Join Date: May 2002
| | The ACCUTANE - DIET connection
Ok, well I originally goofed on my initial Accutane, Insulin, Puberty post [url="http://www.healthboards.com/ubb/Forum1/HTML/016428.html"]http://www.healthboards.com/ubb/Forum1/HTML/016428.html[/url] , but I am now about to correct that. ;-)
Truth is that Accutane is a bit of a paradox. It actually INCREASES Insulin Resistance while on treatment, but the effects usually disappear afterwards. [url="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_u ids=11747145&dopt=Abstract"]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list _uids=11747145&dopt=Abstract[/url] While on treatment you can get High LDL levels, poor glucose disposal rates, increased Insulin Secretion, and low SHBG. Wow, it seems to go against everything that we are trying to accomplish (clear skin) by going on these diets and medications etc.
On the other hand, Accutane still treats acne, but the effects are only during treatment (supposedly). Anyway, apparently it does so because the effects of 13-cis-retinoic acid (causes the above) possibly overrides certain aspects of IR, so that it can still inhibit DHT conversion in the sebaceous follicles, decrease sebum production, and slow skin cell shedding, etc. Therefore, it does still work positively along the hormonal aspect of the Insulin Resistance pathway. Meanwhile, Roche hasn't entirely figured this out and that's OK because
there are several articles out there that explain WHY: [url="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_u ids=11880314&dopt=Abstract"]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list _uids=11880314&dopt=Abstract[/url] (nothing to do with acne but proves that retinoic acid increases IGFBPs) [url="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_u ids=9064277&dopt=Abstract"]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9064277&dopt=Abstract[/url] (vit. A and it's role) [url="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_u ids=11404231&dopt=Abstract"]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list _uids=11404231&dopt=Abstract[/url] (proves that it depends on the form of Vitamin A as to whether a certain type of IGFBP hormone will be increased). [url="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_u ids=7518821&dopt=Abstract"]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7518821&dopt=Abstract[/url] ( I think this is also a good one to read)
Of course, if you can't understand that, then this is my version of how Acne, Insulin Resistance, & Accutane all tie together:
OK, so you're at lunch and you eat something, lets say a SANDWHICH (meat, vegetables, grain bread), and it enters your digestive system where it's broken down. Now, depending on it's glycemic load, a certain amount of glucose will be available for your body's energy needs. This prescence of glucose will cause your pancreas to produce insulin to enhance glucose utilization and sometimes it will be a HUGE amount of insulin! Insulin works by binding to insulin cell receptors to allow glucose to pass through the cell. Now, if your body (cells, tissues) doesn't need the glucose, it will be converted into glycogen and fat for storage in your liver, skeletal muscle, adipose tissue, and skin.
Now, if your liver can NOT store the glycogen & fat and your cells & tissues will not accept the glucose then you have a problem. This is known as Insulin Resistance, which can later lead to Type I Diabetes (don't make enough or ANY insulin), Type II Diabetes (unable to use the insulin you do make), Heart Disease (due to high LDL cholesterol levels, free fatty acids), Hypertension, Dyslipidemia (lipid imbalance in blood stream), Obesity etc. all prevalant in most Western societies. So anyway, IR occurs because your cells are either too full of glucose or they don't RECOGNIZE the insulin you do have. As a result, you not only have all this extra insulin, but glucose, free fatty acids & amino acids floating around in your blood stream with no where to go....
Now, some of us do not have the same gene defects (read middle of article on CYP450 for specifics). Therefore the PATHWAY to this next part, is different for all of us depending on what our defect, or in other words, hormonal disorder is. Examples of hormonal disorders with acne as a POSSIBLE Symptom are Hypothyroidism, Hyperadrenalism, Insulin Resistance, Polycystic Ovarian Syndrome (PCOS)-Syndrome X, Hyperandrogenism, Congenital Adrenal Hyperplasia (CAH), Hypercortisolism - Cushings Syndrome, etc.
So depending on the pathway, this extra or free insulin is going to cause your Adrenal Glands and Ovaries OR Testicles to produce the followingSteriod Hormones: Estrodial, Estrone, Progesterone, Testosterone, Androstenediol, DHT (5-alpha-dihydrotesterone) and DHEA (Dihydroepiandrosterone). These hormones in excess or in deficiency create your...hormonal imbalance.
Obviously, if it's in excess you know why you have the problem, but what about if you are deficient in a hormone (vitamin, enzyme, etc) right? What happens is that your body is looking for this hormone and if it can't find it, and is capable of making it, will produce MORE. At least it thinks it's producing more, but sometimes it's unable to produce the hormone and as a result, OTHER hormones get overproducedin the process.
