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In this week’s lecture, Dr. Bikman explores the metabolic origins of acne, challenging the conventional view that acne is purely a skin issue. While acne is often attributed to excess oil production, clogged pores, bacteria, and inflammation, Ben highlights how metabolic factors—especially insulin—play a significant role.

Insulin directly stimulates sebaceous glands, increasing oil production, and also triggers the release of androgens (such as testosterone), further worsening acne. Additionally, insulin resistance promotes inflammation and hyperkeratinization, both of which contribute to acne severity.

He explains that puberty naturally induces a state of insulin resistance, which helps drive growth and development. However, when combined with modern high-carbohydrate diets, this physiological insulin resistance can be exacerbated, leading to severe acne in some teenagers. He also discusses the role of insulin-like growth factor 1 (IGF-1), which is stimulated by high insulin levels and is known to increase sebum production and accelerate skin cell turnover, worsening acne conditions.

Ben then presents compelling research on metabolic-based acne treatments, including the use of metformin, an insulin-sensitizing drug that has shown promise in reducing acne, particularly in conditions like PCOS. He also highlights dietary interventions, particularly low-carbohydrate and ketogenic diets, which have been found to significantly reduce acne severity by lowering insulin and improving skin health. One study found that young women on a ketogenic diet saw a 33% reduction in acne severity and a 50% improvement in skin quality within just 45 days.

He concludes that acne is not just a cosmetic issue but a metabolic condition that can be managed through dietary and lifestyle changes. While conventional acne treatments address symptoms, tackling insulin resistance through proper nutrition provides a long-term solution. He encourages those struggling with acne to focus on cutting out refined carbohydrates, prioritizing protein, and embracing healthy fats to regulate insulin levels and improve skin health.

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Acne & Insulin Resistance: Why Your Diet Matters More Than You Think

The Metabolic Classroom with Dr. Ben Bikman