I do my version of paleo for acne and I will just give you my thoughts on the foods I would personally tweak/ avoid while trying to heal the imbalance in my body (acne is internal problem, right?). Just to maybe give you some ideas (without refs/ evidence):

Olive oil/ fish: Moderate your PUFA. That is alot of fish (maybe swap some out for mussels/shellfish). 1 can of sardines a day seems to be my limit and even then I will start noticing rising inflamation (Reduction in all PUFA ie Peat helps my acne ALOT)

Broccoli/coli etc: Cook the crap out of it and moderate due to antithyroid(I focus on improving my thyroid after years of abusing goitrogenic foods)

Sweet potato: Anti thyroid. Be careful to not over-carotene yourself as I slowly turned orange from 1 sweet potato a day (3 months) and I suspect it was antagonising my real Vit A retinol levels (thread on carotene).

Coconut oil: My gut seems so much happier using tallow/ beef broth marrow fat YMMV.

Brown rice: replace with white rice for less gut irritation and see how you go.

Onions/garlic/avocado: all pretty bad fodmap style foods to mess up your gut if its not in a good place to start with.

Apples: Apples/ pears are pretty rough IMO and I feel weak afterwards so I can only imagine what they are doing inside me. I only realised this after trying out citrus fruits/ melons/ papaya/ banana etc. I think you could benefit greatly from some variety in your fruits.

Overall your diet sounds pretty balanced to me besides the heavy fish consumption (+FLCO!!) and apple eating. To remove acne, Elimination of some things are probably needed and supplementing zinc/mag/C/D is good.

I also am of the opinion that if you aren't eating liver and some bone broth you are missing out on one of paleos greatest tools.

As VB said it is most important that you come back and post if something worked for you!

Hey Lost and found, I guess i should give you an answer in the answer area instead of the comment area.

I can give you suggestions based on ONLY educated guesses and personal experience. Please do not be dissapointed if it doesn't work for you because, as you will see over and over again here, "everyone is different"

I've experience some pretty crappy skin during my lifetime, especially during the "pre-paleo" era (archaeologists are probably scratching their heads right about now). Eating whole foods and eliminating processed crap definitely helped, but i always did suffer from dried skin and acne.

Dietary changes that helped immensely was:

1) Eating bacon ( really!) i suspect it's just the saturated fat content, but i don't care, it made my skin glow and smooth out. And it doesn't hurt that it's damn tasty too. if you're iffy about bacon, try some other sources of animal fats (grass fed meats and fish are pretty lean on the whole)

2) I upped my carbohydrates by A LOT - I was eating a diet that consisted of low to moderate carb amounts. About 50-150grams/ day i would say. From there, I increased it to about 200- 300 grams/day. Fruits, starches, whatever.

3) I also decreased my protein intake from meat - I found that it DID make my skin puffy and red. I was eating organic/ grassfed meats as well as wild caught fish. I suspect that i wasn't getting enough of the type of proteins found in gelatinous cuts of meats. It's actually more financially wise for me to supplement with gelatin and decrease my meat intake, so that's what I do.

4) somewhat related to 3. Bone broth can help, mainly for it's gelatin content. If you have the time and patience, it's worth a try. If not, try some gelatin powder supplements.

5)As Paleomouth said, liver is gold. It may or may not do the trick for you, but it certainly will fill in what ever nutritional deficiencies you may or may not have..

good luck sir

::hat tip::

I have just got off my PPIs for the second time and gave myself a word that I am never going to follow any doctor's advice without seeing a naturopath.

The thing is, I have a flawless skin, but every time I start PPIs, I break out. I have pimples on my chin. This is horrible because I NEVER break out.

Well, I went off PPIs and no more pimples. Which leads me to believe that acne is an indication that something is wrong.

I have a suggestion for you but here is my warning - I am not a doctor of any kind and I don't really know. But this is what I would do if I had acne:

I would start an elimination diet. The only thing that I would eat for a couple days or even for a week would be:

1. grass fed lamb (as lean as possible)
2. peeled organic cucumbers
3. sea salt
4. water

Actually, you can even try it without lamb. I know it sounds very restrictive, but this is just for a couple of days.

Nothing else. Why?

Because this is as basic as it comes. You cannot go any basic than that. Peeled cucumbers are the most benign vegetables there are and we are eliminating any possible allergies that could be. Please peel them to eliminate mold. Why lamb? Most people are not sensitive to grass-fed lamb.

