Acne: Diving Deep Below the Surface

What causes acne? That’s a question I must have Googled 100 times as a teenager. I started getting acne at 12 years old and I used to get so frustrated seeing all my friends with their clear skin, wondering why mine wasn’t the same. Going to any type of event was stressful and I used to spend hours trying to cover all my acne up. At family events there was always that one relative telling you that all you have to do is wash your face. Needless to say, I know just how stressful, frustrating and exhausting dealing with acne is. Can anyone relate to this?

Unfortunately, a lot of the time acne isn’t treated very seriously as a medical condition because it’s considered just aesthetic. Anyone who has had acne knows very well that it is not simply just aesthetic and the downstream effects of acne run much deeper. Besides the physical damage that acne causes to the skin, most people experience psychological and emotional trauma that can deeply affect our thoughts and behaviours. Anxiety, fear, depression, frustration, anger, embarrassment and insecurity are just some of the words I hear from patients when describing how acne has impacted them. A lot of patients even experience some form of bullying and will shy away from social interactions. These feelings of inferiority and insecurity can start to affect all aspects of someone’s life, including job prospects or advancements. It is estimated that acne causes a reduced quality of life on par with conditions such as asthma, arthritis and diabetes.

Acne IS a medical condition and every patient deserves to have all possible root causes explored.

It’s not as simple as just washing your face. Acne is a multi-factorial condition, each factor essentially fueling the fire. Every patient is unique and it takes some investigative work to figure out what factors are contributing. More often then not, there’s multiple root causes at play!

With my patients, we dive deep below the surface of the skin, ensuring no root cause is missed:

1) Sleep

Sleep is when our body actually heals and recovers! While we’re sleeping, our body is working hard to heal and eliminate hormones and toxins from the body that might be contributing to acne flareups. Additionally, sleep helps the body recover from stress burdens from the day and reduce inflammation. Without adequate quality sleep, the body is only operating at a percentage of what it could be.

2) Stress

Stress is a huge contributing factor when it comes to acne. It’s important to remember here that stress is highly variable between individuals as it is our own perception of external situations. This tells our brain that there is a challenge or threat present (fight-or-flight response) and in turn, our body releases hormones like adrenaline and cortisol to help us “survive”. During these stress times, our bodies direct resources away from non-essential functions (like skin health) that aren’t immediately critical for survival. For the short-term, this mechanism works great but the problem is that in today’s society, stress is much more chronic than it is short term. Our bodies were not designed to operate in a fight-or-flight mode long term and the result is a cascading inflammatory response leading to things like poor digestion, poor skin health and poor immune function. It’s essential to thoroughly investigate stress levels, contributing stressors and cortisol levels.

3) Diet

Certain foods have been linked to acne flareups and these include sugars, fast food, non-healthy fat foods, wheat/gluten and dairy. These foods are common inflammatory triggers. Although, these are the most common triggers for most patients, it’s important to remember that food triggers are highly unique to each person! Determining potential food triggers or sensitivities can be done through a proper elimination diet or food sensitivity testing can be considered.

4) Poor circulation

Poor circulation means that the body isn’t able to effectively get blood pumped everywhere it needs to be. Typically, individuals with poor circulation often have chronically cold hands and feet and can notice that cuts take a long time to heal. Having good circulation is important for acne because blood is responsible for delivering oxygen to tissues, including skin cells. Blood also helps pick up and eliminate toxins and dead skin cells. There are simple ways everyone can improve circulation but sometimes, depending on the circulatory severity, stronger interventions might be needed.

5) Sebum and dead skin

When it comes to sebum (oil that your pores produce) and bacteria (P. acnes is the troublesome bacteria here), genetics does play a role. Genetics can affect the quantity of sebum produced and the strains and number of bacteria present on our skin. Sebum production is an important factor to look at because it’s actually what feeds P. acnes bacteria. Regardless of genetics, there are simple ways to not increase sebum production and “clog” pores even more. One of these ways and I see this often, is to not dry out the skin. Patients with oily skin often think to combat the oil, they need to not moisturize as it will make oil production worse. It’s actually the complete opposite! Dry skin triggers your sebaceous glands (pores) to produce more oil. Don’t be afraid to moisturize but it is important to know what moisturizer is the best option when dealing with acne.

6) Hormones

Some hormones have been linked to worsening acne or have been connected with acne flare-ups. Testosterone and DHEA are important hormones to get tested as they have been the most studied in connection with acne. What researchers have found is that high testosterone or DHEA are connected with an increase in sebum production. As we know, sebum feeds P. acnes bacteria and the two of them together lead to acne. Other important hormones to look into include estrogen and progesterone levels. It is suspected that these hormones also play a role in sebum production, which is why some women notice that their acne worsens around their cycle. It’s important to have a healthy estrogen to progesterone ratio. All of these hormones should be tested through the blood or saliva with a discussion around optimal healthy levels.  

7) Gut health

When it comes to acne the health of our gut is important for two reasons; the gastrointestinal system is home to most of our immune cells and if the lining of the gut is damaged, this can cause all sorts of little things to leak through into our bodies (bacterial by-products and food proteins are the biggest problems). The gastrointestinal lining is delicate and it can be damaged from infections, inflammatory foods or food sensitivities, stress and a dysbiosis within the gut (too much bacteria and yeast overgrowth are the most common). When the lining gets damaged, the cells become inflamed and are no longer tight against each other. This means that there’s tiny holes between cells that allow things to leak through into the body. This leaky gut or increased intestinal permeability has been associated with acne and food sensitivities, just to name a few. It’s important to have your gut health properly assessed as the correct course of intervention will differ substantially between individuals.

8) Vitamin D

Vitamin D is anti-inflammatory and has a strong role in skin cell growth and repair. It also supports and helps regulate the immune system. Vitamin D is of particular importance if your levels are deficient or suboptimal and in North America, this isn’t uncommon. Vitamin D can only be made in our bodies from UVB ray exposure from the sun. In Canada, UVB rays are low, especially in the fall and winter and people can slip into a state of deficiency. Vitamin D levels should be tested in the blood and supplemented accordingly.


Last but not least, the importance of water cannot be stressed enough! Water is key for ensuring that skin cells are hydrated, which means they can do their job efficiently and properly. This includes clearing sebum and bacteria, as well as absorbing important nutrients. Water is also important in making sure that all organs are running efficiently, including the liver which is one of our body’s main detoxification organs! Water also contributes to our blood volume which means better circulation. Really what it boils down to is that water helps our body run as one efficient unit, ensuring that no organ, including the skin, is left lagging behind.

I hope this blog has empowered you to look for solutions beyond the surface of the skin. Remember that the skin is an organ and it works in tandem with your entire body. Acne doesn’t have to be something you just deal with or hope one day goes away. It can start getting better now, you just need to know what’s fueling the fire.

Written by: Dr. Hailey Traut, N.D.




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