Research meets ritual

The Skin Sage

Welcome to The Skin Sage, a modern guide to holistic beauty through whole-body health + wellness.

Fluoride and Acne: What’s the Connection?

Dermatologists have linked fluoride to acne and perioral dermatitis dating all the way back to 1950s. But, is the link a plausible one? Read to find out more.
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The Truth About Magnesium Glycinate and Breakouts (+more)

Magnesium glycinate is a helpful supplement for many people, offering benefits for sleep, mood, and more. But, not everyone can benefit from magnesium glycinate. In fact, in some of us, magnesium glycinate may have a paradoxical, negative effect and even trigger breakouts. Read to learn why!
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Is Vitamin D Causing Your Breakouts?

By Sophia Ruiz, Founder/CEO

Supplements are a tricky thing. They can be hugely helpful, missing pieces in our healing journey. But, sometimes, they can be counterproductive.

As many of you reading this will understand, this is especially the case for acne.

There are hundreds of posts on the Internet with people raving about all sorts of supplements – zinc, fish oil, beta-carotene, etc. – and how they were the miracle cure for their breakouts. But, it seems like for every positive post, there’s another person who seems to break out from the same exact supplement.

The sad truth is that sometimes even good ingredients can turn out to be not-so-good for acne-prone skin. And even good ingredients for some acne-prone skin types can be counterproductive for others.

In my experience, this can really throw a wrench in the acne healing journey because these good supplements can often fly under the radar as an acne trigger. This can 1) make it hard to identify where breakouts are really coming from and 2) mask the benefits of other products/modalities that might actually be working for us.

A great example of one of these hidden triggers is vitamin D supplements.

I totally understand that this may come as a surprise. After all, vitamin D is hugely beneficial for the body as a whole and for the skin directly.

But, in certain situations (as we’ll get into), taking vitamin D may actually exacerbate breakouts.

In this post, we’ll talk about:

  • why breakouts really occur with vitamin D supplements (and bust some myths on the topic)
  • why you should still take vitamin D if you’re deficient
  • why breakouts when taking vitamin D are probably related to a deeper issue (rather than the vitamin D itself)
  • ways to reduce your chances of getting breakouts when taking vitamin D supplements

Vitamin D and the skin: a primer

Vitamin D is an essential nutrient produced by our skin in response to sunlight. It’s part of the fat-soluble vitamin family that also includes vitamin A, D, E, and K. Vitamin D functions like most nutrients, in that it supports the function of our cells, but, within the cells, vitamin D actually acts a whole lot more like a hormone that it does a typical vitamin.

As a steroid, it’s also more structurally similar to our hormones than other vitamins! For this reason, many experts actually consider vitamin D to be a hormone.

Much like how our hormones influence our skin, vitamin D plays a crucial role in supporting our skin health:

  • Vitamin D is anti-inflammatory. Because inflammation is not only a major driver behind most skin conditions (especially acne) but also the reason for some of the symptoms of these conditions (redness, irritation, itching, and flushing), vitamin D supports healthy, clear skin.
  • Vitamin D helps regulate some of the underlying factors related to acne. Acne is, in part, driven by growth hormone fluctuations that lead to changes in oil production and skin cell dynamics. Studies show vitamin D may play a role in normalizing these changes in the skin and, as a result, may help address breakouts.
  • Vitamin D may support skin hydration. Studies show that vitamin D supplementation may help support a healthy skin barrier and increase skin hydration to combat dry skin.

Why might vitamin D cause breakouts?

Looking at these benefits alone, vitamin D sounds like an incredible nutrient for the skin. And don’t get me wrong, it most definitely is.

But, here’s the problem: there are dozens, if not hundreds of users on Reddit that have found their acne has gotten worse or even resurfaced when taking vitamin D, especially in areas on the face traditionally considered “hormonal”. I’ve worked with dozens of women who have echoed the exact same sentiments.

Why could this be the case?

