Yesterday, we discussed a new acne study on water spinach, a green vegetable growing in damp and misty swamps in places like Sri Lanka.
It sounded fantastic on the surface, slaying p.acnes bacteria, and it was undoubtedly decent. However, among the flood of recent studies testing obscure acne remedies from all corners of the globe, it was undoubtedly the weakest.
It failed to match impepho, the superstitious incense twig from South Africa, which obliterated entrenched bacteria better than an antibiotic. It was outshone by Asian hornbeam, the oval-leafed tree which dried oily skin, improved hyaluronic acid enzymes, and dealt with inflammation.
Today though, we have the latest chapter, where our magical acne tour gets back on the rails. We have the cedar (ziziphus spina-christi), a desert dwelling tree which Jesus was supposedly fond of.
If you search the internet for cedar and acne, you will not find a single result from an acne patient west of Turkey. Yet apparently, it’s a beloved folk medicine all over Persia.
Here’s the latest in the noble quest of scientists to analyse acne remedies that nobody has ever heard of…
An experiment directly on pimples
In short, a recent study from November 2019 found that adding cedar leaf to antibiotics made them dramatically more effective against acne.
For inflammatory acne, the red and vicious forms like papules, pustules and nodules, the cedar recipe achieved a 50.1% reduction over 6 weeks compared to just 23.6% for the clindamcyin plus placebo. The non-inflammatory acne like whiteheads fell by 35.5% versus just 15.6%. At the two week mark, cedar achieved 21.6% and 12.8% in inflammatory and non-inflammatory acne respectively.
These were the figures for raw pimple counts, measured by hand. There’s no statistical wizardry here, just raw acne in the bedroom mirror.
However, two technical systems did come in later: the acne severity index and total lesion count. ASI was comedones (whiteheads/blackheads) divided by 0.25 + 2 x the pustule number + papule number, while total lesion counts was ¼ the papules number + pustules number + comedones number. These systems were invented by the global elite of dermatologists at grand conferences which we don’t need to get into, but the goal is to convert the actual appearance of a guy or girl’s face into a handy scientific form.
After two weeks, the cedar recipe reduced the ASI by 17.9% versus a feeble 10.0% for the placebo plus clindamcyin group. After 6 weeks, it was 44.6% vs 19.3%, while for TLC, cedar achieved 46.3% and the placebo only scraped to 20.6%. The TLC figures for two weeks were 19.3% versus 10.4%.
As you can see, cedar-sprinkled clindamcyin beat the normal recipe at every stage. In short, one of the most powerful antibiotics in a doctor’s arsenal can be massively improved by simply sprinkling in the essence of a desert tree. Nothing else was tested; this was a lean and mean cedar vs acne contest.
Cedar works for both, but seems particularly great for inflammatory acne. The side effects were very mild; three people reported irritation and itching out of 32 cedar takers.
What is this plant?
According to ecologists, it’s an invasive species which must be terminated. According to Muslim scholars, it’s the mystical tree which the Prophet Adam first ate a fruit from when he descended from heaven. According to ancient Persians, it’s an earthly visitor from paradise and must be cared for tenderly.
Like water spinach, its history stretches back into the misty, unknowable depths of the past, but it’s inarguable that ziziphus spina-christi is a 65 foot tall tree with a twisted trunk and scaly bark.
Its territory is the scorching deserts of the Middle East and North Africa, at elevations up to 2400 meters. It’s natural empire is massive. It’s one of the most popular herbal remedies in villages in Northern Nigeria, while thousands of miles away in southwest Iran, the tree is everywhere in the mountainous region of Khouzestan. Hotspots include Senegal in West Africa and Sudan in the East.
Ziziphus Spina-Christi is exceptionally tough. Unlike water spinach, which lurks in the dark and damp, the cedar likes areas with a mean average rainfall of 100-500mm with a 10 month dry season. While on a pilgrimage to find the holy grail, you would probably walk past it several times. Its favourite annual temperature is 19-28C and it requires a sunny position, but can also survive inundation in a rare flood.
Nothing can defeat this tree; the oldest known one lies south of Jerusalem in Ein Hatzeva, Israel, and is believed to be 1500-2000 years old.
Some believe that this individual tree was the source of Jesus’ beloved crown of thorns (although some scholars just settle for a member of the species) and that’s why a common middle Eastern synonym is Christ’s thorn jube.
The time of the Pharoahs
The ancient Egyptians called it “Nebe” and it seems to have been a staple of their civilisation. In the papyri medical text Ramesseum V, dug out of the Ramesseum temple by archaeologists, cedar is mentioned in 33 different medical prescriptions.