If you eat like this, you need to carefully monitor each day - do you get any more acne? Yes, no? If you get more acne then you can come back here and curse me all you want - I will take it. If your acne seems a little better, I would slowly add other foods, one item at a time (or even one item per couple of days), like raw carrot, then wild Alaskan salmon next, then raw organic lettuce - something very very basic.

Make sure to eat RAW FOODS WITH EVERY MEAL!!!!

Yes, I know you wrote you have tried low carb and anti-candida diet. But this is not about low carb or anti-candida. This is about foods you maybe sensitive to. Just like a food sensitivity issue.

Coconut oil, eggs, nuts, sweet potato, fruit, fermented foods, mushrooms and sauerkraut should be the last to add. They can be bothersome for some people and they can trigger an immune reaction.

If this does not work, I would seriously consider doing Ray Peat. Who knows, maybe he is onto something. You can ask Korion for more guidance.

Again, I am not a doctor but the advice I am giving you really helped me.

GOOD LUCK!!! COME BACK AND POST!!!

Get rid of olive oil (atleast for now), nuts, and ALL grains.

Eat lots and lots more saturated fat, like fatty cuts of beef. What cuts of beef do you eat now? You need to eat more saturated animal fat instead of vegetable and fish fats.

Lower dosage of supplements. In fact, stop supplementing Vit E and selenium. And some people say the cod liver oil causes acne if they have too much of it. Plus since you already eat so much fish, I really, really doubt it you need cod liver oil. However, the butter oil is probably a good idea to keep in your diet.

Stop eating so much cauliflower and broccoli. You're eating so much of it, that's dangerous*! Eat more dark leafy greens like turnip greens, swiss chard, spinach. Cooked.

Make sure your food is well salted, specially when you eat cauliflower and broccoli. Make sure to buy good quality salt.

Also... you are not eating Paleo. You know that, right?

I went through your previous posts and I see you've been eating brown and white rice for a while now. If you say you've got inflammation and acne problems this is the first thing I would change. Get rid of the rice. All of it.

If you really feel you need carbs, why not try squashes, carrots, and fruits like banana and mango (or whatever fruits you like) instead of white and brown rice and white potatoes? Also, do the carbs need to be the starchy kind? Can't you just up the carbs but make it mostly non-starchy?

You might need to avoid nightshades (white potatoes, peppers, eggplant), all nuts, and fruits, if your acne/inflammation is autoimmune.

If you still don't understand the Paleo diet (I see on your previous posts you said Paleo diet was difficult to understand), check out this web page and ask if something confuses you.

http://paleodietlifestyle.com/paleo-101/

PS: Do you get plenty of restful sleep?

Get your D tested. Accutane and some of those other acne meds can strip the D out of your system in a big way, leaving you very prey to infection. Make your A beta-carotene only. You could already be getting too much from your cold water, whole body fish. Definitely, no "ret-" anything. You need K2 to absorb your D. Also not sure you are getting enough B12 and folic acid.

my 2 cents: I have been changing so many things and I still struggle with acne. But I believe it starts in the gut, and started paying attention to how i felt after meals, constipation, etc.

I started supplementing with HCl/Betaine because I think I wasn't digesting the protein as well. Stopped eating as many really fibrous vegetables and more herbs.

But, believe it or not, the biggest change I had in my cystic chin acne was when I stopped avoiding fluorine containing things: tap water, supermarket chicken legs, supermarket turkey legs, canned fish like sardines and anchovies.

i still get some on my forehead and cheeks, but i think those are from sugar. i strongly believe that different deficiencies/foods cause acne on different places, though i can't prove it.

anyway, back to fluoride: I am an extreme case - I used to eat toothpaste when I was a kid, took fluoride pills, and drank A TON of tap water living in an area with high levels of fluoride in it before I noticed it. also, the cysts would crop up when i would travel.

thanks to the cellulite experiment I made this connection! and I realized I was eating a lot more fluoride containing foods since going paleo/primal.

When I found that site, the cellulite experiment, and her ebook on fluoroderma, a light came on - i always got huge cysts after drinking tap water in restaurants, traveling, from iced tea, eating chicken, raisins, all these things that are ok on paleo/primal. again, I recognize I am an extreme case.

