Acne 101: Maintaining Skin Health by Drinking Sufficient Water Daily and Having a Healthy Diet

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Most people do not consider our skin as an "organ," but the skin is actually our body's largest and heaviest organ. Constituting approximately 15 percent of human body weight, the skin has a mass of 8 to 11 pounds (4 to 5 kilograms), with a total surface area of about 12.9 to 23.7 square feet (1.2 to 2.2 square meters). In contrast, the liver only has a mass of approximately 3.1 to 3.5 pounds (1.4 to 1.6 kilograms).

The skin consists of two layers, the epidermis (the outermost layer, the protective barrier) and the dermis (the innermost, vascularized layer). Another layer of loose connective tissue—the fatty layer also known as the hypodermis or superficial fascia—lies beneath the skin and functions as an insulator and shock absorber. The skin—together with its components of sweat glands (eccrine and apocrine sweat glands) and oil glands (sebaceous glands)—with hair and nails make up the integumentary system, which has the following functions:

  • Enclosure of internal organs and body fluids.
  • Physical barrier for protection against external physical and chemical damages.
  • Thermoregulation and help to maintain a constant body temperature.
  • Excretion of excess salt, water, nitrogenous wastes through sweating.
  • Detection of physical stimuli in the external environment.
  • Storage of a significant amount of blood within the dermal vasculature.
  • Synthesis of critical biological compounds such vitamin D.

One of the major skin diseases is teenage acne. While adolescent acne is widespread, in recent years it has been reported by dermatologists and epidemiologists that post-adolescent acne (divided into two categories: "persistent" which affects those from adolescent to adulthood, and "late-onset" acne which afflicts those having acne for the first time after 25 years of age) is increasingly common among post-pubescent women from ages 25 to mid-40s. Doctors have reported that these groups of women have a longer-lasting disease periods and require a longer treatment period. While reasons for persistent acne is not widely understood, some researchers with published studies in peer-reviewed medical journals have attributed this phenomenon to hormones and endocrine abnormalities, resistant bacteria, use of certain types of cosmetics, use of certain drugs, and increasing stress levels in fast-paced workplaces, (Knaggs et al., International Journal of Cosmetic Science, June 2004; Williams and Layton, American Journal of Clinical Dermatology, Volume 7, Issue 5, 2006). Adult acne problems have been known to lead to more stress, depression, social withdrawal, a plunge in self-confidence and a deteriorating self-image, job impairment, and intimacy problems, according to surveys of adults with persistent acne and late-onset acne.

What leads to acne?

Although the exact cause of acne is not yet known, there is a general recognition among dermatologists that the process by which acne develops is complicated. We know that a skin pore collapses onto itself and blocks the oil from exiting the sebaceous gland on the skin. Many factors may contribute to both adolescent and adult acne (both persistent and late-onset acne), such as the following:

  • Genetics (e.g., family history of acne formation).
  • Stress and the subsequent increase in output of hormones through adrenal (suprarenal) glands. Under stress, the adrenal glands produce hormones cortisol, and catecholamine hormones adrenaline and noradrenaline. Prolonged stress can lead to high blood pressure, diabetes, high cholesterol levels, and cardiovascular diseases.
  • Poor personal hygiene which leads to the accumulation of dead skin cells.
  • Poor diet (e.g., a high-fat diet, a diet lacking in fresh fruits and vegetables, a junk-food-filled diet).
  • Vitamin deficiency. Scientists have noted that people with acne tend to have "significantly lower" levels of vitamins A and D as compared with people without acne. For example, researchers in Jordan recently found that people with acne have "significantly lower" levels of vitamin A and E than people without acne; this study was published in a peer-reviewed medical journal Clinical and Experimental Dermatology (El-akawi et al., Volume 31 Issue 3, May 2006). Vitamin C is also good for your skin because it has antioxidant and anti-inflammatory properties, which can facilitate the skin-damage repair and prevent the return of acne.
  • Hormonal fluctuations(e.g., puberty and menstrual cycles). For example, during puberty, testosterone, which is present in both boys and girls, increases and stimulates sebaceous glands of the skin to enlarge and produce oil. According to the American Academy of Dermatology, whiteheads (closed comedones), blackheads (open comedones), and pimples (pustules) are all present in adolescent acne.
  • Intake of excess simple sugars (glucose and fructose). When people eat too many simple sugars (as opposed to complex carbohydrates), the liver converts the sugars into lipid, which then shuts down a gene called SHBG (sex hormone-binding globulin), thus reducing the amount of SHBG protein circulating in the blood. SHBG protein controls the amount of testosterone and estrogen in the body: when there is reduced SHBG protein in the blood, more testosterone and estrogen will be released throughout the body, thus increasing the occurrence and development of acne, infertility, polycystic ovaries, uterine cancer, and cardiovascular disease, according to a recent research study published in the Journal of Clinical Investigation (Hogeveen et al.,Volume 109, Issue 7, 2002).
  • The use of or coming into contact with skin-irritating products. Many products can irritate the skin, further aggravating an acne condition. Avoid these products and substances.
  • The use of certain drugs (e.g., anabolic steroids, certain antibiotics)
  • Not drinking sufficient water necessary to flush out toxins accumulated in the body.

