If your lab data is normal, then the problem is diet. Switch to a Paleolithic Diet and post everything you eat and drink after 1 week of implementation. Most people don't really follow the diet but claim it doesn't work.

This statement is not true for everyone. Just because your labs come back "normal" doesn't mean that the balance between certain hormones is optimal or even good. Normal is relative. You said it yourself: "Lab data is used to catch gross excesses or deficiencies and confirm a clinical diagnosis."

That's great that diet worked for you, but I speak from experience too... all tests came back "normal." I tried all sorts of diets including paleo, and it didn't touch my skin. It wasn't until I tried hormonal methods (spiro, then progesterone and dim) that I began to clear after over a decade of cystic acne.

If your lab data is normal, then the problem is diet. Switch to a Paleolithic Diet and post everything you eat and drink after 1 week of implementation. Most people don't really follow the diet but claim it doesn't work.

This statement is not true for everyone. Just because your labs come back "normal" doesn't mean that the balance between certain hormones is optimal or even good. Normal is relative. You said it yourself: "Lab data is used to catch gross excesses or deficiencies and confirm a clinical diagnosis."

That's great that diet worked for you, but I speak from experience too... all tests came back "normal." I tried all sorts of diets including paleo, and it didn't touch my skin. It wasn't until I tried hormonal methods (spiro, then progesterone and dim) that I began to clear after over a decade of cystic acne.

Ok, I'll edit my post and change normal to optimal. I thought that was understood after just discussing the etiology of the lab reference range and specifically noting optimal hormone levels (that are in the proper ratios).

I really am happy for you that you have found something that works. It would be interesting to see your lab data if you are willing to redact the personal information and post the results.

I'm not being arrogant here or challenging you but want to make this point as it may help someone reading this. In every case i have seen where there has been an issue with paleo not working, the problem has been implementation. They forget something they are eating or use a version other than Loren Cordain's or worse just modify the diet based on individual preferences and then claim it doesn't work.

The paleo diet requires planning and a radical change in behavior.

The food log resolves this quickly.

The other problem is that unless you have PCOS or a tumor, most women don't have elevated testosterone. For those that do, spironolactone (an aldosterone antagonist) as a testosterone antagonist on a chronic basis is a poor choice.

1. It decreases aldosterone (not wise unless you also have hypertension); and

2. It's tumorigenic.

#4 is actually a valid point.

Though to say that the Paleo diet is a panacea doesn't follow from your points.

Why is it always brand-new members that come in with broad sweeping statements like this?

The way you talk about the Paleo diet is the way old school nutritionists used to talk about calories. "It's just calories in and calories out. It doesn't matter if it's a doughnut or a steak." "If you're not losing, you must be a closet binge eater or you're not counting your calories closely enough." And oh how they were wrong...

Sometimes it's not implementation. Sometimes we are simply fallible humans who still don't know enough about the human body to say why something works for one person and doesn't work for another.

I don't doubt that a strict paleo can help many people, but how many can actually follow this diet long term? There are people who follow this and end up having nutritional deficiencies in the long run. So, it's not for everyone, although I don't doubt that it's probably one of the best diets for clear skin because, by Western standards, it's one of the most extreme.I'm happy doing a modified paleo with some grains instead of beating myself up for not following a diet to the t.

As for lab testing, I think it there's a serious deficiency or imbalance, it might be detected through blood tests (that's how I found out I had low progesterone). But unless there's a full panel that tests hormonal fluctuations several times a month, along with the full thyroid panel (which regular blood tests sometimes don't test for both T3 and T4), I don't think those tests can be indicative of anything.

I'm doing the saliva testing to see what it will show compared to the blood tests that were pretty much pointless since I only took them once a month, during my "calm" phase.

Anyway, it's either hormonal testing or trial and error...we don't really have too many options.

#4 is actually a valid point.

Though to say that the Paleo diet is a panacea doesn't follow from your points.

Why is it always brand-new members that come in with broad sweeping statements like this?

The way you talk about the Paleo diet is the way old school nutritionists used to talk about calories. "It's just calories in and calories out. It doesn't matter if it's a doughnut or a steak." "If you're not losing, you must be a closet binge eater or you're not counting your calories closely enough." And oh how they were wrong...