Some have explained it away as vitamin D increasing testosterone production. However, most of the studies showing an increase in testosterone have been performed in men or women with low testosterone levels. In these cases, vitamin D increases the production of testosterone (a good thing).

But, women with hormonal acne (in most cases), are in neither of those categories. Instead, hormonal acne in women is typically caused by increased levels of testosterone.

And when testosterone is already elevated in women? Studies show vitamin D actually has the opposite effect: taking vitamin D supplements actually lowers testosterone!

So, if vitamin D doesn’t increase testosterone (in fact, it has the opposite effect) in women with acne, what could cause these apparent “hormonal” breakouts?

After digging up some research papers, I have a theory that may have flown under the radar!

Vitamin D, your liver, and your hormones

Testosterone is probably the most well-known male hormone. But, it’s not the only male hormone and it’s certainly not the only male hormone that can cause acne in women, when increased.

Dehydroepiandrosterone (DHEA) is one such male hormone. And when it comes to breakouts that appear after vitamin D supplementation, DHEA might just be the missing link.

Let’s talk about why.

Vitamin D is not just about vitamin D3

In the body, vitamin D undergoes an extensive, multi-step processing in the body to produce the most active form of vitamin D, called calcitriol. This is the form of vitamin D that is responsible for many of vitamin D’s benefits.

But, the metabolites and intermediate compounds produced during this process are also considered to be biologically active and beneficial for the body.

Some of the most abundant and, arguably, most important vitamin D metabolites are the sulfated forms of vitamin D. Research indicates these forms of vitamin D are storage forms of vitamin D that we can pull on when vitamin D levels are low.

These forms of vitamin D are also, interestingly, water-soluble. This is a stark contrast from the rest of the vitamin D compounds, which are all fat-soluble. 

This is really important – mainly because the solubility of compounds matters, especially in how they are transported and utilized in different types of tissues. So, even though vitamin D and its sulfated forms share similar chemical characteristics, the solubility can drastically change their effects. In fact, some researchers believe that sulfated forms of vitamin D may be able to reach certain tissue types that regular vitamin D can’t, pointing to a true importance of these sulfated metabolites.

All of this to say: both vitamin D and their sulfated metabolites (which a significant amount of vitamin D is converted into), are super important for overall health. In fact, without the sulfated metabolites, we may not be able to get the full breadth of benefits vitamin D has to offer.

So, what does this have to do with hormones? And what is the connection to acne?

Sulfated vitamin D forms and DHEA

Remember that male hormone I mentioned earlier, DHEA? Well, as it turns out, the exact same enzyme responsible for converting vitamin D into its important sulfated metabolites is also responsible for de-activating DHEA: an enzyme called sulfotransferase 2A1 (SULT2A1).

When DHEA isn’t properly sulfated (de-activated), it causes overactivity of androgens and plays a role in hormonal acne.

The problem is: when two compounds share enzymes, they each compete for a spot on that enzyme. This means that, depending on many different factors, one compound may prevent another from properly binding to that enzyme. This is especially true if the body is flooded with one compound over the other (like is the case for high-dose vitamin D).

If we take this into account with vitamin D and DHEA, we see an issue start to emerge: if the SULT2A1 enzyme is busy processing vitamin D, it may block DHEA from binding to the SULT2A! enzyme. In essence, vitamin D could create a “hormonal traffic jam”, possibly leading to DHEA staying in its active form.

To make matters worse, SULT2A1 activity is drastically lowered in the presence of inflammation, which is often present on a systemic level in acne patients. What’s more, some studies have shown that acne patients are more likely to deal with intestinal hyperpermeability, a.k.a leaky gut. Leaky gut is a direct contributor to liver inflammation, suggesting that the main site for DHEA and vitamin D sulfation (which is the liver) may be directly impacted in acne.

