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

by Chris Kresser

Last updated on


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.


Join the conversation

  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.

  9. Dear Chris and knowledgeable readers,

    If somebody could give me a well-informed opinion on the following case, that would be greatly appreciated:

    My boyfriend, age 34, has suffered with acne since his teenage years. He went through intensive anti-biotic treatment when he was around 18 years of age, but this never really helped very much. When he was young his diet was…. As far from palao as you could get. But in the last 3 year he has almost entirely cut out sugar and refined foods, and all dairy except full fat cheddar cheese (which he does have quite a lot), and drinks minimal alcohol. He is, however, eating whole grain spaghetti, also quite a lot. He is slim and healthy looking, though does very little exercise, and he never gets I’ll.

    His acne is much clearer than before, however it persists on his upper back with occasional flare ups. He doesn’t think the wheat spaghetti or cheese are linked to his flare up. Instead he has a sneaky suspicion that having sex may be linked with the flare ups. Could it be that a surge in testosterone is accountable? If so, is there anything to do about that?

    Any thoughts or comments are welcome.

    Thanks in advance! 🙂

    • Hi, I’m a passing skincare addict. I would suspect testosterone after suspecting everything else. I would suspect diet second to the last.

      If I were your boyfriend, I would inspect the ingredients of his body products. If acne is localized to the upper back, perhaps its root cause are some comedogenic ingredients in his shampoo or soap. Perhaps, since he’s male, he uses body products that are marketed to males—these are terrible, with skin-irritating fragrance and skin-irritating cooling ingredients such as mint. I’d switch these for unscented products for marketed for people with sensitive skin.

      However, given that his acne has lasted that long, I would suggest consulting a dermatologist before heeding the advice of a blogger or a blog commenter.

    • Testosterone levels are pretty stable as far as I know, there is no timing needed for testosterone tests and I have never heard of a “testosterone surge” from intercourse. The only way for him to find out if diet is related is to eliminate casein altogether and gluten. I have to say, I was completely addicted to cheddar cheese before I started AIP 28 years ago. I’m not sure I would give it up for just something as cosmetic as acne. But if he does want to see if a Paleo diet is helpful in his case, and he is keen to resolve the acne, he needs to actually do the diet for at least a month, preferably 3-6.

    • please don’t tell that poor guy to stop having sex!!! if I even look at a yogurt cup the wrong way I break out with acne/eczema. Both my brothers had Non Hodgkins lymphoma, aunt has RA, I could continue with genetic issues in my family but won’t. I can’t tolerate ANY gluten or dairy in ANY form. Kefir, raw, whole grain – all of it is out for me. He needs to find what works for him, but I think he should experiment with his diet before anything else.

    • As an acne sufferer from adolescence to adulthood I can relate. I did try all the conventional advice, and the only thing that worked temporarily was roaccutane, but it gave me dry, scaly skin, not nice, soft, velvety, clear skin. And it didn’t take long for the acne to return after stopping it.

      On my journey I’ve discovered that the state of my skin is really am indicator of the health of my gut. When my acne is flared up I tend to notice more headaches and joint pains and gut symptoms. Part of the problem with identifying dietary triggers is there is a time delay of 48-72 hours following exposure to the trigger and the initiation of acne, although it can see increased excess facial oil within about 12 hours.

      So conditions that seem to impact gut health also impact the acne. So food intolerances are very suspect, but if you are eating the offending food more than once every couple of weeks it can be hard to pick up. So you really need to completely exclude likely foods 100% for a good 30 days, and when you reintroduce them you need to monitor for a week while looking really closely for symptoms. Get rid of gluten, soy and dairy 100% for 30 days, then introduce them one at a time and see how he goes.

      Gut flora is really important, and he might have to work hard to rebuild his colonic flora using probiotics +/or raw fermented foods +/or prebiotics, or even go as far as a GAPS diet to try to rebuild from scratch.

      SIBO might be implicated, and is probably pretty common among people with acne. It certainly seems to be common with rosacea. You don’t necessarily have to have IBS symptoms. It’s not the easiest thing to identify, or treat apparently.

      Check symptoms of pyroluria. The severe deficiencies of zinc, vitamin b6, magnesium and biotin can really impact gut health and are often associated with acne. Seminal fluids are very high in zinc, so he might need more zinc before or after sex.

