You may remember Seppo Puusa from the guest post he wrote on acne for the blog back in August (and his insanely revolutionary guide to overcoming acne I keep raving about, Clear for Life). I heaped on the praise then, and I’m excited to have the opportunity to do it again.  Seppo has the most comprehensive view of acne of any health advocate I’ve yet worked with on the issues of acne, and is so well read in the science of acne it would take me years to catch up to him.

Years.

So usually when a health advocate works on acne they focus on one aspect of it, failing to account for the whole picture. The gut, for example. Or stress. Or topical care. Or antibiotics. Not Seppo, however. Seppo demonstrates with his work how genetics, hormones, inflammation, detox, oxidative stress, anti-oxidants, emotional health, gut health and topical care are all crucial for clear skin.

With, as he says, an “action-oriented” approach, packed with more concrete acne advice than any resource I’ve ever come across.   Very often in the health world acne advice amounts to “eat real foods” – but the vast majority of us who are looking for help on my site and others already do that. What else can we do, and how can we best leverage those foods? Seppo knows all the about the gut, but he knows all about lotions and antioxidants, too.

Seppo says: don’t treat acne with just one trick, something that I tried for so long. I wanted low carb to be my trick. Then I wanted it to be low fiber. Here’s the thing, though: you’ve got to attack it from all angles. Seppo says: “Some people suffer from the extremely dangerous I will do this one thing and it will get me clear syndrome….but the thing is is that with this mentality you’ll end up trying a lot of things, the vast majority of which won’t make much of a difference. So you’ll chalk that up to the ‘I tried it and didn’t work for me’ box. Not only is going from failure to failure very taxing psychologically, but you’ll also end up discarding many useful approaches.”

So do all of the important stuff, or lots of different tricks at the same time, and do it with patience and care.

And you’ll kick ass.

Here are my two greatest ways to demonstrate endorsement: 1) Seppo is the only person I credit with helping me with my acne, remember these beauties:

and 2) Seppo’s blog is the only blog on the whole internet I regularly check for updates. [To be fair, it’s actually that and Huffington Post’s “Entertainment” section.]  Why? Because his advice helps, and also because I learn something every time I read from him.

For example, the chapter “What causes acne” opens with this paragraph:

“Let’s start by looking at the acne formation process….The process starts with excessive growth of keratinocytes, which are cells that produce keratin and make up a large part of the skin. Keratin is a strong protein that binds cells together to form the structure of the skin. In healthy skin, the cells die as they separate and are pushed out of the skin follicle. In acne-prone skin, excess keratin hinders this post-death separation of cell, and the skin follicle accumulates larger clumps of dead skin cells. Faster than normal growth of these cells means acne-prone skin accumulates more dead cells than healthy skin.

Skin follicle is like a tube made of skin cells. In areas of hair growth they are also called hair follicles as hairs grow through them. Sebaceous glands, the glands that produce sebum, are attached to the sides of the skin follicle. They push sebum into the follicle which, in healthy skin, flows through the follicle and onto the surface of the skin.

Think of it like a river. In healthy skin the river flows freely. In acne-prone skin the mixture of excessive sebum production and clumps of dead skin cells blocks the flow.”

Some other snippets I pulled from the section “what causes acne:”

-“Studies in acne patients have shown lower levels of anti-oxidant vitamins, both in sebum and in blood, and higher levels of inflammatory markers.”

-“Vitamin E is of course the major antioxidant in the skin…” “Vitamin A is 33 percent lower in acne patience; vitamin C is 40 percent lower; vitamin E is 45 percent lower; beta-carotene is 65 percent lower….low levels of zinc and selenium have also been found in acne patients.”

-“There’s also some evidence that hyperkeratosis is linked to malnutrition…this is common in gastric bypass surgery…”

-“In 2010, Indian researchers tested an antioxidant blend supplement on acne. The supplement delivered a daily total of 45 mg zinc, 180 mg vitamin C, 18 mg mixed carotenoids, 45 IU vitamin E (d-alpha-tocopheral acetate) and 0.4 mg chromim. After 12 weeks, a dermatologist evaluated improvements in acne. In the evaluation, 38 out of the 48 (79 percent) were judged to have an 80-100 percent improvement.”

-“Benzoyl peroxide application in one study showed a 95 percent reduction in vitamin E And a 70 percent reduction in vitamin C in skin sebum following application. With sch drastic effect on skin antioxidants its easy to see how overuse can cause skin problems rather than solve them.”

-“Sebum in acne patients has lower levels of linoleic acid than that of healthy controls. This deficiency is also thought to contribute to hyperkeratinization. There’s also some evidence that androgens play a part.”

-“Acne-prone skin produces proportionally more squalene [the fatty acid that oxidizes into clogged pores] than other fatty acids in sebum. For example, a 200- study showed squalene makes up 15 percent of total sebum composition, while the average total for acne patients was 20 percent. The study also showed that acne patients produced 59 percent more sebum. Putting these figures together, acne patients have 112 percent more sebum than people without acne.”

-“Animal studies show that squalene peroxide applied to rabbit ears produces a comedo [the clogged pore], and the size of the comedo is related to the degree of squalene suffered.”

-“A massive study of 458 pairs of identical twins and 1099 pairs of fraternal twins found that genes explained 81 percent of the difference in acne prevalence. Only 19 percent was explained by non-shared environmental factors such as diet and stress.”

-“IGF-1 deficiency prevents the occurence of acne. The findings suggest that an interaction between IGF-1 and androgens is necessary for the development of acne.”

-And, furthermore, that “insulin levels affect IGF-1.” and “Insulin also stimulates release of IGF-1 from the liver.” So “chronically high insulin levels mean more bioavailable IGF-1.”

And, get this, Seppo demonstrates the power of hormones with sex change studies:

-“Male to female transsexuals treated with estrogens and anti-androgens showed sharp drops in both testosterone and sebum levels. At the beginning of the study six of the participants (29 percent) bt after four months of treatment, the acne had cleared in all of these subjects. 

The opposite happened in female to male transsexuals. At the beginning of the study only 31 percent had facial acne, but after four months of androgen treatment that figure shot up to 94 percent. “

All of which happens, and so much more, before page 41. Pages 42-263 comprise chapters

-The gut-skin axis

-Stress and emotional health

-Emotional healing – here be dragons

-Diet

-Strategic supplements (This is where Seppo’s work sings the loudest – he talks about causes of acne and internal mechanisms I have never heard of, and demonstrates why different vitamins or food choices or pharmaceuticals or moisturizers are good for each)

-Other lifestyle factors

-External skin care

-Next Steps

And to be honest with you, my favorite chapter is the one on emotional healing, which talks not just about the active, conscious mind, but also how powerful the subconscious mind is in decision making and emotional health, whether we know it or not. Very cool stuff.

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So. If you want to reduce your squalene oxidation, your testosterone-mediated sebum development, your SIBO, your inflammation,  or just about anything else, Seppo Puusa’s 332 page acne guide is the best way to do that.

And to understand the real science of what’s going on behind it all.

IMHO.

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(I know!)