What Triggers Acne?

Dig Deep + Treat the Root Causes to Create Clear Healthy Skin

Dr. Heidi Lescanec, ND

Acne is one of the most common chronic skin disorders, with multiple underlying causes. As we present ourselves to the world in our skin, a visible skin disorder like acne, can impact us both physically and emotionally. People often see a doctor to address acne for aesthetic concerns. The first “go-to” is usually a topical, surface oriented treatment which can range from topical antibiotics or steroid creams to surgical laser techniques. Despite the abundance of treatments on the market, the majority of acne sufferers find they only work for a short period of time at best. Unfortunately, acne can be one of the hardest conditions to treat, often proving resistant to multiple topical medications, with relapse common.

As frustrating as this skin condition is, chronic acne provides us with an opportunity to dig deeper into the underlying root causes within the body and work on these to effectively treat what is showing up on the surface. In Naturopathic Medicine, we view the skin as a window; the external terrain of the skin provides clues as to what is going on in a person’s internal environment.

What are the common triggers of the deeper imbalances that cause acne?

Dietary Triggers

Many recent studies have shown a strong link between the consumption of both dairy and high glycemic index foods and acne development. These types of foods negatively impact two things internally: sebum production (natural skin oils) and hormone balance. First let’s review sebum. Individuals prone to acne breakouts have been shown to secrete a greater quantity, as well as a different quality, of sebum. Sebum is a fat-rich fluid which our skin’s sebaceous glands use as lubrication, waterproofing and as the vehicle to transport molecules like toxins to the surface of our skin. Interestingly, the sebum that allows for acne development, is linked to imbalances in two hormones: increases in IGF-1 (Insulin Growth Factor-1) and decreases in SHBG (Sex Hormone Binding Globulin). Now, how is cow dairy involved here? Research has shown that IGF-1 is not only found in dairy, but in addition, the human liver is actually stimulated to produce this hormone when dairy products are eaten. How does eating high glycemic food impact hormones? Consumption of these foods (like sweetened simple carbohydrates) reduces insulin sensitivity which negatively affects blood sugar balance and weight management, and it also increases androgens and lowers SHBG which will then allow acne to develop.

Hormone Imbalance:

An increase in androgens (like testosterone) can contribute to acne flares. Elevated androgens do this is by over-stimulating the sebaceous oil glands and resulting in excess sebum production. This hormone imbalance is influenced by diet (as you read above), the state of the liver (our main detox organ often being congested/overloaded) and an unhealthy digestive system. A condition called PCOS (polycystic ovarian syndrome) is at the intersection of many of these issues as well.

Elevated Stress Response:

High stress affects the immune system, upsets blood sugar levels, and over time can negatively impact the hypothalamus-pituitary-adrenal axis and consequently disrupt the delicate sex hormone balance, negatively influencing many of the for- mentioned issues.

Dysbiosis: an imbalance of microorganisms in the gut (either presence of harmful ones like candida, parasites or SIBO – Small Intestinal Bacterial Overgrowth) or a deficiency of beneficial bacteria, like probiotics, can also be a trigger for acne. Why? An imbalance in good and bad microbes can upset the immune system and allow for an increased number of the acne-causing bacterium; Propionbacterium Acnes, in addition to increasing liver burden and inflammation within the body; all of which can act as mechanisms for acne flares.

As you can see, there are several major underlying causes of acne that are often interconnected. At Sage Clinic we offer many effective tools in treating the root causes of acne in addition to topical compounded medicines, which can palliate and help heal the skin. In conjunction with nutritional evaluation and counseling, there are a number of functional lab tests you may consider in digging deeper to find the root causes: blood testing (to determine food allergies), saliva testing (to determine state of sex hormone and adrenal hormones), stool and breath testing (to determine dysbiosis of the gut and digestive health).

The good news is Naturopathic Medicine offers many effective options for treating these imbalances and optimizing inner and outer health for a long lasting acne-free, radiant complexion.


Adebamowo CA, Spiegelman D, Berkey CS, et al. Milk consumption and acne in teenaged boys. Journal of the American Academy of Dermatology. 2008;58(5): 787-793.

Aizawa H, Niimura M. Elevated serum insulin-like growth factor-1(IGF-1) levels in women with 
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Melnik BC, Schmitz G. Role of insulin, insulin-like growth factor-1, hyperglycemic food and milk consumption in the pathogenesis of acne vulgaris. Experimental Dermatology. 2009;18(10): 833-841

Kaymak Y, Adisen E, Ilter N,et al. Dietary glycemic index and glucose, insulin, insulin-like growth factor-I insulin-like growth factor binding protein 3, and leptin levels in patients with acne. Journal of the American Academy of Dermatolology. 2007;57(5): 819-823.