The general treatment of acne involves using a non-soap cleanser twice a day, and ensuring no make-up is worn to bed. Alpha-hydroxy acid, lotions and scrubs are useful, as are topical retinoids, benzoil peroxide and sometimes antibiotics, both on the skin and swallowed. Tea tree oil works as well as benzoil peroxide in its antibacterial and anti-inflammatory actions but neither of these prevent microcomedo formation.
Finally, Isotane® shrinks the sebaceous gland and reduces sebum formation, and normalises follicular keratonisation, as well as being anti-inflammatory and inhibitory of the acne bacteria. The problem with this is the side-effect of dry mouth, eyes, as well as itch and depression in small numbers of women. Hormone therapies like the contraceptive pill can be used as well. Lasers, light therapies, facials and other treatments all help but don’t cure this condition.
In adult women, what will really help this condition is attention to hormones, diet and a phenomenon called insulin resistance.
Insulin resistance is the body’s increasing inability to deal with sugar. This phenomenon is found in women with polycystic ovary syndrome, women who tend to gain weight around the trunk, and those who cannot lose weight easily. Insulin resistance is also found in acne in teenagers. If a person continues to eat the typical western diet with sugar, white flour and lots of white starches, these starches turn into sugars in the body and so the sugar load becomes high. Some people have difficulty disposing of the sugar and so their pancreas has to start making more and more insulin. In the early phases, these people will have a normal fasting glucose level when tested, but if their fasting insulin level is tested, it will be found to be starting to increase. These people will start noticing that they cannot shift the weight from their trunk. Insulin resistance is also associated with Metabolic syndrome which includes diabetes, hypertension and abnormal cholesterol.
Metabolic syndrome is caused by the ever increasing calories, fat and sugar load in our typically sugar and starch-based diet. It can also be worsened by stress, inadequate exercise, chemical toxicity, hormone imbalances and any inflammatory conditions like arthritis, autoimmune diseases or bowel diseases. Metabolic syndrome starts with the accumulation of fat around the trunk, which then causes insulin resistance. This sets up a vicious cycle. As the person gets worse, they may start to develop high blood pressure, abnormal cholesterol levels, or polycystic ovary syndrome. If metabolic syndrome is allowed to continue to its fullest extent, it can be associated with heart disease, stroke, diabetes, blood clot, depression, kidney failure, migraine, ringing in the ears, infertility, gout and many other problems. As you can see, Metabolic syndrome is becoming a Western epidemic.
Early telltale signs that Metabolic syndrome could be on the way include a waist circumference in women of over 80cm. If you add to that some blood pressure and cholesterol problems then this person should be looking carefully at their diet and lifestyle. Often women with Metabolic syndrome have hormonal imbalances similar to those of polycystic ovary syndrome.
Polycystic ovary syndrome is something that can be present from teenage years onwards. It is commonly associated with hairiness, acne and being overweight, although some sufferers can be quite slim. One of the important things associated with polycystic ovary syndrome is insulin resistance as well as infertility. The infertility is associated with the hormonal imbalance. Interestingly, using diabetes-type medicines can help people with polycystic ovary syndrome and so can diet – this is the same for Metabolic Syndrome. PCOS patients can also benefit from hormone therapies. The diagnosis of PCOS is made when the hormones are seen to be unbalanced and there are no regular cycles. What can also help with the diagnosis is ultrasound evidence of cysts on the ovaries although this is not strictly necessary to be present.
Premenstrual syndrome occurs in up to 75 percent of women in the childbearing age group and up to 10 percent of them have it very severely, causing major effects on their quality of life and productivity. There are theories as to the causes and they include imbalances of vitamins, hormones and brain chemistry. But what is not theory are some of the disabling symptoms that include breast swelling and tenderness, abdominal bloating, weight gain, mood swings, depression, anxiety, rashes, food cravings, headache, migraine and inability to concentrate or function properly.
In fact, premenstrual dysphoric disorder is a severe form of premenstrual syndrome, which includes severe psychological symptoms.
Those at most risk of PMS are those with painful periods, high stress, or a personal or family history of mental illness, depression or anxiety. In my opinion, stress makes it worse because it further unbalances hormones and increases vitamin deficiencies in the brain.
