The Healthy Skin Show 013: What's Really Going On Behind Adult Acne? w/ Brie Weiselman

Most people think of acne as a teenage affliction. But there are many adults with pimples, many of whom even had great skin as teens. Brie Wieselman studies an often overlooked cause of chronic acne in women. Polycystic ovary syndrome (PCOS) is more common than many people realize. Even though it can lead to a number of conditions, as you are about to hear, it is totally manageable with expert help.


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Brie is a digestive and hormonal health specialist who works with women around the world in her online practice. She also specializes in helping people with a range of digestive issues so that they can build a healthy microbiome. Her programs integrate functional and Chinese medicinal approaches. I have personally worked with Brie several times and can vouch for her knowledge and expertise.

In today’s episode, we dive deep into the issues surrounding PCOS and why acne is more than just a simple skin condition, but can potentially be a sign of a more complex hormonal imbalance. We look closely into some hormonal issues and how they are connected to the skin. The hormonal component of understanding skin issues is complex and it’s important to find an expert like Brie when dealing with it.

Have you wondered if a hormonal condition like PCOS could be causing your acne? What have you done to address it?

Let me know in the comments!


In this episode

  • Some of the common causes of chronic adult acne, many of which people don’t even know they have
  • What polycystic ovarian syndrome (PCOS) looks like and why it’s more common than you might think
  • What questions you should ask your doctor if you are concerned you might have a hormonal imbalance
  • Why acne is often a symptom of a much more complex problem



“I’m talking about women with acne. And this could be any aged woman with acne, so it really could be applied to somebody in her teen years, but this becomes more obvious when it’s acne that showed up either a little bit later in life or that persisted after the teen years despite treatment.” [1:56]

“People with PCOS are born just more susceptible to developing a sensitivity to our insulin and that will drive this problem. That can be managed with diet, lifestyle, nutrition, and other therapeutic steps once you know what’s happening, but before it can just look like this bunch of symptoms that’s showing up in someone.” [8:02]

“No one is looking at the big picture and educating their patients and saying ‘Hey, you have this condition. Here’s what it means to live with it and here’s how to keep yourself healthy over your whole life”  [11:13]



Find Brie Wieselman online

Take Brie's Healthy Hormones Quiz here!

Watch Brie's Hormones & Skin Rash Interview during the Eczema & Psoriasis Awareness Week

Follow Brie on Facebook | Twitter | Instagram

The Healthy Skin Show 013: What's Really Going On Behind Adult Acne? w/ Brie Weiselman

013: What's Really Going On Behind Adult Acne? w/ Brie Wieselman FULL TRANSCRIPT

Jennifer:              Hello everyone and welcome back to the Healthy Skin Show. I want to welcome a guest who for those of you who tuned in to the eczema and psoriasis awareness week, you know my guest, she had one of the best and honestly, gosh, I felt like all of the talks were eye-opening, but hers was particularly eye opening in terms of hormonal issues. So we're going to dive a little, we're going to try and dive deep today into some hormone issues and how that's connected to the skin. Brie Wieselman is a digestive health and hormone balance specialist working with women around the world in her online practice. Besides women's health, Brie specializes in helping people with digestive problems such as IBS, parasitic infections, candida overgrowth, and SIBO to rebuild a Bulletproof microbiome. Using her programs that integrate functional and Chinese medicine approaches. She's worked with hundreds of clients living all around the world, Dubai to New Zealand to California empowering them with the personalized roadmap for understanding and transforming their health. Thank you for joining us, Brie.

Brie:                       Thanks for having me. I'm happy to be here.

Jennifer:              I know this is like, this is like our second time doing this and it's super exciting.

Brie:                       It is. I know, I know. I love what you're doing. We were just, you know, when we were just chatting for a moment, I just, I love your mission and the vision and really getting this awareness out there. Cause I think, I think it's an area that there's a lot of room for improvement, a lot of room for getting the info out. So thanks for doing that.

