Stress is a major driver of acne. It’s why when you have a big event coming up (party, interview, dare I say a hot date!) you have a break out. This is largely because when our body perceives danger it enters into what is commonly known as the ‘fight or flight’ mode and our sympathetic nervous system is activated. In modern day life, we are no longer running from a sabre-toothed tiger but a lot of us are suffering with low-grade chronic stress which explains why acne is on the rise especially in age-groups where we don’t always expect people to still be getting acne. When we’re ‘stressed out’ our immune system is dampened and less able to fight infection allowing the acne loving bacteria (Cutibacterium acnes formerly known as Propionibacterium acnes) on our skin to proliferate.
In response to stress, our adrenal glands produce three hormones, cortisol, adrenaline and noradrenaline. Cortisol regulates immunity and enhances glucose production so in the past when we were running away from a sabre toothed tiger, the upregulation of the cortisol hormone would tell the body to make a load of glucose which would be converted into energy allowing us to run away faster.
The problem today, however, is that if we are suffering from low grade chronic stress.
Our cortisol hormone is still telling the body to pour glucose out into the blood and the pancreas is constantly having to produce insulin to shunt the glucose into the cell and there comes a point where the cell becomes more and more insulin resistant which has not only been shown to be a driver of acne but also a major factor in type 2 Diabetes.
Let’s look at some of the more common mechanisms linking acne and stress and what actually happens in our bodies when we suffer from chronic stress:
Psychological stress can set off a cascade of inflammatory chemicals such as interleukin-1 which is an inflammatory cytokine.
Relevance to Acne:
When IL-1 levels are high, they can cause cells within the pore to become sticky and clog the pore resulting in an acne lesion. Inflammatory foods can also increase the production of IL-1.
Shifts in the microbiome and increased gut permeability
Relevance to Acne:
Stress can impact the gut bacteria to produce different neurotransmitters in the brain which then cause changes to the composition of the microbiome (good/bad gut bacteria) that can increase the likelihood and severity of intestinal permeability commonly referred to as ‘leaky gut’. This means that toxins, bugs and partially digested food that should only be in the gut can get into the blood stream (where they don’t belong). They are then deposited in the skin creating the perfect environment for systemic inflammation and local inflammation in the skin. Acne is a chronic inflammatory condition.
Stress depletes certain vitamins and minerals (B vitamins, magnesium, vitamin C)
Relevance to Acne:
These vitamins & minerals are key to good glycaemic control. Poor glycaemic control leads to insulin resistance which can trigger a hormone called IGF-1 which has been shown to increase sebum production in sufferers of acne.
Shifts in sex hormone levels
Relevance to Acne:
Some scientists believe that shifts in sex hormones (during puberty, stress, the menstrual cycle etc) are opportunities for bacteria to travel more easily. During these times, white blood cells called lymphocytes are at their weakest and the Streptococcus bacteria (associated with acne) can escape from the liver into the lymphatic system and, if conditions are favourable, into the subcutaneous tissue just beneath the skin, just waiting for that moment to erupt.
Altered glucose metabolism
Relevance to Acne:
Acne is often referred to as ‘diabetes of the skin’. In order to balance your hormones, you need to balance your blood sugar and this can be achieved largely through eating a low-glycaemic-load diet which is short for cutting out the crap (sugars, refined sugars, processed foods, junk foods etc) and replacing it with whole foods.
Decreased sleep quality
Relevance to Acne:
Several studies have shown that reduced quantity and quality of sleep leads to impaired glucose tolerance (see my blog article for more information on the importance of sleep: https://www.empoweredtonourish.co.uk/post/is-lack-of-sleep-sabotaging-your-health)
Lack of sleep also leads to poor food choices for breakfast with an over reliance on sugary foods which then sets the day up for the consumption of more and more sugary foods.
You’re probably wondering what all this has to do with food and nutrition?
At first glance, it may seem preposterous to say that diet influences how we feel; but think about it. In the cold, hard light of science, feelings are chemistry! Of course, in the first instance, it is our environment, our experiences, and to an extent, our personality that makes us feel the way we feel.
But our feelings of fear, anger, overwhelm or love and confidence trigger the release of hormones in our body, which is where chemistry kicks in. We need the happy hormone serotonin and the pleasure hormone dopamine to feel good, the sleep hormone melatonin to sleep, the stress hormones adrenaline and cortisol for our get-up-and-go and to fight or flee when we’re under threat. Hormones work in unison with each other. Some hormones suppress others; some trigger the release of others. But for these feedback mechanisms to work, for our body to even be able to manufacture the chemicals that we need, we must supply the raw materials they are made of.
Those raw materials are fatty acids, proteins, vitamins, minerals, and phytonutrients – in short ‘nutrients’. What’s more, even our friendly gut bacteria contribute to how we feel by extracting more nutrients from our food for us, manufacturing some, such as short-chain fatty acids, from scratch and even providing some ready-made serotonin! So, if you think of feelings that way, what we eat is bound to have a massive impact on how we feel and how we cope with the challenges life throws at us.
