Obesity: 7 Confirmed Connections To Acne

It seems like two completely opposite stereotypes exist in the world of obesity and acne. Firstly, there’s the fat guy walking around with a cheerful smile on his face because of his freakishly clear skin, enjoying a donut as you seethe with jealousy. He shrugs his shoulders and says that being large has at least one decent advantage. The second stereotype, however, is a cheeto eating videogame addict hunched over his computer desk, 6 stones overweight and with the poorest complexion you’ve ever seen.

Whether these folklore characters really exist or not, it illustrates a simple fact: how the role of obesity in acne is a complete mystery to this day. 

We’re no closer to uncovering the truth than 20 years ago, when teenagers were mulling over the fatness shield in the playground.

Obesity is like caffeine: people’s individual reactions are extremely hard to predict. Fat cells release over 50 hormones and signalling molecules, which fall under the umbrella name of adipokines. There’s overlaps aplenty, involving hormones, immune system chemicals, enzymes and more.

The studies don’t help either. This one on 143 Polish schoolchildren aged 12-18 found that obesity fuelled the fires of pimples, but when 600,404 soldiers were tested in Israel, obesity was a shield. You can read this article for the full, confusing weighting of the evidence.

One day, we’ll know the truth (or maybe we never will – we could still be debating it in 4000AD). For now though, here are 7 confirmed connections between obesity and acne.

We know their individual roles; the mystery is their individual strength, and how they interact.

 

One – increasing estrogen

A hormonal surge which might be the single strongest connection of body fat to acne. Vitamin D and inflammation have their place, but this could be a tidalwave washing away everything in its path.

All the estrogen in your body, whether you’re a 20 year old woman or a musclebound marathon runner (everyone has a little estrogen), is converted from the two androgenic hormones testosterone and DHT. Most importantly, the aromatase enzyme facilitates this conversion, and aromatase is produced by adipocytes, AKA fat cells.

The greater your fat cells, the greater your estrogen conversion, and the greater your estrogen levels.

With it comes the hormone’s signature smoothness, hydration and loss of toughness. Essentially, the characteristics of a woman’s skin, smooth and soft, versus a man’s sandpaper-like skin, which cuts your finger open the second you touch it (supposedly).

It also explains another common headscratcher: why overweight people commonly have such healthy looking skin, despite obesity being the very opposite of health. Sometimes, it’s just fall cells building up under the skin and stretching out wrinkles, a very basic method of smoothness. However, female athletes sneaking in illegal testosterone injections are often shocked at the rough skin that suddenly appears.

There’s one caveat: this link is probably much more significant for men, who produce almost all of their aromatase in fat cells. Women produce some in their fat cells, but most in the ovaries.

Results in isolation – your pimple count will fall.

While testosterone and DHT are healthy hormones, they also cause oily skin by stimulating the sebaceous glands dotted all over your face. With more aromatase, more DHT and testosterone will be depleted during conversion to estrogen.

 

Two – decreasing vitamin D

10 years ago, it was already accepted that body fat drains your vitamin D supplies, and since then, the evidence has solidified to diamond status.

The theory is simple: as a fat soluble nutrient, greater fat cells will lead to more vitamin D being stored away. Less vitamin D will be flowing through your body, whether it’s funnelling calcium to your bones or keeping your mood sunny.

In one study, every 1 point increase in BMI decreased bloodstream vitamin D by 1.15%. Obese people also enjoy a much smaller summer vitamin D increase, and a smaller rise after taking supplements (study).

Fat cells seem to be a one way ticket to lower vitamin D levels. Fat and thin people manufacture roughly the same vitamin D after sun exposure – the problems lie in the distribution to bodily reservoirs.

For example, people with genes linked to obesity are much more vitamin D deficient, yet people with genes linked to low vitamin D are no more likely to be fat. Clearly, obesity lowers your vitamin D and not the other way around.

Results in isolation – your pimple count will rise.

Alongside zinc, vitamin D is unbeatable for creating not a more powerful, but a more efficient immune system. Just look at its popularity for flu, and for pimples, vitamin D will constrain the barrage of pro-inflammatory chemicals like TNF-a. Not every acne study is incredible, and some are even negative, but the balance clearly tilts towards benefits. Likewise, low bloodstream vitamin D is strongly correlated with pimples.

