Follow these guidelines and you’ll have significantly improved skin within two weeks. These actions are geared towards lowering inflammation and insulin, which are more linked to acne than any other biomarkers.

In the study pictured below, patients with severe acne had 3x the cRP (inflammation) as those with moderate acne. A similar study showed extremely elevated insulin in patients with acne.

inflammation acne study

1. Diet: Diet has a powerful effect on acne. Almost no one who eats a natural, anti-inflammatory diet will experience acne. Nutrition is a complex and unresolved subject, but the anti-acne basics are straightforward: Don’t consume any form of sugar. Until your skin is clear, consume less than 30 grams of net carbs (carbs minus fiber) a day. Avoid flour, soy, dairy, rice, grains, and alcohol. Eat mostly vegetables and wild fish with limited amounts of fruit and meat. Don’t eat anything cooked in canola, soy, palm, safflower or sunflower oil. Use olive, avocado, and coconut oil instead. Don’t eat anything processed. Avoid nuts with carbs (cashews, pistachios) and omega 6s. Macadamia nuts are excellent skin food. This is a daily meal plan that will keep your skin remarkably clear. Eat only two or three times a day to avoid excess insulin spikes. There is some reason to believe that you should eat your meals earlier in the day and in daylight. Ketogenic, Paleo, and Whole 30 diets are all good, simple options to experiment with.

2. Supplements + medications: Research has demonstrated that Metformin, NAC, Zinc (75mg/day), Vitamin D, Turmeric, Milk Thistle, Selenium, Magnesium Threonate, a daily probiotic, and Vitamin B5 can significantly reduce acne. DO NOT TAKE BIOTIN. Biotin causes acne in many people. Metformin will require a prescription, but it is very effective so worth the effort. Agelessrx, joinfound, plushcare, and other online pharmacies will prescribe this for you. Take zinc with food or you will experience nausea.

3. Tretinoin + Azelaic Acid: Tretinoin will reduce acne but can worsen rosacea. For those suffering from red skin or visible red capillaries, use azelaic acid instead of tretinoin. It is equally effective in treating acne without the side effect of making skin red and irritated. With tretinoin, there will be an initial “purging” period in which you aggressively break out.

4. Sleep: Sleep more than 8 hours every night, always going to bed at roughly the same time and as early as possible. Alcohol is the most powerful disruptor of REM sleep known to man — even a single drink damages REM sleep. If you need an alarm to wake up, you are going to bed too late. Wear blue-blocking glasses after dark. Go to sleep as soon after sunset as is realistic and don’t sleep in past sunrise. Use an Oura Ring to track your sleep and tweak your lifestyle to maximize REM sleep, deep sleep, and the total length of your sleep. Other ways to improve sleep: dry sauna before bed, lots of daytime sunlight, meditate before bed, turn off electronics at 10 pm, avoid stress at night, keep the lights off at night, and don’t eat or exercise within 2 hours of bedtime.

5. Sunlight: To regulate your melatonin cycle, spend more time outside during the day. In the shade, not in direct sunlight. Go for a 30-minute walk as soon as you wake up and another at noon. Avoid exposing your skin to the sun — walk in the shade! Your eyes (and pineal gland) need exposure to unobstructed sunlight, not your skin. I recommend blasting your body (cover your face) with direct sunlight at least once or twice a week. Use the dminder app to make sure you have optimal vitamin D but avoid burns and skin damage.

6. No coffee, No caffeine, no nicotine: If you can’t cut out coffee altogether, do what you can to drink less, and drink it further away from bedtime. Green tea is less likely to cause acne and rosacea than coffee, and easier switch to switch to than a full decaf lifestyle. Stimulants induce stress and increase sebum production, as well as making it harder to get consistently good sleep. Many people simply cannot solve acne while drinking caffeine.

7. Monitor your prescriptions and don’t use drugs: If you can’t get clear, consider switching or stopping the medication you are on. A huge portion of this site’s traffic comes from people on new medications who experience new and prolonged acne outbreaks.

8. Birth control causes acne in an estimated 20% of users. Progestin-only birth control can have unpredictable effects on acne but it more often than not it increases it. Readers had switched from Kyleena to Mirena and experienced a dramatic reduction in acne. If you are taking birth control and experience acne, consider switching birth controls or pausing it altogether.

9. Water Fasting: Fasting does wonders to reduce inflammation and acne. 24-hour fasts can be done easily, and daily 16/8 fasts are beneficial. A 5-day fast is all but guaranteed to eliminate 100% of new acne. If you experience new acne after a 5-day fast, you are allergic to something you are putting on your skin, a medication you are taking, or something in your environment. Valter Longo’s work has shown that fasting can permanently improve biomarkers associated with acne such as inflammation (measured via C-reactive protein) and fasting blood glucose.

From Valter’s website:

10. Exercise:¬†Excercise every day. Walk for 45 minutes if you can’t summon the motivation to do more.

11. Blood tests Ask your doctor for a blood test of inflammation markers (C-reactive protein), along with testosterone, estrogen, vitamin B, vitamin D, IgG, IgE whatever other biomarkers he/she finds appropriate. Fix any that are out of sync. Inflammation markers are particularly relevant to acne and easy to improve with diet and fasting.

12. Take lukewarm showers Hot showers are inflammatory, irritating, and cause your body to release histamines. They turn skin red and trigger rosacea.

13. Meditation and stress avoidance Become aware of when you feel stress. Daily meditation will make you less stressed. A continuous blood glucose monitor can help monitor stress. When cortisol (the stress hormone) rises, blood sugar rises with it. The morning before I had to deliver bad news in an all-hands talk to my company, my blood sugar was extremely elevated for 3 hours. Cortisol and elevated blood sugar lead to acne and other health problems. If you manage stress, your skin, sleep, and overall health will improve.

14. Air filter: Buy the best air filter you can justify. Particulates in the air cause inflammation. With my air filter off, my air quality monitor shows a particulate count of 15-30 inside my home. Within an hour of turning on the air filter, the count drops to 4.

This study concluded that urban air pollution is associated with inflammation, oxidative stress, blood coagulation, and autonomic dysfunction simultaneously in healthy young humans.

15. Eat earlier in the day, in sunlight if possible. Eating later in the day and at night doubles the thing of time your blood sugar stays elevated after a meal.

16. Wear a continuous glucose monitor. The Dexcom G6 is the most accurate. The Freestyle Libre is a more affordable option. Keep your blood glucose low and stable. Avoid meals that spike your blood sugar.

17. Improve your insulin sensitivity/lower your insulin resistance. This can be done with fasting and low-sugar diets. In this controlled study, those with insulin resistance had significantly worse acne.