Pills or Paleo? Preventing and Reversing Acne and Other Skin Problems

Pills or Paleo? Preventing and Reversing Acne and Other Skin Problems

by Chris Kresser

Last updated on

Paleo diet and acne
Nutrient dense foods like on the paleo diet, can help heal the skin of acne and other types of inflammation, from the inside out. istock.com/evgenyatamanenko

Acne and skin problems may not be life-threatening, but they’re associated with depression, anxiety, and social isolation. Conventional medicine has very little to offer for these conditions, but Paleo offers a safe and effective way to prevent and even reverse them.

This article is part of an ongoing series comparing prescription medication with a Paleo diet as a means of treating common diseases and health problem. Click here to read the other articles in the series.

Over 3,000 distinct types of skin disease have been identified, and skin diseases are extremely common in the industrialized world. Between 79–95 percent of adolescents and 40–54 percent of adults in western societies experience acne. Twenty-five percent have dermatitis, 11 percent have eczema, 5 percent have rosacea and 1 percent have psoriasis.

Yet while skin conditions may seem like a fact of life for those of us living in the industrialized world, anthropological studies have found that they are rare or virtually non-existent in hunter-gatherer cultures. (1) This suggests that most skin disorders are influenced primarily by environmental—rather than genetic—factors, and that changes in nutrition and lifestyle may be sufficient to prevent and even reverse them in many cases.

Acne and other skin problems got you down? Find out how to treat them naturally, without drugs or steroid creams.

The skin is influenced by other organs in the body, and this is especially true of the brain and the gut; scientists coined the term “gut-brain-skin axis” to describe the interconnection between these three systems. As far back as the 1930s, researchers had connected emotional states like anxiety and depression to changes in the gut microbiota, which they theorized promotes local and systemic inflammation and skin disease. (2) These pioneering early theories have been confirmed by modern studies showing strong associations between skin conditions (like acne, eczema and psoriasis) and both mental health problems and digestive disease. (3)

Unfortunately, the conventional approach to treating skin problems does not acknowledge the important role of diet, lifestyle, and digestive health. Instead, it is almost entirely focused on suppressing the symptoms.

With all of this in mind, let’s compare conventional treatment with a Paleo-type diet and lifestyle for the prevention and treatment of acne and other skin problems.

Conventional Treatment for Skin Disorders

The most common treatments for acne include topical creams and gels like Retin-A, Differin, Renova, and Tazorac—which work by unclogging pores—and oral antibiotics, like doxycycline, tetracycline, minocycline, or erythromycin—which kills the bacteria that causes inflammation around the blocked pores. In teenage girls and young women, doctors might also use oral contraceptives as a means of attempting to regulate hormonal imbalances that can lead to acne. Finally, in the most severe cases of acne, doctors may prescribe a medication called isotretinoin, which was originally marketed as Accutane.

The effectiveness of these treatments varies. The creams and antibiotics help some quite a lot, while for others they have little effect. Oral contraceptives do seem to outperform placebo in the treatment of acne for teenage girls, but they must be taken for 3–6 months to have their maximal effect. Isotretinoin is a very powerful treatment for acne, which can even clear up severe, scarring breakouts that don’t respond to antibiotics, creams, or contraceptives.

But the potential side effects and risks of these treatments is often substantial, and in some cases, life-altering. For example:

  • Long-term use of antibiotics has a profoundly negative impact on gut health, one that we are only beginning to understand. Given that disturbances of the gut microbiota are associated with everything from anxiety and depression, to obesity and diabetes, to autoimmune disease, the consequences of taking antibiotics for months or years should not be underestimated. (For more on the risk of antibiotic use, see this article.)
  • The list of side effects associated with oral contraceptives is so long I can’t even post it here. But it includes nausea, vomiting, constipation, acne, hair growth in unusual places, crushing chest pain or heaviness, extreme tiredness, coughing up blood, and swelling of the gums.
  • The side effects and complications for isotretinoin (aka Accutane) are downright scary. In fact, due to the number of adverse events reported (including severe fetal abnormalities in women taking Accutane during pregnancy) and an FDA-issued “black box” warning, Roche stopped manufacturing Accutane in 2009. Accutane has also been linked to inflammatory bowel diseases like ulcerative colitis and Crohn’s disease, as well as an increase in suicides. Many people who were harmed in these ways by taking Accutane have successfully sued Roche.

