The Connection Between PCOS and Acne + How to Start Restoring Balance

Acne is a common symtom of PCOS, but why? What’s happening within the body that’s resulting in acne, and what can be done to set things right?

In this interview, I sit down with PCOS expert Vivien Allred of Viva Natural Health to discuss the connection between PCOS and acne, and her best tips for restoring balance to your hormones and skin.

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Welcome to the Expert Skinterviews Series, where I sit down with experts in the holistic health and wellness fields to discuss different aspects of the body system and our health as they relate to the health and appearance of our skin, both from the inside out and outside in.

The interviews are short and quickly get to the heart of the matter — the biggest takeaways on the topic straight from the expert.

Today we’re talking with Vivien Allred (Dip CNM, mBANT, CNHC), who specializes in polycystic ovarian syndrome or PCOS.

And a very common symptom of PCOS — for reasons we’ll discuss — is acne. Since around 10% of all women have a form of PCOS, I knew this is a topic we needed to talk about in the Expert Skinterviews series.

In this interview, Vivien and I chat all about:

• Vivien’s personal experience with PCOS and acne (2:15)
• What IS PCOS and the most common symptoms (6:00)
• The root causes of PCOS (9:12)
• Why acne is such a common symptom of PCOS (13:00)
• The most important steps to take to restore balance back to your body and skin if you are currently struggling with PCOS (15:55)

Vivien’s podcast ‘Hormones in Harmony’ has quickly become one of my favorites, and I knew she’d be the perfect person to have this talk with.

So now without further ado, let’s hear from Vivien all about the connection between PCOS and acne.

[Full interview transcript below video]

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COMPLETE INTERVIEW TRANSCRIPT

Nadia: Hi again, Vivien. Thank you so much again for talking with me today. And I’m so excited for our conversation because you specialize in PCOS and as we know, PCOS affects so many women. It’s about one in 10 or 10%, which is definitely not a small number and acne is such a common symptom of PCOS. So of course, I knew that this was something we needed to talk about in this Expert Skinterviews series and that you would be the perfect person to sit down and chat with about this. And so I’ve already introduced you, but I’d love to hear just a little bit more about your own personal story and what’s really inspired your work and led you to where you are.

Vivien: Thank you, first, for having me. I’m always happy to discuss PCOS and acne because it’s something that I’ve struggled with myself personally. So I understand the anxiety and the struggles that you can experience going through that. So for me, I was perfectly healthy all through childhood and the start of my teenage years, and I was always the one who had amazingly clear scan – like porcelain skin and I was always that annoying person who would never get a breakout. And then things really turned when I was around age 18: I started to over-exercise and under-eat to try to look better and get lean. But my skin light exploded in acne and I always said that it compensated for the lack of acne that I had for the previous years – I got it all at once. When everyone else’s skin was clearing up mine became absolutely terrible, and it was literally all over my face. 

My hair was falling out, my periods stopped, and I looked good physically – like people complimenting my weight and saying how good I looked – so that obviously fueled the fire, but after a few months I was like, “This isn’t good. This is harming my mental health now – I’m anxious and depressed because of these symptoms.” So I went to the doctors, and they diagnosed me with PCOS because I had no periods, I had acne, I’d heard hair loss. – I was displaying typical symptoms, all of that. And they put me on the [hormonal birth control] pill. They said your option is to just carry on with what you’re doing and see what happens. Obviously, if I wasn’t going to change anything it would just get worse. And being 16, I didn’t necessarily want a period – I didn’t care about that – but I wanted my skin to be clear. That was like my number one goal. 

So I was like, yeah, I’ll go on the pill. And the first pill I went on was absolutely terrible – I had a really bad reaction. I became really depressed for the first month and only lasted like a month on it. I was like, I have to come off. And then I swapped to another pill and stayed on that for two years and that definitely cleared up my skin. It looked amazing. It was back to how it was originally, but other things started to happen: I would get lots of food sensitivities and digestive issues, and mood issues as well. A lot of things happen in the next few years: I developed gut infections and thyroid issues and adrenal issues. Eventually I came off the pill and my skin got a hundred times worse again because of something called an “androgen rebound”…

Nadia: Oh, I’m very familiar with that. That was my personal story.

Vivien: [After stopping the hormonal birth control pill, it’s common that] your sebum and your testosterone become overproduced because you’ve suppressed it for those many years that you’ve been on the pill. And I was like, “Should I go back on the pill? Do I need to go on Accutane or something?” 