Some recommend the tree’s leaves, while others prefer the wood or fruit. A bread made from cedar was one of the main foods offered to the dead in rituals, although living Egyptian people ate the bread and cedar cereals sometimes too. Many gardens had cedar trees growing in them. Ziziphus was prescribed against Setscha, AKA swelling; the secret was to boil a bread of the ziziphus fruit before wrapping the victim in a bandage dipped in it, at a warm temperature.
For a snake bite, the recipe was cedar leaf plus the ibsa plant, ima tree leaves and acacia leaves, with the cedar ground finely.
For “cooling” a broken bone after reattachment to the body, the recommendation was cedar combined with sycamore, ima tree leaf (again), and mimi corn.
Are you a 14 year old Pharaoh with swollen legs, probably from lazily sitting on your throne for too long? Your palace physician will probably prescribe cedar bread mixed with red ochre, gourd, sweet beer, vine and last but not least, the excrement of a Tomcat.
Yet not once did an Ancient Egyptian think to use it for acne… or did they? There are some old acne secrets that we will never know. It’s logical that this “Setscha” solution was applied to pimples at some point, which are definitely a swelling.
Supposedly, ancient Persian medicine did recommend Ziziphus Spina-Christi for skincare, but I haven’t managed to track down the textbooks.
The methodology – was it fatally flawed?
The study was far from perfect, but overall, the reliability was solid enough to take seriously.
It was a standard experiment for testing an acne plant. Vitamin B3 was also compared to clindamcyin in this study (hint: it won). Clindamcyin replaced the much older erythromycin when p.acnes started getting resistant, but as predicted, the same is happening to clindamcyin.
105 acne patients were gathered, and of the 68 who finished the study, 22 were men and 46 were women. The age range was 15-45, averaging at 26.1.
It was a double blind study, the pinnacle of reliability, so neither the scientists nor patients knew which recipe they were taking. The procedure was like a spy film; subjects randomly received a mysterious package containing the cedar recipe or the placebo, which were identical in shape, odour, colour and consistency. The equipment was probably stashed under a park bench in a briefcase somewhere, with the location told to them on a secret computer in a phone booth which self destructed after 5 seconds.
They were counted by a “blinded researcher”. No, he wasn’t fumbling around the laboratory for his magnifying glass (I assume anyway); he didn’t know which recipe the patients had used either. This eliminates the risk of bias, as even the greatest of scientists might have assumptions sneak into their subconscious mind.
When counting by hand, it’s particularly important, because it’s up to the scientist to decide what constitutes acne. It isn’t a hard, unchanging set of data like the quantity of vitamin C in someone’s bloodstream; it’s very open to interpretation. He might have been passionate about cedar as a remedy for years, and despite being determined to conduct a fair experiment, the gears of excitement turning at the back of his mind could make him skim over the smaller pimples. We have no such problems here.
The placebo and cedar groups were very close in terms of sex, age and weight. The only difference between the two formulas was the cedar leave extract, making it a true comparison.
Did the study have failings?
Yes, as the sample size was fairly small. 68 people isn’t so tiny it invalidates the conclusion completely, not like this study on fenugreek and acne with 14 people, but it’s not cast iron reliable. The average age of 26.1 was high, and teenage acne is more tightly linked to wildly fluctuating hormones. This might not be affected by the inflammatory acne which cedar seems to specialise in, but that said, the root cause of teenage acne is still chronic inflammation.
Also, antibiotic resistance is rising year on year and it’s forecast to usher in a global apocalypse any second now. Clindamcyin is particularly vulnerable, so that might be why these patients achieved such tiny benefits. 20.6% is surprisingly small for an antibiotic; the whole point is their destructive side effects, not that they don’t work.
However, even if true, it doesn’t disprove cedar’s powers. It exaggerated the benefits from whatever point they were at. The only flaw would be if the antibiotic resistant all coincidentally ended up in the non-cedar group.
An anomaly in the universe
Outside of methodology, the weird thing about this study was how quickly non-inflammatory acne reappeared.
After falling to 35.5% less than baseline after six weeks, it sprang back to 4.5% less within just two weeks of discontinuing the remedy. Yet somehow, inflammatory acne only crawled back to 42.4% less, from 50.1%. It could simply be that cedar leaves specialise in extinguishing inflammation, but both types of acne plummeted – the non-inflammatory acne just recovered faster.
Why were they so different? If cedar root’s benefits were down to anti-inflammatory phytonutrients such as flavonoids, they could accumulate in the skin cells over 6 weeks like vitamin E does. They could then linger for weeks or years after discontinuing the topical treatment.
