Acne—it’s not just for kids anymore. Actually, it never was. Whether or not you were plagued by pimples in high school, you can have acne as an adult…after age 50, 15% of women and 7% of men have acne. Cystic acne is the most severe form—not just pimples but embedded larger cysts that often are red and inflamed and cause scars.

Dermatologists have many interventions for cystic acne. Ointments that contain benzoyl peroxide, for example, can dry out oils that clog pores and inhibit acne-causing bacteria. Topical antibiotics and retinoids (vitamin A derivatives) can also work. If they don’t, systemic medications may be prescribed, ranging from low-dose antibiotics to hormones to oral retinoids. These treatments often are effective, but like all medications, they have risks and side effects, some serious.

If you’re concerned about going too far down that path, naturopathic physician Andrew Rubman, ND, a Daily Health News consulting medical editor, has a suggestion—to improve your acne, improve your digestion. The trigger for acne is often the gastrointestinal system—specifically, the liver. His advice: Improve digestion and liver function, and cystic acne often resolves on its own.


It might sound far-fetched to think that something going on in your belly can cause pimples on your cheeks. But there’s a strong connection. How can the liver affect the skin? Both organs—yes, your skin is an organ—are involved in ridding your body of toxins. “Sebaceous glands act as backup organs of elimination for the liver for certain fat-soluble compounds,” explains Dr. Rubman. When digestion and liver function aren’t good, oily toxins flow to the skin in excess, clogging pores and trapping dead skin cells that skin bacteria feed on. The result can be cystic acne.

To improve your acne from the inside out, says Dr. Rubman, the first thing you need to do is get your stomach digesting food properly. To do that, it needs to produce enough acid. When acid is too low, food may remain partially digested and fat-soluble compounds will not exit the liver sufficiently…so they get shuttled to the skin. Poor diet, stress and age all can prevent the stomach from producing enough acid.

So do drugs called proton pump inhibitors, such as Prilosec and Nexium, which have other health risks, too. For his acne patients with chronic heartburn, Dr. Rubman often prescribes DuoZyme, a supplement that provides digestive enzymes such as pepsin along with betaine HCL…which mimics stomach acid. (See a health-care professional before taking this supplement, however, especially if you have an ulcer, which it can make worse.) And for everyone, he recommends chewing food thoroughly, limiting fluid with meals to about one-half cup and entirely avoiding caffeine-containing beverages with meals (including that cup of coffee after a meal—wait at least an hour). These actions can help stomach acid remain at the proper level.


The next step: Support the liver. To do this, eat plenty of sulfur- and nitrogen-containing foods such as dark green, leafy vegetables and eggs. That promotes the production of bile, which is key to helping move fat-soluble compounds out of the liver efficiently. Dietary cholesterol (also in eggs) and B vitamins also promote bile production, Dr. Rubman says. He recommends talking to your health-care provider about the proper dose of a B vitamin complex for you.


Changing your diet isn’t always easy, and many people are impatient for results, so Dr. Rubman often recommends a particular fiber supplement, glucomannan, made from the root of the konjac plant, as well. It’s a capsule that you take a half an hour before each meal, with plenty of water, and it can improve cystic acne within seven to 10 days, he says. Glucomannan is often used as an appetite suppressant, but what makes it helpful for acne is that it gets down into the small intestines where it binds to bile acids, he explains. “That helps move toxins out of the body more efficiently.”


According to Dr. Rubman, improving diet and taking glucomannan capsules can improve at least 50% of cystic acne cases, with patients often seeing some progress within a few days and significant results in less than two weeks.

In the meantime, you can continue to use topical treatments recommended by your dermatologist or other health-care provider. One that Dr. Rubman often recommends—a face mask made from the Aveeno colloidal oatmeal bar soap. First, work up a stiff lather, then apply to your face, let it dry, and wash it off—morning and night. Also, squalene, a particularly effective moisturizer found in many cosmetics, can be applied to the skin without fear of clogging pores, he says. It helps to reduce inflammation while also moisturizing. He likes the Mayumi brand.

The best part of treating acne primarily from the inside out, through digestion and nutrition, says Dr. Rubman, is that it benefits not just the skin, but the functioning of the entire body. It’s helpful for less severe forms of acne, too.

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