Sometimes it's not implementation. Sometimes we are simply fallible humans who still don't know enough about the human body to say why something works for one person and doesn't work for another.

I'm not sure what you mean when you say I'm claiming that paleo is a panacea as that's not what I'm saying.

What I am saying is that the etiology of acne is elevated testosterone and poor diet. Typically it's a combination of the two but not necessarily. For most people the easiest of the two to fix is diet and in almost all cases paleo works as that's what we were designed to eat. I'm sure you know that acne is not ubiquitous in all cultures/societies. There is a reason for this, in areas where the population is not exposed to phalates/endocrine disruptors, toxic chemicals and poor food, there is no acne - none, zero. The occasional exception does not exist.

You are correct that there will be the occasional exception here, but that's rare. There is a common misconception that a particular medical algorithm what work's for one person may not work for the next. Yes there are minor genetic differences that can result in the way medications are metabolized for one person to the next but the algorithm takes care of that with alternatives, some of which may not be medication. The basis for this misunderstanding is that the current medical model is set up to treat acute problems only, not chronic disorders. It's only been the last number of years that the family doc has been available for the low cost of a co-pay. Prior to that is was cash and you only saw the doc when it was necessary. They just aren't good at dealing with the chronic problems yet, so the general public forms the conclusion that we all must be different otherwise their treatment would work.

There actually are a small number of good physicians that understand how to treat some of these disorders and for reasons I can't explain, the information they have remains elusive for most people, including most of the medical community.

I have some of this information as it relates to acne and am trying to share it with others here. I certainly wish I had someone to provide me this information 30 years ago, I might have little to no scarring.

So if your hormone levels are corrected and optimized and you are eating well (typically paleo), then acne resolves. As I have said before, the most common problem is that the diet isn't really followed. Having a cheat meal every few days doesn't cut it with acne if you have a severe problem.

If you have evidence to the contrary I'd like to see it. Evidence is hormonal lab data and food logs. I highly doubt you have that. I hear all the time that paleo doesn't work (particularly with fitness related problems). It takes about 2 minutes of quizzing to discover they are following their version or following part time.

I don't doubt that a strict paleo can help many people, but how many can actually follow this diet long term? There are people who follow this and end up having nutritional deficiencies in the long run. So, it's not for everyone, although I don't doubt that it's probably one of the best diets for clear skin because, by Western standards, it's one of the most extreme.I'm happy doing a modified paleo with some grains instead of beating myself up for not following a diet to the t.

As for lab testing, I think it there's a serious deficiency or imbalance, it might be detected through blood tests (that's how I found out I had low progesterone). But unless there's a full panel that tests hormonal fluctuations several times a month, along with the full thyroid panel (which regular blood tests sometimes don't test for both T3 and T4), I don't think those tests can be indicative of anything.

I'm doing the saliva testing to see what it will show compared to the blood tests that were pretty much pointless since I only took them once a month, during my "calm" phase.

Anyway, it's either hormonal testing or trial and error...we don't really have too many options.

You are CORRECT that it's a difficult diet to follow long term because of the planning involved and the schedules that most of us have. You are ABSOLUTELY INCORRECT that the diet is unhealthy. This is the diet we were designed to eat. There are mound of data to prove this. Grains are NOT HEALTHY. There is as much data to support this and more being added each day. One of the worst foods for you is whole wheat bread. It's like most things in life, a trade off. What do you want more - to gratify your immediate urge to eat a pizza and top it off with ice cream or have clear skin. Believe me, I'm not perfect. I can follow the diet all week, have clear skin and then go out with friends on the weekend and kaboom, acne the following week. I know what I'm doing and choose to enjoy myself and take the health risk and a small amount of acne to enjoy the weekend.

As far as hormones go, the free fraction fluctuates throughout the day, however the totals don't change quickly and generally decline slowly as we age. You don't have high totals in December, low totals the following February and high totals again in June. If you are concerned about progesterone, the best day to test is day 21 of your cycle as this is the day progesterone peaks. Salivary tests are not very accurate and only test the free fraction. There are a few docs that know how the interpret the wide reference range, but that's unusual. The clinical value of salivary testing is low. I do have the charts and will be happy to share the data if you want to see it.