The same thing applies to IR, if your cells don't recognize the presence of insulin (can't bind to cells), then your body keeps making more insulin, "thinking" that you don't have enough in your system. Unfortunately, it doesn't matter how much your body produces or tries to produce of a hormone, because there is a problem in the pathway that makes this mechanism work perfectly. Therefore, until the defective pathway is FIXED, the viscious cycle will continue...or get worse (burnout, tumors, cancer).
One of the results of this would be testosterone conversion into DHT (a super androgen) in your blood stream and in your sebaceous glands & hair follicles. There are several enzymes responsible for this conversion such as, 5-alpha reductase, 3-alpha-hydroxysteroid dehydrogenase, and 3-beta-hydroxysteroid dehydrogenase. As a result of DHT conversion, there's an increase production of sebum, skin cell proliferation, inflammation, etc. all thought to contribute to the production of acne in SUSCEPTIBLE individuals.
Does any of the above sound familar? Well it should considering that by now we should have learned that during Puberty, we ALL go through a state of INSULIN RESISTANCE! The only way our tissues can grow is if they become insulin resistant (IR). Therefore, IR increases the proliferation of not just tissue cells, but skin cells, etc. Now through your DIET you will accquire or overproduce IGF-1 (Insulin-like Growth Factor) and Insulin, both of which increase our male hormones. However they do this because we have DECREASED levels of IGFBP-3 (Insulin-like Growth Factor Binding Protien) and SHBG (Sex Hormone Binding Globulin). Both of which bind steriod hormones and growth factors that are responsible for the production of acne and certain other hormonal & health (cancer, tumors) problems.
Now, this is the pathway to which Accutane (13-cis retinoic acid) works. It increases your IGFBP-3 hormone which prevents IGF-1 from binding to the androgen receptors. In turn, this prevents the production of Androgen which means a decrease in the amount of DHT (5alpha-dihydrotestoterone) that will be converted in the sebaceous follicles. Furthemore, it also DIRECTLY prevents the conversion of DHT by inhibiting the enzyme (3alpha-hydroxysteroid dehydrogenase) neccessary for this function.
So Vitamin A, Natural Accutane (program by which you create your own 13-cis retinoic acid), and Accutane are going to attack acne by INCREASING IGFBP-3. Which prevents IGF-1 from binding to androgen receptors, decreases androgen production, DHT conversion, skin cell proliferation, and sebum production. While various other medications, supplements (like the popular B5) and also various DIETs are going to attack acne along other Insulin Resistance pathways.
So if we continue discussing diet, then by avoiding certain problematic foods for YOU, like High Glycemic Load Carbohydrates, etc you can naturally INCREASE SHBG and IGFBP-3. Now, we already know what IGFBP-3 does by reading the above articles, and SHBG works by having a higher affinity to binding male hormones over female hormones in your system. In fact, in the presence of Estrogen (birth control pills), SHBG will be further synthesized in the liver, but in the presence of Insulin, it won't be produced and Obesity, Acne, Hirusitism, PCOS, Hypothyroidism, ovarian tumors, and enlarged prostates, and gigantisism can result.
Furthermore, just by lowering or balancing your insulin levels which HAVE been done through dietary changes and/or medications/supplements, you will also prevent the conversion of DHT by inhibiting enzyme (5-alpha reductase and 3-beta hydroxysteriod dehydrogenase) function, skin cell proliferation, inflammation, and sebum production. However, not everyone notes a complete decrease in sebum production, despite dramatic improvements in clarity. Which indicates that sebum production isn't neccessarily NEEDED to have acne. If you think about people with dry skin with acne and others with ingrown hairs, the problem isn't sebum but skin cell proliferation, poor exfoilation, and inflammation, right?
Of course that aspect can be controlled or prevented, topically anyway, by following a regimen similar to the "Acne Cure" I've been doing the Acne Cure for years now and I didn't even know it...lol. Using (gentle) acids and exfoliants on your skin is great way to help unglue the clogged pores (sebum helps here), and encourages faster skin cell turnover & shedding. Not to mention, taking certain vitamins will also enourage faster healing and skin cell sheddingwhich I guess is what makes an acne sufferer's skin different from someone that happens to just have "Oily" skin.
Now, I would like to clarify once and for all (LOL) that we don't all experience the same SYMPTOMS and that is also why Diabetics (type 2) and kids going through PUBERTY (medically defined state of Insulin Resistance)don't ALL get acne, hirsutism, etc. Symptoms can be external or internal and they vary WIDELY depending on what ENZYME/GENE is defective (usually somewhere on a CYP450 gene [link=drnelson.utmem.edu/P450lect.html]drnelson.utmem.edu/P450lect.html[/link] ) and they could occur at the age of 10 or possibly catch up to you in late adulthood. I guess that's what makes people feel safe and comfortable to do whatever they please DESPITE the scientific evidence behind it all.
