Acne occurs when the pores on the surface of the skin become blocked with dead skin cells, oil and bacteria (specifically a nasty little bug called propionibacterium acnes). When stress, hormonal changes, poor diet choices, inflammation and other factors cause the glands to produce an excess of sebum the oil mixes with dead skin cells and P. acnes bacteria. These substances then form a plug and the body responds to this by sending out red and white blood cells to combat this infection. These blood cells accumulate at the skin and cause further inflammation, resulting in acne. While we’re clear on how acne forms, the why is not always so obvious. There are numerous root causes of acne and understanding the reason behind your acne can help you treat breakouts successfully and permanently.
Acne is a signal from the body that something you’re doing isn’t working for you and is creating dis-ease within your physiological systems. A naturopathic approach to lab testing seeks to uncover the imbalances that are at the root of your acne. All humans are unique and there are many causes of acne, which is why it’s so important to test and see what specifically is causing your skin problems. Functional testing is individualized to each patient so that your Naturopathic doctor can come up with an effective treatment plan to address your unique case.
The Common Causes of Acne:
- Dietary causes: dairy and sugar cause a spike in IGF-1 which causes your skin to produce excess oil and also increases systemic inflammation.
- Hormone imbalance: Acne can be caused by elevated Androgens (male hormones), deficient female hormones (usually progesterone) or a hormonal condition called PCOS which is caused by elevated androgens, increased inflammation and insulin resistance.
- Inflammation: Inflammation in the skin leads to an increase in glycoproteins IL-6, IL-8, IL-12 & IL-17 which encourages the growth of acne-causing bacteria on the skin. Increased levels of P. acnes bacteria then causes the immune system to secrete even more inflammatory glycoproteins resulting in even more inflammation and even more acne … you can see how this could become a problem …
- Stress: Increased cortisol (stress hormone) levels leads to increased sebum thickness in the pores of the skin causing it to be oiler and more prone to acne.
- Insulin dysregulation: this is one of the most important hormones to focus on when it comes to acne since it becomes very difficult to clear your skin if your blood sugar levels are out of balance. You can check out my article on blood sugar and skin health to learn more about how high insulin levels impact acne.
- Impaired hormone metabolism: 5-alpha-reductase is an enzyme that converts testosterone to a hormonal byproduct called DHT. This is important when it comes to the health of your skin since high DHT levels are linked to cystic acne and greater levels of 5-alpha-reductase have been seen on the skin of acne sufferers.
Important labs for Acne Patients:
- HbA1C & Fasting glucose: These labs will help us to assess your blood sugar levels to determine whether or not insulin dysregulation is impacting your skin.
- ESR, CRP: These are relatively easy, inexpensive, non-specific tests that are commonly used to help detect inflammation associated with conditions such as acne.
- Salivary hormone panel: While many doctors will agree to test your hormones with a blood test the problem lies in the fact that hormones are not biologically active in the blood stream so this method of testing does not always give accurate results (free testosterone is the exception here, since studies show that serum levels of this one particular male hormone can accurately reflect physiological levels). Salivary testing shows us your functional hormone levels since saliva results will accurately show us hormones concentrations at their biologically active sites in the tissues of the body.
- DUTCH: The advantage of this specialized urine test is that it measures both parent hormones and metabolites. Metabolites are an important addition to your overall hormone picture since they can help us to understand what underlying pathology is causing your hormones to become imbalanced in the first place. For example, this test will tell us whether or not there is a problem with 5-alpha-reductase & DHT conversion, as discussed above. As an added bonus DUTCH testing can also look at stress hormones and sleep hormones, giving you the most complete picture of your overall health.
- Adrenal cortisol panel: This salivary test looks at your stress hormone levels throughout the day and can help us determine whether or not cortisol dysregulation is the root cause of your skin issues.
- Food Sensitivity testing: While it’s advisable for all acne sufferers to reduce overall dairy and sugar intake this test will help us to determine which exact foods are causing your issues in order to avoid having to eliminate entire food groups.
Looking to connect with a Naturopath in Oakville to develop a personalized acne protocol to clear your skin from the inside-out? Book your in-person appointment here or visit my website for more information.
*Note: online services provided by Dr. Sarah to those of you living outside of Ontario are delivered as a Certified Functional Medicine practitioner consult and not as an Naturopathic doctor appointment & as such they will not be eligible for reimbursement through private insurance.