Endocrinology is one of my favorite subjects and have accumulated a huge amount of information on the subject matter. It was actually through my study of Thierry Hertoghe's physician training courses on endocinology that I stumbled on the etiology and treatment for acne. He has used it successfully for years.

If you have a specific endo question I would love to take a crack at answering it.

You are CORRECT that it's a difficult diet to follow long term because of the planning involved and the schedules that most of us have. You are ABSOLUTELY INCORRECT that the diet is unhealthy. This is the diet we were designed to eat. There are mound of data to prove this. Grains are NOT HEALTHY. There is as much data to support this and more being added each day. One of the worst foods for you is whole wheat bread. It's like most things in life, a trade off. What do you want more - to gratify your immediate urge to eat a pizza and top it off with ice cream or have clear skin. Believe me, I'm not perfect. I can follow the diet all week, have clear skin and then go out with friends on the weekend and kaboom, acne the following week. I know what I'm doing and choose to enjoy myself and take the health risk and a small amount of acne to enjoy the weekend.

As far as hormones go, the free fraction fluctuates throughout the day, however the totals don't change quickly and generally decline slowly as we age. You don't have high totals in December, low totals the following February and high totals again in June. If you are concerned about progesterone, the best day to test is day 21 of your cycle as this is the day progesterone peaks. Salivary tests are not very accurate and only test the free fraction. There are a few docs that know how the interpret the wide reference range, but that's unusual. The clinical value of salivary testing is low. I do have the charts and will be happy to share the data if you want to see it.

Endocrinology is one of my favorite subjects and have accumulated a huge amount of information on the subject matter. It was actually through my study of Thierry Hertoghe's physician training courses on endocinology that I stumbled on the etiology and treatment for acne. He has used it successfully for years.

If you have a specific endo question I would love to take a crack at answering it.

Well, I have to either have some grains or pass out, so I chose to have some grains that I consider healthy. I read a lot of articles about grains, and I do think that some grains can contribute to inflammation, but based on my own trial and error, some grains don't bother me. Mentioning pizza and ice cream as examples is very extreme, I never eat that stuff because I know my skin will be paying for it. But I'm not opposed to potatoes or some grains that help me stay full. I need something else besides vegetables, meat, and fish. I used to have almonds and walnuts as snacks, but I noticed that my inflammation decreased when I cut them out, so now I have some grains as snacks instead. I don't mean pizza or anything unhealthy. And all grains I eat are gluten free and low carb for the most part.

I noticed that on the paleo forums many people who are strict paleo also take supplements....we are not designed to take supplements either, but people on the paleo who support supplements don't seem to mind that contradiction. I don't think that some diets can fulfill all of our nutritional needs unless the meal planning is very strategic and the quantities of vegetables especially are very high or juiced. Add to that some vitamins, minerals, and aminoacids that we can't adequately obtain from food, like taurine, inositol (made in the body, but women with PCOS especially are prone to deficiency), vitamin D. If you manage to get all your nutrients through diet alone, then good for you. But for people like myself who have problems with absorbing some nutrients, some supplementation is needed to complement a healthy diet until the digestive or other issues are under control. Anyway, that's my opinion based on a ton of trial and error, and I feel more comfortable with a diet that's more realistic for my lifestyle. It has its flaws for sure, but it's far better than the average American diet.

About the hormones, I didn't mean monthly fluctuations. I meant daily fluctuations. My hormones can fluctuate to the point where one day I'm depressed and then next I'm very energetic and my sex drive is out of control. If that's not hormonal, I don't know what is. The same thing with my skin - it can go from good one day to horrible the next, although now it's manageable thanks to a lot of effort and research.

Blood tests never helped me that much, except to indicate low progesterone (which was low even during the peak stage). That's why I'm trying saliva - I go to an integrative medical center and they only do saliva testing for hormones. I'll include cortisol and thyroid. I have to take saliva samples every week I think. Why is the clinical value of saliva tests low? I would be interested in seeing some data from impartial sources. I'm not going to 100% trust even the saliva test results I will get, but at least I might have an indication of which hormones are off balance. At this point, trial and error got me further than the blood tests I had, but it would be nice to have some data to back up my suspicions about my hormones so then I'd feel more confident adding more supplements to regulate hormones.

