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Today we're talking all about acne. My guest shares her favorite nutrients on the journey to clearer skin…and some of them are quite controversial!
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My guest today, Robyn Johnson, is a Functional Medicine Dietitian Nutritionist.
Her passion of using food and lifestyle as medicine found her after a personal battle and triumph with psoriasis. She specializes in helping women optimize their hormones, gut and skin by finding the root cause to their symptoms.
Robyn runs a virtual private practice, is the creator of The Clear Skin Lab. Robyn believes healthcare should be individualized and that starts with each person understanding how their body works and what their body needs to truly thrive!
Join us as we discuss some controversial nutrient solutions for acne.
Has working on your nutrition helped your acne? Let me know in the comments!
In this episode:
- Different types of acne
- Robyn's favorite nutrients for acne
- Thoughts on Vitamin A toxicity: How worried should you be?
- Sources of vitamin E + why it can be helpful for hormonal acne
- Iodine and acne
- Topicals that may be beneficial for skin health
- Why are minerals important for the skin?
Quotes
“Vitamin A is used for acne, but people don't talk about the importance of food and using it in its most natural form.” [4:11]
“Vitamin E is beneficial for acne for many reasons, I would say the top reason is it's potent antioxidant effects.” [10:41]
Links
Healthy Skin Show ep. 016: Can Fluoride Be A Hidden Trigger For Your Skin? w/ Melissa Gallico
Follow Robyn on Instagram
224: Nutrient Solutions For Acne (Some Of These Are Controversial) w/ Robyn Johnson, RD FULL TRANSCRIPT
Jennifer: Robyn, I am so excited to have you here on the show. It's been so great getting to know you, and I figured you'd be a great addition, because I know that my guests absolutely love to hear more about acne issues. So thank you so much for being here.
Robyn: Yes. I'm excited to nerd out. I love talking about this topic.
Jennifer: Well, why don't we start off of with talking about acne types because you have a very interesting approach to this. This is one of the main focuses that you talk a lot about, so tell us what are acne types? How do they differ from one another? Is there a way that somebody could easily identify which type they are?
Robyn: Yeah. I tried to simplify a very complicated topic by giving people some ways to understand their skin, so acne types are basically different ways to term different root causes of acne. The five acne types are hormonal. That means your acne is driven by some hormonal mechanism. There's infection, oftentimes related to by bacteria, fungus, that could be on the skin that could be in the gut, systemically. Inflammation, most people have some version of this with their acne type. Irritation, this is usually a sensitivity to a product or you're touching your skin a lot or your pillow has animal dander on it and then stress, which is the one nobody to ever admit they're dealing with. Once you've ruled out these other things and you can tell acne is worsening during stressful periods, that's usually a stress mechanism. So it's just a way to try to simplify things.
Robyn: We have a quiz, an acne quiz to help guide people to their most dominant type, and then from there you may obviously take to support that root cause. But at the end of the day, I will say, no matter what your acne type is, you still have to do the foundational things. There's still like, when you're building a house, the framework is still the same, but the details may differ based on your acne type.
Jennifer: Would this apply to a woman who is in her 40s, who all of a sudden develops acne or even into her 50s as opposed to a teenager or 20 something?
Robyn: Yep. Everyone can start by trying to figure out what their root cause is and you can do that with the quiz or just assessing how your skin shows up. I would say teenagers tend to be more hormonal, they tend to have maybe a hormonal inflammation combination. Then depending on what is happening in the 40s to that person, there also may be a hormonal type with premenopausal changes. But at any age you can have any type.
Jennifer: That is very true. This is where it gets complicated. I always say, well, the older you are, the more historical information there is, and unfortunately, sometimes that makes it more complex. Kids sometimes can be easier. Teenagers can sometimes be easier because they just haven't been here quite as long as the rest of us.
Robyn: Yeah. Not as many things may be going on or built up.
Jennifer: Exactly. Exactly. In terms of supporting the skin, there are nutrients, some of which I think most people can agree on are helpful for acne, but then there are some that are more controversial. I think this is a good spot to start digging into today. What nutrient is one of your favorites to talk about that we could discuss first?
Robyn: Yeah. I'm going to talk about two that are very controversial. The first one, the one that I think makes the biggest impact in acne is vitamin A, and I'm talking real food, vitamin A. I'm not a fan of using synthetic versions and beta carotene is not what I'm referring to. I'm talking vitamin A, that comes from real food and we can talk about sources and stuff. This is controversial for sure. But when we think about it, let's look at how acne's even treated in a conventional setting. Most of the time by their dermatologists or somebody they're talking about retinoids, which are topical vitamin A for the skin, and then with medications, oftentimes people are led down the path to accutane, which is synthetic high dose vitamin A. Vitamin A is used for acne, but people don't talk about the importance of food and using it in its most natural form.
