Do Refined Carbs Cause Acne?

Have you ever noticed pimples after eating certain food? We all know that all foods we put in our mouths go through the gut. If it doesn’t go through the gut, you are not a well functioning creature from the planet Earth. It is obvious to think what goes through affects what’s around. So the food affects the gut health, but what’s the connection between gut and acne?

Does gut health affect skin health?   

“All disease begins in the gut” – Hippocrates.   

Hippocrates answers it in the 5th century.

Many scientist/researchers had this question. They found out the gut-skin connection. A study with 114 patients showed that 58% percent of the patients had impaired gut microbiome.(1The gut microbiome affects systemic lipids and tissue fatty acid profiles; therefore, it may influence overall sebum production and specific free fatty acids within sebum.(2)

In Epidemiological study in 2008, patients with rosacea acne had a significantly higher SIBO(small intestinal bacteria overgrowth) prevalence compared to the healthy group and treating SIBO resulted in remarkable improvement.(3) SIBO is just what it sounds like: Too much bacteria in the small intestine. When you have SIBO, it releases something called Zonulin. The zonulin opens up the tight junctions of the gut barrier. Usually, the barrier separates the immune cells and bacteria. When zonulin opens the junction of the barrier, the immune cells can see the bacteria. When immune cells see the bacteria, they start to attack the bacteria. That would cause bloating and inflammation. Gluten also causes Zonulin to be released.(4) A high level of Zonulin is associated with increased intestinal permeability(5), which affects the skin condition.      

Endotoxin is a part of the bacterial membrane that is released when immune cells kill bacteria in the gut. The gut barrier separates the immune cells and bacteria, but when the gut health is compromised and permeable, the immune cells see the bacteria in the gut and start to attack them. Then the endotoxin that’s released gets into the bloodstream, and it binds to LDL cholesterol. The reason why it does that is because the endotoxin is very damaging, which can cause sepsis and death when someone has enough of it. The body has a response mechanism in which the cholesterol is soaking up endotoxin, so it doesn’t damage the tissue and organs.    

The problem is when the endotoxin binds to that LDL cholesterol, it can’t go back to the liver because endotoxin binds to the docking sites that LDL cholesterol uses to go back to the liver and get out of the circulation. LDL cholesterol that’s smaller, which has endotoxin, which can’t go back to the liver and stuck in the circulation, gets attacked by the immune cells because endotoxin is like a foreign invader signal for the immune cells. The immune cells try to kill cholesterol, but they can’t kill it because it’s not live bacteria. They secrete all pro-inflammatory cytokines which recruit more, and then it gets beginning of a foam cell, which is a bunch of immune cells stuck to the LDL particle, so it’s now small dense, and it is stuck there in the circulation. This happens when someone is under chronic inflammation at the level of the gut – which affects the skin. 

There is a piece of evidence showing that patients with acne had higher levels of endotoxins. When they added endotoxins to blood, micro clots formed in every acne patients, whereas this was rarely seen in mild acne patients and never in healthy skin groups. This study suggests that increased intestinal permeability is associated with acne.(6)    

Gut inflammation and intestinal permeability is caused by many factors. Two main factors are food and stress. There are so many ways that food influences the gut and skin health. One of the big issues is refined carbohydrates.  

The five ways that refined carbohydrates are causing acne.  

1. Damaging the gut health  

The gut and skin are connected, called the gut-skin axis. When gut health is poor, so does skin health.  

Mucin is essential for the gut barrier. The gut cells make mucin out of short-chain-fatty-acid. The short-chain fatty acid is generated by fermentable fiber. When you eat fermentable fiber, the good type of bacteria in the gut ferments the fiber and make short-chain fatty acids. Then, 70-90% of short-chain-fatty-acids go right to the gut cells, and it fuels to make mucin – which makes the gut barrier strong.   

When you’re not consuming enough fiber and eating lots of refined sugars, a bunch of other bacteria in your gut that don’t ferment fibers overgrow because they like to take sugar in. As a result, the other not-so-good bacteria occupy the spaces in your gut that your good bacteria would occupy.    

What’s happening on the other side; is that the more sugar you eat, you create insulin resistance in the gut. The gut cells start to not making insulin. As a result, they do not respond to sugar. The bacteria are getting to starve of energy, and when the gut bacteria are deficient in energy, they start to break down mucin in the gut barrier (because it has carbohydrates). When the gut loses the normal microbial biofilm, it causes intestinal permeability.   

Therefore, a low fiber and high refined carbohydrate diet can cause a massive gut barrier to break down, which would cause inflammation in your skin. The key to good gut health and skin is not eating these refined carbs and sugars and eating more fermentable types of fiber.  

2. Displacing Healthy Foods  

Zinc, Vitamin A, Selenium, and omega-3 are the most common nutrients that acne patients were deficient in.(7), (8). Increasing the amount of this nutrient consumption resulted in improvement for the majority of the patients with inflammatory acne.(9), (10), (11), (12), (13). Unfortunately, by the nature of processing food, those refined carbs become high in energy but very low in nutrients. Refined carbs make up a big portion of the average American diet.   

Consuming refined carb-based food such as bread, pasta, cookies, cereal, cakes, and a bunch of snack foods often displaces nutrient-dense food such as vegetables, fruits, and high-quality protein. A nutrient deficiency will cause not only skin issues but also a bunch of other health issues. Eating nutrient-dense food is the key to healthy skin.    