If you have evidence to the contrary I'd like to see it. Evidence is hormonal lab data and food logs. I highly doubt you have that. I hear all the time that paleo doesn't work (particularly with fitness related problems). It takes about 2 minutes of quizzing to discover they are following their version or following part time.

Seriously?

If you have evidence that the Paleo diet will resolve acne, I'd like to see EVIDENCE. Evidence is a systematic review of multiple randomized controlled clinical trials using the Paleo diet and acne patients specifically.

Good luck on that one!

You are CORRECT that it's a difficult diet to follow long term because of the planning involved and the schedules that most of us have. You are ABSOLUTELY INCORRECT that the diet is unhealthy. This is the diet we were designed to eat. There are mound of data to prove this. Grains are NOT HEALTHY. There is as much data to support this and more being added each day. One of the worst foods for you is whole wheat bread. It's like most things in life, a trade off. What do you want more - to gratify your immediate urge to eat a pizza and top it off with ice cream or have clear skin. Believe me, I'm not perfect. I can follow the diet all week, have clear skin and then go out with friends on the weekend and kaboom, acne the following week. I know what I'm doing and choose to enjoy myself and take the health risk and a small amount of acne to enjoy the weekend.

As far as hormones go, the free fraction fluctuates throughout the day, however the totals don't change quickly and generally decline slowly as we age. You don't have high totals in December, low totals the following February and high totals again in June. If you are concerned about progesterone, the best day to test is day 21 of your cycle as this is the day progesterone peaks. Salivary tests are not very accurate and only test the free fraction. There are a few docs that know how the interpret the wide reference range, but that's unusual. The clinical value of salivary testing is low. I do have the charts and will be happy to share the data if you want to see it.

Endocrinology is one of my favorite subjects and have accumulated a huge amount of information on the subject matter. It was actually through my study of Thierry Hertoghe's physician training courses on endocinology that I stumbled on the etiology and treatment for acne. He has used it successfully for years.

If you have a specific endo question I would love to take a crack at answering it.

Well, I have to either have some grains or pass out, so I chose to have some grains that I consider healthy. I read a lot of articles about grains, and I do think that some grains can contribute to inflammation, but based on my own trial and error, some grains don't bother me. Mentioning pizza and ice cream as examples is very extreme, I never eat that stuff because I know my skin will be paying for it. But I'm not opposed to potatoes or some grains that help me stay full. I need something else besides vegetables, meat, and fish. I used to have almonds and walnuts as snacks, but I noticed that my inflammation decreased when I cut them out, so now I have some grains as snacks instead. I don't mean pizza or anything unhealthy. And all grains I eat are gluten free and low carb for the most part.

I noticed that on the paleo forums many people who are strict paleo also take supplements....we are not designed to take supplements either, but people on the paleo who support supplements don't seem to mind that contradiction. I don't think that some diets can fulfill all of our nutritional needs unless the meal planning is very strategic and the quantities of vegetables especially are very high or juiced. Add to that some vitamins, minerals, and aminoacids that we can't adequately obtain from food, like taurine, inositol (made in the body, but women with PCOS especially are prone to deficiency), vitamin D. If you manage to get all your nutrients through diet alone, then good for you. But for people like myself who have problems with absorbing some nutrients, some supplementation is needed to complement a healthy diet until the digestive or other issues are under control. Anyway, that's my opinion based on a ton of trial and error, and I feel more comfortable with a diet that's more realistic for my lifestyle. It has its flaws for sure, but it's far better than the average American diet.

About the hormones, I didn't mean monthly fluctuations. I meant daily fluctuations. My hormones can fluctuate to the point where one day I'm depressed and then next I'm very energetic and my sex drive is out of control. If that's not hormonal, I don't know what is. The same thing with my skin - it can go from good one day to horrible the next, although now it's manageable thanks to a lot of effort and research.

Blood tests never helped me that much, except to indicate low progesterone (which was low even during the peak stage). That's why I'm trying saliva - I go to an integrative medical center and they only do saliva testing for hormones. I'll include cortisol and thyroid. I have to take saliva samples every week I think. Why is the clinical value of saliva tests low? I would be interested in seeing some data from impartial sources. I'm not going to 100% trust even the saliva test results I will get, but at least I might have an indication of which hormones are off balance. At this point, trial and error got me further than the blood tests I had, but it would be nice to have some data to back up my suspicions about my hormones so then I'd feel more confident adding more supplements to regulate hormones.