But I stuck it out. I addressed all of the underlying imbalances, like nutrient deficiencies, poor gut health, stress. And the missing puzzle piece for my skin in particular was histamine. So I have information on this on my blog, but that was really my last thing. My skin did clear up with addressing the male hormones, but my last thing was histamine in my situation – and I know that this isn’t for everyone, so I’m not talking about that too much. But addressing the male hormones, the insulin resistance, all of that: it really made a huge difference.

Nadia: And the histamine intolerance is actually really interesting because so many histamine-rich foods are really healthy foods. So yeah, I’d love to link to that post for sure.

[See Vivien’s blog post Histamine & Your Hormones for more information]

And can you quickly explain what PCOS is? So a quick rundown and the most common symptoms.

Vivien: So the classic classic ones: typically women with PCOS have insulin resistance. It can be pretty mild and not really affected the weight, or it could be full blown where they are obese or morbidly obese as well. Acne is a big symptom, especially for women who have acne into the adulthood and it doesn’t really improve when they come out of puberty, and if it’s on the lower part of the face as well, that can be due to PCOS. But in extreme versions, it affects the whole face, or sometimes the back on glutes in some cases because these are the places with the most sebum production and androgen receptors as well. If you think about it, these are the places that males typically grow beards [and hair]. And then hair loss can be an issue. There are other causes for hair loss, but hair loss can be a symptom of PCOS as well. You can have irregular cycles or no cycles, or you could have amenorrhea. You may have issues with your fertility because PCOS is the leading cause of infertility in women of reproductive years. 

And it really is a complex reproductive and metabolic disorder. So it’s not just about hormones, even though it is an imbalance of male and female hormones – classically, that’s what the overview of it is – but it also involves the metabolism as well, and insulin and blood sugar really play a huge role.

There are all different types of PCOS. It could be driven by stress, it could be driven by insulin, or inflammation, or poor gut health. So conventionally we’re told that you just need to lose weight by eating less carbs, exercising more. But for someone who isn’t insulin resistant or just has adrenal issues – so their PCOS is driven by stress – that could actually make the situation worse. Hence why a lot of women don’t get the relief that they want with that – they can’t lose weight. 

[See Vivien’s blog post The 4 PCOS Types & How to Identify Yours for more information]

So the conventional approach is hormonal birth control pills, maybe Metformin, maybe Spiralactone. But we need to address the root causes because if you just symptom-suppress, that’s just going lead to imbalances down the line.

[See Vivien’s blog post Conventional PCOS Medications & 6 Natural, Effective Alternatives for more information]

Nadia: Your story is so similar to my own. So I wasn’t officially diagnosed with PCOS as a teenager, but I was put on birth control at 16 because I started menstruating at age 13, but then between 16 or 13 I probably had my period only a handful of times. And so then they put me on the pill. And then when I got off of it at 21, I experienced that androgen rebound. But like you’re saying, these medications are really just suppressing symptoms and then they can come with their own side effects. And ironically with the pill, one of those big side effects can be that androgen rebound. 

So you just kind of touched upon some of the root causes of PCOS. Can you expand upon some of them a bit more?

Vivien: So there are three big drivers of PCOS. 

The first one is insulin resistance, and people may have heard of this in terms of diabetes, type two diabetes – that’s the extreme version. How it starts off is insulin resistance. And it’s basically where our body becomes numb to the actions of insulin. So what happens when we eat tis: blood sugar levels rise, naturally, and then insulin comes along and it takes that blood sugar from the bloodstream into the cells. But what can happen in insulin resistance is this process gets disrupted, and the glucose can’t get into the cells to be used as energy. And that leads to the blood sugar rising and insulin starts to rise because it’s trying to pump that blood sugar back into the cells where it should be. The body doesn’t like to be out of homeostasis – it likes blood sugar to be regular, regulated, and controlled. And when that doesn’t happen, that can lead to insulin resistance. With PCOS, the excess insulin can stimulate the ovaries to produce testosterone and other androgen hormones, which can interfere with ovulation and drive symptoms like acne.

The other one is stress. So chronic cortisol release can drive PCOS as well. 

