London Centre for Functional Medicine

28/10/2024

A Functional Medicine Approach to Acne

Acne vulgaris is one of the most widespread skin disorders, with the frequency of occurrence ranging between 15% and 40% of the population [1]. Taken mainly as a hassle, which during teenhood is often thought only to wear off eventually, persistent acne' poor social impact is an issue for many adults [2]. The good side of traditional methods is topical retinoids, antibiotics and hormonal treatments, but these also have side effects. In addition, conventional over-the-counter therapies fail to address the basic underlying factors that fuel the formation of acne.
Functional medicine would put a different aspect here, having a patient-centred view. Instead, it would regard acne as a manifestation of the disbalance of the body's intricately woven systems network. By identifying and removing the (biochemical/pathogenic) factors that cause (dermohirsoma), functional medicine tries to reestablish health and prevent future troublesome acne breakouts. This multifaceted, integrative strategy will be a feasible resolution or additional solution along traditional acne regimens.

Understanding Acne's Root Causes
The pathogenesis of acne is multifactorial, involving four main mechanisms: Provocative sebum production, dysregulated keratinisation of the pilosebaceous unit, residual colonisation by Cutibacterium acnes bacteria, and inflammation [3]. Functional medicine incorporates the aspects of diet, lifestyle choices, environmental toxicity, genes, gut health, and any other factors that could be involved in disrupting the processes and triggering acne.

Diet and Acne

A large amount of literature reveals that foods with high glycemic index and dairy products may give rise to acne, which is the precursor of hormonal pathways and inflammation [4,5]. Adopting a low-glycemic diet in which anti-inflammatory omega-3 fatty acids like fish, nuts, and seeds are emphasised might be one thing that will end acne breakouts [5]. The persistence of food sensitivities to gluten or dairy can trigger inflammatory reactions. Such reactions can then adversely affect individuals susceptible to acne [6].
Gut Health and Acne
The gut microbiome disturbance received much attention, with gut microbiota imbalance at the core of many skin problems, especially acne. The dysbacteriosis and the increased intestinal permeability, also called "leaky gut", promote an influx of inflammatory antigens, pro-inflammatory cytokines, and endotoxins into the systemic circulation and, consequently, an excessive chronic low-grade inflammation [8]. Under these conditions, a great chance of acne development is because these factors trigger sebum production, induce keratinised cell proliferation and release pro-inflammatory markers, which further initiate inflammation. The probiotics may assist in bringing back harmony to the microbiome and help scale down acne severity.

Stress and Acne

Psychological stress and oxidative stress appear to both participate in acne production. It is not clear yet which one triggers the acne. During the body's response to psychological stress, cortisol and other hormones' production increases, causing hyperactivity in sebaceous glands and skin barrier disruption [11]. Oxidative stress also activates inflammatory pathways, affecting not only follicular keratinocytes but others [12]. Some coping strategies include meditation, yoga and cognitive behavioural therapy, which may promote health. Antioxidant-bearing foods such as vegetables and fruits can also help neutralise oxidative stress. These can be brought about through various micronutrients, including vitamins C, E, zinc, and selenium.

