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Acne was ruining my life,” says Olivia Gilmer, who suffered from persistent blemishes on her face and chest in her early 40s. Over-the-counter topical treatments and prescription antibiotics offered only temporary relief. A dermatologist suggested birth-control pills to balance her hormones, but those didn’t help either. Worried about side effects, Gilmer (not her real name) resisted taking a prescribed acne medication.

Finally, after years of suffering, she consulted naturopathic physician Trevor Cates, ND, in Park City, Utah, who inquired about her dietary habits and digestion issues. Gilmer admitted she had a bit of a sweet tooth and often felt bloated and uneasy after meals. Cates suspected that Gilmer’s diet was the culprit behind her issues and recommended several changes.

In addition to limiting sweets to stabilize Gilmer’s blood-sugar and insulin levels, Cates recommended adding more fiber- and antioxidant-rich veggies to support her body’s detoxification systems and restore hormonal balance. She instructed her to eat foods high in amino acids to assist the synthesis of collagen (a protein that plays a vital role in skin structure) and to take prebiotics and probiotics to support gut health. Cates also suggested Gilmer eat two servings a week of wild-caught fatty fish to boost her intake of omega-3 fatty acids, which help minimize inflammation.

Within two weeks, Gilmer began to see improvements. Three months later, her skin was clear.

“Most traditional doctors dismiss the idea that what patients eat can significantly affect their skin,” explains Cates, author of Clean Skin From Within. In fact, the American Academy of Dermatology does not provide dietary guidelines; the organization recommends topical therapy, including retinoids (typically the first-line treatment for acne), antibiotics, and oral contraceptives.

“Treating the skin in this manner doesn’t address the underlying cause of skin problems,” Cates says. “As a result, the body remains inflamed and out of balance, and symptoms reappear in a vicious cycle.”

More Than Skin Deep

A growing body of research links diet to such skin conditions as acne, atopic dermatitis, psoriasis, and rosacea, as well as premature skin aging.

“The skin is a mirror of our internal health,” says Vivian Shi, MD, University of Arizona assistant professor of medicine and dermatology. “For example, psoriasis is an indication of a systemic inflammatory state. A topical cream alone often won’t solve the entire problem. You have to treat the person as a whole from both inside and outside.”

“The skin is a mirror of our internal health.”

A whole-person approach addresses deeper issues that can affect the health and appearance of skin, including dysregulated blood sugar and poor digestive function.

If the digestive tract’s permeable lining is inflamed or has been damaged, for instance, bacteria and microscopic food particles can pass through, stimulating the immune system to attack them. This may result in systemic inflammation, which often manifests as skin problems. (Learn more at “How to Heal a Leaky Gut.”)

“When digestion is compromised, the gut is challenged to absorb nutri­ents and use them efficiently,” explains functional-medicine nutritionist Cindi Lockhart, RDN, LD, IFNCP. “Skin issues often indicate that we’re not getting enough nutrients — and we may be getting too many foods that cause problems. It’s more than the body can handle.”

For example, keratosis pilaris (which causes patches of rough bumps sometimes called “chicken skin”) can reflect deficiencies in key nutrients, including vitamin A and essential fatty acids, says Lockhart.

Sensitivity to foods such as dairy (low-fat dairy in particular) may pose skin challenges for some people. A study published in the Journal of the American Academy of Dermatology in 2016 found an association between the insulin-like growth factor 1, or IGF-1, in skim milk and increased production of sebum — an oily substance produced by the sebaceous glands — which, in turn, is linked with acne.

A diet high in refined carbohydrates and sugar increases insulin production, which stimulates sebum production as well. A high-sugar diet may also result in glucose binding to collagen, which reduces the amount of collagen in skin and leads to premature wrinkles and sagging.

Choosing health-supporting foods (see “Nourish Your Skin”) and eliminating harmful ones, including the items that appear in “Complexion Busters” at the end of this article, can provide therapeutic and preventive benefits for your skin and entire body.

Nourish Your Skin

Healthy skin thrives on a whole-foods diet that provides vital nutrients to support digestion, balance blood sugar, promote detoxification, and manage inflammation. Therapeutic levels of certain nutrients may be needed to nourish your skin as well. (For more on this, see “9 Supplements for Healthy-Skin.“)

1) Essential Fatty A cids

Omega-3 fatty acids in fish oil — including EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) — are anti-inflammatory. Because inflammation is a root cause of acne, they’re an excellent choice for fighting it, as well as psoriasis and other autoimmune skin conditions. “EPA and DHA change the fatty-acid composition of cells, tamping down inflammation-instigating cytokines. They also help address inflammatory skin issues, including atopic dermatitis, eczema, and acne,” says Trevor Cates, ND. Omega-6 fatty acids, such as linoleic acid in flaxseed oil and gamma-linoleic acid in borage-seed oils, can also be helpful. (For more on essential fatty acids, see “The Omega Balance.“)

Eat Up

  • Wild-caught fatty fish, including salmon, sardines, mackerel, and herring, are rich in omega-3s. Experts advise eating two 3.5-ounce servings weekly; look for low-mercury options.
  • Flaxseed oil contains ALA (alpha-linolenic acid), an omega-3 fat that the body converts in low levels into EPA and DHA, as well as omega-6 linoleic acid. Mix into yogurt, salad dressings, and smoothies — but don’t cook with it, because heating the oil creates damaging free radicals.
  • Walnuts are rich in ALA and vitamin E, both of which protect the skin and fight inflammation.
  • Sunflower seeds contain linoleic acid, an omega-6 fatty acid that moisturizes skin. In an observational study of more than 4,000 women, published in the American Journal of Clinical Nutrition, higher intakes of vitamin C and linoleic acid appeared to lower the risk of dry, thin skin as women aged.