What about whole-grain flour? Wouldn’t it be better and healthier? Nay. The truth is most of the whole-grain flour used to make whole-grain products like bread, cereal, and pasta have been pulverized into a fine particle size with just some germ and bran added back. These whole grain flours still have a high glycemic index and glycemic load and are depleted in nutrients.(14

3. Metabolic dysfunction  

The consumption of refined carbs raises blood sugar and insulin, causing metabolic dysfunction. Refined sugars and flours are taken out of the fiber. Those foods become high on the glycemic index (meaning that once the foods are ingested, they will rapidly convert into glucose, which will increase insulin level), which will produce glycation that binds to collagen through an oxidative process. This process causes sagging, wrinkled, and aged-looking skin by breaking down collagen and elastin. Not only that, these blood sugar swings and steep insulin spikes also develop insulin sensitivity and increase skin oil production, which plays a part in the clogging of follicles, which can worsen the skin condition. Some researchers consider acne as a metabolic syndrome of the hair follicle because of the insulin level plays a role in developing acne.(15), (16), (17)  

4. Depression  

High consumption of refined carbohydrates is associated with depression.(18Refined carbohydrates may contribute to depression by systemic inflammation and altered mood by blood sugar swings. Depressed people tend to treat their depression with high carbohydrate foods. Emotional states (e.g., depression and anxiety) could alter normal intestinal microbiota, increase intestinal permeability, and contribute to systemic inflammation. Gut microbiome and oral probiotics could be linked to the skin, and particularly acne severity, by their ability to influence systemic inflammation, oxidative stress, glycemic control, tissue lipid content, and even mood.(19 

5. Energy trapping  

Refined sugars are taken out of the good kinds of stuff, such as fibers and polyphenols. They are usually sucrose (~50% glucose and ~50 % fructose). During the digestion phase, the sucrose is splited into glucose and fructose. The fructose doesn’t get absorbed by all the cells. It only gets metabolized in the liver, and it traps ATP (source of energy), which sends a signal through the vagus nerve to the brain and tells, “I lack energy!” The brain thinks that the body hasn’t been fed. It drives us to consume more and more calories to correct perceived energy deficiency. This explains why a lot of people can eat lots of refined sugars or high fructose corn syrups, but still feel hungry. Energy trapping is critical because the more you eat, the more likely of 1,2,3,4 above would happen.  

So how can we avoid all the refined carbs?  

First of all, if you are doing well – meaning your blood markers are good and you feel good and you have tons of energy – on diet high in refined carbs, there’s no need to get rid of it. Certain athletes have no problem with it.

For me, it made the biggest impact on improving acne. Just like me, when you find out that you don’t feel good or your body is not responding well to certain diets & lifestyles, that’s an opportunity to find what is ‘my thing, my way’ for optimizing your unique life. Time to change for the better. However, Getting rid of refined carbohydrates is not as easy as it sounds. 

The easiest way to change the diet is changing grocery foods. There are many options to replace refined carbs at your home. For example, monk fruit, erythritol, and stevia can be sugar substitutes. Almond flour, coconut flour, plantain flour and tapioca flour are good options for wheat flour substitutes. 

When you look at the ingredients that restaurants use and the ingredient list on the labels of products, refined carbohydrates are literally everywhere. I know it can be overwhelming. I have been there. My wife freaked the fuck out when I told her we gotta throw out all of these pro-inflammatory foods. Yes, I couldn’t tell her we need to consider going to restaurants so often. They taste too good to resist.

When eating out a lot, look for paleo-friendly restaurants. Gluten-free restaurants often take extra care in choosing ingredients. Often it is hard to find a good ingredient using restaurants. For me, that’s when I practice ‘don’t give a fuck and eat happy’. I know even though I get pimples, stress will add more inflammation and prevent proper digestion which will add extra pimples.

Foods have to be enjoyable, and I agree with that. If it is not sustainable, for mentally or physically, it needs some changes and tweaks. At the end, pleasure and happiness are what we’re hardly wired. It’s a matter of the objects and perspectives of pleasure and happiness.

In coaching, the objects and perspectives of things shift which led to long lasting change, and open a whole bunch of new thinking and possibilities.

Mental health influences gut health, and gut health influences skin and brain health – and every part of the body. Therefore, creating a diet & lifestyle that does feel right to you is critical.

Every individual is different; therefore, everyone’s body & mind responds differently to different types of diets and lifestyles. Peanuts can kill someone while someone can eat pounds of it. 

Starting small is the key to build self-efficacy. In behavioral change, it is better to succeed small than fail. 

For example, our family began with 80/20 rule, where we ate 80% of healthy meals and allowed ourselves to enjoy 20% of whatever meals. In a couple of months, we replaced all of the refined carbs/pro-inflammatory foods with nutritious/anti-inflammatory foods. We are allowing ourselves to enjoy when eating out. 

Another example, one of my clients started with 20% of healthy eating, and that’s okay! You can start with 2% or 0.2%. One of the secrets to sticking to a healthy diet & lifestyle is to succeed with a bit of a stretch, each time. Nothing succeeds like successes. Does he succeed in changing his diet? He rocked.

What did you find the most difficult getting rid of refined carbs, and how did you deal with it? Have you noticed a connection between refined carbs & processed food and skin? Please share in the comment for others!possibilities

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