In putting all the pieces together, we start to see why vitamin D could potentially cause hormonal-like breakouts for some of us. By causing a “hormonal traffic jam” for the (possibly already less-than-optimally functioning) SULT2A1 enzyme, it’s possible vitamin D supplements may increase active DHEA, leading to hormonal breakouts.

So, what can we do about this? Should we stop supplementing vitamin D altogether?

In my opinion, I don’t think so. Vitamin D not only has incredible benefits for the skin, but is also essential for immune function (which is especially important in this day and age), gut health, thyroid health, and more. The benefits of vitamin D are so, so important for optimal health. And the supplemental form of vitamin D is especially important if you live further north, where it’s hard to get vitamin D from the sun throughout the year.

More importantly, I believe there are ways around this side effect for those of us with acne-prone skin.

How to avoid breakouts with vitamin D

As I mentioned, I think vitamin D supplements are worth making work for the benefits they provide (especially if they’re needed to help you maintain a healthy D3 level). And with certain targeted approaches, I believe we can reduce the risk of this “hormonal traffic jam” that may lead to breakouts when taking vitamin D.

The number one important thing is taking as little vitamin D as possible to get the benefits. If you’ve confirmed you’re vitamin D deficient via a blood test, talk with your doctor about what the lowest possible dose is. The less vitamin D that needs to get processed through the liver, the easier it’s going to be to avoid DHEA processing getting backed up. But, of course, you want to make sure you’re taking enough, especially if you’re deficient.

Then, with the minimum necessary amount of vitamin D coming in, you can then support your overall SULT2A1 activity with some targeted measures (of course, with the approval of your doctor if they involve supplements/herbal compounds) to further reduce the risk of interfering with hormone balance:

  • Get enough vitamin A, E, and K. Vitamin A, E, and K help support the production of SULT2A1 (and other sulfotransferases). This makes a ton of sense as the family of fat-soluble vitamins (A, D, E, and K) all work together in synergy. Supplementing with one and not actively consuming enough of the others can often set off an imbalance.
  • Make sure you’re consuming sulfur in your diet. Sulfur is a key cofactor in the activity of sulfotransferase enzymes. So, it’s super important to make sure you’re consuming enough of it! Some acne-friendly sources of sulfur are N-acetylcysteine and sea moss, which contains special fibers called sulfated polysaccharides (maybe this is why sea moss is so great for the skin?!). Sulfur is also really important for producing collagen-promoting proteins in the skin.
  • Optimize your magnesium intake. Magnesium is a super crucial nutrient for a lot of reasons. But, it’s especially important for vitamin D activity. Not only does magnesium activate vitamin D, playing an indispensable role in converting D to calcitriol, but it’s also crucial for producing active sulfur in the body. As a result, magnesium helps assist in sulfotransferase activity, supporting our detoxification of DHEA.
  • Support gut health. As mentioned earlier, leaky gut can contribute to decreased SULT2A1. Healing leaky gut is obviously not a quick or easy fix, but it’s worth implementing even just a few strategies which will have benefits far beyond just sulfotransferase activity. Some of these are: probiotics (especially Lactobacillus rhamnosus GG), fiber, antioxidant-rich foods (like green tea, berries, herbs, and spices), and amino acids like glycine and arginine (collagen peptides are a good source).
  • Drink citrus peel tea or juice. Citrus peels and juice, especially blood orange, contain a flavonoid compound called nobiletin. Nobiletin has been shown to activate a receptor called RORa, which can then increase the expression of SULT2A1.
  • If possible, get safe sun exposure instead of through supplements. The skin produces sulfotransferase enzymes, too. When vitamin D is produced in the skin as a result of sun exposure, part of that vitamin D produced is automatically sulfated, reducing the need for processing by the liver’s sulfotransferase enzymes. Because the liver is the main site for detoxifying androgens like DHEA, having part of the vitamin D sulfation happen in the skin helps to preserve the sulfotransferase where they matter most for hormone balance.

What vitamin D supplements are the best?

