- Omega-3 fatty acids can help combat moderate to severe acne.
- These essential fatty acids can be found in seafood or in supplements.
- Doctors support the use of Omega-3s for acne as well as for general health.
What is an essential fatty acid?
Essential fatty acids are polyunsaturated fats that cannot be made by the body but are required for good health. That means these acids must be obtained through diet or supplementation. The two main types of essential fatty acids are Omega-3 and Omega-6.
Many of the vegetable oils that we presently consume, like sunflower or corn oil, are high in Omega-6 rather than Omega-3. While humans evolved with a fairly even balance of Omega-3 to Omega-6 fatty acids in their diets, the current ratio in western countries may be higher than 20:1 in favor of Omega-6.
Dr. Andrew Newman, a Scottsdale, AZ dermatologist, explains why this matters. “When our Omega-3 fatty acids are significantly lower than Omega-6 fatty acids, we enter a pro-inflammatory state. This could equate to more acne.”
Omega-3 fatty acids play a key role in cell membranes and help regulate hormones, like those that cause inflammation.
Dr. Shearer says that “Omega-3 fatty acids have anti-aging, antioxidant, and anti-inflammatory benefits. Diets deficient in essential fatty acids can lead to aging of the skin, dry skin, and inflammation.”
There are three main types of Omega-3 fatty acid: alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). ALA is mostly found in plant-based sources, while EPA and DHA come from seafood, especially cold-water fish.
ALA is often used for energy and is only converted to EPA and DHA at low levels. While recommended amounts of ALA have been established, there are currently no recommended amounts for EPA or DHA.
How does fish oil treat acne?
Reducing inflammation is one of the main benefits that Omega-3s provide. Many of the anti-inflammatory properties attributed to Omega-3s come specifically from EPA and DHA, which are most prevalent in fish oil. “Fish oil is high in Omega-3 fatty acids, which have anti-inflammatory effects,” explains Dr. Bryan Tran, a California-based osteopath. “This is because Omega-3 fats do not get converted into pro-inflammatory molecules by lipoxygenase enzymes which are always present in the body.”
The link between seafood consumption and acne was explored as early as the 1960s. During a study of 1,000 teenagers in North Carolina, those who consumed more seafood showed less acne than those who consumed less seafood.
Omega-3s also help control the overproduction of sebum. A combination of EPA and gamma-linolenic acid (GLA, an Omega-6 fatty acid) have been shown to reduce the production of a chemical called leukotriene-B4 (LB4). LB4 causes inflammation and increases the production of sebum, an important factor in the production of acne.
They can also help to regulate hormone levels, which can also increase acne. Dr. Susan Bard, a New York City dermatologist, notes, “Omega-3 supplementation helps decrease androgen levels which can cause hormonal acne.” Androgens are hormones that exist both in men and women but usually serve to enhance male characteristics. The body increases their production during adolescence, which coincides with spikes in acne activity.
Studies have demonstrated good results for Omega-3s, says Dr. Tran. “A recent study showed that acne sufferers who took Omega-3 fatty acid for two months ended up seeing a significant reduction in body and back acne.”
Mild versus severe
Another study showed that Omega-3s can help to reduce the effects of moderate to severe acne. At the same time, sufferers with mild cases noted their condition deteriorated. Dr. Bard explains that “Omega-3 fatty acids have anti-inflammatory properties and as a result can help improve inflammatory or cystic acne. It does not have the same benefit in mild or more superficial acne.” But she adds that “Some studies have shown that mild (non-inflammatory) acne can be exacerbated by Omega-3 supplementation.”
What are the best sources of omega-3s?
An easy way to get more fish oil in your diet is, unsurprisingly, from fish and other seafood. What may be surprising, however, are the wildly varying levels of Omega-3s in different types of seafood. Salmon, mackerel, anchovies, herring, trout, tuna, and sardines are all high in EPA and DHA. Even shellfish like oysters, mussels, and scallops boast a reasonable amount of Omega-3s.
If you’re a vegetarian, fear not – there are plenty of plant-based sources of Omega-3s as well, though these are usually higher in ALA than EPA or DHA. If you’re interested in these alternatives, Dr. Bard recommends nuts and seeds, like walnuts, chia seeds, and flaxseeds, as well as soybeans.
Changing cooking oil can also be useful. Canola, soy, flaxseed, and even olive oil all have relatively high levels of Omega-3s.
Fish oil supplements come in many forms, and they’re hugely popular in the US. In 2012, nearly 19 million Americans used Omega-3 or fish oil supplements. The FDA recommends three grams combined EPA and DHA per day, including two grams from supplements.
When choosing a brand of fish oil, look for high amounts of EPA and DHA. Also check the date to make sure the oil hasn’t expired. Dr. Bard has another word of caution: “Supplements can range in quality and aren’t regulated. Often times the fatty acid in the pill has oxidized, rendering it useless or worse, pro-inflammatory.”
Dr. Shearer recommends combining Omega-3 supplements with others. “It [fish oil] has been shown to have better absorption when taken with vitamin E, so I recommend the two supplements be taken together,” she says. “If an acne patient is taking isotretinoin, it would be beneficial to also be on a fish oil supplementation, as that can help reduce the effects on their lipid profile.”
In addition to fish oil, krill oil is also available. Krill are tiny crustaceans similar to shrimp that are found in every ocean. “Krill oil contains the same two fatty acids that fish oil contains (EPA and DHA),” says Dr. Shearer. “Due to increased bioavailability, krill oil can have the same effects as fish oil at lower doses.”
Cod liver oil may seem like it’s a relic from another age, but it too is packed with Omega-3s and other vitamins.
If you’re opposed to consuming animal products, flaxseed supplements are a reasonable alternative. Just remember that flaxseed and most plant sources of Omega-3s are richer in ALA opposed to EPA or DHA.
Are there any side effects?
Because Omega-3 supplements usually contain fish oil, they may lead to a fishy taste in your mouth or a fishy smell to your breath. “If the fishy smell is disturbing,” Dr. Shearer suggests, “purchase a supplement with flavoring, and refrigerate your supplements.”
Sometimes these supplements can lead to indigestion. “A major downfall with these fatty acids is heartburn,” cautions Dr. Newman. “If heartburn is already a problem for you, then you wouldn’t stomach Omega-3 fatty acids.”
High doses of fish oil (four grams or higher) can have antiplatelet effects, potentially making it harder to stop bleeding. People taking anticoagulants like warfarin should take caution when combining fish oil supplements with their medication.
What about mercury?
Dr. Shearer tells us not to worry about mercury in fish oil supplements. “The risk of mercury contamination in fish oil supplements is very low,” she says. “Heavy metals tend to bind the flesh of the fish, not the oil. Secondly, the fish that are at greatest risk for high mercury levels are typically not the source of fish for fish oil supplements.”
However, just to be sure, she cautions, “It is wise to purchase molecularly distilled products that are certified to be free of contaminants such as heavy metals.”
Safe and effective acne treatment
Overall, increasing your Omega-3 intake, through diet or supplements, is a safe and effective way to help combat moderate to severe acne. Doctors consistently support the use of Omega-3s and recommend them generally as a tool for good health.