      Other nutrient deficiencies like iodine and selenium might occur. You could do some testing to see whether there are any micronutrient deficiencies or methylation disorders to address. For a lot of people a nutrient dense paleo diet that includes liver and organ meats on a regular rotation, bone broths, seaweed, fermented foods, oily fish and shellfish is enough. A lot of people require additional magnesium (magnesium supplementation got rid of BO for me, so now I don’t really need deodorant any more), vitamin D, and maybe vitamin C. Some do well with cod liver oil. Others do well with evening primrose oil (especially pyrolurics). Others, like me, need more targeted supplementation and support of detox pathways and glutathione.

      Relaxation and good quality sleep, dealing with stress and meditation are really important too. As well as exercise and getting outside into nature. Limiting exposure to toxins is important, and very hard to do. No matter what you look at in modern life there is usually something toxic attached to it, even our water may have fluoride and a lot of chloride as well as possibly other heavy metals, hormones, pesticides, etc. Skin care , dental care, shampoo, deodorant and other skin care products including sun screen may have toxins. Your car, mattress, sofa, etc. might be giving off gases. Food might have been contaminated by toxins from packaging. He might be inhaling all sorts of chemicals both indoors and outdoors.

      Honey very thinly applied can help heal up inflamed spots more quickly, but it’s nicer to not get the spot in the first place.

      So to summarise, maybe try thinking about what the acne is telling him. There’s systemic inflammation going on for some reason. You might need to be a bit of a detective to figure out where it is. There’s a really good chance that there are nutritional deficiencies that haven’t been identified yet, and also a good chance that his gut microbes are disturbed, but it’s going to be harder to get an idea about what else he needs to do if he’s still eating cereal grains.

      Acne is often seen as a cosmetic problem, but I think it’s a visible indicator of systemic inflammation and a forewarning that other signs of inflammation might appear at some point, anything from anxiety, to autoimmunity, to pains, to fatigue, although it could take years or decades for other complications to appear which gives him time to work on his health.

    • I’ve noticed that after sex in the shower my guy tends to develop pimples on his back. Took me months to figure out it was the combination of the mainsteam shampoo and sweat. So try to switch to a natural brand and well…keep it in the bedroom hahaha

  10. Does anyone know of any primary, accessible sources/citations/references comparing the nutrient value of cereals, vegetables, meats, fruits, pulses and starchy tubers? Chris’s book p 80 has a table of nutrient density scores – adapted from Lalonde – but the reference for Matt Lalonde’s work is a video. A citation (http://ars.usda.gov/Services/docs.htm?docid=22113) given in the accompanying comments for this video is not very helpful.

  11. Chris, I’m loving the Pills or Paleo series because it is so relevant to our health crisis. You are doing a great job of making it clear what Paleo lifestyle is really about – the simple, easy solution rather than the big loud guns. I just wanted to say please don’t leave out SSRIs, Adderall and other psychiatric meds. I sort of thought you were going to lump them into this article when you touched on depression and anxiety at the top, but now I’m holding my breath for them to get their own installment of Pills or Paleo!

  12. I’m 44 and I have been dealing with horrible acne for the last year or two… looking for any information that could help.

  13. I get eczema from eating tomatoes and Brassicas. I haven’t had a tomato in years and think that I probably don’t need to retest them since I do best without nightshades. But, I so miss my Brassicas! I haven’t had broccoli in a few years and retested recently. I flared up with painful joints from inflammation and broke out in two patches of eczema. Any thoughts on how to overcome something like this? I’d love to be able to add Brassicas back to my diet.

  14. Great post! And we can say eating more paleo like has helped our adult acne. For those that are interested you can check out our blog where Lori shared her journey http://purelytwins.com/category/acne/ Although I am dealing with eczema despite doing a gut protocol and paleo like diet. But I am getting better with a few adjustments one being VITAMIN D!! So to all my other eczema suffers please check that checked. I will be sharing my experience soon on the blog. I want others to know that have skin issues to not give up!! Keep trying new things. Paleo might not work for you but it is a great place to start then tweak as you go!! Wishing you all the best on your journey to clear skin!

    • Wow! Curious about your eczema. My daughter has it quite bad. I cannot and will not force her to go full Paleo. She’s 14, that’s just not going to happen… I’ve read elsewhere about a Vit D connection. What else have you done?

