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!