Don't get me wrong; I’m not saying that diet will cure an anxiety disorder. However, if we try and fuel our body with poor quality food that does not provide the building blocks of the hormones and catalysts our brain chemistry requires, we’ll have a much harder time overcoming mental health issues.
4 key nutrients to combat stress & anxiety
1. Magnesium
Often referred to as ‘nature’s tranquiliser’ – which hints at just how crucial this mineral is for supporting balanced mood, relaxation and deep sleep. There’s some in most foods, particularly in green leafy vegetables – think broccoli, spinach, kale, and watercress – but also in grains, such as brown rice, buckwheat and quinoa, nuts and seeds, or fish and seafood. Despite this, deficiency is common, which may have something to do with our penchant for convenience and junk foods that are just not as nutritious as real food.
2. L-theanine
A 2019 study found that the amino acid L-theanine might help manage anxiety and support a balanced stress response. L-theanine is found in green tea. It increases the activity of the neurotransmitter GABA, which has calming, anti-anxiety effects. The amino acid also raises dopamine and the creation of alpha waves in the brain. This is because l-theanine can cross the blood-brain barrier, a membrane that protects our brain from unwanted and harmful substances. The high intake of green tea by Buddhist monks may contribute to their famously calm demeanour and intense focus during meditation. If you want to give green tea a try, be sure to choose an organic one to reduce your exposure to pesticides and other toxins, which have been found to disrupt the brain’s stress circuitry.
3. Omega-3 fats
Omega-3 fats are critical for brain health and have been shown to reduce anxiety symptoms. As vegan diets are becoming more popular, it is important to note that omega-3 fats from plant sources, such as flaxseed oil or walnut oil, do not cover our daily requirements, let alone achieve therapeutic levels. The omega-3s these foods contain are inferior to the ones we need: EPA and DHA. Although the body can make those long-chain fatty acids from plant-source omega-3 (alpha-linoleic acid or ALA), the conversion is sluggish and easily disrupted. Only about 5 per cent get converted. If you are vegan, do not like fish, or are allergic to it, your diet alone will not cover your needs. I recommend finding a good-quality supplement with omega-3 from marine sources (i. e., algae), which is the only vegan source of DHA.
4. Pro-biotic foods
When talking about anxiety and nutrition, we must not neglect the role of the microbiota, the friendly bacteria in our gut. The majority of available research studies in 2019 showed that it is beneficial to give our gut bacteria some TLC. Interestingly, “non-probiotic interventions were more effective than the probiotic” ones.
That suggests that just popping a probiotic capsule may not be enough – and that’s no surprise, really. Don't get me wrong; probiotics are beneficial; there is no doubt about that. However, their contents – live bacteria, e. g. Lactobacillus and Bifidobacterium species – are not going to settle in the gut. They are only travelling through, and while doing so, they help create a bacteria-friendly climate and temporarily crowd out undesirable microbes. But really, they are only lending a helping hand to our own, indigenous bacteria. Those are the ones that are at home there, and those are the ones that can protect our gut, feed our brain, improve our mood, and keep us healthy.
You can look after your friendly bacteria by giving them real food, especially fibre-rich plant foods, including vegetables, fruit, nuts, seeds, pulses, whole grains, herbs, and spices. Variety is key here. While probiotics – especially in the form of fermented foods like sauerkraut, kimchi, live yoghurt, kefir and kombucha – are great, prebiotics – fibre – are even better. We still need to learn much more about all the different microbes living in our guts, but what we do know is that the more different species we have, the healthier we are.
How do we cultivate a variety of species? By keeping our diets interesting. I am constantly telling my clients that ‘variety is the spice of life’! We need variety, abundance and diversity in our diets because different microbes have different preferences. By varying what we eat, we are creating a desirable place for them to live.
Of course, although hugely important, diet is not everything. Lifestyle factors, too, play a crucial role in mental health. It will come as no surprise that it is worth reducing stress as much possible if you suffer from anxiety. Interestingly, stress also damages the microbiota and interferes with the conversion of omega-3 fatty acids – among many other things, so just getting on top of stress will do you a whole lot of good.
I know that that is easier said than done, but there is a shedload of information on stress management on the internet, ranging from relaxation techniques, such as meditation or breathing exercises, to self-care and me-time tips.
Lopes Sakamoto F, Metzker Pereira Ribeiro R, Amador Bueno A, Oliveira Santos H (2019): Psychotropic effects of L-theanine and its clinical properties: From the management of anxiety and stress to a potential use in schizophrenia. Pharmacol Res. 2019 Sep;147:104395.
Caudle MW (2016): This can't be stressed enough: The contribution of select environmental toxicants to disruption of the stress circuitry and response. Physiol Behav. 2016 Nov 1;166:65-75.
Yang B, Wei J, Ju P, Chen J (2019): Effects of regulating intestinal microbiota on anxiety symptoms: A systematic review. Gen Psychiatr. 2019 May 17;32(2):e100056.
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