There’s also an indefinable, unexplainable glow that vitamin D seems to create. It could just be spending more time in the sun, but supercharged antioxidant defences are another possibility. These antioxidants improve acne too: vitamin D is important for superoxide dismutase (SOD) creation.

 

Three – decreasing DHT

The androgenic sex hormone, the right hand man of testosterone. Again, bloodstream DHT will automatically fall because of the aromatase enzyme surge, but there’s also two other enzymes.

Firstly, body fat cells or adipocytes somehow signal 5-alpha reductase to decrease. Seeing as this enzyme has one job in the body, converting testosterone into DHT, this lowers your overall DHT massively. The second enzyme is 3α/β-HSD, which degrades the existing DHT floating through your veins, creating an ineffective metabolite called 5alpha-androstane 3alpha,17beta-diol. 3α/β-HSD is manufactured directly by fat cells.

All roads point to lowering DHT – for reasons unknown, it’s obesity’s speciality. Why would a high BMI make a hormone behind sex and aggression less necessary? What’s its motive? Evolutionary speaking, if your energy reserves are plentiful, then there’s probably no need to be prowling around hunting. However, the satiety hormone leptin does the reverse; it increases your energy expenditure when food is plentiful, as there’s less need to preserve the body’s energy stores.

It’s a mystery, but fat lowering DHT is probably the sturdiest connection of this list. In fact, there’s speculation on baldness websites that obese people have a fuller head of hair. Blocking DHT is how hair loss drugs like finasteride work.

Results in isolation – your pimple count will fall.

If lowering DHT was body fat’s sole power, then your acne would never be heard from again. Your sebaceous glands would pump out 65% less oil, and your pores would never clog up. The sebaceous glands have direct receptors for DHT, the evil twins of the vitamin A receptors which decrease their activity.

 

Four – increasing inflammation

One of the biggest discoveries since 2000 not just in acne and obesity, but obesity science overall.

Apparently, obesity directly causes a state of chronic, low-grade inflammation, due to chemicals churned out by individual fat cells. In the olden days, fat tissue was supposedly an inert blob devoted only to energy storage, but now, they’re known to be mega-bioactive.

The interest was sparked in 1993, when a study proved that fat cells manufacture the pro-inflammatory chemical TNF-a. In a 2000 study, 25 obese women had dramatically more bloodstream interleukin-6 then 12 healthy women. One third of the body’s IL-6 may originate from fat tissue.

Then there’s C-reactive protein (CRP), which as decided at a grand conference back in 2002, is the default biomarker scientists use to detect inflammation. In Montenegro, 30 healthy weighted postmenopausal women had significantly less bloodstream CRP than 60 overweight postmenopausal women (study).

Results in isolation – your pimple counts will rise.

TNF-a, IL-6, CRP. These are the villains we constantly mention when talking about miraculous blueberries or pimple-calming broccoli. Obesity is a direct mirror to acne. It causes chronic, low-grade inflammation, and that’s exactly the condition we warn of – the hidden root cause of acne.

 

Five – decreasing magnesium

The evidence is less overwhelming than for vitamin D, but as BMI creeps up, your magnesium almost certainly creeps down.

This study featured 140 children aged 2-14, divided into two groups of 70. The difference in magnesium was clear, averaging at 2.08mg/dl in the overweight group compared to 2.55 in the healthy group, a 18.5% reduction.

This study was already moving on, testing whether vitamin D could fix magnesium deficiencies in obese people. It did, but stepping back a second, 25% of obese women were deficient compared to 12% of normal women, among 82 women aged 17-50.

Magnesium is a hard mineral to find at the best of times, but obesity makes the situation grimmer.

There’s only one flaw: magnesium is known to stoke the metabolism. Therefore, deficiencies could be causing obesity, but it’s almost certainly the other way round; a small metabolism increase will pale compared to calories in, calories out.

The reason, however, is less known. The old bodily storage concept could return, but one notorious magnesium enemy is sugar, which obese people will inevitably eat more of.

Additionally, the phosphorus in soft drinks is a notorious mineral blocker in the gut, particularly against magnesium. The chemically related phosphoric acid is added to Coca-cola, Pepsi and friends to stabilise them. Unlike vitamin D, it could be 10 factors combining into one.

