Why You're Still Breaking Out: The Root Causes of Acne a Naturopath Actually Looks At
Acne is one of the most common skin complaints - but it's also one of the most misunderstood. If you've tried every topical cream and still can't figure out why you're breaking out, you're not alone. As a naturopath, the biggest thing I see in clinic is people treating their skin as a surface problem when it's actually an internal one.
This post breaks down the key drivers of acne and what a truly holistic approach looks like.
Acne Is More Than Skin Deep
Your skin is your largest organ. When something is off internally - whether that's your hormones, your gut, your blood sugar, or your stress levels - your skin is often the first place it shows up. Acne isn't just a teenage rite of passage. Adult acne is incredibly common, particularly in women, and it's usually a sign that something deeper needs support.
The Main Drivers of Acne (That Most People Miss)
Hormonal Imbalances
Androgens like testosterone drive excess oil (sebum) production, which clogs pores and causes breakouts. This is especially common post-pill, with PCOS, or during hormonal fluctuations throughout the menstrual cycle. Breakouts around the chin and jawline, or that flare just before your period, can point to hormonal involvement - but not always.
Insulin Resistance
This is a big one that flies under the radar. When blood sugar is chronically unstable, the body produces more insulin - and insulin itself acts as an androgen. I've had clients with unexplained acne whose insulin levels came back elevated, and once we addressed that, their skin improved significantly.
Gut Health and the Gut-Skin Axis
Your gut and skin are deeply connected - they even share a microbiome. An imbalanced gut microbiome, leaky gut, or poor digestion can all drive systemic inflammation that shows up on the skin. Irregular bowel movements also mean your body can't effectively clear excess hormones and toxins, which can worsen breakouts.
Stress and Cortisol
Chronic stress raises cortisol, which in turn drives androgen and sebum production. This is why skipping meals, over-exercising, or doing extreme diets can actually make your skin worse - they're all forms of stress on the body.
Nutritional Deficiencies
Nutrients like zinc and essential fatty acids are critical for skin barrier repair and inflammation regulation. If your gut isn't absorbing nutrients properly, or you're not eating enough of the right foods, your skin will struggle to heal and recover.
What to Eat for Clearer Skin
The foundation is simple: a whole foods diet with regular, balanced meals. Three meals a day with complex carbohydrates, protein, and healthy fats keeps blood sugar stable - which is one of the most impactful things you can do for your skin.
Key foods to prioritise:
Zinc-rich foods: Nuts, seeds, seafood (especially oysters and shellfish)
Healthy fats/omega-3s: Oily fish 2-3x per week, avocado, olive oil - or a quality fish oil supplement
Vitamin A: Carrots, pumpkin, sweet potato, and liver (or desiccated liver capsules)
The Lifestyle Piece
Supporting your hormones means more than eating well. It also means:
Going to the bathroom regularly (essential for hormone detox)
Reducing exposure to endocrine-disrupting chemicals in plastics, skincare, and home products
Managing your stress load and nervous system - consistently, not just occasionally
A Real Client Story
One client came to me with persistent acne alongside other symptoms. Microbiome testing revealed a pathogenic strain of E. coli. Once we cleared that, her skin improved dramatically - just in time for her wedding. No topical product would have found that.
The Bottom Line
Acne is almost always multifactorial, and the best results come from addressing both the inside and the outside. If you've been trying to treat your skin from the outside and not getting results, it's time to look deeper.