Environmental Toxicants and Acne

Researchers have suggested a probable role of environmental pollutants in the development of acne through their hormonal disruption and pro-inflammatory effects [15]. Phthalates, parabens, and endocrine disruptors are only a few examples, so to be careful, it's wise to reduce exposure to them in cosmetic products.
The Functional Medicine Therapeutic Order
Rather than simply masking symptoms with drugs or topical treatments, functional medicine follows a systematic, individualised approach called the therapeutic order: Rather than merely masking symptoms with drugs or topical treatments, functional medicine follows a systematic, individualised approach called the therapeutic order:
1. Erase Triggers. Eliminate the causes that aggravate inflammation. It may be food intolerability, gut dysbiosis, environmental toxins, or mental stressors. Testing may reveal gluten sensitivities, leaky gut syndrome, micronutrient usage, or a toxic burden level.
2. Identify And Eliminate Triggers. Once triggers are eliminated, the spotlight is on physiological balance by adopting targeted and balanced nutrition and lifestyle coupled with supplements. Individuals are provided with a diet rich in anti-inflammatory, consisting primarily of Mediterranean foods with plenty of antioxidants and omega-3 fatty acids. Besides relieving the practitioners' emotional stress, mind-body activities also play an essential role in keeping their body and mind healthy. Therapeutic meals like Autoimmune Protocol or a low-FODMAP diet may be recommended further to administer gut healing in the conclusion of dysbiosis.
Nutritional supplements such as probiotics, omega-3s, antioxidants, zinc, lactoferrin, and nicotinamide could help turn down inflammation, recover the intestinal barrier part, normalising hormone levels as well and inhibiting C. Acnes growth [16-19]. Detoxification support is delivered by nutriments such as N-acetyl cysteine and glycine to facilitate the elimination of toxicants gathered.
3. Enzyme Regulation. In females, hormonal acne may need hormonal optimisation and reductions in excess androgens, an androgenic hormone. Certain supplements such as DIM, calcium D-glucarate, and herbs like peony and licorice are hormone-modulating supplements that help the body maintain healthy estrogen ratio [19,20]. Insulin sensitisers, including but not limited to inositol, berberine, and alpha-lipoic acid, have been known to address insulin sensitivity and androgen excess.
4. Improve The Elimination And Excretion System. By Regulating The Pathways Of Detoxification, The Elimination Of Inflammatory Triggers, Byproducts Of Oxidation, And Hormones. Mediating Acne Is Facilitated By The Optimisation Of The Detoxification Pathways In The Gut, Liver, And Kidneys. Through their action on glutathione, methylation nutrients, botanical choleretics and cholagogues, castor oil pack and infrared saunas, and coffee enemas, these compounds cascade elimination through many pathways.
5. Discuss Psychospiritual Effects. The burdensome and shameful face of pimples arises from their outward appearance and manifests in psychosocial dimensions. Cognitive behavioural therapy, mindfulness exercises, counselling, and group support can. However, make the list of mental disorders such as depression, anxiety, low self-esteem, and social isolation manageable.
By precisely following such a detailed therapeutic order, functional medicine doctors tend to bring about biochemical harmony to solve skin problems such as acne. Hence, they do so right from the root.

Integrative Protocols

Integrative dermatologists in the clinical setting may implement a first-principle functional medicine way, that is, addressing the root causes of the patient's pains and, at the same time, combining it with conventional medicine's evidence-based methods, thus taking advantage of multiple modalities of therapy at the same time. A sample protocol for acne might include: A sample protocol for acne might consist of:
• The anti-inflammatory diet consists of (Mediterranean, autoimmune protocol, and low-FODMAP) among others.
• Reestablishing beneficial microflora in the digestive tract with live culture food (like yoghurt and kefir), digestive enzymes, antibacterial herbs and others.
• Lifestyle modifications include reduced stress levels, good sleep quality, and exercise.
• Refilling our body’s reservoirs of antioxidants, zinc, omega-3s, etc.
• DIM, herbs and insulin sensitisers are included to control hormonal activity effectively.
• Traditional antibiotics such as topical retinoids, antibiotics and spironolactone are still widely used in an attempt to treat acne.
• Life-waste detox and removal services.
• Assistance to psychosocial counselling and mind-body therapies.
Therefore, this integrative strategy works simultaneously by blocking the root causes of acne and relieving any current symptoms that may be in place, leading to deeper acne eradication and preventing future outbreaks.
Case Studies
Several case reports provide anecdotal evidence of acne improving through functional medicine interventions:
• A case report about a woman under 35 with cystic acne of severity received nearly complete remission after a specific autoimmune paleo diet, sensitivities elimination, and comprehensive gut restoration were applied [22].
• Concerning another patient, a teenage male has been suffering from severe acne for two months due to the problem of leaky gut and immune deficiency, but when they want to lower the level of inflammation, supplement the diet, improve the leaky gut, and use topical vitamins they have been able to be hassle-free after that two months [23].
• In the case of the pilot program that studied adolescent males, implementing a low-glycemic load diet produced a greater reduction in the counts and severity of acne lesions compared to the commonly employed American Diabetic Association diet [24].
These cases only illustrate the main argument in favour of the correlation between functional medicine and acne treatment; however, large-scale clinical studies should be performed, too.