In common with the other conditions mentioned so far, lifestyle changes like exercise, diet and regular sleep can be extremely beneficial, as can stress reduction and relaxation exercises. Specific to PMS, nutritional supplements that can be helpful include evening primrose oil, vitamin B6, vitamin E, calcium and magnesium. Herbs like
The common themes that run through all of the above conditions in adult women will now be discussed. The typical western diet with many grains, starches and sugars stimulate insulin resistance and for those with acne, PCOS and inability to lose weight/Metabolic Syndrome. The ideal diet is one that avoids sugar, starches and processed foods. Look at an Asian teenager – you can tell if they are eating a western diet or a traditional Asian diet – the one eating a traditional Asian diet has no acne. The excessive sugars and starches in the diet create inflammation in the body, which then causes inflammation in the skin. The inflammation in the body causes polycystic ovary syndrome to get worse, and also causes more fat gain around the waist.
Hormone imbalances are behind all of the abovementioned conditions in adult women. The main hormone that needs attention is progesterone. A deficiency of progesterone relative to oestrogen can be present from teenage years. Typically, what this causes is premenstrual breakout of acne and premenstrual symptoms. This problem is also present in polycystic ovary syndrome and commonly in women approaching the menopause. In acne, other hormones are in play. A low glycaemic diet (one that avoids sugar and starches) helps to reduce androgen levels and correct hormones.
In many women with these problems, simple attention to getting enough sleep and exercise, plus a low GI diet is enough to significantly help their symptoms. In those that need further help, looking at hormones, particularly progesterone, can be useful. I prefer the use of bioidentical progesterone because it is the same as is in the human body. My experience has shown very good success with all of the conditions mentioned.
In some women where insulin resistance is a particular problem, adding in a diabetic medicine, Metformin, can be very useful in helping weight loss and controlling the problem.
Sometimes other hormones need to be looked at and corrected. Here is my programme for helping insulin resistance:
1. Restore normal sleep – this means being in bed and asleep by 10:30pm. If not, the person misses out on the melatonin surge that occurs afterwards. Melatonin is a very important antioxidant and anti-cancer hormone that is released by the pineal gland which is in the very centre of the brain.
2. Treat stress/depression – this is because they cause inflammation in the body.
3. Normalise/treat any imbalance of the following:
• Thyroid function
• Adrenal gland function
• Sex hormones, e.g. oestrogen to testosterone ratio (in men), and oestrogen to progesterone ratio (in women). When these are abnormal it causes increased abdominal fat.
• Gut flora – detoxifying the gut with correct diet and a probiotic or other measures.
• B12, iron, folic acid, zinc, vitamin D.
4. Diet – this will initially be the ketogenic diet (no sugar or starch whatsoever) for rapid fat loss. Later it can be Mediterranean, Zone or ABO blood group diets for maintenance.
5. Exercise– aerobic exercise in a low grade fashion burns calories as well as fat. Resistance exercise like weight training increases the insulin sensitivity of the cells as well as building muscle, which then further burns fat.
6. The addition of the following shortlist of supplements are the first choice:
• Omega 3 fish oil – this reduces inflammatory messengers and molecules in the body. It also reduces all the conditions related to inflammation but also increases learning and memory. Omega 3 fish oil also helps probiotics to stick in the gut lining so they work better.
• Chromium reduces excessive appetite, cravings and depression.
• Probiotics (friendly bacteria) balance the immune system which reduces inflammation. This in turn allows easier fat loss.
• Magnesuim is important in cellular energy production, as well as reducing insulin resistance.
7. Metformin – this is a drug that is very effective at reducing insulin resistance and is also used in diabetes.
8. Natural substances that can be used:
• Alpha lipoic acid – this is a powerful antioxidant which recycles the antioxidant vitamins in the body, and importantly can cross the blood brain barrier. This means it can work in the brain so that the brain is not starved of glucose. Alphalipoeic acid helps diabetes and insulin resistance.
• Resist-X by Metagenics. This contains Korean ginseng which reduces blood pressure and weight. The cinnamon reduces blood glucose, triglycerides, total cholesterol and LDL cholesterol. The caiapo reduces blood glucose and total cholesterol.
• Insulex by Metagenics contains the herbs acacia nilotica and hops. They improve the ability of insulin to work by interacting with the insulin messenger molecules. It also reduces fasting and post-meal glucose, as well as triglycerides. It increases the good HDL cholesterol.
• Taurine – this is an immuno acid and acts as an antioxidant, reducing inflammation as well as blood pressure.
9. Useful hormones:
• Testosterone helps with energy, fat loss, libido, resilience to stress and mood. In men it reduces heart disease and is anti-inflammatory as well as helping mental function. It is often low in ageing men and women.
• Melatonin is a strong antioxidant substance.
10. Other herbs:
• Withania somnifera (aswaganda) reduces inflammation and stress.
• Magnolia bark reduces stress hormones and therefore inflammation.