“Can you help my daughter with her acne? It’s a major cause of distress and is impacting her self-esteem and quality of life. We’ve tried so many traditional approaches, and something tells us that addressing the root and trying to clear her skin from the inside out is something we should consider. She’s willing to try anything at this point”

In the past, I would address such inquiries with an “I’m so sorry, but I can’t help you” type of response. Research on the subject was too limited, and ethically I did not feel comfortable taking on cases on a broad scale unless I knew that my area of practice was evidence-based. But as a former acne sufferer myself and the mom of teen girls, I fully related to the angst of even mild acne sufferers, and my inability to provide any solution felt like a failure to me with each individual I dismissed.

So after extrapolating some data from other areas within functional medicine that address hormonal and gut bacterial imbalances, and based off of what limited research was available, I decided to give it a go. I felt that success in this area would provide me much needed satisfaction given my own history with acne, and felt compelled to provide that much needed address to those who were in current need. With a lot of disclaimers given to potential clients on chance of success, I took on some cases over the course of a period of time.

I was pleasantly surprised to find that all cases had some degree of improvement, many of them significantly, with one or two almost complete. My anecdotal experience in the area made me question why the standard assertion that there is no link between diet and acne, wisely dispensed by google and most dermatologists, isn’t becoming a stronger challenged premise in 2024.

Shana*, a recent fourteen-year-old I worked with, was ecstatic to find that implementing my top ten list of advice for acne sufferers almost completely cleared her skin within two weeks. I always use six weeks as my time scale to judge efficacy, and I was just as pleasantly surprised as she was at the rapid success she saw. “I don’t know if I can do this,” was her main concern at our initial consult, and I spent most of that first session trying to think of practical and easy meal and snack ideas that she liked and could implement quickly. At her one month follow up, she admitted that the change was not as daunting as it seemed to be in the end, and the results she saw were “majorly worth it!”

For the benefit of readers, I’ve summarized the very basics of healing acne from within in an easy-to-read bulleted list. While these are what I call Step One interventions and further nutrition interventions may be needed if these tips are insufficient, many individuals will still see improvement solely from the basic “top ten” guidelines below. As a disclaimer, as with any condition, there are never 100% guarantees for success, but the likelihood of even limited partial improvement is high.

At minimum reduce, or at best cut out completely, all packaged or home prepared foods that contain any inflammatory oils (Ex: partially hydrogenated oil, canola, “vegetable,” soybean, palm.) Sunflower oil in a packaged food is ok in limited moderation. Processed snacks with added oils should be kept to a minimum or cut out completely, and mayonnaise should be avocado or olive oil based (homemade recipes are simple and store in the fridge for 3 weeks.)

Consume 1-2 Tbsp of extra virgin olive oil daily in a salad or low temperature cooked form for anti-inflammatory benefits. For all foods heated above 350 degrees or above a low flame on a stovetop, use avocado oil.

Consume 3-4 cups of brightly colored vegetables, and 2-3 small portions of fruit daily, in particular leafy greens, orange vegetables, and brightly colored fruits such as berries/cherries/pomegranate.

Consume a healthy anti-inflammatory fat, such as avocado, walnuts, pecans, or almonds daily.

Reduce intake of red meat and cheese, and increase intake of protein from white meat chicken, fish, and beans.

Grain products such as cereals/bread/crackers should be mostly whole grain, with minimal added ingredients that are unrecognizable in a home kitchen (ex: preservatives, emulsifiers etc.) Unprocessed whole grains such as barley, quinoa, kasha, and brown rice are ideal.

Address underlying conditions, such as constipation and/or PCOS if pertinent. Poor gut health and constipation are at the root of many skin conditions, and a gut-health trained dietitian can help you improve your digestion. In addition, excess androgens linked to blood sugar spikes are implicated in the acne associated with PCOS, and a Registered Dietitian familiar with the condition can teach you a blood sugar balancing food plan, exercise tips, and supplements that may improve the hormonal imbalance.

Cut out or at minimum limit candy, soda, and foods containing high fructose corn syrup. Use instead honey, organic cane sugar, or coconut sugar in moderation in homemade food items. Packaged food items with table sugar added under 3-5 g per serving are ok in very limited moderation.

Optional after 1 month if improvement is not sufficient: Consider reducing cow’s milk intake, or switching to A1 protein-free forms of dairy (available in kosher health stores, or in kosher grocery stores generally under an “organic grass fed” label.)

Supplement daily with a methylated multi vitamin, 2000 mg of fish oil, 3000-5000 IU of Vitamin D, and a high-quality probiotic with minimum 8 strains/ 50 billion CFU ideally at bedtime.

Give the above suggestions a try for 6 weeks, and if improvement is only partial, a slightly more individualized approach may be all that is needed to jumpstart even further success. Best of luck!

*Name has been changed for privacy