Jennifer:              I know. And you know what your topic today we're going to talk about really jumped out at me. And so a lot of adults struggle with acne, right? So you got an acne, you didn't have it. So why don't you set the stage? Cause I feel like you could do a better job than me. Tell, tell us what's the deal, who are we talking about? So they know like if you're talking to them.

Brie:                       Yeah, absolutely. Well so I mean essentially mostly, okay. So right now, and today I'm talking about women with acne and this could be any age woman with acne. So it really could be applied to somebody in her teen years, but this becomes more obvious, this scenario I'm going to talk about when it's acne that showed up either a little bit later in life or that persisted after the teen years despite treatment. So yeah.

Jennifer:              So like why do I have acne. Why does my skin, I'm an adult, why do I have acne.

Brie:                       Exactly, I have so many clients who have this situation and they're just like, seriously what gives, you know, I thought I thought that was at least I wasn't supposed to have to still deal with that. Right. And I love talking about this because it was exactly my story. So you know, you wouldn't know necessarily by looking at my skin now, but I had a good 15 years of adult acne issues. And the funny thing was I had like perfectly crystal clear skin, as a teen while all my friends were going through the rigamarole and you know, getting treatment, going to dermatologist, I was like, I don't think I've ever had a pimple. And then I hit 20 years old, I think it was like my birthday and all of a sudden I just started breaking out all over my jaw line and my chin and it was horrible. And like cystic and persistent and then little tiny irritated spots that would stay for weeks. It took me years to figure out what was going on. So I love telling people about this because it's kind of like this a big overlooked possible cause if you have that going on.

Jennifer:              Well I think a lot of times people assume, well first of all is it a food issue? That's sort of seems to be like the next most natural step that people go to. But a lot of times when people, when it's a chronic issue like you and I've talked about a lot of chronic skin issues, there tends to be something underneath that is not clear to you the sufferer of what's going on. So in the case of adult acne, what is this one like kind of hidden, I guess, condition that you have discovered, lot of people suffer with that they have no idea they have it?

Brie:                       Yeah. So the, the situation is a syndrome called polycystic ovarian syndrome. And I'll tell you, I'll talk in a minute about exactly what that is and how we define it. But I think what would be better is for me to kind of paint a picture of who this is, you know, at least. Yeah. So commonly what happens, and this is exactly what happened to me, is this woman got her period a little bit later in her teens. If she got it at all, maybe it never showed up or her periods started on time, but then it, you know, most women's periods when they first get them are a little irregular. Like maybe they skip a month here or there, but usually within six months to a year that kind of straightens itself out and they develop a regular monthly cycle. A lot of women with PCOS just never really get that regularity or they have longer windows in between.

Brie:                       Like I used to go three to six months between getting a period for a very long time, the first 10 years that I had a period. And then what happens is acne starts to develop and hair growth in places that you don't want it, like nipples or your lip or your chin maybe on your stomach. And so then this woman goes looking for solutions. And often what's given to her is she's put on birth control pills, usually first to regulate her period and help deal with the acne. And sometimes offered antibiotics like Tetracycline or drugs like Accutane to also suppress them, and control the acne. And I get it, you know, when you're young and if that's the options that are offered to you, those are the first tools offered to you. You're just like, I don't care. Just get rid of that. You know, cause it's really putting a damper on your life to walk around with acne all the time.

Brie:                       So the unfortunate thing is that these drugs, man, if I was telling you, buy the dollar for every time that I had a client that bleeder on working on gut issues in their twenties, thirties, forties, 50s, who, you know, had that exact story of those drugs, you know, I wouldn't, I wouldn't have to practice. No, I'm joking. But it's, it's like adding insult to injury because these are all known to damage the microbiome and promote yeast and fungal overgrowth and dysbiosis in general, which just sets the stage for more inflammation, more acne and other health problems down the line. And women with polycystic ovarian syndrome actually have a less diverse microbiome already. We can work on it, but innately it's less diverse in studies. And that's really important.

