Skin Nutrition and PCOS with Rachel Aust

We all know by now that there is a substantial link between what we put into our bodies and what comes out. No one preaches this more than the beautiful and ever so driven, Rachel Aust. If you haven't heard of Rachel, than you are in for a treat! 

Today on the blog I will be going over some important food and skin related topics with Rachel who has successfully managed her PCOS and adult onset acne through nutrition. 

You've heard me discuss the rise of ‘21st century illness’ on here before, but along with these inflammatory diseases came the rise in acne also. Once upon a time, acne was only common in adolescents during puberty. Now, millions of adults are experiencing acne for the first time.

Statistics show, over eight million people see the dermatologist every year for their acne, whilst millions seek guidance from highly marketed cosmetics products with a whopping  $100 million in sales every year. Prescriptions for ‘acne drugs’ come in at over a billion per year! Acne is on the rise, but why?

We are too busy looking for a lotion or magic pill to cure our acne, instead of getting to the root cause. Lets remember what acne is exactly - a topical symptom of an internal inflammatory response. 

In our western society, we are bombarded daily with mass marketing companies pushing artificially modified foods high in refined sugar. Our carbohydrate intake has risen substantially over the years! Now, not all carbohydrates are equal. Carbohydrates cover a vast range of foods. A ‘quarter pounder meal’ comes under the heading of ‘carb’, but so does a bowl of steamed vegetables. 

These vegetables can be considered as ‘slow carbs’ which are low-glycemic and don’t spike your blood sugar or insulin. These slow carbs usually come loaded with micro nutrient and fiber (essential for good skin health). 

Then there are the highly processed carbs , stripped of their nutrients and fiber. These are your refined sugar, high fructose corn syrup, and white flour filled foods. After you eat a high refined carb meal, your insulin spikes and your blood sugar plummets, leaving you very hungry and fatigued. 

Data suggest that a high intake of refined carbohydrates may increase the risk of insulin resistance (1). The normal function of the hormone insulin is to transfer glucose from the blood into the liver and muscle cells, to be used as energy, and managing our blood glucose levels. Insulin resistance is where the insulin is no longer very efficient at metabolising the sugar correctly, causing more to be released, and ultimately creating a surplus in the bloodstream. One study estimates that 65-70% of women with PCOS are obese and have insulin resistance.

Skin problems are very common with women suffering PCOS due to the androgens and other hormonal imbalances. Excess insulin in the bloodstream stimulates the ovaries to produce testosterone, leading to traits such as acne,excess hair growth or even the opposite, hair falling out, alopecia, which can also be a consequence of excess androgen.

Rachel Aust is a Photographer turned nutritionist and fitness inspiration. 

In 2017 Rachel followed a ketogenic diet for 11 months to help improve some of her PCOS symptoms. Her body wasn’t using carbohydrates correctly, and she was having a very hard time maintaining her weight, with her body gaining fat despite the fact she wasn’t eating in a caloric surplus. No matter how much she trained or what she did, it just felt like my body didn’t ‘work’.This was due in part to insulin resistance, which had tagged along as part of her PCOS.

Along with these symptoms came adult onset acne. I wanted to bring Rachel on the blog to chat from the perspective of a qualified Nutritionist, the importance of food when it comes to skin and an insight into her skin journey through nutrition. 

Here are Rachel's top tips for dealing with PCOS symptoms, cleaning up your diet and how a short term Keto diet, may be the answer to your skin concerns:

1. What would you recommend is the most important foods to avoid once you have been diagnosed with PCOS?

When it comes to PCOS there are no 'hard and fast' rules, as what works well for one might not work well for another, but there have been some general trends studied, and also some principles I like to use with both myself, and the clients I am coaching who have PCOS:

Avoiding refined/processed sugars (+ sugars without fibre)

By keeping these at a minimum we are not only looking after the health of our gut, but also helping stabilise our blood sugar levels. Gut health and PCOS are so strongly linked, and if you aren't considering what the food you are eating is doing to your microbiome, now is the time to start.

On top of this there is a strong relationship between PCOS and insulin resistance

Your body does require sugars for energy, however sugar isn't able to get into your blood cells on it's own - this is where insulin comes in. Insulin is a hormone produced by the pancreas which regulates how much glucose goes into your blood. It 'attaches' to the sugar and feeds it into the blood cells.

If you have or are developing insulin resistance the insulin has a much harder time getting into your blood cells. Regularly spiking blood sugar levels from things like fizzy drinks, chocolate, lollies, and even your beloved açai bowls can lead to your body producing more insulin on top of this ("the sugar isn't in the cells yet.. why not? Let's send out more insulin to get it in!"). 