In the case of other skin disorders like psoriasis and eczema, treatment often involves oral and topical steroids. Talk about a laundry list of side effects and risks! These include:

  • Weight gain
  • Acne
  • Mood changes, including aggression
  • Thinning skin
  • Muscle weakness
  • Cushing’s syndrome (stretch marks across the body, acne, fatty deposits in the face)
  • Osteoporosis (even at a young age)
  • Diabetes
  • High blood pressure
  • Glaucoma and cataracts
  • Increased risk of infection

I don’t discount the psychological suffering that acne and other skin conditions can cause, but when dietary and lifestyle changes can often mostly or completely resolve the condition, it’s difficult to make an argument for putting yourself or your loved ones at risk with these medications.

A Paleo-Type Diet for Skin Disorders

As I said in the beginning of the article, acne and skin disorders are shockingly common in the industrialized world, but nearly unheard of in hunter-gatherer cultures. That should tell us that there is something about our modern diet and lifestyle that is contributing to skin disease. It also suggests that returning to a way of eating and living that more closely mimics are ancestral template could be an effective means of preventing and treating skin problems.

The most important thing to understand about virtually all skin disorders is that, like all other “diseases of civilization”, they are inflammatory in nature. So they key to addressing them is to follow an anti-inflammatory diet and lifestyle. That’s what Paleo is all about. For example:

  • Paleo eliminates the highly processed modern foods that provoke inflammation, such as refined flour, excess sugar, and industrial seed oils.
  • Paleo encourages regular physical activity, which reduces inflammation and strengthens immune function.
  • Paleo promotes getting adequate sleep, which has also been shown to reduce inflammation and support healthy immune function.

Another common cause of skin disorders in the modern world is nutrient deficiency. In the industrialized world we are overfed, but undernourished. In fact, more than half of Americans are deficient in zinc, calcium, magnesium, vitamin A, vitamin B6; and about one-third are also deficient in riboflavin (B2), thiamine (B1), folate (B9) vitamin C, and iron. (4)

In addition to reducing inflammation, Paleo works well for skin conditions because it’s so nutrient dense. Studies have shown that the meat, fish, vegetables, fruits, nuts, seeds, and starchy tubers featured in the Paleo diet are the most nutrient-dense foods we can eat. (5)

Finally, Paleo is a very gut-friendly diet, which is important given the strong connection between the gut and the skin. For more on this subject, see this previous article I wrote on the gut-skin connection.

But just how effective is Paleo for reversing skin problems? I see fantastic results in my work with patients every day, and I’ve also received hundreds of success stories from readers, like this one from Malori Mayor (note the connection we’ve discussed here between gut and skin!):

My skin problems (eczema and acne) started over 10 years ago, when I was 16. The eczema got so bad at that time that I got a cortisone shot. My stomach problems started over 5 years ago, beginning with lactose intolerance, discovering by personal trial that I was gluten intolerant a little over 2 years ago, and eventually receiving a diagnosis of lymphocytic colitis and mild small intestinal inflammation 6 months ago. I have also experienced chronic joint pain all over but especially in my hands.

My GI doctor prescribed me Uceris for the colitis but I chose to be non-compliant and never got the prescription filled. Despite the nurse telling me that “there is no natural remedy for colitis” I was determined that there was. I also knew that skin issues and stomach disorders are closely related, as I’m a nutrition nerd that loves reading and studying on my own.

I had been kinda-sorta doing Paleo (gluten free, sugar free and mostly dairy free), but at the end of May I decided to do a 30-day reset, as Chris talks about in Your Personal Paleo Code. I even blogged about it to keep myself on track! I followed the Autoimmune Protocol (AIP), and about halfway through, I realized that my joints did not hurt AT ALL. My GI symptoms were almost non-existent, the awful eczema patches on my hands disappeared after the 30 days, and my acne flare-ups stopped. It was totally amazing!! 🙂

Now I don’t adhere to a strict AIP diet – I can tolerate white rice, goat dairy, and nuts in moderation – but I try to avoid nightshades, seeds, and eggs for the most part, as I notice joint pain and skin issues flare up when I eat those things too much. As for my stomach? Gas and bloating used to be a daily thing for me, but now it’s only occasional.

So what will it be for you? Pills, or Paleo?

If your answer is Paleo, make sure to check out my book (just published in paperback with a new name: The Paleo Cure) for a detailed explanation of how to use Paleo to prevent and reverse disease and feel better than you have in years. And don’t miss the bonus chapter on addressing skin conditions with diet, lifestyle, and supplements, including a list of specific nutrients you should focus on for skin health.

As always, check with your doctor before starting or stopping any new treatment plan—including what I’ve suggested in this article. This is not intended to be medical advice, and is not a substitute for being under the care of a physician.