Jennifer:              Well, I was going to say for somebody who's listening to this and they're like polycystic ovarian, like I didn't even know I had a problem with my ovaries.

Jennifer:              I just, they're just, they're absolutely, what is that? Yeah, what is it?

Brie:                       So, okay, so it's defined as, it's the most common hormone and metabolism imbalance that exists. It affects one out of 10 women, and it's an imbalance of our reproductive hormones, testosterone, estrogen, and progesterone. That creates a problem with how our ovaries function. So it makes it so that the egg that normally develops the each month that we ovulate may not develop fully or it might not be released during ovulation. So we think of polycystic ovarian syndrome as an ovulation problem, but it's so much more than that. So this is a whole, the, the, the take home is that this is a whole body metabolic issue with multi-system involvement and not just a skin thing or not just a reproductive thing. So the, the clinical picture, what we look for is that this person is going to have what we call androgen excess. Androgens or like our testosterone or DHEA or hormonal metabolites down the stream from those.

Brie:                       And this can look like that excess hair growth that I mentioned, or male pattern, hair loss or hair thinning acne having like a short temper or mood swings or easy to get stressed out or irritable of course stress response and actually being more prone to depression. And then coupled with that, we look for ovulatory issues and signs. This would be someone who is not ovulating , like there may be having long irregular cycles or have a missing period. And in the later years, this can lead to fertility challenges. So in fact, it's the most common cause of female sub fertility. And infertility is PCOS and if you look on an ultrasound,uoften, but not always, you'll see multiple cysts like follicles. It looks like a ring of pearls. It's been said on the ovaries, on imaging. Now this is all related to insulin signaling in the body and blood sugar balance.

Brie:                       And so some of that is genetic and people with PCOS , those of us with this are born just more susceptible to developing less sensitivity to our insulin and that will drive this problem. And that can be managed with diet, lifestyle, nutrition and other therapeutic steps once you know it's happening. But before it's happening, it can just look like this kind of bunch of symptoms that's showing up in someone. In a lot of people, they could start to gain weight around their middle or struggle to keep their weight down despite having a good diet or regular exercise. But there's a whole bunch of women in fact, like over 50% who are what we call thin types, meaning they're normally or underweight even. So there's a misconception with PCOS, you know, stereotypically in, when we initially started to understand what this was, it was people, women who were overweight or obese and had, you know, hair growth, like the bearded woman, you know, in the circus and missing periods or irregular period that was like the picture. But we now understand that this affects so many more women and to varying degrees.

Jennifer:              And so for someone who's like, all right, first of all, I've got this acne, which, oh my gosh this is awful. And it, you know, it's embarrassing. There's a lot of shame around, you know, not being able to cover it up, especially when it's cystic and it's painful and your skin just is not look smooth. But then also you've had have this flip side of where we live in a society now where it's like remove all the hair that you possibly could have. So if you then have had hair removal, like I think that's a, that's actually important because if you've had hair removed in these areas, that may have been a sign of something rather than, oh, it's just an annoyance. Like your body's just like doing what it wants to do. It's actually trying to tell you there's a hormonal problem underneath the surface that's driving these symptoms essentially. I think that's an important point is that how many times do you go to the dermatologist? Gosh, I went to the dermatologist a lot as a teenager and as an adult unfortunately. And they just look at your skin and go, oh, here's some cream. Try this pill. Like they don't really look any deeper. And what we're talking about is blood sugar.

Jennifer:              We're talking about formal balance, like.