However, what if a small chunk was down to reducing sebum (oil) production? Scientists didn’t test oily skin. Maybe the unidentified compounds that calm down the sebaceous glands wear off much more quickly.
The other possibility is that this is a complete anomaly caused by the small sample size. However, it would be great if cedar acts as an inbuilt shield against red and angry acne for weeks afterwards, even if whiteheads bounced back. This result doesn’t derail the study one bit, it’s just an interesting mystery which we need to solve.
Our top theories
With some new remedies, the magical compounds become apparent instantly.
Sea buckthorn reduced oily skin by 45% in this study and its phytoesterols like beta-sitosterol and stigmasterol were already known to counteract testosterone.
Today, however, we have a bunch of vague studies floating around in cyberspace, but no bullseye. Possible explanations include…
Antibacterial – there no experiments on p.acnes bacteria, but this study tested staphylococcus aureus, and streptococcus, two more gram positive strains (the same family as p.acnes). Cedar extract inhibited them with ease. In this study, the shape of Staphylococcus aureus and Bacillus cereu was warped and distorted.
The normally round s.aureus became longer, while the rod shaped, b.cereu became shorter and developed round sections. The diagnosis: loss of cell wall integrity, triggered by cedar. It’s the equivalent of a human being becoming six foot wide and 1 foot tall, waddling along on two tiny feet. Translate this structural mayhem to p.acnes and we will be in business.
Compounds – the second antibacterial study theorised that its “tannins, saponins, polyphenols and alkaloids” were responsible. Rare compounds have been discovered too, such as beutic acid and ceanothic acid, alongside more commonplace flavonoids. Water spinach seemed to have a more run-of-the-mill phytonutrient profile.
This study identified a whole new flavonoid in cedar leaves called quercetin 3-xylosyl(1→2)rhamnoside-4′-rhamnoside, along with the common rutin found in raspberries, plus hyperin and quercetrin. Remember that today’s study was on the leaves; a bunch of other studies test the tree’s fruit or bark.
Anti-inflammatory – annoyingly, some of the best anti-inflammatory studies are on the fruit, but this one found that cedar tree leaf protected against the surge in inflammatory chemicals from mercury. That’s the deadly heavy metal lurking in tuna and contaminated tap water. Plus, today’s study shows its speciality in extinguishing inflammation; the question is how.
The scientists leaned towards the flavonoid argument, saying how they block enzymes behind free radical production, such as microsomal monooxygenase, and mitochondrial succin oxidase.
As we mentioned yesterday, the flavonoid quercetin can deactivate DNA gyrase in a bacteria cell and prevent it from replicating. Then there’s the back to basics power, deactivating free radicals running giddily around the surface of your skin.
If the antioxidants are hyperconcentrated, then they could be the heroes alone, but adding 26.5% to the reduction from clindamcyin is too huge. I’m sure there’s another factor at play.
The verdict
All in all, the minor flaws fail to dent the great possibilities of this acne remedy.
The sample size is definitely a worry, considering how amazing the added 26.5% reduction was. The fall in pimple counts seems too good to be true, but maybe this biblical leaf really is that good.
Cedar is definitely in an another league to water spinach. Antibacterial powers are great, but it’s only one root cause of acne, particularly when neither inflammation nor sebum were tested either. There’s always that niggling doubt about whether it will really manifest as clear skin, but with a direct study, cedar has moved to the next level. It’s in the storied hall of directly proven remedies, sitting alongside fellow graduates such as aloe vera, tea tree oil and the purple Thai fruit mangosteen.
A final interesting fact is ziziphus spina-christi is used to make one of the most storied varieties of honey in the Arab world. Legend states that the honey is particularly packed with bioactive compounds, and the hub is the do’an valley of Yemen, with winter the peak season.
Unfortunately, the war in Yemen is taking a big toll. Honeybee farmers have to move from hive to hive with their baskets through the wide valleys, and being bombed by airstrikes is a real threat. However, the honey industry has now reached 10% of the country’s economic value of its oil output. It’s claimed that while a bee normally makes 36,000 foraging trips before dying, ziziphus spina-christi is so potent that the weaker bees die after 3 trips.
Sidr honey is supposedly “one of the finest honeys in the world”. Buy Sidr honey, and you will be “hooked forever”, which is probably a less appealing advert than they think.
This could be the final piece of the acne puzzle. Why? Because a honey’s nutrition is closely affected by the plant bees obtain it from. The legendary rich taste could be the raw, acne-clearing power manifesting in the real world.
Thanks for reading!