Robyn: There is really good research on acne and vitamin A, and obviously there's a lot of controversy with dosage. People are very scared of vitamin A and don't want to hit a toxicity level, which is understandable. The good news is there is no toxicity study done with food versions, with real food vitamin A. In terms of dosage, our RDA for vitamin A is like 700 micrograms. The upper limit is 3,000 micrograms, and some of the research done uses 9,000 to 90,000 micrograms for months, and there's no symptoms of vitamin A toxicity. The reason this can be so helpful for skin is, there's a lot of details within this. It impacts the thyroid. It impacts active copper. It impacts iron recycling and all of these mechanism impact acne. But the biggest thing is it's going to help speed up healing, reduce inflammation, and those are why people tend to see faster results when they incorporate healthy doses in the right form of vitamin A.
Jennifer: Let's talk about what those forms actually are. Because I know liver is a good source for vitamin A, but per me personally, I'm not going to eat it and I can't swallow pills. So doing an encapsulated forms, not going to work. What would you do with someone like myself that really has this issue?
Robyn: Yeah. The best forms as you name, the top one is going to be organ meats, liver, and that could be if someone's willing to do food, great. I'm like you, I can't, I've tried so many times, I just can't. So, I do pill versions. You could potentially take a pill and open it up and sneak it in a smoothie, sneak it in a parfait or whatever it might be, eggs, egg yolks specifically. But when we're talking about dosage, three ounces of liver a week are taking liver pills once a day is about 2,500 micrograms per week. A single egg is about 65, so there's a huge difference in terms of dosage. The other form of vitamin A or source is dairy. Dairy's going to have some, however, that's a big trigger food for some people with acne, so it's not really one that I start with.
Robyn: In your case, it would probably be trying to figure out a way to open up if you can't swallow pills, open up the beef liver, see if there's a way to sneak in tiny amounts in taco meat or something like that. I don't know if you can tolerate dairy or not, but that could be a source, so you have to get creative sometimes. There are cases where I'll use vitamin A drops if someone's like really struggles, but that would never be a general public recommendation, I would want to monitor someone on vitamin A drops.
Jennifer: Can I ask you quickly because there's a lot of people who love to do plant-based and I'm not dogging on a plant-based diet, but they are under the impression that if they get enough beta carotene in their diet, it's going to be converted to vitamin A. Do you have any concern or clinical experience and help perhaps you can't depend on beta carotene intake for appropriate vitamin A in this particular instance where you need higher amounts.
Robyn: Yeah. It's a challenge for sure, and I would say one of my toughest clients in terms of results is, she's vegan who ethically does not want to incorporate anything, so it's hard to get vitamin A. Depending on the person in their genetics, we convert beta carotene to vitamin A via the BCMO gene. But how well someone's BCMO gene works is very individualized and you could have genetic snips, there's other nutrients that are needed to make that enzyme work. If you can't convert that very well, then you're not going to have good vitamin A status, and if you're not willing to eat those foods, at some point, there can be a roadblock.
Jennifer: I agree with you 100 percent. With that said, so vitamin A we've covered, we've talked about this. I want to ask you really quickly though. If you read online, you'll see a lot about vitamin A toxicity. What are your thoughts on that?
Robyn: That study, the big one that was done with that was using synthetic vitamin A. As I mentioned before, if you're using real food versions, there is no research on toxicity with beef liver or something like that. That's typically what I recommended people if they're willing to do that. Even with that, the upper limit of vitamin A, as I mentioned earlier is 3,000 micrograms, three ounces of beef liver a week, or taking four to six capsules a day is around 2,500 micrograms, so you're still under that level. The issue is if you're taking, I mean, I did tell you some of the studies are done on 9,000 to 90,000, so that's clearly really high. I would not clinically do that unless I was really monitoring someone. It would never say public to go take that much. But those studies did not have any reports of vitamin a toxicity.
Robyn: Obviously you would be safe if you're pregnant. If you're trying to get pregnant, nursing, you wouldn't do high levels. But I would say most people are safe doing three ounces of beef liver a week, or taking beef liver capsules four to six caps a day, that still stays within a healthy range.