2) Antioxidants

“Orange, red, yellow, and green vegetables and fruits are important in terms of skin health,” says Cindi Lockhart, RDN, LD, IFNCP. These foods boast antioxidant phytochemicals that can neutralize the damage free radicals cause and help protect the collagen in skin from oxidative stress. She recommends seven to nine servings daily.

Eat Up

  • Sweet potatoes and carrots contain beta-carotene, which is converted into vitamin A and can act as a mild natural sunblock. Other orange produce loaded with beta-carotene include apricots, cantaloupe, and yams.
  • Red and yellow peppers are good sources of beta-carotene, as well as collagen-supporting vitamin C.
  • Broccoli offers lutein, which acts like beta-carotene in the body, protecting skin from oxidative damage. It also contains antioxidant vitamins A and C, as well as zinc and sulforaphane, which may help protect against various types of cancer, including skin cancer.
  • Avocados deliver healthy mono­unsaturated fats and vitamin C, a key factor in collagen production. Several studies suggest that avocados protect skin from ultraviolet (UV) damage.
  • Green tea contains catechin poly­phenols, which defend the skin from sun damage. One study showed that drinking green tea reduced UV-induced sunburn by 25 percent, while also improving skin moisture and elasticity and reducing roughness and thickness.

3) Probiotics and Prebiotics

A healthy population of ­microorganisms in the ­digestive tract protects the gut lining, improves the body’s ability to absorb nutrients, and guards against harmful bacteria. It also protects the microbial ecosystem on the surface of the skin by supporting the skin’s natural lipid barrier and immune system. Probiotic-rich foods build populations of healthy bacteria, while fiber-rich whole foods deliver prebiotics that gut microbes rely on to survive.

Eat Up

  • Fermented foods, such as yogurt, kefir, kimchi, sauerkraut, kombucha, and miso, are rich in probiotics and have been shown to help relieve acne, rosacea, and psoriasis. Look for refrigerated or “naturally fermented” foods; many commercial products have been pasteurized, which kills beneficial bacteria.
  • Fiber from bananas, greens, onions, garlic, soybeans, artichokes, and whole grains feeds the microflora in your colon and promotes digestion.

4) Collagen

Collagen is a fibrous protein that maintains the structure of the body and elasticity of the skin. As we age, we naturally produce less, but we can support collagen synthesis through diet.

Eat Up

  • Citrus fruits, strawberries, and bell peppers are rich in vitamin C and support collagen production. Eating foods that contain vitamin C also increases natural levels of hyaluronic acid, which acts as a cushion and lubricant for joints.
  • Egg whites, tofu, tempeh, cabbage, and mushrooms contain the amino acid proline, a component of collagen that supports the growth and maintenance of connective tissue.
  • Beans, kale, and pumpkin, as well as gelatin and bone-in, skin-on chicken, are some good sources of glycine, a structural component of collagen molecules. Though the body produces its own glycine, it’s not always enough for collagen synthesis, so dietary sources are important.
  • Oysters and other types of shellfish, whole grains, beans, nuts, organ meats, dark leafy greens, dark cocoa, and prunes are rich in cuproenzyme, a copper enzyme that links collagen and elastin and helps the body form strong and flexible connective tissue.

(Learn how to use food and supplements to boost your body’s collagen production at “How to Get More Collagen“.)

5) Detoxifying Foods

The body is always detoxifying itself: The liver neutralizes toxins, and the kidneys and digestive system filter waste. Keep your body nourished and hydrated to support proper detoxification — and promote clearer skin.

Eat Up

  • Water is crucial for detox. Start each day by drinking 16 ounces of purified or filtered water, recommends integrative physician Dana Cohen, MD, coauthor of Quench: Beat Fatigue, Drop Weight, and Heal Your Body Through the New Science of Optimum Hydration. She advises adding a dash of sea salt and lemon to provide hydration-optimizing electrolytes and minerals.
  • Cruciferous veggies, such as cabbage, broccoli, Brussels sprouts, and kale, contain glucosinolates, compounds that optimize the liver’s detoxification process.
  • Fiber in veggies, legumes, and whole grains nourishes the microbes in your gut and support elimination.

(For more nutritional advice aimed at supporting your skin’s health, see “11 Vital Nutrients for Skin Health.”)

Complexion Busters

Skin problems? It may be something you’re eating, such as these four common suspects.

  1. Dairy:
    Studies associate intake of dairy — and more specifi­cally, low-fat dairy — with acne in teenagers and young adults. One theory is that insulin-like growth factor 1 in dairy stimulates the oil-producing sebaceous glands.
  2. Refined Carbohydrates:
    Our bodies convert the refined flours and sugar in baked goods — including pastries, crackers, breads and many processed foods to glucose, which raises insulin levels and increases sebum production. A 2012 study found that participants who consumed less sugar and fewer pastries and cakes had lower rates of acne.
  3. Chocolate:
    Scientists con­tinue to debate whether chocolate causes acne and exactly what it is about the treat that may be to blame. A small 2017 study suggests that it’s not just chocolate’s glycemic load that may be the culprit. When college students with acne were given either jelly beans or a milk chocolate bar, the chocolate group had more new lesions 24 hours later. Some research suggests that even dark chocolate triggers a more aggressive immune-system response to acne-causing bacteria, increasing inflammation.
  4. Food-Allergy Triggers:
    When you eat an allergen, your immune system creates specific antibodies (immunoglobulin E, or IgE) that release histamine to attack the perceived invader; this can result in eczema, hives, and other skin irritations. Similarly, food sensitivities can disrupt the gut microbiome and lead to skin problems. Allergy testing and an elimination diet can help you identify triggers.

This originally appeared as “Healthy Skin From the Inside Out” in the January-February 2019 print issue of Experience Life.

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