Your Acne Might Be Telling You More Than You Think
By Dr. Parya Bahrampour, ND | EBL Naturopathic Clinic | Maple, Ontario
Maybe you've tried every cleanser, serum, and spot treatment you can find.
Maybe you've been on prescription creams or antibiotics. Your skin improves for a while, but a few months later, the breakouts are back.
Maybe your acne gets worse before your period.
Maybe it's always along your jawline and chin or cheeks.
Or maybe you've noticed something interesting: when your digestion, stress, sleep, or diet gets worse, your skin seems to follow.
If you've been treating your acne for years but it keeps coming back, it may be worth looking beyond your skincare routine.
Because acne is not just about having "dirty" skin or clogged pores.
It's a complex inflammatory condition influenced by hormones, oil production, genetics, the skin microbiome, inflammation, medications, diet, and potentially the gut microbiome too.¹
So instead of only asking:
"What should I put on my skin?"
Sometimes it's worth also asking:
"What might be contributing to my acne from the inside?"
Your Gut and Skin Actually Communicate
Your gut and your skin may seem completely unrelated, but they are connected through what researchers call the gut-skin axis.
The microorganisms living in your digestive tract interact with your immune system, metabolism, and inflammatory pathways. Emerging research suggests that differences in the gut microbiome may be associated with inflammatory skin conditions, including acne.²
Does that mean everyone with acne has a gut problem?
No.
And it doesn't mean treating the gut will magically clear everyone's skin.
But if your acne occurs alongside bloating, constipation, diarrhea, digestive discomfort, or a history of frequent antibiotic use, your digestive health may be another piece of the puzzle worth considering.
Hormonal Acne Is More Than Just Estrogen
If your acne consistently appears around your jawline, chin, or lower face, especially around your menstrual cycle, hormones may be contributing.
Androgens can increase sebum production and influence the development of acne.
This is why it can be useful to look at the bigger hormonal picture when acne comes with other symptoms such as:
Irregular periods
Increased facial or body hair
Scalp hair thinning
Difficulty managing weight
Significant PMS
Changes in menstrual cycles
Conditions such as PCOS can also present with acne, which is one reason persistent adult acne sometimes deserves a broader hormonal assessment rather than another new skincare product.
Blood Sugar Can Affect Your Skin Too
Have you ever noticed that your skin seems worse during periods when you're eating more sweets, refined carbohydrates, or highly processed foods?
There may be a connection.
Research suggests that diets with a high glycemic load can contribute to acne in some people.³
Repeated blood sugar and insulin elevations can influence pathways involving IGF-1 and androgens, both of which can affect oil production and acne development.
That doesn't mean you need to stop eating carbohydrates.
Instead, think about creating steadier blood sugar by building meals around protein, fibre, healthy fats, and less heavily refined carbohydrates.
Sometimes the goal isn't to eat less.
It's to eat differently.
Does Dairy Cause Acne?
This is one of the questions I hear all the time.
The answer is:
Sometimes, but not for everyone.
Research has found an association between dairy intake, particularly milk in some populations, and acne. But the relationship isn't strong enough to say that everyone with acne should eliminate dairy.³ ⁴
If you notice that your skin consistently worsens with a particular food, that pattern is worth paying attention to.
But unnecessarily removing dairy, gluten, eggs, soy, and half your diet at the same time usually makes it harder to figure out what's actually affecting your skin.
What About the Microbiome?
This is where acne research is getting particularly interesting.
Both the skin microbiome and gut microbiome are being studied for their potential roles in acne.
Even Cutibacterium acnes, the bacterium commonly associated with acne, isn't simply a "bad bacteria" that needs to be eliminated. It normally lives on human skin.
Acne appears to involve a more complicated interaction between microbes, sebum, the immune system, hormones, and inflammation.¹
Researchers are also studying whether changing the gut microbiome could influence acne.
Some clinical trials have found improvements in acne with certain oral probiotics, but the research is still developing and results vary depending on the strains and treatments studied.⁵
So probiotics may eventually become a useful adjunct for some patients, but they shouldn't be presented as a universal acne treatment.
What About SIBO and "Leaky Gut"?
This is an area where I think we need to be careful.
The gut-skin connection is real and scientifically interesting, but we don't currently have enough evidence to say that SIBO or increased intestinal permeability is the root cause of acne in most people.
If someone has acne and significant digestive symptoms such as persistent bloating, altered bowel movements, abdominal discomfort, or other signs suggesting a gastrointestinal condition, investigating the digestive symptoms may make sense.
But I wouldn't assume that every acne patient needs SIBO testing or a gut protocol.
Testing should answer a clinical question, not simply be ordered because someone has acne.
So, How Do You Figure Out What's Driving Your Acne?
Instead of immediately eliminating foods or buying another supplement, start by looking for patterns.
