Supplements supported with research and clinical experience

 

A quick Internet search will reveal a plethora of supplements claiming to be the magic bullet cure for your acne. In this article, I discuss four nutrients (and zero magic bullets) I find get consistent reductions in acne lesions for my clients.

 

No surprise that these are also the ones with the most research.

 

I also discuss two, which although less researched might also be worth considering in the right situation.

 

As a general precaution, high dose nutrient supplementation is not recommended long term. Aside from toxicity issues, nutrient balance in your body is a delicate and intricate dance. Pushing high amounts of one nutrient can knock another out of whack and create additional problems.

 

My supplement mantra is:

  1. Use only when indicated (a naturopath/nutritionist can help you identify this),
  2. Use the lowest dose needed for the job,
  3. Make adjustments to your diet/lifestyle to support long term optimal nutrition
  4. Stop supplementation as soon as you don’t need them any more. Unlike puppies, nutrient supplementation (with the rare exception) should not be for life!

Some of the nutrients discussed below are also used topically. This article only discusses their oral use.

 

My top 4 nutrients for acne

(backed by plenty of research)

 

Zinc

Zinc facilitates over 300 processes in the body, so it’s an essential mineral to have around 1. People with acne have been found to have lower serum levels of zinc. Studies have found it to reduce acne lesions as effectively or better than oral antibiotics, such as tetracycline 2.

 

If I had to choose one supplement for acne, it would be zinc.

 

How does zinc improve acne?

  • Supports collagen which is vital for overall skin health
  • Improves wound healing so any acne lesions will heal faster and with less scarring
  • Modulates and balances hormones. Having plenty of zinc reduces the amount of testosterone converting to more acne promoting dihydrotestosterone (DHT). It also supports progesterone production via enhancing ovulation. Both these actions are beneficial for women with PCOS 3.
  • Zinc plays a crucial role in reducing inflammation. It has been shown to reduce inflammatory mediators such as Interleukin -6 and tumour necrosis factor alpha 2.
  • Reduces bacteria Propionibacterium acnes implicated in lesion formation

 

Studies seem to suggest it will have the most benefit for moderate to severe acne with pustules. Zinc improves both inflammatory and hormonal acne 4.

 

People at risk of zinc deficiency include:

  • Teenage boys. Puberty triggers the production of semen which contains a large amount of zinc.
  • Women on the oral contraceptive pill. The contraceptive pill often causes an increase in the bodies copper stores. Too much copper inhibits the action of zinc.
  • People who are moderate to heavy drinkers. Zinc is required to detoxify alcohol.
  • People who consume large amounts of sugar or who are under stress as the body will excrete more zinc.
  • People with digestive issues preventing the absorption of zinc.
  • People who consume plant-based diets exclusively. Although plants contain zinc, it often gets bound to phytates making it unavailable. This effect is reduced with appropriate food preparation methods.

 

Side effects

Zinc is generally considered safe. Supplements (especially in larger doses) can cause nausea. This can be reduced by taking the supplement with a meal.

 

Vitamin A

 

How does Vitamin A help skin?

Vitamin A (retinoids) is responsible for maintaining the health of skin cells and ensuring the right ones are made at the right time, in a controlled manner. It teams up nicely with Vitamin E for healthy skin 5.

 

Vitamin A suppresses comedogenesis which is when pores get blocked created whiteheads or blackheads. Blocked pores present a risk for cystic inflammatory lesions which may scar 4.

 

Vitamin A also has anti-inflammatory effects.

 

Those at risk of deficiency of vitamin A include:

  • Smokers
  • Moderate to heavy alcohol drinkers
  • Diabetics
  • Those with digestive issues impacting on fat absorption (gallbladder, bile production on pancreas issues). Vitamin A is a fat-soluble vitamin.
  • Exposure to long term stress (physical, environmental, psychological)
  • Protein-energy malnutrition

 

A note on safety

More is not better when it comes to Vitamin A. Preformed Vitamin A (retinyl esters) can be toxic when consumed at high levels over extended time in amounts greater than 3,000IU per day for a six-year-old child or 15,000 IU per day for an adult. Natural cod liver oil contains between 400-900IU per 5mL serve to make it a safe source of Vitamin A and one I often recommend.

 

Vitamin A supplementation should be avoided by those using isotretinoin (Roaccutane) and only used under supervision in pregnancy.

 

Vitamin E

Another fat-soluble vitamin often found to be low in those with acne, and lower levels correlate with higher severity4. Vitamin E is an important antioxidant and is involved in multiple immune and metabolic processes 5.

 

The exact mechanism of action is unclear. Its benefit in acne is thought to be related to it’s ability to lipid peroxide radicals, an initiating step in acne.

Those at risk of deficiency of vitamin E include:

  • Moderate to heavy alcohol drinkers
  • Smokers
  • Those with digestive issues impacting on fat absorption (gallbladder, bile production on pancreas issues).
  • People with coeliac or Crohn’s disease
  • Exposure to long term stress (physical, environmental, psychological)
  • Long term high intakes of polyunsaturated fatty acids including fish oils
  • High-fat diets
  • People undergoing radiation or radium therapy
  • Medications including thyroxine, aspirin, oral contraceptives, epileptic drugs
  • People also deficient in selenium as this mineral is required for transport and storage of vitamin E

 

Isotretinoin treatment has been found to deplete Vitamin E.