So, you're implementing strategies to support your body's processing of vitamin D and DHEA. But, what about a specific vitamin D supplement? Which one is the best?

In general, there’s no one vitamin D supplement that is going to be better than another one. But, anecdotally, some acne-prone individuals have reported better results with tablet forms vs. softgel forms and vegan D3 (from lichen) vs. animal-derived D3 (from fish oil, lanolin, or cholesterol).

There is one thing I would recommend, though, and that’s always taking your D3 in the morning. This is because some studies show that D3 can interfere with melatonin production. So, out of an abundance of caution, it’s best to space your D3 as far away from sleep as possible.

The conclusion: vitamin D3 may cause breakouts, but there’s a way around it

While there is a lot of anecdotes pointing to vitamin D3 causing breakouts in some acne-prone individuals and research to explain why this may be the case, it doesn’t mean you should stop taking D3 altogether (especially if you’re deficient).

Instead, breakouts from vitamin D3 probably suggest a deeper issue that can be resolved by making sure you’re getting enough of the other fat-soluble vitamins (A, E, and K), magnesium, and sulfur as well as supporting the gut. Citrus peel tea and/or juice as well as opting for safe sun exposure over supplements may also help address supplement-related breakouts.

And when it comes to supplementing vitamin D, there’s no one “best” vitamin D supplement. But, there is a better way to take it: make sure you take it in the morning (to avoid any effects on melatonin and sleep). And while it may not make a difference, you may even want to consider experimenting with a vegan D3 in tablet form if you’ve had issues with softgel or animal-based D3s (from lanolin or fish oil) in the past.

Like with many things, finding a way to make vitamin D work for you (and take advantage of its benefits) will probably require some trial and error. But, I truly believe these trial-and-error experiments often provide us with valuable information that benefits us (and our skin) for years to come.

Have any questions about vitamin D (or anything else)? Feel free to leave a comment below or get in contact with me via e-mail any time!



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The Lymphatic System and Acne: Why It's So Important

By Sophia Ruiz, Founder/CEO

The lymphatic system is probably one of the most under-appreciated body systems. Research is really only just beginning on the lymphatic system and how it impacts health and wellness.

But, what researchers have found so far is pretty profound and really emphasizes just how important healthy lymphatic function is – not only for overall health, but especially for skin health.

And when you dig a little bit deeper, the effects that lymphatic function can have on the skin might even be involved in acne.

Let’s dive a little bit deeper!

What is the lymphatic system?

To start, it’s important to understand what the lymphatic system is: an often over-looked, under-appreciated part of the body’s circulatory system. It contains lymph, a type of fluid that surrounds the cells of our body, which is moved around the body by lymphatic vessels. Lymph is drained to structures around the body called lymph nodes and lymphatic system organs like the thymus and the spleen, where these organs help coordinate our immune function and disposal of waste from our cells.

What does the lymphatic system do for our health?

The lymphatic system is super important for overall health, and for a few reasons.

Probably the number one reason why it’s so important is that it helps drain away inflammatory mediators after active inflammation.

Inflammation is the body’s active means of fighting off foreign invaders in the body. During inflammation, the body transports immune cells and signaling molecules to help keep inflammation going until the foreign invader is effectively contained.

After this point, the body transports the immune cells and any cellular debris/waste that accumulated during the inflammation process away from the affected area and out of the body. This is called acute inflammation and is essential for us staying alive!

But, when these cells and waste aren’t properly transported out and, instead, hang around in the area, they can actually maintain inflammation longer than is necessary.

When this happens, inflammation that was once intended to be acute turns chronic. This chronic inflammation can then eventually result in damage to our cells (not good!). So, transporting these inflammatory “mediators” out of affected areas is super important for maintaining optimal health.

Here’s how this connects to the lymph: the lymphatic system is one of the major transport systems of these mediators. Not surprisingly, studies have found a direct relationship between poor lymph flow and chronic inflammatory states.