Check out Thierry Hertoghe's work. I have some of his physician hormone training materials. The reason Saliva testing has low clinical value is the reference range is very wide. You can land in the low or high end and it appears normal.

The same can happen with serum testing, however its been used longer, the range is not as wide and experienced docs have learned what is optimal based on extensive correlation with clinical exams.

The most potent stimulator of libido in both the male and female brain is free estradiol. Of course you also need dht and testosterone for the system to work correctly.

If you have evidence to the contrary I'd like to see it. Evidence is hormonal lab data and food logs. I highly doubt you have that. I hear all the time that paleo doesn't work (particularly with fitness related problems). It takes about 2 minutes of quizzing to discover they are following their version or following part time.

Seriously?

If you have evidence that the Paleo diet will resolve acne, I'd like to see EVIDENCE.

Evidence is a systematic review of multiple randomized controlled clinical trials using the Paleo diet and acne patients specifically.

Good luck on that one!

Yes seriously. Those studies don't exist. This forum is the ideal place for you to test my assertion. The problem here is acne. I am providing a viable solution. Some people here are very frustrated and willing to try something like this. For those that think my solution doesn't work, let's evaluate diet and discuss.

This is not a pissing match. You are loosing sight of why we are here.

I would be interested in controlled studies too, but let's face it, who is going to sponsor those studies? Not pharmaceutical companies or major institutions. To add to that, acne is at the bottom of the list, so even if there were large scale clinical studies on the effects of paleo, I doubt that acne would be the first condition on the list. I mean, there are barely any large-scale studies on the impact of diet on acne, but there are SO MANY anecdotal ones and, based on my own personal experience, I do believe there is a definitely link. But also, how foods are digested can be almost as important as what we put into our bodies.

I have more faith in saliva testing than blood testing for hormones, but I'll tell you for sure when I get the test results back.

As for high estradiol and high libido, how come symptoms of estrogen dominance list LOW libido as a possible side effect? I never got that connection. I understand why estrogenic birth control pills can lower libido, but why would the free estradiol produced in the body lower libido? Doesn't testosterone also have to be low too for that to happen?

I would be interested in controlled studies too, but let's face it, who is going to sponsor those studies? Not pharmaceutical companies or major institutions. To add to that, acne is at the bottom of the list, so even if there were large scale clinical studies on the effects of paleo, I doubt that acne would be the first condition on the list. I mean, there are barely any large-scale studies on the impact of diet on acne, but there are SO MANY anecdotal ones and, based on my own personal experience, I do believe there is a definitely link. But also, how foods are digested can be almost as important as what we put into our bodies.

I have more faith in saliva testing than blood testing for hormones, but I'll tell you for sure when I get the test results back.

As for high estradiol and high libido, how come symptoms of estrogen dominance list LOW libido as a possible side effect? I never got that connection. I understand why estrogenic birth control pills can lower libido, but why would the free estradiol produced in the body lower libido? Doesn't testosterone also have to be low too for that to happen?

I generally agree with you on this post.

In terms of estradiol most docs have no clue about how to create a treatment plan for correcting hormone imbalances. The best way to look at this is that the hormonal system must be balanced. If everything is optimally balanced and a mild increase in estradiol occurs then libido increases, but only to a point. If it's too high it will have the reverse effect. Same if too low. Another interesting fact about estradiol is that it stimulates the parasympathetic nervous system. If estradiol is too low you will feel fatigued. Too high and you can feel almost manic. It's a giant balancing act. There are about 10 major hormones that we know enough about to correct. Some that I haven't mentioned are oxytocin, vasopressin, aldosterone (affected by spiro), insulin, cortisol (the most important hormone in the human body), IGF-1, melatonin, growth hormone, pregnenalone and msh.

MSH is a very interesting hormone. It's responsible for skin color. Many people have reported that it immediately clears up their acne. There is no FDA approved version of this peptide and it requires a subcutaneous, routine injections. Very experimental. Some versions can elevate blood pressure so don't try this on your own. Requires medical oversight.