I have a very similar story. After months of researching potential causes and solutions, and many scars later, I finally concluded that my outbreaks were reactions to food allergies. I have leaky gut syndrome and developed allergies to many foods I used to eat before going Paleo, and then some even after. Foods like citrus, squash, black pepper, garlic, etc. Even though your digestion is good now, you may have a compromised intestinal mucosal lining from when you were battling IBS. It takes a looong time to heal. Some of my worst reactions have been when exposed to yeast. I would try cutting out the brewers yeast first and see what happens. If you have or had issues with Candida prior to changing your diet then you may have developed an allergy to yeast. Also read this article on the connection between acne and the gut.

http://www.gutpathogens.com/content/3/1/1

You will want to make sure you are getting plent of probiotics. I see you eat kraut, but you might want to consider supplementing with more. My doctor put me on this probiotic:

http://www.vsl3.ca/about.html

it's for people with Chron's or IBS, but you can buy it over the counter at some pharmacies.

You need to figure out what is causing the internal inflammation. Food allergy testing is helpful, as are elimination diets.

Topically you can use 35,000 IU Vitamin E oil to help with scarring (I buy Jason's)
Also tea tree oil in a jojoba oil carrier is a good cleanser.

Nutrient-dense foods are not always good foods. That being said, you're overlooking 2 big factors in acne : PUFA and amino acid balance. Your muscle meat intake is high. You could win money and get better skin at the same time by making bone broth daily and drinking it. If you don't always have bones, buy some gelatin online (it's not expensive). The most important supplements are fat-soluble vitamins (including k2) and magnesium, though calcium is extremely important too. You can get calcium from bone broths and egg shells.

Eating chicken etc. is nice, but it's not the best choice when you have bad skin. It'd be better to substitute it for bone broth (it can be chicken broth for example).

Hopefully this helps a bit. Don't supplement immediately, just eat root veggies, liver and bone broth most of the time and you should already see improvement.

I hate to give you a succinct answer after such a detailed post, but the same thing happened to me years ago when I went off BC, and I was on a 100% SAD diet (if that makes any sense), and my acne eventually went away with no changes to my diet. It did take a lot of time, though, so if altering your diet hasn't helped, it might just be one of those sucky things you need to wait out :(

I've had fairly good success using two things: zinc gluconate (50mg/day) and glycolic acid toner on my face (go for at least 10%). Make sure you take your zinc with food.

I know this question is older, but I see that there's still time (since you posted this 3 months ago and said you're getting married in 5 months). I hope you've had success with the suggestions... but just in case:

You say you take cod liver oil and butter oil, and I've noticed that consuming any more than small amounts of fish oil (anything more than 2 grams every few days, or a serving of fish every other day) absolutely breaks me out (I've read posts all over the internet about people who have the same problem, especially going primal/paleo who start taking fish oil supplements), and I have strong suspicious that (like literally thousands of other people online) I react to dairy also, though I know this should be a smaller issue with butter oil, which is pretty refined and supposedly free of lactose and casein - the usual suspects.

So my suggestions:

--Cut the butter oil just to see

--Cut all dairy - even 'safer' things like butter, ghee, butter oil

--Cut fish oil and just eat salmon twice a week or so (at least temporarily)

--Get a chocolate bar that does not have lactose in it. Lindt's dark bars are the only widely available ones I know of that don't have milk fat, butter fat, and/or lactose in them. I see you eat lots of it so this could be an issue.

--Take zinc daily (try to find just the 25 mg dose to take with meals, 50 causes nausea and risks copper deficiency). For the longest time I took it and didn't realize it was helping a little and causing things to heal faster and pores to look smaller. And it's one of the most tried and true supplements, has been shown in a study to be as effective as antibiotics in treating acne, and is often prescribed in France for just that purpose. It gets great reviews online and few people actually break out on it in the beginning like b5, fish oil, etc.

Sorry for any typos or confusing sentences since I'm in a hurry... but I reeeally hope things get better for you!!

Hi Hannah, unfortunately I don't have any advice for you...your diet looks awesome. I'm just here to commiserate as I am dealing with acne as well. My heart totally goes out to you and I know how frustrating it is. Stay strong! <3 I have been on strict paleo for about 3 weeks I think and while my forehead is almost completely clear I continue to breakout on the lower part of my face. My last resort is a naturopath if I can't get this cleared up by myself!

