By Dr. Mercola Nearly 85 percent of people have acne at some point in their lives, making acne the most common skin disorder in the US.1 While acne typically begins during puberty, it's not restricted to adolescents and may impact any age group – even into your 50s and beyond. While not physically dangerous, acne can take a considerable psychological toll. Some sufferers become so self-conscious and embarrassed that their professional and personal lives suffer, leading to increasing feelings of alienation, depression, and social withdrawal. Many mistakenly believe acne is mostly an aesthetic problem, but it is actually a sign of deeper imbalance in your system, often in your gut. Most physicians miss this connection entirely, instead prescribing acne drugs and other topical treatments. Americans spend more than $2.2 billion every year on acne treatments, including prescription and over-the-counter products,2 but many will turn out to be useless if you ignore the foundational cause of most acne – improper diet. Desperate to Clear Your Skin? Stop Eating Gluten and Grains Full-blown celiac disease, which is an extreme form of gluten sensitivity causing both the adaptive and innate immune system to attack your small intestine, affects an estimated 1.8 percent of people in Western cultures. But non-celiac gluten sensitivity may actually affect as many as 30 to 40 percent of the population, and according to Dr. Alessio Fasano at Massachusetts General Hospital, virtually all of us are affected to some degree.3 This is because we all create a substance called zonulin in the intestine in response to gluten. Glutinous proteins, found in wheat, barley, and rye, known as prolamines can make your gut more permeable, which allows partially digested proteins to get into your bloodstream that would otherwise have been excluded, any of which can sensitize your immune system and promote inflammation, which can contribute to worsening acne. Once gluten sensitizes your gut, it then becomes more permeable and all manner of gut bacterial components and previously excluded dietary proteins—including casein and other dairy proteins—have direct access to your bloodstream, thereby further challenging your immune system. If you have acne, you should try eliminating gluten and other lectin-containing foods, although I actually recommend that everyone following my beginner nutrition plan eliminate all gluten from their diets. Among the most important to avoid are those grains that contain the sticky, hard to digest prolamine proteins, such as wheat, barley, rye, and yes, even oats, rice, and corn. However, I don't recommend you stop there… Avoid All Grains (and Sugar) If You Have Acne While glutinous grains should certainly be eliminated if you struggle with acne, I recommend you avoid all manner of refined carbohydrates as well. Acne is much less of a problem in non-Westernized societies, where refined carbohydrates and sugar are consumed in much lower amounts.4 Diets high in sugar and refined carbohydrates are one of the primary causes of acne. When you eat grain carbohydrates and sugar/fructose, it causes a surge of insulin and insulin-like growth factor called IGF-1 in your body. This can lead to an excess of male hormones, like testosterone, which cause your pores to secrete sebum, a greasy substance that attracts acne-promoting bacteria. Additionally, IGF-1 causes skin cells known as keratinocytes to multiply, a process that is also associated with acne. Additionally, these very same foods -- refined carbs, such as fructose, sugar, and grains -- will also increase inflammation in your body, which may trigger acne, and at the same time they will also wreak havoc on the makeup of your intestinal bacteria, as mentioned above. In fact, in 2007 a study published in the American Journal of Clinical Nutritionfound that young men (ages 15 to 25) with acne problems who were placed on low-glycemic diets for 12 weeks showed significant improvements in acne and insulin sensitivity.5 Research published last year also found that a high-glycemic diet and frequent dairy consumption are linked to acne.6 Indulge in Vegetables, Limit Processed Foods to Control Acne Flare-Ups Any meal or snack high in refined carbohydrates (i.e. grains and sugars) will generate a rapid rise in blood glucose. To adjust for this rapid rise, your pancreas secretes the hormone insulin into your bloodstream. High blood sugar levels cause repeated surges in insulin and this causes your cells to become "insulin-resistant," which leads to the production of even higher levels of insulin, and, eventually insulin resistance, another key factor linked to acne. Prolonged excessive insulin secretion can also eventually burn out your pancreatic beta cells which produce it, leading to "double diabetes," a mixture of type 2 and type 1. This is why, if you struggle with acne, you want to avoid all foods that contribute to insulin resistance (namely sugar and grains), not just the gluten-containing grains. The best way to know if you are insulin/leptin resistant is to measure your fasting insulin level. If it is below 3, you are not likely resistant. However, if you are overweight, have high blood pressure, diabetes, cancer, or abnormal cholesterol levels, it is likely that you have some element of insulin/leptin resistance and you would likely benefit from restricting your intake of sugars and grains until the conditions resolve. You'll be happy to know that simply eliminating grains, sugars (particularly fructose), cereals, potatoes, corn, rice, pasta, processed foods, etc., radically improves acne for most people. Fruit contains a fair amount of fructose, so it should be consumed in limited quantities if you are predisposed to acne. Or, at least focus on the low-sugar, high-nutrient-dense fruits like berries. And fruit juices should be strictly avoided since the sugar is very concentrated in them, without the buffering effect of fiber, pectin, and other food cofactors present in whole, raw, organic fruit. Fresh vegetable juices are great, though, especially green juices, as are most vegetables, which are slow to break down into simple sugars, with minimal insulin impact. Why Optimizing Your Gut Health May