  15. I battled adult acne for my entire adult life – from about 18 to recently at 41. It wasn’t just my face either, I broke out all across my upper back, my upper chest and a bit on my upper arms, and various parts of my face at different times of my life. I tried absolutely everything, including Accutane several times, every topical option, every kind of birth control pill, and the only thing that worked to some degree that I’ve taken for about 8 years is spironolactone prescribed by my dermatologist. It’s not a well-known treatment but it worked for me in that it cleared up my back and chest and helped with my face but never completely stopped my breakouts there. I determined what foods aggravated it and avoided them, particularly dairy. But when in the mountains of France last summer I couldn’t resist the pure, fresh, organic homemade yogurt where I was staying and ate it every day for 2 weeks – and guess what? Not a single pimple. I made the connection and have kept up with it (and other probiotic foods) and my skin is changed. As long as I keep my gut balanced I don’t break out at all. I’m in the process of decreasing the dosage of my medication, which before would cause me to break out worse almost immediately but so far I’ve had no change. The connection to gut health is real. I feel better in other ways too and am so glad that “cheating” on my diet led me to this revelation.

  16. Chris, based on your experience, what is the food or lack of nutrients most frequently associated with rosacea? I have kust done a fkod sensitivity test..I hope I will find out soon. I have had rosacea for 10yrs.

    • Have you tried increasing your stomach acidity?

      I use betaine hydrochloride with pepsin supplements. I think it is a fairly simple factor in the gut flora balancing act. This was a very rare case where I noticed the effects of a supplement, almost immediately. It seemed like dysbiosis in my upper GI tract, mouth, and even my sinus cavity improved. There are many online guides to determine your need for this supplement. Other factors in some treatments involve B vitamins and probiotics. Dr. Jonathan V. Wright has written about this. He’s been using this sort of treatment for many years.

  17. I started strict Paleo 19 days ago and cannot quite believe the difference in my body. I am not overweight but did enjoy couple of glasses of wine every night, occasional take out, addicted to carbs, bread and pasta but generally reasonably healthy or so i thought. i had developed strange joint pains and weird sensations during the night – cut a long story short, all aches and pains and sensations have stopped, i have been on pariot for a hyatis hernia for 15 years, i haven’t needed one pariot in 19 days, i was also on dioxycline for rosacea, i haven’t touched it, i did have a flare up in last 2 weeks but i see it settling down now after nearly 3 weeks. i also have two large glasses of water, one morning and one evening with one tablespoon of organic apple cider vinegar. I am back with my personal trainer twice a week and i am feeling dangerously well. Best decision i have ever made in my life to go Paleo. thank you Chris for embracing Paleo and we can only hope that people listen and try it for themselves, they will never turn back to conventional food.

  18. Been soy/dairy free for a few years and Paleo since July (meat, fruit (no tropicals), veg, nut butters, nuts, sweet potatoes/squash, NO GRAINS NO BEANS).. taking L-glutamine, 50mg zinc, 1000VitD, bifidobacteria powder (amazing!)… still drink coffee (2 cups) ALL FOR FACIAL ACNE.
    White potatoes break me out, onions, flax, sugar.

    Was on antibiotics for 9 years(eek) and stopped 3 years ago.
    Im 25, female, low BMI.

    I’m considering getting a SIBO test since I still have acne around my mouth/half on lips. Tired switching to all natural toothpaste. Bifidobacteria makes these pustules VANISH once I get them every week of my period but its so expensive.

    Thoughts upon which SIBO test to take?
    1. https://www.gdx.net/product/organix-dysbiosis-test-urine
    2. http://sibocenter.com/ordering-a-sibo-test/

    • I should say I also have had bouts of stomach burning, almost like ulcers. Hurt when I sit down @night. One of them years ago was right after taking a antibiotic so my dr suggested maybe disbyosis. I know lactobicillus FEEDS candida so I take bifido. Would fermented foods feed or balance the gut? Im so confused by theorys on this but Im CONVINCED I need to repair my gut.

      • Wait, since when does lactobacillus feed candida? I thought it balanced it out.. I think you’re confused on that one, but if I’m wrong, I want to know.

        The issue of what kind of probiotic one should take is very confusing. Especially if SIBO has been found.

      • Its probiotic powder (just pure bifido bacteria not mixed with other probiotic strains). Bifido is the bacteria that makes up MOST of the gut so I bought a pure form…. I get it on nutrikey.org (a nutritionist company that has their own supplement brand). Im OBSESSED WITH IT. Just re-looked at the supplement facts and realize you need very little per serving… 1/2 tsp…for 30 billion !! Really good deal for the price.

  19. I have been eating paleo for quite some time and although my overall health is excellent, I still struggle with acne and dandruff at times. What are common contributors (vegetables or other things)? I noticed one poster mentioned nightshades. Is this a good place to start?