For example, did you know that Insulin Resistance is not only genetic but can also simply be passed on if the Mother is in an state of Insulin Resitance during pregnancy? Perhaps that's why some kids have terrible problems that their parents didn't have. Of course, the research wasn't there 50, or even 30 years ago, but it is here now! So in terms of general good health, that right there is the reason we should be getting the Willett's Food Pyramid in 2004. Yes, thankfully, they have admitted that the USDA Food Pyramid was not based on much scientic research and may be the reason behind increasing Obesity and Diabetes rates.
Therefore, I understand one's skepticism and distrust, but you've got to learn to research and connect the dots for yourselves. For when you do, you'll discover that while there are MANY different ways to attack acne, there are also treatments in existence that are SAFE & effective, but were never fully publicized (like topical spironolactone) [url="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_u ids=2972662&dopt=Abstract"]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2972662&dopt=Abstract[/url] and [url="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_u ids=2150020&dopt=Abstract"]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2150020&dopt=Abstract[/url] . Nevertheless, the majority of the topicals, medications, supplements (like B5), dietary changes (allergic or not), and alternative methods (meditation, exercise, etc) b]all work on some hormonal level[/b]. As such, they are all attempting to either fix your homonal imbalance by Controlling your Insulin, by preventing the Conversion of DHT in sebaceous follicles, by preventing the proliferation of skin cells, or by reducing your free testosterone/androgen in the blood stream, etc. ALL of which could be caused by a lack of Insulin sensitivity or Insulin Resistance.
So once again, prolonged hormonal imbalances are due to some sort of lack of an enzyme, which explains why SOME people cleared when taking Probiotics, Digestive Enzymes or doing Liver Cleanses & Detoxes. Not to mention, that since most of us use treatments ranging from topical anti-androgens to Internal Anti-androgen medications, supplements, diets or exercise programs we have found ways to reduce, control or ELIMINATE acne (and other hormonal problems). Therefore, you must analyze your body's own "blue print" and depending on YOUR own external and/or internal factors and [/b]personal sensitivty level[/b], you may need to use one or ALL of these methods to solve your problems.
Also, I am not ALWAYS entirely for dietary changes only. Not everyone HAS to do that. I believe that many factors (Environmental, External, Internal-Mental) are involved with acne and just because one is irrelevant to you, doesn't mean that it is for someone else. Unfortunately because there are NUMEROUS choices out here, at some point we have ALL chosen the wrong ones. The truth is, whether some of you like it or not, certain methods work BEST for certain people. Hence, one must know their body and understand just what hormones & enzymes are involved in causing THEIR problems. Once they do that, it is easier to find a treament (natural or traditional) that will be more effective than anything they've done before. Unless of coure they simply GROW OUT OF IT, as I'm more often wondering is the case with Accutane...
If you don't know what is wrong inside, then you should discuss your problems & "symptoms" with your doctor so that you can be referred to a Gastroenterologist, Endocrinologist, Allergist, Nutritionist, Naturopath, or some other Specialist that will help you find out. For most of you this is, thankfully, only puberty (still suxs), but for others this can continue for several decades. While I know some of you tend to worry & overdo things, thanks to the angst acne can put us in, please note that it's impossible to eliminate ALL DHT or ALL sugar from your system and still function (normally). Therefore, when trying to find the connection for yourself, PLEASE don't obsess over avoiding every possible problematic food or give up too quickly. Remember, we are all different and our bodies will decide when we've done the RIGHT things, not us ;-) So, the sooner you find out the truth for you, the less hormonal and health problems you may have to deal with in the future.
Oh and one more thing, the reason it's Important to know how Accutane, the "greatest discovery for acne in the past 30 years," they say, works, is because now we know how to implement this for ourselves. Now that we know how it relates to diet, we can take that information and find a way to increase those chemicals "naturally." So instead of orally taking 13-cis-retinoic acid or finding a natural way to convert this in our system, we can jump straight into what's REALLY doing the job. Remember, Accutane inhibits the actions of IGF-1 by INCREASING IGFBP-3! We already know that we can accomplish this through diet as well. Therefore, we need to eat right, take the right supplements, or find some miracle pill that will effectively increase IGFBP-3 at a safe level for us. Then we have the acne controlling effects of accutane, only permanently and hopefully without any negative side effects. Whadda you think? ;-)
[This message has been edited by SweetJade1 (edited 08-10-2003).]