Put simply: without proper lymphatic flow, we increase our risk of chronic inflammation.

The other reason why it’s so important: optimal lymphatic flow is necessary for optimal function of our immune system. 

Lymph fluid and lymphatic vessels are necessary for two important steps of immune function:

  1. They carry “messages” of a foreign invader in the body to lymph nodes, where the immune system can then act accordingly.
  2. After these messages have been presented to lymph nodes, immune cells responsible for fighting foreign invaders are activated. These immune cells then migrate to the foreign invader through the lymphatic vessels.

So, lymphatic health is important for both supporting our body’s defense against microbes (like bacteria and viruses) as well as preventing inflammation from turning chronic (when it becomes harmful) – two super important roles in our optimal health.

A lot of times, we think of these things – inflammation and immune function – and we think of things like fighting infections or inflammation in somewhere like the gut or respiratory system. But, in reality, proper immune function and keeping inflammation to a minimum is just as important for keeping the skin healthy as it is the rest of the body… especially when it comes to acne.

How is the lymphatic system involved in acne?

There is no research that has explored a direct link between acne and lymphatic function. By that, I mean, no researchers have ever looked at the lymphatic function of those of us who struggle with acne. But, because of what we know about acne and how it forms and how the lymphatic system affects the skin, it’s safe to assume lymphatic health could definitely contribute.

Here’s why:

Most of the time, when we think of acne, we think: bacteria and clogged pores. But, the truth is, low-grade inflammation is the first step to acne formation, even before bacterial overgrowth or pore clogs even enter the picture. 

There are many, many reasons why low-grade inflammation in the skin might happen. In a lot of cases, the lymphatic system may not play a role at all. At the same time, the lymphatic system does play a crucial role in resolving inflammation. In fact, studies in animals have shown that after blocking proper lymphatic function, inflammation soon follows. Similarly, restoring proper lymphatic function then resolves inflammation.

Not surprisingly, researchers have found that lymphatic vessels in inflammatory skin conditions like psoriasis are dysfunctional. This suggests that poor lymphatic flow may, at the very least, contribute to the chronic inflammation seen in conditions like psoriasis.

Taking all of this into account, we can see that lymphatic dysfunction clearly plays a role in skin inflammation. And while we don’t have any data on its role in acne, we know that even small amounts of chronic inflammation can contribute to breakouts. And if we know the lymphatic system can have a significant effect on inflammation, it’s very well possible that it may (at the very least) contribute to skin inflammation that we know causes breakouts.

But, even beyond preventing acne formation, the lymphatic system might also play a role in reducing acne severity when spots do pop up.

The reason for this: suppression of the skin’s immune system is believed to increase the severity of acne. If inflammation is what controls the formation of acne, our skin’s ability to detect and kill bacteria is what controls the severity of acne spots that do pop up.

Better immune function of the skin = less severe spots, suppressed immune function of the skin = more severe (even cystic) spots.

I like to think of this like a smoke detector.

If a smoke detector (your immune system) is highly sensitive, it will pick up smoke from something burning on the stove (your skin). You’ll rush into the kitchen – maybe your pan is burnt and you have to throw out the food you were cooking, but there’s no major damage. On the other hand, if your smoke detector is only sensitive enough to pick up large amounts of smoke, by the time you hear the smoke alarm, there’s a fire. Crisis mode.

This is exactly what happens in acne. When the immune system of the skin is impaired, it doesn’t properly recognize the early stages of bacterial growth. By the time the skin’s immune cells do recognize the bacterial overgrowth, it realizes “oh no, there’s a TON of bacterial overgrowth here” and goes into panic mode. The result: a large, cystic pimple that can take a while to heal.

With an optimally-functioning skin immune system, you may still get a breakout, but it’s small, mild, and goes away quickly.

And because we know the lymphatic system plays a significant role in transporting cells to fight bacterial overgrowth, poor lymphatic function can undoubtedly interfere with our skin’s ability to keep acne-causing bacteria in check.