So anyway, I changed my diet and now, for protein, because of perfect health diet, I eat meat and fish. Perfect health diet's Paul Jaminet (which is not paleo) calls for eating less chicken and pork because they have less toxins and I have felt much better since and had less acne since. I make sure to eat ~1 lb of FRESH fish a week, the rest is meat and then once or twice per week chicken or pork, plus egg yolks, probably one a day.

maybe, you can try to lay off the canned foods? I feel like you never know what you can react to from them, even though they are cheap. I swear, I never would have been one of those, "Fluoride is bad for you! Canned foods are bad for you!" people before this. but really, stick to fresh food and drink bone broth with meals. pay attention to what you eat, how you feel after (do you drink a lot of water with meals? i used to - very bad for stomach acid), and when you go. chart it. i think gut health has SO Much to do with acne.

I know it sounds crazy but just an example of how you need to pay attention to your symptoms and everyone is different. I never would have guessed, but truly, acne is a way of your body getting rid of things through your skin.

and agree on the liver. make paleo dirty rice. it's great.

Your diet looks pretty good already. Unless you are sensitive to something you eat, I seriously doubt your acne is diet-related. It's possible your acne is related to gut health. But from everything you've tried I get the feeling you've been on a gut healing diet already? It might be wortwhile to introduce some home-made yogurt or kefir into your diet, or some other fermented foods.

Then we have to acknowledge the fact that acne is strongly genetic. There's only so much you can achieve with diet. Seriously. People who are into natural health and different diets tend to always forget or ignore genetics.

The short story is that genes make acne-prone skin far more sensitive to hormones and more prone to inflammation. Even if your hormones are at normal levels they can cause problems in the skin. Diet helps for sure, but in many cases it's not enough to get you completely clear. Long story on what genes do to acne-prone skin is here: http://www.acneeinstein.com/genes-acne/

You can't cure or fix genetic issues on the skin. But you can manage and mitigate them. This is the reason all good acne treatment plans should include some topical treatments. You just can't leave the skin to fend for itself like people with healthy skin can.

Stress is another big issue. I don't know how much your acne bothers you or about your stress levels in general. But given how much effort you are willing to put into solving it, my guess is that it does bother you quite a bit. The problem is that stress from acne can perpetuate it. Chris Kresser also talks about how stress wrecks the gut. So I would seriously consider adding stress management into your daily routine. It can be as simple as this: http://www.donothingfor2minutes.com/

It's my humble opinion that you can make yourself crazy chasing dietary triggers for your acne. And in your situation there's a good possibility you've already eliminated most or all of those.

Aside from the many things mentioned in the above posts (STRESS! SLEEP! very important!) The deal breaker for my acne is sugar. Very basic: I eat some sugar -> I break out. If this was the issue for you, I would recommend cutting out fruit and other sweets. I have sweet potato daily no problemo, but fruit always caused problems.

Hope this helps!

i had to cut out all nuts and my skin cleared right up. dont know the science behind it, but it worked like a charm for me! i wish you the best of luck!

one more comment: I almost never read acne.org, but there is an interesting thread on how a guy Cured his acne. His solution: he took the NOW brand Fiber 3 that has omega 3's in it, and says the second step and most important is PROBIOTICS.

http://www.acne.org/messageboard/index.php/topic/292477-i-found-my-acne-cure/

so...how regular are you? chris kresser says he has yet to see a patient with acne who doesn't have gut issues. do you squat to poop and get everything out? Do you have lots of gas? is your stomach acid what it should be?

Finally, I know it seems like a supplement might help you, but in my (VERY LIMITED) experience the supplements can also harm you. it's a lot of variables to consider. the FCLO might be causing harm, as fermented foods can cause acne flares in some people. acne is really crazy in that I think every person gets acne in their own, weird, individual way. good luck, don't stress (it will be over) and try to have good digestion!

I was also battling big time

I went back on the pill - and this helped my acne My doctor gave me a cream called Retin A - which i put on the pimples - then moisturise it is very drying so dont use too much Oh another thing - Hydrogen peroxide - on cotton wool on the acne - worked like a dream! I also changed my diet totally - no dairy whatsoever no rice, not even brown

Be careful of Omega 3,6,9 - if its in your food e.g. salmon etc. u dont need to supplement that day - too much omega 3,6,9 can cause breakouts

Drink alot of water

dont touch your face Limit your stress

Good luck - hope it works - if you can - let me know Vanessafarah30@gmail.com