And inflammation, and this can stem from multiple different factors. A lot of the times, it’s poor gut health because the home of our immune system is primarily in the gut, and the immune system is in control of inflammation – so if there’s a chronic gut infection or you’re constantly eating foods that you’re sensitive to, that’s going to cause a lot of inflammation. And that can negatively impact female hormones because evolutionarily, if we’re stressed – either mentally or emotionally, or physically – the body wouldn’t want us to potentially conceive during that time and have a baby around because it’s not a safe environment. So our body and our genes haven’t really adapted to know the difference between finances and bills and a gut infection or a chronic inflammatory response in the body.

Nadia: It’s so interesting. I think that so many of us are so stressed these days and that’s always the most difficult aspect when I’m working with clients – stress management. I was happy to hear you say that. And over-exercising is also something I see a lot and you even explained that that was part of your story.

Vivien: People are trying to do the right thing with exercising, especially if they’ve been diagnosed with PCOS but they’ve not been told what type of PCOS or what their drivers are, and they go online and start reading about PCOS and how they have to exercise and do all of this cardio and restrict carbohydrates and sugars… and then they actually make things a lot worse.

Nadia: It’s a good reminder that every body is unique, and we always need to be in tuned to what our unique body really needs. And also to take every bit of advice – especially if you’re not working with somebody like yourself or myself directly – to really take everything with a grain of salt and really be in tune with your body as you’re moving through the process. Because certainly that’s so frustrating: when you feel like you’re doing it all and you’re following all the advice and things aren’t getting better or they could even be getting worse. 

And so we’ve talked a lot about insulin and androgens and could you just explain a bit more about the connection between insulin and androgens and acne? And why acne is such a common symptom of PCOS for this reason?

Vivien: So as I mentioned before, when insulin resistance occurs, we end up with really high levels of blood sugar – really high levels of insulin circulating in the bloodstream – and that’s very inflammatory to the body. And this excess insulin in women with PCOS can stimulate the outer cell of the ovaries called the fica cell to kind of thicken and over produce androgens… and then obviously the excess androgens can interfere with ovulation – and PCOS really is a condition of chronic unovulation – so either you don’t ovulate at all, or you ovulate at different times of the month, you ovulate at way too late in the cycle. (And that obviously impacts fertility as well.) And the androgens that are produced can upregulate sebum production. 

[Androgens] can cause the skin not to shed as it should. And obviously excess sebum and inflammation in the skin is a precursor to breakouts. So that’s the main reason behind the breakouts: the androgens over produce oil in the skin and can lead to breakouts.

Nadia: Yeah. And that process you talked about where the skin cells aren’t shedding properly, it’s called hyperkeratinization… so when everything is operating as it should be, the skin cells are shedding and there’s no problem – that’s part of the skin’s own exfoliation process. But with hyperkeratinization, they’re instead shedding in these little clumps, and those can very easily get clogged in the pore – it’s like a little cork in the pore. And then also with the elevated androgens, we’re getting excess sebum production. So if you have a cork in the pore and you have more oil that now can’t escape because it’s corked, you’re of course going to get that back up and get a zit. And that’s when we get the inflammation and the classic breakout that we all know oh too well.

Vivien: And the other thing is with acne and skin and PCOS: the androgens interfere with our progesterone. Typically we only produce a hormone called progesterone once we ovulate. So women with PCOS are typically very chronically low in progesterone. Progesterone is so important for skin health, hair health, mood, and all of that. So if anyone’s struggling with premenstrual symptoms or acne breakouts prior to [menstruation], or they have issues with their hair… that can be a lack of progesterone because progesterone is the pro-pregnancy hormone, whether you want a child or not. And we’ve all seen those pregnant women who glowing – their skin’s clear and hair is luscious and thick – and that’s due to progesterone as well. So with women with PCOS though, they’re not being exposed to the right amounts of this hormone as they should be because they’re not ovulating correctly.

Nadia: And so if a woman were to come to you with PCOS struggling with acne, what are the first steps you would take to balance her body and her skin? (Which of course is just one symptom of PCOS.)

Vivien:  So the first step is to regulate blood sugar, because again, if insulin resistance is an issue. And like 70 or 80% of women with PCOS have some degree of insulin resistance, and this should be [diagnosed] with thorough investigations – blood glucose testing, insulin testing, all of that; the fasting glucose test alone isn’t enough. But certain symptoms can indicate issues with blood sugar as well: so if you maybe store a lot of your weight in the abdomen; maybe experience skin tags; you could have thickened, dark patches of your skin called acanthosis nigricans; you may feel tired after eating (particularly carbohydrate heavy meals); you may have sugar cravings. These are just some of the signs of insulin resistance. 