Of course, there can be other factors that influence our skin’s ability to keep inflammation to a minimum and optimize immune function, but the lymphatic system’s role here is undoubtedly important and definitely worth considering if you deal with acne.

But, the lymphatic system’s effects go beyond just the skin itself when it comes to acne. Optimal lymphatic system flow may also play a role in supporting healthy hormones.

Can the lymphatic system affect our hormones?

The lymphatic system isn’t just exclusive to the skin. Every organ in your body has its own lymph and needs proper lymph drainage to function properly. This includes the ovaries.

Because we know that optimal lymphatic flow is important for reducing and preventing chronic inflammation, optimal lymphatic flow within the ovaries is just as important for preventing inflammation in the ovaries as it is for preventing inflammation in the skin (or any other organ in the body).

And as it turns out, keeping inflammation to a minimum in the ovaries may also be important for healthy hormones (and, as a result, hormonal-type breakouts) – in specific, for cases of high male hormone production in women, sometimes as part of a condition called polycystic ovarian syndrome (PCOS). This is the most common hormone imbalance that we see in acne.

So, what do the ovaries and inflammation and the lymph have to do with hormone imbalances? Well, in studies on women with PCOS, researchers have found evidence of both 1) inflammation throughout the whole body as well as 2) inflammation in the ovaries specifically. This ovarian inflammation is believed to contribute to the production of excess male hormones in PCOS, with studies showing as inflammation in ovarian cells goes up, so does the production of male hormones.

These male hormones produced in the ovaries can then be absorbed into the blood and travel to the skin, where they can lock onto receptors that cause hormonal acne.

Connecting this back to the lymph, if an optimally-functioning lymphatic system is important for reducing chronic inflammation, it’s very well possible that reduced lymph flow in the ovaries could contribute to ovarian inflammation, just like it does in the skin. And if ovarian inflammation is both seen and a contributor to male hormone excess in PCOS, it’s possible that poor lymph flow in the ovaries could, at the very least, exacerbate the hormone imbalances we see in PCOS (and, as a result, hormonal acne).

Interestingly, researchers have actually performed proteomic analyses (aka looking for proteins and their amounts) on the ovarian fluid of women with PCOS and found evidence that the lymphatic system might actually be impaired. 

LYVE1, a receptor in the walls of lymphatic vessels, contributes to the growth of new lymph vessels (which, in turn, helps support optimal lymphatic flow). In the ovarian fluid of women with PCOS, LYVE-1 is lower than normal, suggesting the growth of new lymphatic vessels might be impaired. And because the growth of new lymphatic vessels in a major contributor to optimal lymph function, and optimal lymph function is necessary for reducing inflammation, it’s very well possible that lower lymphatic function might contribute to ovarian inflammation in PCOS.

This lines up with the more traditional perspective of pelvic "congestion" contributing to hormonal disorders and hormonal acne.

According to some herbalists, congestion in pelvic area is believed to “reflex” onto the jawline, showing up as “congestion”, a.k.a breakouts. This mirrors exactly what we see in hormonal acne! It also provides an energetic link between poor lymphatic flow (congestion) in the ovaries (pelvic region) causing hormonal imbalances that then reflex onto hormonal acne regions on the skin (the jawline). I always find it so fascinating how age-old traditional perspectives on the body often line up with what we see in clinical research!

Putting all of the pieces together, we see a picture begin to form: the lymphatic system both in the skin itself and throughout the body may play a role in both acne formation and acne severity.

But, what causes impaired lymph flow? Is there a reason why the lymphatic system would stop functioning optimally?

What leads to impaired lymphatic flow?