The issue of vitamins A and D deficiency is also related to that of a poor, unbalanced diet full of high-fat foods, junk food, and a lack of fresh fruits and vegetables. Specifically, in studying the link between vitamin deficiency and acne, researchers concluded the strong link between acne and vitamins A and D deficiency, as follows:

  • "We found that plasma vitamin A concentrations in patients with acne were significantly lower than those of the control group (336.5 vs. 418.1 µg/L, respectively) P = 0.007. We also found that plasma vitamin E concentrations in patients with acne were significantly lower than those of controls (5.4 vs. 5.9 mg/L) P = 0.05. In addition, we found that there is a strong relationship between the decrease in plasma vitamin A levels and an increase in the severity of acne condition. Patients with severe acne had significantly lower plasma concentrations of vitamins A and E than did those with lower acne grades and the age-matched healthy controls. ...Based on our results, we conclude that low vitamin A and E plasma levels have an important role in the pathogenesis of acne and in the aggravation of this condition." (El-akawi et al., Clinical and Experimental Dermatology, Volume 31 Issue 3, May 2006). Emphasis was added by the author of this article.

People cannot control their family history and genetics, nor can they manipulate the timing of hormonal fluctuations (i.e., stopping or delaying puberty and/or menstrual cycles), but two factors they can control are their water intake and their diet. It is clear that drinking plenty of water and eating a healthy and balanced diet full of fresh fruits and vegetables are important to maintaining skin health and preventing and even reducing the severity of acne.

Simple lifestyle changes for maintaining healthy skin and preventing acne

Essentially, the skin is an important organ, and like any other organ, it requires good care to maintain its health. The following simple lifestyle changes can prevent the occurrence of acne as well:

  • Drink plenty of pure water each day (about 2 liters a day).
  • Exercise and keeping in shape can lower one's stress levels and therefore reduce all stress hormones in the body.
  • Reduce sugar intake. Try to eat foods with complex carbohydrates (e.g., brown rice, whole-wheat bread) rather than those with simple sugars (e.g., candy bars, donuts).
  • Eat plenty of fresh fruits and vegetables.
  • Avoid high-fat foods and so-called junk food.
  • Develop good personal hygiene and habits.
  • Wash face and other parts of the body prone to acne (neck, upper arm) with clean water and mild soap or cleanser daily.
  • Wear as little cosmetics as possible. Most cosmetics are made with chemicals not friendly to your skin. Oily cosmetics can clog skin pores and further exacerbate an existing acne condition.

Again, when you wash and wipe your face, use pure water and mild, natural soap. This regimen keeps the oil and dirt (including dead skin cells) out and helps prevent blockages and infections—and acne. It's just one way to be kind to the skin you're in!

Finally, drink plenty of pure water for best skin health!

For healthy and vibrant-looking skin, drink plenty of pure water. There is no need to spend a lot of money buying many commercially available "skin-care products." The best skin-care product is free: pure water.

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