One of the most common complaints I get on social media is “I went paleo and my acne got worse!!”

I hear you, sister. That happened to me, too.

The thing about acne is that it’s almost impossible to just follow some “diet” (such as paleo) and clear your skin. Your diet needs to be specific about supporting clear skin, and what you need for clear skin most specifically. If you adopt some general diet, you might end up worse than you started.

Paleo is certainly no exception to this rule. Here are the 7 most common reasons people make their acne worse with paleo:

1) Too high omega 6 intake

If you go paleo and all of the sudden start eating higher quantities of certain omega 6 containing foods, this may be why. Omega 6 fats are inflammatory and in high doses can cause real skin problems. Examples of foods high in omega 6 fatty acids are:

• Nuts (except for macadamia nuts)
• Chicken and other poultry fat
• Chicken and other poultry skin
• Fatty cuts of meat (cow, pork, etc) from animals raised on conventional feedlots

Importantly, the omega 6 content of animal fats is higher in animals that are grain fed, raised on feedlots, or fed agricultural scraps. If you “go paleo” then start eating lots of meat that isn’t healthfully sources, you may run into some trouble. The best way to make sure you get a good omega 6 omega 3 balance in your animal products is to buy as much grass-fed (and grass-finished) products as possible. I personally love Butcher Box’s products.

2) Shifting diet to fat (and especially saturated fat)

People who have been on low fat diets and have some acne may experience an acne problem when they make the jump to a fattier diet. This is because fats are the backbones of hormones. Since the male sex hormones testosterone and DHEA-S cause acne, it’s entirely possible that shifting up your body’s production of these hormones (and this is of course even worse if you have a hormone condition such as PCOS) will at least temporarily cause your acne to spike.

This is all the worse if you’re consuming a lot of saturated fat, since saturated fat has the greatest potential of all the fats to be inflammatory.

(You can also have skin problems if you go on a low fat version of paleo, but this is reasonably uncommon.)

3) High intake of insoluble fiber

If you used to eat lots of fiber-free foods, switching to paleo may be a bit of a shock to your system. Insoluble fiber in particular can be rough on the gut. Nuts and vegetable skins are the worst potential offenders in this regard. These problems are exacerbated if you do not have a robust gut flora population hanging around, ready to break down the fiber for you. Hopefully you’re integrating fermented foods (my faves here) into your paleo diet, and that will help you in the longer run. If you’re not, a probiotic supplement such as Prescript Assist may be in order.

4) Consuming foods you may have a sensitivity to or that may exacerbate acne

There are a number of foods acceptable  to “paleo” that may still irritate your gut and/or your immune system. Unfortunately it takes a lot of experimentation to figure out if any of these are problems for you. The most common ones are:

• nightshade vegetables

These are a class of vegetables that can sometimes be inflammatory, especially for people with autoimmune conditions. Many paleo people know tomatoes, potatoes, peppers, and eggplant are on that list. Also on the list but less often discussed are tomatillos and goji berries. I personally get terrible acne from goji berries, and didn’t understand why until discovering this fact.

• high B12 foods

High B12 foods and supplements can contribute to acne because of the metabolism of bacteria on the skin. When you eat hefty amounts of B12, they shut off their own production and instead make a pro-inflammatory compound. High B12 foods include eggs, liver, shellfish, tuna. I personally still get small breakouts from these foods if I eat too many of them too many days in a row.

• chocolate

Studies have actually demonstrated that chocolate (though for uncertain reasons) can cause acne. And it’s not because of the dairy in most chocolate products, but the cocoa itself.

• egg whites

Some people don’t tolerate egg whites well, which leads to inflammation in the gut.

• imbalance of vitamins A, D, K

If you’re taking a cod liver oil supplement, a vitamin D supplement, or a K supplement, you may find that your balance of A, D, and K becomes skewed on paleo. This can be a problem. If you haven’t seen any improvement with these supplements to date, consider lowering your dose or discontinuing and waiting for two weeks to see if there is any improvement.

5) Not eating enough

Many people unintentionally reduce their calorie intake when they go paleo. Some do so intentionally. In either case, not eating enough food can cause your body to stop produce the important acne-fighting hormones estrogen and progesterone, and instead produce the acne-causing stress hormone DHEA-S.

Importantly, intermittent fasting can also have this effect. I personally start to get bumps on my forehead after about six hours of fasting after I’ve gotten hunger pangs.

6) Working out too much or not refueling properly

Intense workouts can cause stress hormones to spike. Normally this is healthy, but if you do it a lot and undereat or are stressed out besides, you may be in for a bit of a deluge of stress hormones. Importantly, testosterone (an acne-causing hormone) levels rise during workouts. They fall back down to original levels if you refuel after your workout. But if you do not refuel, testosterone levels stay elevated.

Unfortunately, since I don’t know your personal history or context, I couldn’t say whether you work out  “too much.” (I do have a post on it: Do you exercise too much?) So far as refueling goes, shoot for 200-300 calories of carbs and protein combined. Beef sticks and dried fruit are a great way to do this if you’re on the run.

7) Too much protein

Paleo dieters tend to really go wild with protein. This can be a problem if you’re acne prone, since protein has been shown to participate in the stimulation of growth processes in the skin. Protein does matter; I don’t recommend cutting protein out of your diet or eat much below 50 grams a day.  I usually recommend 50-100 grams a day for women, depending on your activity level. If you’re really active  (or muscular or tall!)120 grams may work great, but it’s ideal for skin not to push too far beyond that.

So those, in sum, are the seven most common reasons people’s acne may worsen on paleo. Now, it’s entirely possible that your acne just stays the same, and you’re left wondering “but wasn’t paleo supposed to heal me?”

Paleo is a great starting template for managing many different conditions and symptoms. But  it is precisely that: a template. Once you dig into paleo, if you have conditions you want to overcome such as acne, it’s important to dig deep into acne-specific science and acne-specific nutrition. 

Coincidentally enough, I have written a comprehensive ebook about the science of causing acne and the ways to specifically tailor your diet and lifestyle choices to overcome it. It has just gone on sale (I haven’t even told facebook yet!) and is 50% off this week only! Plus, fully refundable if you don’t like it for any reason, so not much for you to lose at all! Feel free to check it out here: Clear Skin Unlocked: The Ultimate Guide to Acne Freedom and Flawless Skin. 

If you’d like to read a blog post about the program and how I wrote it, check it out, here.