Jennifer: I would say this, if anyone here feels very tempted to go quite above this conversation and dosage amount, you really should talk to your practitioner to see if that's the appropriate thing for you to do because everybody's different. I'm sure you may at times recommend a higher dose to somebody, but it's based off of their particular situation, their labs and whatnot.
Robyn: We're test vitamin A regularly in practice, and I forgot to mention one Cod liver oil is another good source of vitamin A. I know that's another pill, but they have liquid versions too. It's just really rough to take that one.
Jennifer: My dad used to put it in orange juice to try to get my sister, so I'm like totally traumatized from childhood.
Robyn: Yeah. Orange juice is ruined for you.
Jennifer: Liver and Cod liver oil, my least favorite foods. All right, so what is your next favorite yet controversial nutrient you want to talk about?
Robyn: I guess vitamin E would be my more favorite one, but it's not controversial, so we can talk about that one first. Vitamin E is beneficial for acne for many reasons, I would say the top reason is it's potent antioxidant effects. In terms of acne though, there's such a huge role with hormones and specifically androgens, which is the “male sex hormones”, but obviously women have them too. But then there's vitamin E has very pro progesterone effects, so part of what happens with hormonal acne is there's too much androgen in relation to progesterone. Not only is vitamin E helping with the antioxidants or the oxidative stress part, but it's also helping boost that progesterone in that hormonal effect. That's a huge one that I really love, but again, I don't think that one's controversial so we could go on to the next controversial one if you want.
Jennifer: Well, I actually want to ask you though. I think vitamin E we talk a lot about it as vitamin E, but where do you get vitamin E in your diet? Are there any really good vitamin E sources?
Robyn: It's in small doses in a lot of things. Some of the big ones that people talk about are almonds and hazelnuts and different nuts and seeds. We do a lot of supplementation form to get the dose you would need to see a benefit because, since a lot of people have damaging oils in their diet, which that's hard to avoid completely, but a lot of oxidized, inflammatory fats and oils like vegetable oils and stuff like that though, that competes with vitamin E. A lot of people are lower in vitamin E because they're being depleted with the amount of damaging oxidizing oils. To get a good dose, to see a change in skin, you're going to have to do a supplementation form. I don't think you would see that in food alone.
Jennifer: Fair enough. See everybody, when you're listening to this, yes, food is medicine, but there may be some instances where you actually need to increase and utilize supplements in order to help you. I think that there's this weird pushback. Some people are like, I only want to take use food. Food is medicine, and I'm like, but sometimes the hole so deep or the Well so dry, you've got to use some supplements at time to help bring you back up to a level you need to be at.
Robyn: Especially with skin, it's like, you want to see the change and it takes such a long time anyways, to do that all with food, without using any supplement nutrient support, it's just going to delay the healing even more. I personally know with skin issues that you just want to get to that point where you feel better about it.
Jennifer: Can I just ask if someone's on spironolactone, does that play a role in how much vitamin E someone would take or are they completely not related?
Robyn: No, not that one. If someone's on spironolactone, I may be more cautious of the level of potassium they're doing in like a mineral drink, because that's a potassium sparing medication, but I wouldn't worry about the vitamin E piece. Actually if someone's on spironolactone and it's helping their skin, it does tell me we're probably working with androgens, we're probably dealing with a hormonal type and there's probably a need for a lot of minerals. That's actually a big telling factor if it works for them.
Jennifer: Interesting. That is an interesting, I love it. I love the interesting clues. What is the next controversial nutrient that you want to talk about?
Robyn: The next one would be iodine. Most of the time, and if you do a Google search and you look for foods that trigger acne, you're going to see iodine or kelp information listed. While it is true that if someone starts iodine, they might see worsening skin. We have to ask why is that happening? When I've dug into more of the mechanisms, it's not necessarily that acne in itself is causing a reaction, it's that they probably have higher levels of fluoride and bromide. Because those are all halogens, if you look at the periodic table, they're all in the same row, they compete at the receptor level. So when you add iodine, you're sloughing off potassium fluoride and bromide off that receptor, and it's got to go somewhere, so it goes through the skin.
Robyn: There's a term that's actually a former FBI investigator term, because she had this issue, but fluoroderma, it's essentially the skin reaction to fluoride, same thing can happen with bromide. In my professional opinion, the issue is not to avoid iodine it's to get these other halogens out and then be able to tolerate iodine because we do need iodine for thyroid health, for breast health, ovarian health, so many tissues in the body. So I don't like the message of being scared of it, but I understand why when someone has it, they have a reaction and then they think that they maybe have a sensitivity to iodine.
Jennifer: Actually, I think her name is Melissa.
Robyn: Yep. Gallico I think.