There are many reasons why the lymphatic system might become dysfunctional. Some influences can cause severe lymphatic dysfunction (resulting in a condition called lymphedema) – things like obesity, radiation treatment, or lymph node removal. There are also less prominent factors that may result in much less severe lymphatic dysfunction, but dysfunction that’s possibly still relevant to skin health. After all, the goal isn’t just to prevent severe lymphatic disease, it’s also to optimize our lymphatic health in a way that translates to our skin.

Some of these less prominent, but still relevant factors include:

Increased cholesterol levels

Increased cholesterol levels have been shown to interfere with optimal lymphatic function by damaging the lymphatic cell walls. Various studies have found acne patients tend to have higher levels of cholesterol compared to individuals without acne!

Too much copper

Oxidative stress (aka damage by free radicals), which can be caused by excess copper, lowers lymph flow. As a result, excess copper’s effect on free radical damage may contribute to poor lymphatic function.

It’s important to note that elevated copper levels are rare. But, they might be more common in both women and women who deal with acne, even it’s generally uncommon in the general population as a whole. The reason: copper levels in the blood are increased in PCOS and may be increased in some copper IUD users. Use of IUDs (whether copper or hormonal) in general have been associated with an increased risk of developing acne or increased acne severity. In the case of the copper IUD, copper’s effects on lymphatic function may be why!

Interestingly, one study also found that the follicular fluid (fluid inside the ovaries) of women with PCOS contained higher copper levels than follicular fluid from women without PCOS. They also found that the levels of copper were correlated with testosterone levels – as copper levels increased, so did the levels of testosterone. This mirrors what we talked about earlier: poor lymph flow leading to or worsening ovarian inflammation, leading to excess male hormone production.

Considering all of this, it’s possible that excess copper may play a role in poor lymph flow throughout the body but also in the ovaries themselves, where it may then contribute to hormonal imbalances.

Not enough movement

The lymphatic system is 2-3x more active during exercise than when the body is at rest. Movement is key to supporting lymphatic health!

Leaky gut

When the gut becomes “leaky” (increased permeability of the intestinal lining), bacterial membranes, called lipopolysaccharides or endotoxins, can leak out into the lymphatic system. In animal studies, these endotoxins have been shown to drastically reduce lymphatic flow. Not surprisingly, studies have shown that the presence of leaky gut is more common in acne patients vs. individuals without acne, possibly (in part) because of an effect on lymphatic function!

What are some signs of lymphatic dysfunction?

When the lymph is backed up, I find that breakouts usually occur around lymphatic drainage points and lymph nodes: under the jawline, under the chin down the sides of the neck, in front of the ears, behind the ears, and in the center of the chest. 


Because of the possible role of lymphatic health in hormone balance, it’s also very well possible that breakouts in these places might overlap with breakouts along the jawline, which are often related to hormone imbalances.

How to support the lymphatic system

#1. Movement

There are many ways to increase lymph flow. But, probably the most effective is also the simplest: movement. Studies show that the lymphatic system is 2-3x more active during exercise compared to when at rest.  This applies to both resistance training and cardio! But, because increased lymph flow tends to stay relatively stable over the period of a workout whether it’s resistance- or cardio-based, it’s possible that longer workouts could mean more benefits for lymphatic health (simply because lymph flow is increased for a longer period of time). I personally find that walking for 30 minutes to an hour, 1-2x per day is where I feel the most benefit for my lymph (sometimes, I’ll even feel my spleen start to drain after a long walk!).

#2. Heat

Another simple, low-cost intervention that you can implement is heat. Studies show that exposure to 40 degrees C / 104 degrees F and infrared sauna bathing has the potential to increase lymph flow. Whether in the an infrared or traditional sauna, a hot shower, or bath, heat can help enhance lymph flow. Personally, I find this is really effective for me. I always feel super clear-headed and energized after any sort of heat therapy – possibly in part because of increased lymph drainage.

#3. Herbs

Herbs are also widely used to support the lymphatic system, but there isn’t much research documenting their effects. Nonetheless, herbs are a magic in their own right and have been used to support the lymph for hundreds, even thousands, of years.