Conclusion

Functional medicine seeks to treat acne by addressing each patient's unique multifactorial underlying causes instead of traditional therapies that address surface-level symptoms. This all-encompassing, systems-oriented method can produce long-lasting acne clearance by reestablishing physiological balance and optimal health, even if it will cost time, energy, and money. Functional medicine is yet a field of study and development, but it provides an energising, all-encompassing complement to dermatology's usual armament.


References
1. Acne. American Academy of Dermatology. https://www.aad.org/public/diseases/acne/
2. Dunn, L. K., O'Neill, J. L., & Feldman, S. R. (2011). Acne in adolescents: Quality of life, self-esteem, mood and psychological disorders. Dermatology online journal, 17(1).
3. Kraft, J., & Freiman, A. (2011). Management of acne. Cmaj, 183(7), E430-E435.
4. Burris, J., Rietkerk, W., & Woolf, K. (2014). Relationships of self-reported dietary factors and perceived acne severity in a New York young adults cohort. Journal of the Academy of Nutrition and Dietetics, 114(3), 384-392.
5. Kucharska, A., Szmurło, A., & Sińska, B. (2016). Significance of diet in treated and untreated acne vulgaris. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, 33(2), 81-86.
6. Bowe, W., Patel, N. B., & Logan, A. C. (2014). Acne vulgaris, probiotics and the gut-brain-skin axis: from anecdote to translational medicine. Beneficial microbes, 5(2), 185-199.
7. Salem, I., Ramser, A., Isham, N., & Ghannoum, M. A. (2018). The gut microbiome is a significant regulator of the gut-skin axis. Frontiers in microbiology, 9, 382698.
8. Bowe, W. P., Patel, N., & Logan, A. C. (2012). Acne vulgaris: the role of oxidative stress and the potential therapeutic value of local and systemic antioxidants. Journal of Drugs in Dermatology: JDD, 11(6), 742-746.
9. Kang, D., Shi, B., Erfe, M. C., Craft, N., & Li, H. (2015). Vitamin B12 modulates the transcriptome of the skin microbiota in acne pathogenesis. Science translational medicine, 7(293), 293ra103-293ra103.
10. Bowe, W. P., & Logan, A. C. (2011). Acne vulgaris, probiotics and the gut-brain-skin axis-back to the future? Gut pathogens, 3, 1-11.
11. Chiu, A., Chon, S. Y., & Kimball, A. B. (2003). The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stress. Archives of dermatology, 139(7), 897-900.
12. Okakhu A, Umar I, Mukhtar N, et al. Oxidative stress suppresses catalase expression. Case of inflammatory dermatological conditions. Human and Environment. 2016; 42(4): 155-167.
13. Ayer J, Burrows N, Tophof M, et al. Acne: Prevalence and lifestyle associations among medical students in Malaysia. F1000 Res. 2016;5:352.
14. El‐Akawi, Z., Abdel‐Latif, N., & Abdul‐Razzak, K. (2006). Does the plasma level of vitamins A and E affect acne? Clinical and experimental dermatology, 31(3), 430-434.
15. Kamalpour L, Saki N, Sadeghi S, Fathipour N. The Association between Environmental Exposures and Acne: Evidence from a Review on the Comparative High Prevalence of Acne Among Farmers and Individuals with Occupational Exposure to Pesticides and Microparticles. International Journal of Women's Dermatology. 2022; 8(1): 57-65.
16. Dreno B, Araviiskaia E, Kerob D, et al. Multilaux-avéné: an integrated strategy for acne management. J Eur Acad Dermatol Venereol. 2019;33(6):1094-1105.
17. Dhaher YY, Dhalimi MA, Aswad WA. The effect of nicotinamide on acne-prone individuals. Dermatological Practical & Conceptual. 2021; 11(4): 472-478.
18. Rubin, M. G., Kim, K., & Logan, A. C. (2008). Acne vulgaris, mental health and omega-3 fatty acids: a report of cases. Lipids in health and disease, 7(1), 36.
19. Fabbrocini G, Iorio M, Avagio A, Cantelli M, Maida P. Lactoferrin: An Emerging Therapeutic Target in Dermatology. Int J Mol Sci. 2022;23(7):3731.
20. Shawky MW, El-Fath OA, El-Deen SA. Could lactoferrin and DIM modulate acne by targeting lipogenesis and the androgen pathway? J Cosmet Dermatol. 2020;19(1):184-191.
21. Kicińska, A. M., Maksym, R. B., Zabielska-Kaczorowska, M. A., Stachowska, A., & Babińska, A. (2023). Immunological and metabolic causes of infertility in polycystic o***y syndrome. Biomedicines, 11(6), 1567.
22. Rachow S. The gut-skin connection in acne vulgaris. J Eur Acad Dermatol Venereol. 2022;36 Suppl 5:18-25.
23. Robertson J. Integrative Approach to Acne: Case Report and Review of the Literature. Integrative Medicine: A Clinician's Journal. 2018; 17(3): 54-61.
24. Smith, R. N., Mann, N. J., Braue, A., Mäkeläinen, H., & Varigos, G. A. (2007). A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomised controlled trial. The American journal of clinical nutrition, 86(1), 107-115.