Brie:                       Absolutely no, we have to be our own advocates here. This is why I like talking about this a lot. Like what you just said. That's like one of my pet peeves or one of my issues with our system is that, so what happens is you know what happens. You go, oh, I have acne, I want help. You go to your doctor, maybe they refer you to a dermatologist. The dermatologist is going to give you drugs, right? They're not referring you out to a gynecologist to look at if you have a reproductive syndrome. And even if you are talking to your gynecologist about it. I would say nowadays more so some gynecologists are at least aware of this and we'll kind of think about it. But often even if they're helping a younger woman or even a more mature woman diagnosed polycystic ovarian syndrome, usually the only tools that they have to offer the person, or let's put you on birth control to quote “regulate your period”, which we all know doesn't actually regulate anything.

Brie:                       It just creates a withdrawal bleed and suppresses your hormones. Or if it's a woman of reproductive age who's trying to get pregnant, then it's like down the line of Clomid and invitro and you know, how can we get you to achieve pregnancy, wrangle your body into that. So no one's looking at the big picture and educating their patients and saying, hey, you have this condition, here's what it means to live with it. And here's how to keep yourself healthy over your whole life. Cause the acne and or tendency to gain weight or having to work harder to keep that balance is one thing. And that's frustrating. But there are ramifications that have to do with bone health and cardiovascular health and brain health over the woman's whole life. Even, you know, when she's in menopause. And those are the things that doing this lifestyle stuff can really help women maintain their health.

Jennifer:              So if somebody is going to go to the doctors, maybe they go to their PCP or their GP and they're like, Hey, like me, I'm the jerky patient that shows up with this list of blood labs that I want my doctor to run. Thank God my doctor loves me. But , what are some things that maybe they could go to their doctor with it are like super easy to ask for that maybe their insurance might pay for that would at least start hinting toward there being a problem. So maybe they can at least get some clues and then maybe you have some more advanced testing suggestions or something like that that would be helpful.

Brie:                       Absolutely.

Jennifer:              Yeah. So there's a couple of like the simplest labs and then there's a whole set.

Brie:                       I was that girl too. Like, hey, can I run this? Can I run that until I could run my own lab? So I'm one of the most clear signs, although I will say this isn't present a hundred percent of the time, is if you run two hormones that are commonly run in women one that's called LH, leuteinizing hormone, and the other one that's called F S H or follicular stimulating hormone. Those are hormones that help regulate our menstrual cycle. And they're often run when you do a hormone workup on a woman. So they're really easy to get. And if you run those, they should have a pretty balanced ratio, like one-to-one ish, something like that. But if the ratio is between two to one and closer to three, to one of LH to FSH, that's a big suggestion that somebody is dealing with PCOS and then they can go to look deeper.

Brie:                       The other thing I look at is I'll look at, you know, fasting glucose, but more importantly, fasting insulin because you might have normal glucose levels, but a imbalanced or overblown insulin response. And so there's actually a particular ratio we can look at between those numbers. But ultimately we're just looking for that fasting insulin. We want it to be five or lower ideally. So if it's creeping up, then that can be a suggestion. So those would be kind of like some of the first, and then also of course, I actually kind of overlook the more obvious ones. It's just running estrogen, progesterone, and testosterone. So those are other hormones that would be part of a basic hormone workup, like the LH and FSH you might see in somebody's elevated testosterone or elevated. There's another androgen or male hormone called DHEA. And that can be commonly elevated also. So if you see elevated testosterone or DHEA, and oftentimes you'll see elevated estrogen and low progesterone. So that's a pattern that's very suggestive.

Jennifer:              Interesting. And this is stuff you can actually go to your regular doctor. And if you can, you know, again, this is why there's a danger of saying you know, oh my symptoms are all separate. They're all one picture, they're all one constellation. And if you as the patient, don't put them together and present them as a picture to your doctor. If you're just like, I'm just here for my skin, but you have all these other issues going on, it's hard for them to even be able to justify running these labs. But when you sit down and you really write out all the symptoms that you have going on systemically, so as a whole, throughout your body, all of a sudden they might go, hmm, maybe I do have cause to write for these labs and your insurance will at least pay for it and give you some, you know, this is a good starting point. So if we go on to things that are more like, if we were to dive a little bit deeper, what are some other labs that real quick that you might use?