Ask yourself:
Does my acne worsen before my period?
Is it mostly along my jawline and chin?
Did it change after starting or stopping birth control?
Do I also have irregular periods or other signs of higher androgens?
Do certain foods consistently seem to trigger breakouts?
Do I have digestive symptoms too?
Did my skin change after taking antibiotics?
Has my acne worsened during a particularly stressful period?
These details can help determine what is actually worth investigating.
Depending on the individual, assessment might include blood sugar and metabolic markers, androgen testing, thyroid testing, evaluation for PCOS, nutrient status, or digestive testing when gastrointestinal symptoms suggest it's appropriate.
The goal isn't to test everything.
It's to figure out which pieces of the puzzle actually apply to you.
What Can You Start With?
You don't need to completely overhaul your diet tomorrow.
Start with the basics:
Build balanced meals. Include protein, fibre, healthy fats, and minimally processed carbohydrates to support more stable blood sugar.
Pay attention to patterns. Track your breakouts alongside your menstrual cycle, diet, stress, digestion, and sleep for a month or two.
Don't eliminate foods randomly. If you suspect dairy or another food is affecting your skin, investigate it systematically rather than cutting out multiple food groups at once.
Take care of your skin barrier. Internal factors matter, but evidence-based topical skincare still matters too.
Give treatment time. Acne rarely changes overnight. Skin takes time to respond, regardless of whether you're using topical, medical, dietary, or integrative strategies.
When Acne Deserves More Attention
Acne isn't dangerous in most cases, but it can significantly affect confidence and quality of life.
And some patterns deserve further assessment.
If you're developing deep, painful cysts, experiencing significant scarring, suddenly developing severe acne, or your acne is accompanied by irregular periods, increased facial hair, scalp hair loss, or other hormonal changes, it's worth discussing with a healthcare practitioner.
Moderate to severe acne may also benefit from co-management with a family physician or dermatologist. Evidence-based topical and prescription treatments can be extremely valuable, particularly when preventing permanent scarring is the priority.¹
Natural and conventional treatment don't have to compete with each other.
Sometimes the best approach uses both.
Your Skin Is One Piece of a Bigger Picture
If you've been fighting your skin for years, you don't necessarily need another restrictive diet, another complicated supplement protocol, or another drawer full of skincare products.
Sometimes you need to look at the pattern.
Your hormones.
Your blood sugar.
Your diet.
Your stress.
Your digestion.
Your skincare.
And then determine which of those factors actually matter for you.
Because the goal isn't just to temporarily calm the next breakout.
It's to understand why your acne keeps coming back in the first place.
Ready to take a closer look at what's contributing to your acne?
Book a consultation at EBL Naturopathic Clinic
This article is for educational purposes only and does not replace individualized medical advice or assessment.
References
[1] Reynolds RV, Yeung H, Cheng CE, Cook-Bolden F, Desai SR, Druby KM, Freeman EE, Keri JE, Stein Gold LF, Tan JKL, Tollefson MM, Weiss JS, Wu PA, Zaenglein AL, Han JM, Barbieri JS. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024 May;90(5):1006.e1-1006.e30. doi: 10.1016/j.jaad.2023.12.017. Epub 2024 Jan 30. Erratum in: J Am Acad Dermatol. 2026 Jul;95(1):347. doi: 10.1016/j.jaad.2026.04.009. PMID: 38300170.
[2] Sánchez-Pellicer P, Navarro-Moratalla L, Núñez-Delegido E, Ruzafa-Costas B, Agüera-Santos J, Navarro-López V. Acne, Microbiome, and Probiotics: The Gut-Skin Axis. Microorganisms. 2022 Jun 27;10(7):1303. doi: 10.3390/microorganisms10071303. PMID: 35889022; PMCID: PMC9318165.
[3] Meixiong J, Ricco C, Vasavda C, Ho BK. Diet and acne: A systematic review. JAAD Int. 2022 Mar 29;7:95-112. doi: 10.1016/j.jdin.2022.02.012. PMID: 35373155; PMCID: PMC8971946.
[4] Juhl CR, Bergholdt HKM, Miller IM, Jemec GBE, Kanters JK, Ellervik C. Dairy Intake and Acne Vulgaris: A Systematic Review and Meta-Analysis of 78,529 Children, Adolescents, and Young Adults. Nutrients. 2018 Aug 9;10(8):1049. doi: 10.3390/nu10081049. PMID: 30096883; PMCID: PMC6115795.
[5] Lin HW, Tam KW, Huang YC. Efficacy of oral probiotics in patients with acne: a systematic review and meta-analysis of randomized trials. Clin Exp Dermatol. 2025 Dec 23;51(1):68-77. doi: 10.1093/ced/llaf388. PMID: 40832719.