Constipation Can Trigger Acne According To A Naturopathic Doctor — Here's How

Naturopathic Doctor By Stacey Shillington, N.D.
Naturopathic Doctor
Stacey Shillington, N.D., is a naturopathic doctor of medicine who is a graduate of Canadian College of Naturopathic Medicine and McGill University, where she was the recipient of McGill’s prestigious Scarlet Key Award
woman with slight acne on her chin

After helping thousands of acne patients heal their acne over the years, I know this for sure: I cannot help my patients clear up their hormonal acne unless I help them resolve their constipation first.

It may seem like a bit of a stretch—I mean, we understand that the state of the bowel influences your skin, but can it really affect your breakouts that much? The answer is a solid yes. Traditional naturopathic doctrine has always recognized the strong relationship between the gut and the skin, and the connection between hormonal acne and constipation is especially solid. (Editors note: Modern medicine is catching up via expansive research on the gut-skin connection, thankfully.)

Well, having the bowels move at least once daily is critical to help remove and prevent the reabsorption of waste products in the body. Any less than one bowel movement per day is considered constipation, along with straining or feeling as if you haven't fully evacuated.  

What causes constipation, and how is it tied to your skin?

The most common causes of constipation include lifestyle choices such as a low-fiber diet and not enough water or exercise. But many people with acne also have other factors that affect the mobility of their bowels and can lead to a vicious cycle of constipation and acne.  

Many acne patients have many issues with their gut and motility. In fact, often there are genetic polymorphisms (put very simply: something that's inherited) in acne patients—which is one of the reasons that acne is often genetic—that can even lead to liver stagnation. This affects bile production, which can inhibit the motility of the large intestine, leading to constipation.

Another overlooked cause of constipation is an imbalanced microbiome, which is very common when acne is present. An overgrowth of certain microbes in the gut can lead to the fermentation of ingested food, which creates gases that inhibit the bowel from moving optimally.  

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Why is constipation so bad for hormonal acne?

Hormonal acne is often the result of an imbalance between estrogen and progesterone levels, and very often estrogen is the dominant hormone. The goal of healing hormonal acne is to balance these hormones, and constipation can make this incredibly difficult.

The body needs to metabolize and remove excess estrogen from the body, and the liver and large intestine have to work very closely to make this happen efficiently. The liver is responsible for inactivating estrogen by adding a methyl group and making it water-soluble, and then the large intestine is supposed to remove it from the body.  

When constipation is part of the picture, however, two things happen that lead to increased estrogen levels in the body—and more hormonal acne:

  1. Chronic constipation is often accompanied by an imbalanced microbiome—which can lead to the overproduction of an enzyme called beta-glucuronidase. This enzyme reactivates the previously inactivated estrogen in the bowel and allows it to be reabsorbed into the bloodstream.
  2. Constipation allows the estrogen to sit in the bowel for a longer period of time–which means the enzyme beta-glucuronidase has more time to reactivate more estrogen and send it back into the body. The cycle continues.

The result? As more estrogen reenters the body, the imbalance between estrogen and progesterone is amplified and hormonal acne is aggravated.

Practices that promote daily BMs and clear skin.

A few tips to help you keep regular:

  • Increase your fiber consumption. Aim for six to nine servings of nonstarchy fruits and vegetables daily, and consider adding raspberries, which contain more grams of fiber per cup than any other fruit or veggie out there!
  • Drink more water. An easy way to calculate how much water you should drink daily is to convert your weight into kilograms and drink that many ounces of water each day. For example, 120 pounds converts into 54 kilograms, which means you should drink approximately 54 ounces of water each day.
  • Move more. Daily exercise and movement encourage the large intestine to increase its contractions, which promotes bowel movement.
  • Support your liver. Because efficient liver function is important to produce adequate bile, consider supporting your liver with supplements such as milk thistle, NAC, alpha-lipoic acid, and glutathione.
  • Balance your microbiome. To prevent the production of beta-glucuronidase, you need to reduce the fermentation that can lead to further constipation. You can consider taking a probiotic and including more fermented foods, such as sauerkraut and miso, into your diet.*
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