Brie:                       Yeah.

Brie:                       So these are the ones, those ones I mentioned are ones that you're going to ask any doctor. And they're probably not going to argue with that, with you about it. And then there's a couple that are like, ah, we have to have a good reason to run that. Right. So one of them is called AMH anti Mullerian hormone. That's a hormone that's usually only run when a woman is in her thirties to forties and is looking to check on her ovarian reserve, meaning how fertile her eggs are at this point, how much fertility she has lacked. So it's a pretty accurate marker. But in women with PCOS, what happens is that because they have more of the follicles that are waiting to ripen this number, it disproportionately represents this. It's not a true marker of reserve and this sense of remaining fertility, it's just the number is going to be larger because there's more follicle hanging out.

Brie:                       So that number is ideally dependent on age. So if you're under 33 years old, then the AMH might be as high as 6.8 and still be considered normal. So if you have someone who has it at like eight nine, 10 that's going to be suggestive of polycystic ovarian syndrome. But by the time you're like age 35 or 40, everybody is, all women's. AMH will have gone down relative to what it was in their twenties. And so then the more common range that we see would be between 1.3 and 3.5. So when it's more like four or five, six, that's when you know, you're kind of thinking, okay, maybe this is a PCOS picture.

Jennifer:              Interesting. So Brie, I think that at this point, knowing how much more we have to talk about, I think we should do a part two of this interview. That's my feeling here because I feel like we just have so much more to unpack because this is a big, this is a big embarrassing point for women and it's, it's a big topic.

Brie:                       Completely.

Jennifer:              So if you're if down, I want to have you come back. First off everybody. So Brie is amazing. I really love her and, and she just knows so much about hormonal stuff. That's why I know Brie has a gift for you guys. She's got this great hormone balance quiz that you can take for free to kind of give you an idea of what's going on now. Brie, how can they go take that because I think everybody's listening to this going, Oh gosh, I got to go ask for labs, but this might be a first good step in the right direction.

Brie:                       Absolutely. It's a great way to just get a general sense of if you have an imbalance of any of these hormones we were just talking about and it'll kind of point you in the direction of which ones might be out of balance. So that exists on my website, on the homepage and actually I'm on my Get Help With Hormones page and I think I can also give you the link and maybe we can post it in the notes.

Jennifer:              Yes, absolutely. We will have a link for you guys. If you come over and check out the post for this podcast. We will have all the show notes, Brie linked, everything. Again she is awesome. I really feel lucky that A, I have met her B, that I've had the pleasure of working with her a couple of times. She's super great and I hope that, you know, she'll be an asset to you just as she has been to me and she's a great resource for this kind of stuff because the hormonal component of skin issues is pretty complex. It's not simple and you have to really understand hormones. That's been my experience. If you don't really know hormones, you should find somebody who does or say, hey, I appreciate your help, but I need to find another practitioner that really understands this balance because you can mess things up when you screw with your own hormones and don't know what you're doing. So.

Brie:                       Definitely.

Jennifer:              We can see when the body is not happy hormonally, not so pleasant this things happen. So Brie, let us continue this conversation. But thank you for joining us and I can't wait for the next little chat. We're going to continue this.

Brie:                       Thanks for having me. I can't wait to come back.

Jennifer:              Alright, so Jeremy, you're going to cut this into a second. We're going to do a cut. Okay. This is so good. I was like, I can't ask you about dairy in like two minutes. I felt like that was just such a good conversation. And I'm like, this is like, we'll just do two and call it a day. Alright. So that's, this is what it's like. It's like I have to manage the time. I've got to figure out like how.

Brie:                       You're amazing I'm, so impressed. Like I don't have this experience in my, you know, arena, you know, in my world yet. So I'm really impressed at how you're doing it.