  1. HELP
    I was on yaz for 5 years and developed acne badly just on my face. I got off yaz and stil had acne. I waited about 5 months and if hadn’t cleared up and I started getting chest and back acne now. I went gluten and dairy free for 60 days and am still going and my face has cleared up a lot but my chest and back won’t clear up… What should I do?!

  2. I’m a 50-something yr old post-menopause female. In my 30s and early 40s I had some small areas of mild eczema on my shins, behind my knees, and a few other small patches in wintertime during, but it cleared up and didn’t return after I was diagnosed with hypothyroidism and began treatment with desiccated thyroid hormone (NatureThroid) at age 44.

    That is, no eczema outbreaks until early-mid Summer 2015. During some late June summer roadtrip and several days of lots of sitting combined with more hot, humid weather than I experience in my home area’s mild climate, I developed a very uncomfortable case of Gardnerella vaginitis combined with a raging external candida (yeast) overgrowth. My gynecologist prescribed two rounds of Diflucan oral antifungal Rx medication and vaginal Metrogel, which cleared things up quickly and nicely. Or so I thought.

    While traveling again in early July, however, I experienced some intensely itchy bug bites that swelled quite a bit. A week later a 2-3″ patch of really itchy eczema appeared on the inside of my left wrist, plus an area of itchy eczema on my inside right wrist. I don’t know if the eczema was related to the previous Diflucan and Metrogel treatments, a reaction from the bug bites, or if the two back-to-back trips shifted my gut and/or skin microbiome in a hugely negative direction, but over the next few months the eczema became the worst I’ve ever experienced.

    The left wrist patch not only wouldn’t go away, but through October 2015 it became much worse and continued to expand until the red, itchy, scaly rash was a big patch that reached 2/3 of the way up my left inside arm toward my elbow, small patches on the backs and insides of my fingers on both hands, behind my ears, and starting in several areas around my hairline. I tried several brands of OTC 1% hydro-cortisone cream as well as an OTC anti-itch cream, but there was no improvement at all – HC didn’t stop the spread and I couldn’t detect any improvement in itching, redness, or texture. I was careful to take short showers with tepid water, avoid soaps & perfumes, and to keep the area well moisturized (finally I just used 100% plain shea butter). The itch was unbearable; I willed myself not to scratch during the day or to just rub with the base of the palm on my other hand or a bent index finger knuckle (to avoid breaking the skin until it bled and became infected), but at night I had to wrap my left forearm with a bandage or else I’d scratch in my sleep.

    But still the ugly rash wouldn’t resolve and continued to spread and become redder and more rough. Despite my family’s urging, I was reluctant to go to my primary doctor or a dermatologist because I figured I’d be offered only the standard treatment – a Rx steroid cream or Elidel cream – which would suppress the symptoms somewhat but does nothing to address the underlying cause. I strongly suspected that my sudden eczema outbreak probably had a gut origin, though I hadn’t detected any significant changes in my typical gut behavior or symptoms.

    I looked up studies that focused on eczema, gut bacteria, probiotic treatment, etc. but most of the supporting data seems to pertain to infants and very young children, birthing methods and breastfeeding, not middle aged adult females (and if it still matters a half century+ later, I was birthed as naturally as a baby could be in an early 1960s era military base hospital – my young but wise 20 yo mother taught herself the Lamaze method of natural childbirth from a book and breastfed me for at least a year).

    Nonetheless, it made sense to me to see what I could do to improve and encourage good gut flora balance. I consumed homemade yogurt from organic whole milk (not ultra-pasteurized) more regularly, cultured with Fage Greek Total or 2% plain yogurt. I mostly eat yogurt plain (unflavored) or in homemade tzatziki and similar savory mixtures. I also occasionally took some probiotic capsules that I already had at home, but I wasn’t very consistent about it and I didn’t pay much attention to the strains. I made an effort for more than a month to include soluble fiber-rich foods daily in my diet for their prebiotic benefits. I already generally avoid highly inflammatory foods and most of what I eat I prepare from scratch. The best I can say is the yogurt and occasional probiotics maybe slowed the eczema spread a little, but they weren’t nearly enough to make the current patches improve or fade.

    During a big sale at my local health food store’s vitamin department in late October, I decided to try a more expensive and comprehensive probiotic blend (Garden of Life brand – Primal Defense Ultra) that was highly recommended by the store staff, plus a container of Jarrow Inulin FOS probiotic powder, which is essentially tasteless and mixes easily into water, tea/coffee, or other beverages. I started taking both right before bedtime. After a few days I added another dose first thing in the morning. By the end of the second week I added an additional dose during the day for a total of three doses of each daily. I increased the Jarrow Inulin FOS dose from 1 scoop to 2 scoops per scoops, too. I also switched from using shea butter to extra virgin coconut oil rubbed into the affected areas in the morning, at least once during the day, and at bedtime.