    • Sometimes people need to go a little bit deeper than regular Paleo. You may have additional food sensitivities that you need to rule out or specific nutrient deficiencies that are contributing to your skin issues. The Paleo Autoimmune Protocol may be a good place to start and then you can fine tune it from there. Defects in the MTHFR gene can contribute to decreased function of the body’s natural detoxification pathways and I’ve found that is often a contributing factor as well.

    • This is heresay but I was told at one point that dandruff can indicate a deficiency in EFAs. Anyone know? Would love to know this as a family member has it.

  20. I can attest to the huge improvement that the Paleo diet made with my acne. It completely cleared up within a few weeks. I was told for decades that it would clear up on it’s own. Very soon. Never did. Suffered for years. My skin has been outstanding for the last five years and I have a hard time believing that I was plagued with acne.

  21. I had moderate acne that improved significantly (almost disappeared) with:

    – Paleo eating, consistent activity, adequate sleep
    – Meditation habit
    – Prescript-Assist probiotic
    – Fermented cod liver oil
    – AOBiome skin mist

    Hard to say which factors had the biggest impact, but the combination has allowed me to give up any topical treatments (other than washing my face every 2-3 days)

    • How much cod liver oil did u take (green pastures?) Im considering taking the cod liver oil (not the butter blend since im sensitive to dairy) and what benefits did u notice from that? I take L glutamine for healing of gut

      • 1 teaspoon / day. I started it around the same time I started a few other things (probiotics, meditation), so can’t say what impact this specifically had (isn’t that annoying?).

        I stuck with it because I figure that I’m probably Vitamin D deficient, so it’s helping even if it doesn’t (noticeably) affect my skin.

  22. My son is 15 and developing acne. My wife and I are paleo and I’ve been trying to get him to do it with us but there is so much pressure from everyone around him to eat crap.

  23. Hi Chris,

    Thanks for this wonderfully informative article. I have a question on the direction of the relationships in the gut-brain-skin axis. In my late teens, I took a long course of antibiotics (which were wholly unnecessary, thanks conventional medicine!). Soon after, I simultaneously (not literally, I suppose, but a decade later a can’t fully resolve the timeline) developed SIBO, anxiety, and acne. Years later I came to suspect that the root cause of these conditions was antibiotic mediated dysbiosis, which led to a dysregulation of gut produced neurotransmitters, leading to the anxiety, and systemic inflammation, leading the to the skin problems. If this hypothesis is true, the course of treatment would be to correct the dysbiosis and eridicate the overgrowth. However, if the cause was in fact the anxiety leading to changes in the gut microflora, as your article suggests, then both the root cause and the treatment would be different, with the course of antibiotics possibly being incidental. Of course it’s possible for the mechanisms to operate bidirectionally, such that I’ll never know the root cause. But I wonder if you know which is more likely?

    Thanks for all that you do.

  24. I went off sugar, caffeine, grains, corn, beans, peanuts, seed oils n of course didnt eat soy or trans fats already. Was quite low carb, quite high fat, ate alot of dark greens. Even gave up dairy. This was for 4 mos. My acne made not a huge improvement. I plateaued in my wgt loss shortly after starting no beans and dairy. I have PCOS so nothing ever helps. At 50 yrs old I have acne, oily hair, hirutism, a thyroid system problem, low functioning adrenals.
    I hope ppl get some relief with paleo but for me it did not much.

    • Thyroid problems? hmmmm… could you be either low on iodine or, if you supplement, could you have taken too much iodine, particularly at the beginning?
      There are different types of acne but one type is very much associated with skin blemishes.

      Just a thought. 🙂

    • In the case of PCOS, high androgen levels are probably causing the acne. I also have PCOS and taking myo-inositol helped clear up my acne a bit, even though I don’t have the insulin resistant type of PCOS. I’d recommend finding a naturopath who is aware of the different PCOS ‘types’. They will look for the root cause, since a PCOS diagnosis isn’t a real disease, and has many different causes in different people, so treatments will also be different. For example, a lower carb diet would work for someone whose PCOS is caused by insulin resistance, but not if it’s being caused by a thyroid problem. A thyroid problem may need iodine and selenium supplementation, or perhaps even thyroid hormone.

      Tons of people have been able to reverse their PCOS symptoms, so it’s really not something you have to suffer through due to lack of treatment options. But it’s necessary to get some bloodwork done to actually find out what is causing the symptoms, which is why I recommend an experienced naturopath, because they will be familiar with what’s needed to figure out what’s going on.