In the short term elevated insulin levels can lead to increased free testosterone levels in females - which is exactly what we are trying to avoid with PCOS.

In the long term this can lead to your body producing more and more insulin until the pancreas is worn out, which results in Type 2 Diabetes.

Ditch the alcohol

Women with PCOS already have enough trouble keeping their hormones stable and stopping their body from gaining excess weight. Our ability to burn fats and sugars slows right down when we drink alcohol and your liver is too busy dealing with the alcohol to make stored sugars for you to use later, leading to massive blood sugar drops, which you'll then attempt to spike back up with your post-drinking feed at 3AM or the following day. When your liver is not functioning at it's best hormones can recirculate through the body, and lead to hormonal excesses and/or imbalances

Other things to limit

I'd also recommend (for everyone, not just people with PCOS) limiting foods that contain transfatty acids (think of your fast food chains and fried foods) and processed meats (ham, hot dogs). 

2. What is the Ketogenic diet and how did it help you with your symptoms?

The ketogenic diet is a very high fat, moderate protein and extremely low carbohydrate (<50g per day) diet - there are no cheat meals, and very little room for error. It was created in the 1920s as a treatment for childhood epilepsy, and has since been used as a neuroprotective diet for Alzhiemer's and Parkinson's, and also in conjunction with treatments of early stage cancers. Before we jump into it I have to preface this by saying, I am well versed in nutrition, and even when I was on the Ketogenic diet I was still working with a GP, a gyno, and a naturopath. It is a diet which should be monitored, including regular blood testing, if followed incorrectly it can lead to some serious health complications, and shouldn't be done on a whim. Similar results can be achieved with a low carbohydrate diet, only go into ketosis if it is absolutely necessary. 

I was at a point where my body felt.. stubborn. I was training most days of the week, I was eating what most would consider healthy, and my body wasn't feeling as fit, if anything, my results were going backwards. I felt inflamed, I was gaining body fat despite the exercise output, adequate protein intake and a caloric deficit. I was constantly tired, my menstrual cycle had become irregular again, according to blood work I was displaying signs of insulin resistance, and my acne wasn't going away. 

I was in ketosis from February 2017 until December 2017, eventually jumping off because I had lost too much strength in the gym and weight training is one of my favourite things. During this time I got a blood test every 4-5 weeks. 

The results I saw were:

- Weight loss

- Reduced resistance training performance

- Increased cardio performance

- Regulated menstrual cycle

- No more signs of insulin resistance

- Regulated free testosterone levels
- Reduced acne

Please speak to your healthcare professional or a dietician before proceeding with a ketogenic diet.

I am now back on a more maintainable macronutrient ratio of 40% carbohydrates (high fibre, unrefined), 30% (lean) proteins, and 30% fats.

3. How long did it take you to notice an improvement in your skin once you cleaned up your diet?

The skin is a tricky thing! It takes a long time, it's an organ, the largest one in your body in fact. I think we're so often sold the idea that we can have miraculously clear skin in 2 weeks if we just follow this skincare regime, or pay $500 for this one-off treatment, and it's not like that at all. It's taken me years of consistently looking after the internal, as well as the external. Treatments like microdermabrasion, peels and LED therapy are AMAZING for maintenance, but if you're not treating the core problem internally, it's always going to come back, no matter what you do to the skin itself.

My skin went through a bit of an ebb and flow, it'd clear up for a few months, then break out again, then clear up again, etc. Then, slowly, the breakouts stopped happening, or if they did it'd be a single spot, rather than half my face. So I can't give a 100% accurate time line, but let's just say you need to stick at what you're doing consistently for a while to truly notice the difference.

4. Your top 3 foods you couldn't live without for glowing, healthy skin?

Water!!! (I know it's not a food, shush)

3-4L a day minimum! I train hard, so I need to drink more. Your water intake will depend on your gender, age, activity levels, and the climate where you live. Water aids the liver's natural detoxification process, and like I mentioned before, this can help restore or retain proper hormonal balance.

Fatty fish

Salmon is a regular part of my diet. It's packed with omega 3's which help flight inflammation in your body.

Broccoli

Hear me out on this one, but I go through nearly a 500g bag of frozen broccoli every day. It's packed with Vitamin C, which is vital for collagen production. However, Brassicas (broccoli and it's cousins, kale, bok choy, cabbage, cauliflower etc) have a hormone regulatory effect and also support the liver's detoxification process. You'll want about 2 cups of Brassica veg per day to aid with mild hormonal imbalances.