Do you think you could have some food intolerences, sensitivities or true allergies? Those may be causing the break outs....if you can, have an IgG ELISA blood test done. I found out that I'm allergic to cauliflower, pork, cranberry, yeast along with gluten and dairy as well as a few more items. It's only been a week for me that I've been avoiding, except for gluten and dairy, so we will see what happens.....good luck! I have acne rosacea and I was diagnosed a year before my wedding. I understand the annoyance of having something so visible and trying everything under the sun. Eventually, I had to resort to getting laser treatments done. I still flushed at the wedding, but at least I could use makeup to tone down the redness. Before the laser, I couldn't put anything on my skin. It was far too sensitive!

A few things:

1) The only 'product' that worked for me (and it worked very well) was Chandrika Ayurvedic Soap. You want the square bar in the old-fashioned looking packaging. It will seem harsh the first few times but your skin will adjust. It also has a very strong 'hippie'/masculine smell that you may or may not like - I tend to like it.

2) If you find that your skin is reacting to this soap by increasing its oil production, then you should definitely cut all dairy and oil supplements from your diet and see what happens. Don't stop the soap.

3) I have used this soap before and after going paleo; since i'm on paleo now, my skin seems to tolerate this soap really well and doesn't respond w/excess oil production. My skin is much more dry in general after going strict paleo (no dairy, and I stopped fish oil supplements).

I too tried the cod liver/butter oil and oil cleansing method with minimal results. You need some medication to get the situation under control, as it sounds hormonal in nature. Go the the dermatologist. Get an oral antibiotic & a topical antibiotic as well as a differin/retin-a type cream. I went through the same thing as you, and this is what worked for me. Once your skin calms down, you can ease off of the medications and just continue to eat well. I didn't believe it would work, but I saw a noticeable difference after only a few weeks.

I had terrible acne growing up. Went on Accutane twice and my acne returned both times.

Here's my quick suggestion: try taking activated charcoal for a few days and see if your acne improves. If it does, you may have some gut issues to resolve. I'll explain below:

My acne improved slightly when I decided to go off medicated washes and creams (too difficult to obtain in Japan) and then again slightly when I stopped washing with anything other than water and occasionally baking soda.

However, the biggest thing that improved my acne was dietary. I found that if I avoid fruits, nuts, and cocoa not only does my skin not break out, it's also much, much less oily. All those years I spent washing with expensive washes to get oil out of pours, and it seems my diet was just causing me to pump that oil right back into them.

Now, I don't intend to stay off fruits, nuts, and cocoa indefinitely!

Paul Jaminet suggested that I try taking activated charcoal and seeing if it alleviated my symptoms, which it did. This suggested that the charcoal was absorbing something that was not supposed to be passing through my gut barrier, which suggested a leaky gut and dysbiosis. I'm currently in the process of trying to resolve the dysbiosis with a combination of interfase, GSE, and charcoal taken at intervals on an empty stomach. I just asked a question about it actually if you want more details.

http://paleohacks.com/questions/128023/hack-my-interfase-protocol-best-germicides-for-sibo-bugs#axzz1xumAWxq9

However, all of this said, I'm a guy, so the acne cause might be entirely different...

Im in the same boat as you. The advice given i've tried, including probiotics, which give me a terrible reaction and cannot stomach food for a week after consuming even a small capsule.

I've tried vegan, fruititarian, strict paleo, low-carb, and ray peat style....

What I am going to try now is an ancestral diet. My heritage is Anglo-Saxon, and foods that would not have been available to Anglo-Saxons, such as tropical fruits have been included in all my previous failed diets, except for low-carb. And if you go back to the time when my ancestors were eating bananas and tropical fruits, it would have been so long ago that we'd be talking about a vastly different fruit.

Going back to the low-carb diet, I do not remember if it helped my acne because I started to develop severe cardiovascular symptoms and ceased. So the one diet that would have fallen within the guidelines of my ancestral diet, I had to abandon early.

Just food for thought. I don't know your ethnicity, maybe you originated near the equator then you could snack on bananas, and unlimited fruit which would be nice =]