  

Fish oil

Fish oils are well studied for both inflammatory and hormonal acne. Research suggests they reduce lesions by between 40-52% after 10-12 weeks of use6,7. The most benefit seems to be with moderate to severe acne.

 

How fish oil benefits acne

The long chain omega three fatty acids in fish oil (EPA and DHA) reduce the inflammation which triggers acne. In women with PCOS increasing omega three seems to reduce the androgen output from the ovaries8.

 

Who may be deficient

  • People who don’t consume oily fish regularly
  • People who consume a high saturated or trans fat diet
  • Moderate to heavy alcohol drinkers
  • Those with digestive issues impacting on fat absorption (gallbladder, bile production on pancreas issues).
  • People with coeliac or Crohn’s disease

 

Two supplements for acne with less research

(but may still be beneficial for some)

 

Probiotics

The link between gut health and skin health is now widely accepted; however, research into probiotics and acne is limited with small study sizes. In clinical practice, I have had mixed results with probiotics. As these are generally a more expensive item than the supplements above I use them as a plan B unless there are other indications for their use in the case history.

 

A 2013 study found a probiotic contains Lactobacillus acidophilus, L. brueckii and Bifidobacterium achieved a 67% decrease inflammatory lesions after 12 weeks9.

 

Another pilot study of 20 participants with L. rhamnosus GG saw improvements in adult women with acne after 12 weeks. It was thought to enhance insulin sensitivity and reduce systemic inflammation10.

 

B5

Pantothenic acid (Vitamin B5) is a water-soluble member of the B vitamin family. Small studies have found lesion reduction of up to 65% and reduced pore size11.

 

How does it work in acne?

B5 may work on fatty acid pathways and may be useful for hormonally driven acne.

 

In my clinical experience, I have found it useful for reducing acne lesions where the skin is very oily, but it tends to give symptomatic improvement only rather than addressing the underlying cause.

 

Figuring out what nutrients to take for your acne

For long-lasting improvements in acne underlying causes must be addressed through diet and lifestyle modification. Think of nutritional supplements only as a bridge to help you get there – not a solution in themselves.

 

Taking supplements can be costly, so it’s worthwhile working with an experienced health professional to get a tailored prescription.

 

If you liked this you might also enjoy my other articles on acne:

 Acne: what is the underlying cause?

What diet is best for acne?

A guide to using herbs for acne

References:

  1. Morales-Suárez-Varela M, Llopis-González A, González-Albert V, et al. Correlation of Zinc with Oxidative Stress Biomarkers. Int J Environ Res Public Health. 2015;12(January):3060-3076. doi:10.3390/ijerph120303060
  2. Cervantes J, Eber AE, Perper M, Nascimento VM, Nouri K, Keri JE. The role of zinc in the treatment of acne : A review of the literature. Dermatol Ther. 2018;(August 2017):1-18. doi:10.1111/dth.12576
  3. Kucharska A, Szmurło A, Sińska B. Significance of diet in treated and untreated acne vulgaris. Adv Dermatology Allergol. 2016;2(April):81-86. doi:10.5114/ada.2016.59146
  4. Ozuguz P, Kacar SD, Ekiz O, Takci Z, Balta I. Evaluation of serum vitamins A and E and zinc levels according to the severity of acne vulgaris. Cutan Ocul Toxicol. 2014;9527(2):99-102. doi:10.3109/15569527.2013.808656
  5. Braun L, Cohen M. Herbs & Natural Supplements: An Evidence Based Guide. 3rd ed. Chatswood, NSW: Elsevier; 2010.
  6. Khayef G, Young J, Burns-whitmore B, Spalding T. Effects of fish oil supplementation on inflammatory acne. Lipids Health Dis. 2012;11(165):1-5.
  7. Jung JY, Kwon HH, Hong JS, et al. Effect of Dietary Supplementation with Omega-3 Fatty Acid and Gamma-linolenic Acid on Acne Vulgaris : A Randomised , Double- blind , Controlled Trial. 2014:521-525. doi:10.2340/00015555-1802
  8. Phelan N, Connor AO, Tun TK, et al. Hormonal and metabolic effects of polyunsaturated fatty acids in young women with polycystic ovary syndrome : results from a cross-sectional analysis and a randomized , placebo-controlled , crossover trial 1 – 4. Am J Clin Nutr. 2011;93(1):652-662. doi:10.3945/ajcn.110.005538.1
  9. Jung GW, Tse JE, Guiha I, Rao J. Prospective , Randomized , Open-Label Trial Comparing the Safety , Efficacy , and Tolerability of an Acne Treatment Regimen with and without a Probiotic Supplement and Minocycline in Subjects with Mild to Moderate Acne. Dermatology Cutan Sci. 2013;17(2):114-122.
  10. Fabbroncini G, Bertona M, Picazo O, Pareja-Galeano H, Emanuele E. Supplementation with Lactobacillus rhannosus GG normalises skin expression of gene implication in insulin signalling and improves adult acne. Benef Microbes. 2016:1-17.
  11. Capodice JL. Feasibility , Tolerability , Safety and Efficacy of a Pantothenic Acid Based Dietary Supplement in Subjects with Mild to Moderate Facial Acne Blemishes. J Cosmet Dermatological Sci Appl. 2012;2(September):132-135.

 

Need help with your skin?

Norelle Hentschel is an experienced naturopath with a clinic in Crows Nest, Sydney who enjoys supporting her clients to reach their health goals.

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