Some of the most well-known herbs to support lymphatic health are calendula, cleavers, echinacea, red root, and figwort. Other herbs that aren’t often used for the lymphatic system, but are still great are peppermint, citrus peels, and sarsaparilla.

#4. Support healthy cholesterol

Supporting healthy cholesterol levels is an essential part of optimizing lymph health. Omega-3 fatty acids (I like to get mine from flaxseed oil and algae-based EPA/DHA), fiber (especially oats), antioxidants, and vitamin C (around 500 mg/day) have all ben shown to support healthy cholesterol levels. Hypothyroidism is also a major cause of elevated cholesterol, which may need to be resolved for healthy lymph flow.

#5. Manual lymphatic drainage techniques

Manual lymphatic drainage is also a commonly-used modality, through massage, gua sha, or dry-brushing, that has some research behind it. I personally prefer to dry brush because I find it to be the most effective, although self-massage works great, too!

Manual lymphatic drainage, in whichever way you choose to do it, should always be directed towards the heart. General recommendations also suggest you should aim for 20-30 strokes per minute, but any sort of manual manipulation at any pace should help drain the lymph. Experts also recommend pumping the lymph nodes prior to lymphatic drainage to prepare the lymph nodes to receive fluid.

#6. Castor oil

Applying castor oil or using castor oil packs may also support lymphatic flow: Castor oil contains high levels of a unique fatty acid called ricinoleic acid.

Ricinoleic acid has been shown to activate a receptor called the EP3 receptor. When activated, this receptor has been shown to increase the growth of lymph vessels, helping to enhance lymph flow in congested areas. In this same way, using castor oil over the pelvic region may help reduce congestion by enhancing lymphatic flow.

Castor oil packs should never be used during pregnancy, during your period, or if you have a bleeding disorder.

Personally, I’d also advise against using castor oil on the face, simply because activating the EP3 receptor can aggravate inflammatory acne. Supporting lymph flow around the face/neck is better suited to things like massage (always with oils), heat application (like hot toweling), and exercise.

#7. A nutrient rich diet

A nutrient-dense diet – one that makes sure you’re getting plenty of vitamin A and zinc is super important. The reasoning: 1) vitamin A has been shown to increase the production of lymphatic vessels that help enhance lymph flow (I did a big write up on vitamin A that you can read through here!) and 2) zinc helps protect against copper toxicity that might interfere with lymph function. Molybdenum is also important for maintaining healthy copper levels.

My experience with lymphatic healing

After trying many of these modalities for my own lymph health – herbs, a healthy diet, manual lymphatic drainage, etc., I’ve found heat application and movement to be the most effective of any modalities I’ve tried and have provided the most immediate relief. Herbs have definitely helped (I would say cleavers and echinacea especially) and dry brushing has definitely been helpful, but not nearly as helpful as heat and exercise.

Things to note when supporting the lymph

When you start to support your lymphatic system, especially if it’s been sluggish for a while, you may experience some skin purging. This is the immune system becoming better at recognizing the early stages of bacterial overgrowth – when it would normally fail to recognize it. As a result, more mild acne spots may pop up, but it should prevent more severe cystic spots, leading to clearer skin going forward!

And you probably already know this, but it’s always important to check with your doctor before trying any supplements, herbs, or protocols to support your lymph!

Lastly, it’s important to keep in mind that while lymphatic health is important, it’s not always impaired and isn’t always a root cause issue for acne. It can also be one of many contributing factors, meaning you may not see dramatic results in your skin until you effectively resolve other factors involved (like skin barrier repair, nutrient deficiencies, etc.).

I hope you found this article helpful! If you have any questions / comments, please let me know below!


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Why Your Skin Barrier Might Be the Key to Healing Acne

This might be one of the most important aspects of tackling breakouts. Read to learn more about the skin barrier, its involvement in acne, and why I think it's an important aspects of the acne-healing journey!
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