unstable molecules that damage cells. They can be produced through external factors like pollution, UV exposure, and smoking, as well as internal factors like a poor diet. When oxidative stress overwhelms the body's antioxidant defenses, it can exacerbate inflammation in the skin, leading to increased acne severity.
Poor Gut Health
The gut-skin axis refers to the connection between the health of our gut and the appearance of our skin. Many acne sufferers have underlying gut issues that contribute to their skin problems.
Gut Dysbiosis and Leaky Gut Syndrome
Gut dysbiosis occurs when there’s an imbalance in the gut microbiome, with an overgrowth of harmful bacteria and a decrease in beneficial bacteria. This imbalance can lead to increased intestinal permeability, commonly known as leaky gut syndrome. In a leaky gut, particles that should remain inside the digestive tract can leak into the bloodstream, triggering an immune response and inflammation.
This systemic inflammation often manifests as acne. Poor gut health can also disrupt nutrient absorption, meaning that essential vitamins and minerals that support skin health, like zinc and vitamin A, may not be adequately absorbed.
Food Sensitivities
Undiagnosed food sensitivities, such as gluten and dairy, can also exacerbate acne. These foods can irritate the gut lining, cause inflammation, and trigger immune responses, all of which can lead to acne flare-ups. For some, identifying and eliminating food triggers can significantly improve both gut health and skin appearance, however I find that the food isn’t necessarily the issue — it’s the gut environment that the food is going into. When you can improve your digestion and address underlying gut imbalances, food sensitivities become a thing of the past. My goal when working with clients is to ALWAYS get them eating a nourishing diet that does not involve food eliminations unless absolutely necessary.
Poor Iron Recycling System
An often overlooked, yet common cause of acne in women is iron dysregulation. Iron is an essential mineral for many bodily functions, including oxygen transport and immune system support. However, issues with the iron recycling system can lead to acne.
What is Iron Recycling?
The body stores and recycles iron from old red blood cells to make new ones. However, when this recycling system becomes dysfunctional, it can lead to both iron overload and iron deficiency, contributing to various health problems, including acne.
Iron Overload and Inflammation
Excess iron in the body can act as a pro-oxidant, meaning it increases oxidative stress. This can result in chronic inflammation, which can worsen acne. Elevated iron levels can also support the growth of harmful bacteria on the skin or in the gut, further contributing to skin breakouts. You can support the iron recycling system by increasing your intake of copper and vitamin A-rich foods. If iron overload is present, blood donation can also be very helpful.
On the other hand, iron deficiency can impair the body’s ability to heal wounds and support immune function, making it harder for the skin to recover from acne lesions. Proper iron regulation is crucial for maintaining skin health, as both too much and too little iron can lead to problems.
Addressing Acne Holistically
Given the multifaceted root causes of acne, a holistic approach is often the most effective for long-term relief. Here’s how each of these factors can be addressed:
Eat to support your metabolism: Ensure you are eating enough! This is one of the best ways to reduce stress on the body. Nourish your cells by consuming nutrient-dense foods like animal protein, berries, leafy greens, whole food carbs, and healthy fats. Hydration with minerals, adequate sleep, and good detoxification support optimal cellular turnover.
Stress Management: Practice mindfulness, yoga, or meditation to reduce stress levels. Prioritizing sleep and engaging in regular physical activity also help regulate cortisol and insulin levels.
Diet and Blood Sugar Control: Focus on a balanced diet with plenty of low-GI foods like vegetables, lean proteins, and healthy fats. Limit refined sugars and processed carbs, which can cause blood sugar spikes.
Hormone Balance: For those with hormonal imbalances, working with a healthcare provider to assess hormone levels is crucial. Herbal supplements like vitex, maca, or adaptogens may help balance hormones naturally.
Reduce Inflammation: Incorporating anti-inflammatory foods like turmeric, ginger, and omega-3-rich fish into your diet can help manage inflammation. Avoid foods that trigger inflammation, such as ultraprocessed foods and seed oils.
Support Gut Health: Consider adding probiotics and fermented foods like yogurt, kefir, or sauerkraut to promote a healthy gut microbiome. Stool testing can help to identify underlying gut imbalances, digestive capacity, and immune system function.
Optimize Iron Levels: Get regular blood tests to check iron levels and consult with a healthcare provider to ensure you’re not deficient or overloaded. If necessary, support iron recycling with foods rich in copper, vitamin C, and vitamin A which help to support iron absorption and the iron recycling system.
Conclusion
Acne is a reflection of deeper imbalances within the body, and addressing it requires a comprehensive approach. By understanding and managing the root causes, you can take meaningful steps towards the clear skin you desire. Instead of simply treating the symptoms with restrictive diets, pricey skincare, random supplements, or taking medications long-term, addressing these root causes leads to lasting results, not just for your skin but for your overall health.
I created a quiz that helps you to figure out the main drivers of your acne and suggested next steps:
Need more personalized support?
If you’re tired of wasting time and money on approaches that aren’t working for you, I’d like to invite you to try a new way…
In my 1-1 acne healing program, we’ll take a deeper look at what’s going on in your body to understand the root causes of your acne and develop a personalized treatment plan to heal for good. Acne doesn’t need to be your story anymore 🫶
Click HERE to learn more about what it looks like to work together to address your acne root causes and to view some of my past client’s incredible skin transformations
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🥂 to your coming glow-up!
Kate Netz, RDN, LD
Functional Dietitian
All information in this post is for educational purposes only and does not replace medical advice or diagnosis.
