When Lisa, who works as a nurse at a nearby hospital, entered my office, her big, relaxed smile was the first thing I noticed. But her easy manner quickly fell apart when she started talking about what had overwhelmed her for the last five years: cystic acne that wouldn't budge, no matter what she did. Her skin had been beautiful -- perfect -- all through puberty, high school and college; she'd never had to think twice about it. Until she turned 24 and great big, painful pimples started to turn up, starting on her jaw but soon spreading all over her face. She'd tried a number of approaches: a vegan diet, chemical peels, herbal supplements, and medications prescribed by her dermatologist. Nothing helped, and she was becoming increasingly desperate.
Adult-onset acne is a common complaint I see in my practice. The American Academy of Dermatology has cited studies that have shown that women after age 20, in particular, develop acne at greater rates: 50 percent between ages 20-29 and 25 percent between 49 and 49 . People who get acne in adulthood often have beautiful, perfect skin throughout adolescence, the period of time usually associated with fluctuating hormones and nasty breakouts. While women with acne caused by menses-related hormone imbalance are a familiar sight in my practice, I find that another culprit is all too common: gluten, and the havoc it wreaks on the gut that, in turn, affects the skin.
Let's start with a brief primer on basics of this tricky offender. Gluten is a protein in wheat and other grains (oat, barley, rye, spelt) that makes bread dough sticky. It's also in a number of places you wouldn't expect: imitation meats, soy sauce, ketchup and ice cream, among others. Because of its gumminess, it's also added to cosmetics, toothpaste and shampoo. It's all but unavoidable. Some people respond to gluten with symptoms like diarrhea, intense abdominal pain, fatigue and bloating -- all of which are severe and occur immediately after consuming a food containing gluten. This is often diagnosed as celiac disease, which is an autoimmune, inherited disorder in which the protein portion of gluten incurs an inflammatory response in the small intestine. It's diagnosed by a blood test or intestinal biopsy.
This differs from gluten sensitivity, in which symptoms are similar to celiac disease but not as immediate and arise over time. People with gluten sensitivity also complain of headaches, muscle and joint weakness, skin problems, and neurological issues like brain fog and depression. There is no way to definitively diagnose it, but a recent study led by University of Maryland's Center for Celiac Research confirmed that gluten sensitivity is distinct from celiac disease in the type of immune response it elicits from the body, providing direct evidence of its mechanism and existence.
For people who connect their gluten consumption with a range of complaints that are often dismissed by their doctors, this comes as welcome news. But how does this tie in to acne? Researchers behind the Maryland study conjecture that the inflammatory response that begins in the gut's reaction to gluten then spreads to other parts of the body. More investigation is needed on gluten sensitivity's direct impact on the skin, but the connection between the gut and skin has been studied extensively.
In sensitive individuals, gluten acts in two ways. First, it alters the integrity of the gut, creating cracks in the gut lining that allow toxins to recirculate back into the system. Second, because gluten-sensitive people cannot properly digest gluten, these large molecules enter the bloodstream, and the immune system recognizes them as invaders, activating an immune response that increases inflammation, which in turn can result in acne. This kind of immune response also triggers the release of insulin, which results in raised hormone levels, another cause of acne.
Basing my treatment plan on these concepts, I explained my approach to Lisa. She was amazed that her dermatologist and all of the practitioners she'd visited had never mentioned her gut. I explained that naturopathic medicine, unlike conventional medicine, seeks to get at the root cause of disease as opposed to covering up symptoms with antibiotic or steroid creams. That being said, the healing process of natural medicine takes longer but is more permanent. My goal with her, I said, was to teach her to recognize what worked for her body and what did not, food-wise, and to properly supplement her to support proper gut function and skin healing. Lisa was on board. Not coincidentally, she had suffered from constipation for nearly her entire adult life, and gas and bloating were regular annoyances.
My plan with her was as follows:
• Eliminate gluten, first and foremost. I also had her reduce dairy and sugar, while adding more animal protein like turkey, chicken, eggs and fish.
• A daily probiotic to repopulate her gut with proper flora.
• Magnesium glycinate to get her bowels moving.
• DIM. Diindolylmethate is a phytonutrient found in cruciferous vegetables that helps the body excrete excess estrogen. Lisa's painful periods spoke to the gluten's aforementioned side effect of increasing hormone levels, which can result in more breakouts.
• Biotherapeutic drainage. This system of homeopathy is useful for detoxifying specific organ systems. I specifically chose remedies that would help clear the gut and skin.
• Castor oil applied topically. Dabbed on the face at night, this wonder-oil cleanses and heals acne lesions.
When Lisa returned one month later, her cystic acne was gone. She almost couldn't believe it, her smile even wider than it had been when we first met. "I feel amazing," she said. "Sure, I have a few normal-person pimples now but nothing like it was before. And my PMS was so much better this month." She told me how her Greek family gave her a lot of trouble about the new diet, but that she was slowly getting them to come around and her sister was even interested in pursuing naturopathic medicine as a career. Her bloating and constipation were gone, and she went to the bathroom every day. I always joke that we naturopaths love to talk about poop, but healthy bowels really are the key to health. I see it over and over again in my practice: Chronic illness, ranging from acne to chronic fatigue to arthritis, often has a gastrointestinal-related fix. And gluten, unfortunately, is often the gut's biggest enemy.
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