Help with Acne When you clean up your diet as described above, your gut health will naturally improve. You can further support it by consumingfermented foods regularly, to encourage the growth of beneficial microorganisms, which will benefit your skin health in multiple ways. For starters, signals from your gut microorganisms are sent throughout your body and interact with organisms in your skin and gut mucosa. Researchers are looking into how these interactions can help with skin conditions like dryness, improve collagen, or stabilize the microflora on your skin to help with irritations. As noted by researchers in Gut Pathogens:7 "The lines of communication, as mediated by gut microbes, may be direct and indirect -- ultimately influencing the degree of acne by a systemic effect on inflammation, oxidative stress, glycemic control, tissue lipid levels, pathogenic bacteria, as well as levels of neuropeptides and mood-regulating neurotransmitters. …there appears to be more than enough supportive evidence to suggest that gut microbes, and the integrity of the gastrointestinal tract itself, are contributing factors in the acne process." Another interesting connection is via your emotional health, as stress may, too, cause acne via your gut-brain connection. Research by dermatologists John Stokes and Donald Pillsbury conducted more than 70 years posited that your emotions could alter the microflora in your intestines, which could therefore contribute to systemic inflammation that could exacerbate acne and other skin conditions. In 2011, researchers validated this connection, noting:8 "Experimental studies show that psychological stress stagnates normal small intestinal transit time, encourages overgrowth of bacteria, and compromises the intestinal barrier. SIBO [small intestinal bacterial over growth] is strongly associated with depression and anxiety, while eradication of SIBO improves emotional symptoms. Although the frequency of SIBO in acne vulgaris has not yet been investigated, a recent report indicates that SIBO is 10 times more prevalent in those with acne rosacea vs. healthy controls. Correction of SIBO leads to marked clinical improvement in patients with rosacea." Controlling Acne Takes a Whole-Body Approach Your skin is your body's largest organ, and an organ of elimination (e.g. sweating), which is why problems on its surface are often a sign of underlying issues. Your complexion is a reflection of your overall health, which is why topical (or worse, systemic) acne drugs will not heal the problem (and may result in serious side effects). Treating acne takes a whole-body approach that will nourish and heal your skin from the inside out, so don't forget to incorporate these essential factors into your acne-busting plan: • Avoid starchy carbs, sugars/fructose, and grains: This is probably the single most important step you can take to improve your skin health. If you eliminate all sugars, fructose, and grains for a few weeks there is a major likelihood you will notice rapid improvement in your complexion. Replace these foods with healthy fats, like avocados, olives, olive oil, coconut oil, and butter. Be sure to check out my nutrition plan for a simple guide on how to eat right for healthy skin and overall health. • Water: Drink plenty of fresh, pure water every day. Hydrating your body facilitates cell growth and regeneration, elimination of wastes, and sloughing away dead skin cells. Hydration will also improve your skin tone. Every day, drink enough water so that your urine is a pale yellow color. If your urine is bright yellow, you probably need to drink more water (unless you take B vitamins, which themselves turn urine bright yellow). • Exercise: Getting plenty of high-intensity exercise helps your body flush out toxins, including those in your skin's pores. Plus, exercise is vitally important to all other aspects of your heath. If you happen to have access to an infrared sauna, this can be helpful too, because the more you sweat, the more you flush unwanted debris and contaminants out of your pores. • Sleep: Did you know that a good night's sleep can decrease your stress and lead to clearer skin? Your body's main time for healing and rebuilding is at night while you sleep, and this applies to your skin. • Proper balance of bacteria: You can reestablish your bacterial balance by incorporating naturally fermented/cultured foods and raw foods (which contain living beneficial bacteria) into your diet and/or taking a high-quality probiotic supplement. This is especially important if you have been on antibiotics, because these drugs indiscriminately kill off the beneficial bacteria in your gut, without which you cannot have a strong immune system. • Vitamin D: This important nutrient is crucial for maintaining a healthy immune response, and most people are deficient in it. Without adequate vitamin D, your body cannot fight infection, in your skin or elsewhere. Exposing large areas of your skin to appropriate amounts of sunshine is the best way to optimize your vitamin D levels, or alternatively use a safe tanning bed. • Animal-based omega-3 fats: Omega-3 fats help to normalize skin lipids and prevent dehydration in the cells. This keeps skin cells strong and full of moisture, which can help to decrease the appearance of fine lines. Fatty acid deficiency can manifest in a variety of ways, but skin problems such as eczema, thick patches of skin, and cracked heels are common. Plus, omega-3 fats may have an anti-inflammatory effect that can help to calm irritated skin, giving you a clear, smooth complexion. • Address your stress: My favorite tool is the Emotional Freedom Technique or EFT. EFT involves tapping your body's energy meridians with the tips of your fingers to clear emotional blocks, thus restoring balance to your mind and body. EFT is a powerful de-stressing technique that is easy for adults and children to learn. You can also add in other proven stress-busters, such as yoga and meditation. • All-natural acne fighter: Rubbing just a drop of oregano oil on a breakout can speed up the healing and prevent unsightly scarring without resorting to harsh commercial acne medication (remember to wash your hands thoroughly afterward).