Acne affects between 40 million and 50 million individuals in the United States. Epidemiological evidence suggests that acne incidence rates are considerably lower in non-westernized societies, indicating that lifestyle and environmental factors may contribute to the prevalence of acne. A functional medicine approach may help identify which factors could be contributing to acne flare-ups.
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CC: Acne (Face, Chest), Constipation
Ashley* was a 33-year-old female experiencing acne, mainly on her face and chest. She had given birth to her second child one year ago and reported her acne had started during her pregnancy. She had no history of acne when she was younger. Since giving birth, the acne had worsened and was now painful at times. She also experienced constipation intermittently over the past 12-18 months, which was unusual for her. The constipation, which was also predominant during pregnancy, continued despite being prescribed Miralax and stool softeners by her primary care doctor.
Additionally, Ashley reported that she hadn’t yet had her menstrual cycle return post-pregnancy, despite stopping breastfeeding six months ago.
Additional History
Adjusting to her new schedule had come with several life changes for Ashley, including moving from an apartment into a new home that required renovations. She had not yet returned to any of the supplements she had taken before getting pregnant, and her diet had changed as well. Ashley had started eating more packaged/pre-cooked foods for convenience and found herself eating more bread and sugar than she was used to. She reported she had gotten into the habit of eating more refined carbohydrates when she had morning sickness for most of her pregnancy and now felt like she “had” to have them. Since her pregnancy, she had sugar cravings most afternoons and evenings, which led her to opt for fruit or baked goods.
Regarding her skincare, she had not changed any personal care products and avoided fragrances, opting for non-toxic skincare as much as possible.
Lab Work
Comprehensive Stool Test Results
- Pancreatic Elastase Low
- Fecal Fat High
- SCFA Low
- Candida albicans 4+
- Bifidobacterium spp., Lactobacillus spp. 0+ (none detected)
Other Labs Results
Lab Analysis
Ashley’s lab work suggests a few core issues that may be contributing to her acne and constipation:
Dysbiosis and Malabsorption
Ashley’s stool test showed low pancreatic elastase and high fecal fat, indicating low digestive enzyme function and potential malabsorption. This can lead to difficulty absorbing nutrients from food and may contribute to bloating and digestive issues such as constipation. Additionally, she showed a high growth (4+) of candida albicans, with no growth of beneficial microbes such as the Lactobacillus spp. and Bifidobacterium spp, indicating an imbalance in her microbiome. An imbalanced microbiome may contribute to constipation, hormone imbalances, inflammation, and a slower detoxification ability (1, 2, 3).
High Testosterone
Her testosterone levels are elevated. When paired with low progesterone and borderline-low estradiol, elevated androgens may contribute to acne and menstrual cycle irregularities in women.
Elevated blood sugar and HgBA1c
Elevated blood sugar can lead to sugar cravings and inflammation. When paired with high androgens, this is a common laboratory profile seen as a potential underlying factor of adult acne in women.
Multiple Food Sensitivities
Many of the foods Ashley reported eating during and after her pregnancy, including gluten-containing baked goods, sugar, potatoes, and certain fruits (blueberries), showed high antibody levels on her food sensitivity panel. Continuing to eat these foods could be contributing to inflammation as well as her digestive complaints.
Interventions
- Consider removing foods with 3+ on the food sensitivity test and begin a whole foods-based diet focusing on quality protein, healthy fats, and fiber in the form of vegetables, low-glycemic fruit, and limiting starchy vegetables.
- Consider starting a comprehensive digestive enzyme to help support food breakdown and nutrient absorption.
- Consider starting a fish oil supplement to support overall health.
- Consider starting Inositol to help support healthy hormone levels and insulin sensitivity.
- Consider starting Magnesium Glycinate to support overall wellness.
- Consider starting Vitamin D3 to support general health.
- Consider adding a greens powder to increase nutrient intake and support healthy detoxification function.
- Encourage increasing exercise to the point of breaking a sweat 3x a week, plus daily walking (especially after dinner). Ashley decided on weight training with a personal trainer.
- Consider starting red light therapy to areas affected with acne, ensuring eye protection is used (4).
- For a short period, consider using supplements that may support yeast balance and elimination.
- Consider starting a probiotic to support a healthy microbiome.
- Encourage Ashley to take up journaling and breathwork to help manage stress.
Follow Up Labs 3-4 Months Later
Over the course of three months, Ashley implemented her nutritional, supplemental, and lifestyle changes with weekly coaching and support. At our in-depth follow-up visit three months later, Ashley’s acne had improved, and she was now having daily bowel movements.
She had her first menstrual period since pregnancy just before our 3-month visit and noticed her acne flares up the week leading up to her period, albeit temporarily.
Her sugar cravings were no longer there, and she felt she had more energy to work out and cook. Her blood sugar markers had started to fall as well.
Her Omega-3 index showed she still wasn’t in the optimal range, but things were trending in the right direction.
Now that her period had returned, we continued to work on supporting her menstrual cycle to reduce the PMS-related flare-ups she had experienced just prior to our 3-month check-in.
A few weeks later (in the luteal phase), we did a repeat hormone test to get follow-up markers for her hormones, which all came back within the normal range.
Summary
This case demonstrates how exploring potential root causes of acne can be beneficial. It highlights the importance of gut health and a balanced microbiome for bowel regularity and skin health. In Ashley’s case, her experience also serves as a reminder that women can experience a wide variety of changes in their physiology postpartum. These can involve reproductive hormones, blood sugar regulation, gut health, detoxification, and more.
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