Jennifer: Gallico, she was on the show the first year. I apologize to anybody listening. I don't know the episode off hand, but we can put it in the show notes. That way it's really easy for somebody to check out what Melissa had to say, if you did miss that episode. But yes, I did actually talk to Melissa about that, and it was really fascinating also to hear her talk about the fluoridation of water and whatnot. That real concern it was fascinating.
Robyn: There's a lot of history with both fluoride and iodine. In fact, iodide in the 1900s was known as a universal medicine and they used it for so many things at really high doses. I'm talking like gram levels, and then a lot of stuff happens, some interesting questionable research. Then nowadays we have a very big message, and even in the textbooks that iodine should be kept super low. The RDA is 150 micrograms, so it's really interesting when you dig into the history of how we got to that place and why there's so much fear. I am not scared of iodine, but I would say it needs to be used safely. So if you're listening to this, don't just go supplement a bunch of iodine. You do need to be careful with the way you use it. You need to make sure you're monitoring thyroid labs and just protect yourself. But it's not a nutrient to be scared of if used correctly.
Jennifer: Okay. From a topical perspective, it's always interesting, and if this is not your real house, that's totally fine. But do you find any nutrients that can be helpful for skin, from a topical per, just even your own experience?
Robyn: Yeah. A huge one that's important for skin barrier support is vitamin C and you want to make sure you have a quality vitamin C there's a lot of cheap ones out there, and I would say that's one that you probably want to invest in to get a good form that's actually going to penetrate the skin well. But skin barrier is really foundational for topical steps. So before adding retinoids and a bunch of acids and exfoliation, you have to make sure that your skin barrier is strong. That's what protects your skin from the outside world, and vitamin C is a really helpful tool in that area.
Robyn: I will also have people use topical vitamin E. There's an oil that can be used, and again, that just helps with the inflammation, helps with healing faster. Then the other big topic for topicals, this is controversial too, but oils, part of what's going on with acne is an oil deficiency in the hair follicle. So CMI deficiency and linoleic acid or omega six deficiency. Using oils on the skin is helpful long term. However, most people get a purge because that oil is going to go down to the hair follicle and pull up the junk, so that's another situation where people freak out thinking having a intolerance or reaction to the oil when in actuality it's a purge and it's pretty normal.
Jennifer: I want to ask you about pantothenic acid. Do you have any thoughts on pantothenic acid, especially supplementing it to help with acne?
Robyn: Yep. That would be one that would be as needed, so it's not something that I would say everyone needs to start in terms of supplements, but if you're sure you have a more hormonal type or you have pretty severe inflammation, that would be one nutrient. We talk about that in our clear skin lab course where you might want to add that because it can be an effective tool for acne.
Jennifer: I think there was wasn't there like a study? Was this the one that the B vitamin that was a super high dose?
Robyn: It is a pretty high dose that you end up supplementing, so, yeah. There's other B vitamins that are controversial, like biotin and B12. I haven't found that using food versions like beef liver causes any issues, and if you're using more of a complex, I haven't seen an issue, but I don't recommend people do multivitamins or B complexes or stuff like that, just because they're depending on the person, there can be some purging or triggers with some of those B vitamins.
Jennifer: Okay. In terms of minerals, you mentioned that earlier, and obviously we touched on iodine, so why would minerals in this particular instance be so helpful for someone who has acne? Because they might be like, I don't get it. Where's the connection. I've not heard of that before. Because you do hear about vitamin A, you do hear about vitamin E, but what's the deal with minerals that they could be really helpful for acne?
Robyn: Minerals are just foundational to good health period. We have to get them through food and they have an impact on everything from hormones to insulin sensitivity. We could talk about any body piece that usually really has a mineral role and because our soil is more depleted because we live in a productive society, so there's a lot more stress. It's just quite easy to be low in minerals these days, and we know magnesium is a huge one that most people are low in. Part of the reason minerals can be beneficial is it's supporting so many mechanisms, including ones that impact insulin sensitivity and hormonal signaling. When we talk about hormonal acne, the big mechanisms are insulin and the insulin resistance can trigger acne, androgen and progesterone ratios and then androgen and estrogen ratio or estrogen and progesterone ratios.