      Here’s a site I found helpful: http://www.larabriden.com/treatment-for-4-types-of-pcos-treat-the-cause/

      • oh indeed ive tried many things. took T3 for 2 different time periods, a yr and then 2 yrs. never did a thing for me. freezing, unable to lose wgt, scalp hair loss….which also part of the pcos, yes. i take kelp daily now for iodine and trace minerals, also eat dulse n kombu. eat 3 brazil nuts a day. tried taking selenium but did nothing so just sticking to the nuts now. my sugar levels are 100-120 if i dont eat strictly. tried meformin both times with the T3 esp as thats supposed to help the pcos, period, besides help with insulin levels to maybe allow me to lose wgt. it never made much difference so dropped it too. i have to admit it did seem, after 2 yrs consistent use, to lessen the length n maybe amount of arm hair. but having not used it now for over a yr, theres rly not much difference again.
        my acne is quite androgen based as its rly related to excess hair on my face. ingrown hairs are common. but u would think cleanng up my diet, getting the insulin down to not provoke my ovaries, yada yada yada would have helped. the past 2 wks ive developed cystic acne, painful. never had this before.

        • If you comment on the site I’ve linked, the naturopath there seems to reply to many questions, as long as you’re specific and not too lengthy. It sounds like there are probably a bunch of interacting factors causing your symptoms, which is why I think getting some extra help figuring it out would be best. Some treatment options seem to take closer to a year to see any benefits. Maybe look into cortisol as well . . there could be underlying inflammation (perhaps from the gut?) making it difficult to resolve your symptoms. Depending on hormone levels (like LH, FSH), there are also various herbs that are worth a shot, I think. If the metformin seemed to work, myo-inositol and berberine are things you could look into as well.

          My cystic acne seemed to be caused by high histamine foods, and I could make it go away if I took some lactoferrin when I ate, which made me suspect gut dysbiosis. But it also went away when I took myo-inositol. If you exhaust the ‘natural’ methods, there are also anti-androgens to try . . I find the symptoms annoying enough that I’m keeping those as later options. Have you tried working on your gut health with prebiotics and antimicrobials? There was a recent paper on how gut dysbiosis could be causing PCOS symptoms.

      • ^^^^^ Yes! What Cat said! I was going to suggest Lara Briden too 🙂 her book is easy to read and practical – helps to identify the tests required and helps you to discuss with your Dr.

  25. My minor skin issues went away on a Cordain style Paleo diet.

    I’ve tried other variants of Paleo, over the last year, and the skin issue that seems to intermittently flare might be seborrheic dermatitis. That’s my amateur diagnosis. There is something on the back of my head, just above the neck, and on either side of my nose.


    I had a relatively bad flare, last week. I suspect that I ate some damaged vegetable oil. I went to a restaurant where they serve chips, straight from the fryer.

    All of this is just guessing, really.

    • I was diagnosed with seborrheic dermatitis. Strict paleo kept it at bay, but it seemed that any significant amount of dairy would cause a flare-up. Since I began supplementing raw potato starch over a year ago, it hasn’t been an issue.

      Like you say, I’m also doing some guessing, but I feel that developing a healthier microbiome has helped. I haven’t abandoned paleo, but I no longer fear yogurt.

      • Almond yogurt is on my short “to do” list, because dairy remains a small question mark. I take lots of probiotics and prebiotics. I’m not sure about the raw potato starch. I’m inclined to heed Dr. Grace Liu’s warnings, and try to favor RS3 over RS2, and get some inulin or prebiotin. Funny, another theory of mine implicates psyllium. I do well with maybe 150-250g of carbs. I think I was too low-carb for quite a while, and couldn’t heal my gut, as a result. I’m trying to prepare the carbs to get some RS3.

        I was also thinking s. boulardii might be indicated in the probiotic mix, to crowd out other yeasts.

        The good news is that I seem to be able to get symptoms down to a reasonable baseline, to where I can actually do some valid reintroduction testing.

    • I’ve been Paleo for 3 years. It helped resolve so many of my problems. The one it hasn’t resolved is my itchy ears and the itch/dandruff on the lower back of my head. I’ve tried so many different things, doctors, naturalpaths. Nothing non-toxic helps so far. My latest thought is its caused by histamine intolerance?

      • The Omega-6 needs to be an unadulterated, 18 carbon fatty acid, specifically Linoleic Acid. Most Omega-6 in our diet is processed. It can only come from raw foods or supplements that cold press the raw, organic product under a nitrogen blanket to prevent oxidation.

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