    To my great surprise and delight within a week (early November) there was improvement for the first time since the eczema began (mid-July). Even my family noticed the improvement without me saying anything. The milder patches around my hairline and behind my ears and in between my fingers were nearly gone, and the huge, red, very rough patch on my inner wrist and forearm was greatly improved – much less rough, less red, and much less itchy, especially on my inner wrist where the eczema started (the most recent margins and patches closer to my elbow healed more slowly).

    By the middle of November I could only see/feel the tiniest bit of eczema on the backs of a finger or two on each hand, and the huge forearm patch was nearly back to normal smooth texture, with no itching, and just a pale red color to the area (again, on my forearm, the most recent areas closer to the elbow were a little behind in healing compared to the earliest area near my inner wrist). The afflicted areas were slightly more red colored and contrasted with the paler non-eczema areas when my skin was cold, but the texture was still at least 85% smoother and far more normal looking than it had been in months.

    It’s been 3-4 weeks since I started the G of L Primal Defense Ultra probiotic blend, Jarrow Inulin FOS, and EV coconut oil, and except for 1 small quarter-sized area (the last area of eczema to develop), I don’t think anyone else would be able to notice any eczema at all except for some light pinkness when my skin is cold and otherwise pale. I can’t feel any texture difference and there is no itch anymore. I have backed off the Inulin FOS to 1 scoop once daily and skipped the coconut oil applications to see if that slows/halts the healing or the eczema recurs, but it hasn’t, so I think that the probiotic blend probably is the critical factor to initiate and sustain the healing process. I cannot think of anything else besides the probiotics, prebiotic, and coconut oil that changed in my diet, personal care, or lifestyle that could explain the sudden turnaround and continuing resolution of what was IMO quite a severe and sudden bout of eczema.

    Needless to say, I’m thrilled that I tried this route instead of giving in and going to the doctor for a standard Rx. The bottle of 90 probiotic capsules is almost finished so I’ll probably buy another bottle and continue to take it for maintenance.

    I just wish I had done one of those microbiome typing test kits first for a baseline analysis . I’m so interested in my gut health now that I ordered a uBiome test during the fantastic holiday weekend sale but haven’t done it yet. I want to know what my gut population when the eczema is 100% gone for future reference, in case it returns.

  3. Hi,my son is 19 and has had severe cystic acne for almost 3 years now. He was on a low dose of antibiotics for two years,they were amazing for about 6 months and then the acne returned with a vengeance….As a family we stumbled across Paleo and acne by chance we have been juicing for many years so have always been healthy.We are now 14 weeks into a strict Paleo diet and in the first month we saw amazing results but things seem to be returning to how they were…..He has severe cystic acne on his back and face and we really thought we had found the answer but obviously not…How long for Paleo to have full effects ? He is also taking zinc supplement,Vitamin D supplement and Keffir daily….At our wits end …any advice ?

  4. Hello,

    First off I want to thank you for all the great information you share and also I love your book! I have been Paleo for over a year and a half but and have been able to slow down the progression of my disease among many other things but one thing I can not fix is my adult acne! Maybe there are some main things I am missing that can help. I appreciate your suggestions and tips.

    Thank you

  5. What is your advice for someone with Pressure Urticaria? What would be your first set of advise. I am really keen on hearing your view on this difficult condition.

    Thanks so much in advance for your feedback!

  6. Any tips for somebody who was unlucky enough to go through 2 treatments of Accutane in their 20s (so about 12 and 10 years ago)? :/

    • Accutane had ZERO negative side effects for me (not even dry skin, go figure).

      Unfortunately it didn’t keep my acne at bay. My face is back at it.

      Are you still suffering symptoms? If not I don’t think it’s a problem.

  7. Very interesting article. I’ve never even thought of this, but my oldest has had a very bad bout of acne the past few months, and we’re just now starting to switch over to the Paleo Diet….I’m hoping we’ll be able to see results soon.

  8. In the modern days, there are still people who prefer to use the natural products in order to be free from harmful skin disorders. I found out about the natural skin care supplements in an article that is very effective in relieving scabies, yeast infection, eczema, acne and ringworm. The supplement is made of Manuka honey, which contain pure anti-bacterial properties. Aside from the honey, essential oil is also incorporated in the product to produce immediate and effective health results.

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