Virtually everyone who has acne can see clearer skin. Here, you'll find dermatologists' expertise about acne treatment and skin care that you can use at home, along with guidance to figure out when you need to see a dermatologist for clearer skin.

19/04/2024

A Functional Medicine Approach to Osteoporosis

Osteoporosis is an epidemiological issue that society has been struggling with for a long time. This is a condition that is often difficult to diagnose because the symptoms appear to be silence and cause significant disability. It is also characterized by progressive loss of bone mass and a greater risk of bone fractures. While lifestyle changes and medicine use are the fundamental part of the traditional methods, a growing amount of research claims that functional medicine is more comprehensive, holistic, and individualized to that problem.

In functional medicine a treatment depends of the systems that are affected and goes beyond the symptoms to the root of the illness. Functional medicine practitioners aim at general health preservation and well-being by promoting holistic approach which puts in mind strong interaction between genetic factors, environment and lifestyle.

Understanding the Pathophysiology of Osteoporosis

The multiple causes of osteoporosis, including poor diets, inflammation, hormone imbalance and weak digestive system might have miscellaneous morbidities [1]. Generally, conventional medical techniques directs BMD to use only pharmaceuticals and calcium supplements, aiming to improve the bone density numerically.
To make it clear, from the standpoint of functional medicine, bone health starts to depend on its whole physiological processes and metabolism. The maturation of bone structure and the assimilation of minerals could be significantly interrupted by different reasons for example, chronic inflammatory, oxidative stress, intestinal dysbiosis and altered hormones like estrogen, testosterone, and cortisol [2].

Addressing Nutrient Deficiencies and Gut Health

Deficiencies of some nutrients, namely calcium, magnesium, zinc, all B-complex, K, and D vitamins, have been associated with an increased risk of osteoporosis [3]. Functional medicine gives priority to therapeutic nutrition and specially designed supplements which management can be achieved by this approach.
The human bones too are regulated by gut metabolism. The process of immune system functioning, metabolism that involves bone service and absorption of nutrients are all directed by gut microbiota [4]. Functional medicine therapists may propose some measures including special diet, taking probiotics, and handling the underlying disorders like leaky gut-syndrome or small intestinal bacterial overgrowth (SIBO) in order to hold a good condition of microbiota.

Hormone Balancing and Inflammation Management

Optimizing hormonal communication can be a crucial step for maintaining bone health, particularly for those with pathologies that disrupt estrogen, testosterone, and cortisol. Low estrogen is a concluded cause of osteoporosis and menopause are generally cited as examples [5]. In order to taking care about hormone balance practitioners of functional medicine can use natural or bioidentical hormone replacement therapy(BHRT).
In addition to lowered bone growth rate and augmented bone resorption, chronic inflammation is known to be responsible. The target of a functional medicine approach is to pin down the root causes those are responsible for inflammation which may include exposure to environmental toxins, certain dietary patterns or even chronological disorders such as chronic infections or autoimmune illnesses.

Lifestyle Interventions and Stress Management

Lifestylestyle choices like exercise, noise and stress freezing are unavoidable for healthy bones. Experts on functional medicine give a lot of importance to managing stress using proper methods, sleep patterns, and include weight-gaining exercises among other strategies [7]).
High level of cortisol caused by chronic stress will be the factor reducing bone turnover and increasing the risk of osteoporosis due to this. To give help in dealing with stress and to improve people's general health, functional medicine experts tend to propose different stress-managing approaches like mindfulness which can be done through relaxation exercises, or cognitive - behavioral therapy.