[Vivien has a great free download called “PCOS Tests to Request” that you can download HERE.]

So regulating your blood sugar is just crucial for any hormone imbalance that you might have because the number one job of the hormonal system or the endocrine system is to regulate blood sugar – it needs to make sure that glucose is being delivered to the brain and internal organs every moment of the day. So if we’re not doing that correctly – if you’re not eating the right combinations of food – your body’s not going to care whether you have clear skin, pain-free menstrual cycles because you’re not doing it’s number one job.

So the best way to stabilize your blood sugar would be first to close out the inflammatory process. Refined sugar foods, we probably are all all the words that already. Um, but just trying to stick to that as much as possible. Eating real, whole foods – organic as much as possible. And every meal that you have have a source of protein, healthy fats, and fiber – that’s going to help to keep your blood sugar levels nice and stable throughout the day. And I’m not a fan of snacking – so if someone’s snacking like five, six times a day, that’s going to keep your insulin levels way too high.  And obviously women with PCOS already struggle with that, so we don’t want to exacerbate that. So periods of fasting can be nice between meals. I’m not a fan of skipping breakfast or anything like that – which I know is trendy these days. I’d rather someone eat breakfast, lunch, and dinner, and do a nice five, six hour fast between those meals. That helps to bring insulin levels down before the next meal so that they’re not remaining elevated all day long. 

The next thing would be to be more active, and this doesn’t mean killing yourself at the gym, doing back to back classes like I was doing it. It’s just about moving your body throughout the day as well. So parking further away from the grocery store or walking up the stairs rather than taking the elevator. All of these things are really important and spending more time standing and moving around… doing some like lunges, squats, between emails, especially if you’re office-based and just trying to be active.

Particularly walking after meals can be really helpful if you have insulin resistant PCOS because if you have carbohydrates then you just sit down, you’re not really using them efficiently. So you can support your body in using them by putting on your shoes, going out for a brisk walk for 10 to 15 minutes after your most carbohydrate heavy meal that you’re having… so maybe dinner for most people… that’s going to help getting your steps in for the day, getting some fresh air outside, and helping your body and your legs to mobilize glucose. 

And my final tip would be to optimize sleep. [Studies have found that] one night of sleep deprivation reduces insulin sensitivity by up to 33%. So you could be eating in the morning, you could be meditating, you could be doing all of the right things… avoiding these environmental toxins… but if you’re not sleeping, it’s all going to be ineffective regardless.

Nadia: And again, it’s that lifestyle factor, like stress. These are the two things I really struggle the most with clients, getting them to really prioritize stress and sleep. And it’s even my biggest struggle, I don’t know about you… we know we know all of this, but yet it can be hard to implement in your own life even sometimes. And I love the tip of going for a walk after dinner because that also in itself can be really stress relieving and also helps set you up to get a better night’s sleep. And a tip that I like to share usually is the legs up the wall yoga pose – it pushes your body into that parasympathetic mode, helps you get into rest and digest mode, sets you up for a good night’s sleep. So thank you for going through all of that. 

And the other thing I just want to mention before we wrap things up is that as you’re working to balance your blood sugar levels, sometimes cravings can feel really strong. And so if you do have to snack, I always like to say “punch your cravings in the face of protein and fat” rather than giving them carbs. Because you will get sugar cravings as you’re working to balance things out. But instead, you want to be looking to the protein, the fat, and the fiber rather than, crackers or chips or something that you may be craving because t’s not going to be helping you – it’s certainly not going to be helping to balance your blood sugar levels. It’s just going to set you back on that blood sugar roller coaster. 

Vivien: Just start slowly as well. If someone’s eating like six, seven times a day, they don’t expect to go straight to three meals a day. Tomorrow you’re going to feel terrible. Reduce one snack every week and then over time your body will adjust and it will be much more of an easier transition.

Nadia: There’s nothing wrong with taking slow, steady steps.

And one last question. If you just had one quick message to tell anybody who is where you were just a few years ago – so struggling with PCOS, struggling with acne, really looking for an answer, struggling to find that solution – what would you like to tell them?

Vivien: I wouldn’t overlook the simple things… so just eat real food, eat regular meals with balanced macronutrients [protein, fat, carbs], sleep, prioritize stress management… do all of these things first before you even look into the fancy serums, the fancy super food portions…  because yes, they can be helpful, but if you’re not addressing the basics, then nothing’s ever going to be effective longterm.

Nadia: Totally agree. Thank you so much, Vivien!