Robyn: Minerals impact all of those. Minerals like magnesium, potassium, impact how good our cells work with insulin and glucose. Potassium impacts progesterone, potassium impacts androgen, so all of these minerals have a role. It's like the nitty gritty details, but they do matter. So sometimes when people start the minerals, not only do they feel more energy, have better sleep, but in the long run that is supporting those mechanisms that can trigger acne
Jennifer: Aside from magnesium, sometimes chromium for blood sugar balance, but I feel most people ignore some of the trace minerals and especially with all the controversy around salt in general, the idea is like we want to do less salt, and I think that one of the new government regulations was trying to reduce salt even for order from the American diet. But didn't bother to mention anything about sugar intake at all.
Robyn: Right, and what's crazy too, is some of the research that was done back in the day around sodium, they didn't even assess the potassium piece. A lot of the issues that come with high sodium are actually low potassium issues. That history is all also quite questionable. There's a good book called the Salt Fix that goes into a lot of that. But I'm a big fan of using sodium quality versions, especially if you're not eating a highly processed food diet there's room and need for sodium. As you mentioned, there's so many others, there's manganese, there's copper, there's iron, there's so many minerals that ideally were getting through diet.
Jennifer: For everybody listening, this might sound slightly familiar. Kaylee McDevitt was on the show, some episodes back and she and Robyn are friends. So they're really big on to the whole mineral. The big mineral thing, but you also have a fantastic mineral mocktail guide, is that what it's called?
Robyn: Yep. It started out as I'll give some recipes and turned into a 23 page detailed mineral guide. If someone's kind of questioning what is this with minerals? How do I get minerals? That's a great place to start. Mineral mocktails are just a basically a drink. You put water and some, either food versions or there's powdered versions of ways to get sodium potassium in magnesium. That's really what a mineral mocktail is. So it's an easy way to try to boost those nutrients.
Jennifer: Can I ask you one question about potassium robbing, because I think this might be helpful for people and maybe even when it comes to looking at sodium and chloride. A lot of times if you just take the serum zinc value, it's not really that helpful, and yet on a comprehensive metabolic panel, you will get values for sodium and chloride, and I think potassium is on there as well. Do you find that those are good values to help one assess if they need minerals?
Robyn: No. The blood level for serum or for sodium and potassium, if it's low, it's going to tell you that you're really low cellularly, so it can be helpful in that way. But I think a lot of people look at those and they're like I was normal. That's one measurement in time and it's not really testing what's going on cellularly, so the better way that I personally like to test it is a Hair Tissue Mineral Analysis, HTMA. That's going to give you a better insight of what's going on with the tissues, how the body is using, or maybe losing those minerals, so I don't rely on blood for those.
Jennifer: That's a good point if everyone's like wait, hold on. You're talking about being low in these minerals, but my blood work says, I'm fine. This is a very clear sign that you can't just go off of this CBC panel because you're looking at what's floating in of blood. We need to see what's inside the cells, that's actually what's more important. Unfortunately, I don't think they run a red blood cell or erythrocyte potassium or sodium or chloride.
Robyn: No. I see, see the blood cell magnesium most often and most people are low with that too. I honestly would say most people benefit from giving potassium more attention. I'm not saying that one needs supplements and pills. It's so easy to get them in food, but especially with more of a low carb movement, a lot of the good potassium foods are fruits and potatoes and foods that people cut out if they're doing a low-carb diet. Potassium, I think can definitely come from food, and then if you need a boost, mineral mocktail is easy too.
Jennifer: So you all know, I did a while ago, because I was really curious about the mineral piece. I was doing some research for myself. I downloaded Robyn's mineral mocktail guide and I was like, this thing is fantastic. It's got great recipes. I'd highly encourage you all. If looking for some ideas beyond what Kaylee had shared, definitely go to Robyn's website and download that. Then also to Robyn, you were saying, is it the acne type quiz if someone wants to understand what's going on in terms of acne?
Robyn: It's a place to start if you are like, oh, I heard about these acne types. What direction should I consider that acne type quiz leads you to your most dominant type. Then we also have an acne guide. We have a lot of free resources, we also have an Instagram account, the Clear Skin Lab, lots of acne talk there. So we really try to give you a bunch of free content to get yourself started.
Jennifer: Perfect. Well thank you so much for joining us. This was a great conversation today. I hope that this will not be the only time I have you on the show, because I'd love to have you back and please everybody go check out Robyn, she's got two separate websites, so don't be like, wait, why are there two separate websites? The Clear Skin Lab is specifically for acne, and then she has her own website, nutrition by Robyn.com and it's Robyn with a y so that you can learn more. She also works with other skin issues as well, and she's got an awesome Instagram account, always super knowledgeable, and bye Robyn, it's been a real honor to have you here. Thank you so much for joining me today.
Robyn: Thank you. I'll come back anytime. This is fun.