Integrative Treatment Strategies

The approach of functional medicine to osteoporosis treatment is often tailored to the needs of each patient and involves a personalized, multimodal treatment plan. The treatment plans involve illnesses that are the cause of such disease conditions.This might consist of:

Dietary adjustments: Prioritizing dietary diversity and upgraded food choices scales to nourish the mind whereas nutrient-dense and anti-inflammatory substances (such as curcumin, ginger, etc.) and using differential nutrient suplementation to address any particular nutritional deficit.

Lifestyle interventions: As a sport, it includes movements like weightlifting, stress management techniques, and improved bedtime habits.

Targeted supplementation: Some of the minerals, like calcium, magnesium, and zinc, as well as a certain kind of vitamins like D, K, and B- complex, individual requirements depending on condition.

Hormone balance: If necessary be sure to research natural mechanisms or Bioidentical hormone replacement therapy (BHRT), which helps in hormones balancing.

Optimizing gut health: Addressing dysbiosis of the gut, leaky gut, or other causes of digestive problems that lead to poor nutrients' absorption and may affect the bones' health since that is the source of calcium.

Inflammation management: highlighting the reasons of inflammation which can be filled with dietary alternations, specific supplementation or some other ways.

Stress management: Such stress reduction methods might use strategies like cognitive-behavioral therapy, mindfulness drills, meditation, or others.

The goal of functional medicine clinicians is to treat slowing and assisting the bone improvement and thus are using of the alternative approach for re-balancing an organism. The aim of this approach is to develop the bone tissue by reducing or even reversing the pathogenetic processes which lead to osteoporosis.

Conclusion

Because of the complexity of osteoporosis, personalized and comprehensive strategy is required. Functional medicine stands out by diagnosing of the underlying reasons, with the mindset of taking into account rather complex interconnected systems that influence bone health, even though conventional medicine often works successfully in some cases.
Functional medicine professional are committed to achieving sufficient overall wellness as well as to restore a balance in our organism by using targeted supplements, diet modifications, lifestyle interventions, hormone balancing, and good gut health optimization too. This may be the start of deterioration or stop it from further progression. In other words, it may have the opposite effect.
Collaboration with experienced and conscientious healthcare educators is the bedrock of a healing process. One must also seek medical advice from functional medicine specialists who specialize in these types of problems, just as with any other medical ailment. Hope of triumph over osteoporosis can be realized by the people who live in this side of the illness when a plan consisting of dietary changes and holistic treatment is adopted.




References:

[1] Weaver, C. M., Gordon, C. M., Janz, K. F., Kalkwarf, H. J., Lappe, J. M., Lewis, R., ... & Zemel, B. (2016). The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporosis international, 27, 1281-1386.

[2] Wawrzyniak, A., & Balawender, K. (2022). Structural and metabolic changes in bone. Animals, 12(15), 1946.

[3] Ahmadieh, H., & Arabi, A. (2011). Vitamins and bone health: beyond calcium and vitamin D. Nutrition Reviews, 69(10), 584-598.

[4] Ni, X., Xing, X., Deng, Y., & Li, Z. (2023). Applications of stimuli-responsive hydrogels in bone and cartilage regeneration. Pharmaceutics, 15(3), 982.

[5] Khosla, S., & Hofbauer, L. C. (2017). Osteoporosis treatment: recent developments and ongoing challenges. The lancet Diabetes & endocrinology, 5(11), 898-907.

[6] Pisani, P., Renna, M. D., Conversano, F., Casciaro, E., Di Paola, M., Quarta, E., ... & Casciaro, S. (2016). Major osteoporotic fragility fractures: Risk factor updates and societal impact. World journal of orthopedics, 7(3), 171.

[7] Gómez-Cabello, A., Ara, I., González-Agüero, A., Casajús, J. A., & Vicente-Rodriguez, G. (2012). Effects of training on bone mass in older adults: a systematic review. Sports Medicine, 42, 301-325.

[8] Heer, M., Duda, S., & Fischer, E. (2021). Stress and osteoporosis: Mechanisms and hypotheses. Bone Reports, 14, 100778.