Results in isolation – your pimple count will rise.

Magnesium is a mineral of many acne tricks. Firstly, your sleep quality will worsen, as neurotransmitters like melatonin fail to spark up. Secondly, anxiety will rise as the stress hormone cortisol runs riot. Finally, you will manufacture less glutathione, the acne-clearing antioxidant, which requires magnesium, zinc and selenium as ingredients. Speaking of which…

 

Six – decreasing glutathione

It’s the master antioxidant, made by the body itself, and according to this 2014 study, glutathione peroxidase was significantly depleted in 231 obese or overweight Saudi children.

Once upon a time, obese diabetics had dramatically reduced glutathione peroxide (the main antioxidant form) compared to non-obese diabetics (study). When treated with the insulin their bodies craved, glutathione was replenished – but by significantly less in the obese patients.

The loss of magnesium could explain this, as could the chronic inflammation; immune system chaos tends to generate free radical chaos. However, I wouldn’t be surprised if fat cells churn out a specific toxin which decreases glutathione production, given its strange alteration of the enzymes behind DHT.

It also ties into the nature of obesity itself. Your blood sugar will almost certainly be sky high and with it, AGE free radicals. If junk food is your addiction, then so is soybean oil, and with it, the omega 6 fats that make your immune system fire out more free radicals. Obesity’s consequences are messy, and overlap constantly, but in the midst of it, we have strong evidence that glutathione is depleted.

Results in isolation – your pimple count will rise.

Draining glutathione will shatter your skin’s shield against free radicals, adding redness to your pimples. The indirect pathways are countless; the free radicals will also deplete vitamin E on the skin’s surface, which prevents the pore-clogging squalene peroxide from forming. Forget to wear your glutathione armour in your acne-clearing quest, and air pollution and cigarette will surely claim you.

 

Seven – decreasing vitamin C

The signs are clear that the more body fat you gain, the lower this common nutrient will be.

All those cold-busting pills will just vanish into a black hole if your BMI is too high. In 2007, 35 men and 83 women were recruited, with 54% being overweight and 24% obese. Their bloodstream was collected (not all of it).

The higher the BMI, the lower the vitamin C count, particularly for women. 

Cranking things up to a gigantic scale, a 1989 examination of the decades’ long NHANES II survey used 11,592 people, and found an inverse correlation between vitamin C and obesity. European scientists upped the game by examining 19,000 people, using population questionnaires – this time, vitamin C was reduced by abdominal obesity, a beer belly in layman’s terms (study).

The evidence is rock solid, with the sole criticism that obese people are drawn to junk food, where vitamin C is much less common. Or it could be that deficiency causes obesity, because vitamin C is a co-factor for manufacturing carnitine, which burns fatty acids from storage. But I’m sure there’s a connection, and possible explanations include 1) excessive storage in fat cells, or 2) depletion by the immune system chaos, which it must clean up.

Results in isolation – your pimple counts will rise.

Every public speaker worth his salt knows a cheap secret – popping a vitamin C pill beforehand (they’ll probably assassinate me for telling you this). That’s because vitamin C decreases stress hormones like cortisol more effectively than any nutrient other than magnesium. It’s also a powerful water-soluble antioxidant, and accelerates wound healing, and therefore pimple healing, via a nice collagen increase. Vitamin C is needed to convert the amino acid lysine into hydroxylysine, its usable collagen form.

 

 

Conclusion

Obesity and acne is a fog of confusion, but we nevertheless have several rock solid theories.

The raw figures don’t tell the story here. We have 5 against, and 2 which prevent acne, but those 2 are hormonally driven and therefore extremely powerful.

I absolutely don’t recommend lowering DHT and increasing estrogen if you’re a man, but we’re answering a very specific question about obesity here. They could absolutely overpower all those smaller factors. Hormones are why 9 year old kids never get acne, even if their diet of jelly beans and trix cereal is the ultimate for inflammation.

Some connections we didn’t mention here are cortisol, wound healing, and lipid peroxides.

If I had to guess right now, I would say that obesity protects against acne in a slight majority, but with massive interpersonal variation. Regardless, these are the players in the game to remember, to add to your acne knowledge.

 

Thanks for reading!