Acne can sometimes be a good thing, or at least a marker for good things. Your paleo lifestyle--healthy diet, adequate sleep, interval/weight training--lowers your estrogen levels and raises your testosterone levels. This can make your acne worse. Enjoy your lifestyle, and treat your acne. Since it's only been 3 weeks, the acne flareup may be temporary as your skin adjusts to your new nutritional/hormonal milieu.

The other possibility is that fish oil is suppressing your immune response to the acne infection (After all, acne is not just inflammation, it's a bacterial infection in your skin). Your diet sounds like it's already balanced between O3 and O6 oils, so you probably don't need to take extra O3's. Try stopping the fish oil, and see if that helps.

I see that there have been many answers to your question now. It seems that people are missing a bit of perspective on your situation as you changed your diet so recently, I don't see that altering small details of your diet at this stage would be useful. Several foods can trigger acne in some poeple, as other answers have mentioned; these include nuts, eggs, fruit and dairy (though you are not eating dairy). However if untill 3 weeks ago you were eating grains, diary, fries and soda without acne I think it is unlikely that things like the fruits, or the ratio between fat, carbs and protein would be the problem.

Remember that this is a radical change to your diet in a short time which can have many effects. I would be cautious of trying to identify possible problem foods for now as it could simply be getting use to the change of diet that is the cause. The diet you are eating sounds good. Keep eating as you are for at least another 3 weeks and see if the acne improves. If you are still getting acne then maybe consider making changes.

Additional points: If you are eating oily fish (like tuna) and grassfed meat regularly and avoiding seed oils you will probably not need the fish oil supplements. Taking acount of where you live and the time of year I would personlly limit the vitamin D3 supplements to 2000iu/day unless you are getting your blood levels tested.

I have a nagging suspicion that this and other low-grade issues often reported by paleo folks are due to eating too much protein and not nearly enough fat. Fat is needed to properly digest protein and absorb minerals. The recommendation to eat "lean meat" (from, for example, Cordain) is to me among the most obnoxious and misguided pieces of dietary advice in circulation. Fortunately, it does look as though most people here know better, but I think it always merits repeating given the lipophobic conditioning most of us grew up with. In my opinion, if you're not going through a stick of butter or its equivalent at least every two days, you're not eating enough fat. Your meat and vegetables should barely be visible beneath all the butter (or tallow, lard, etc.)!

Due to the high phytic acid (which blocks mineral absorption) and omega-6 content, I'd also go even easier on the nuts, other than macadamias. And what are your chickens eating? If they're fed soy, for example, I wouldn't doubt that it's passing into their meat and eggs, which could be causing you trouble.

Finally, if you can get some grass-fed organ meats and make some fermented foods, these can do nothing but good. What causes acne, exactly? I don't know, but if you try reducing potential problem foods (or problem foods fed to your food), while maximizing nutrient intake and absorption (organ meats+fermented foods=serious nutrient density), and without restricting your calories or fat intake (part of maximizing nutrient intake and absorption!), my guess is your body will resolve the acne soon enough.

Burning fat (which one tends to do on a Paleo diet) releases stored hormones, which can also cause acne.

All the above advice so far have been misleading. You actually may HAVE A LOCAL LINOLEIC ACID (Omega 6!!) DEFICIENCY, all acne sufferers do. Local n-6 deficiency causes abnormal desquamation of the skin making it thicker and prevents it from sloughing off, Imagine a corn or callus on your foot, that's what happens.

(BTW, I'm a CPhT. and also had acne so I do have a bit of molecular research. all right now that's out of the way)

By local, I mean, you will not necessarily fix acne systemically (oral administration). You would have to use topicals to increase the "good" Omega-6 (GLA from Borage oil or Evening Primrose) on your skin.

Now before you slather your face with Borage oil, you have to exfoliate the excess skin (Stratum corneum layer) first, brought about by hyperkeratinization and hypercornification (pre-acne stage). Use Salicylic Acid (SA) EVERY SINGLE DAY. Rite-Aid has that cheap orange facial wash with 2% SA for only 4bux I think. Always exfoliate.

Then apply GLA directly to your skin. It's going to be greasy so you might want to use a non-comedogenic base cream like Jason moisturizing cream: http://www.iherb.com/Jason-Natural-Ultra-Comforting-Moisturizing-Creme-Aloe-Vera-84-4-oz-113-g/6234?at=0

BTW, you would need to add in Magnesium and Zinc Monomethionine to your regime to prevent the Omega-6 foods from converting to the inflammatory arachidonic acid Omega-6.

I also get my borage from iHerb (ConsumerLab's #1 online health store)

Let me know if that was too confusing.

EDIT: Taurine powder AND COCONUT OIL (yes, Lauric Acid is COMEDOGENIC) may trigger acne break outs.

Do you have evidence of Candida / fungal infections? Gut bloating, oral thrush, underarm rashes, rosacea?

I have a pet theory that Candida can cause acne. Ketogenic diets promote Candida growth.

I would suggest eating starches, green leafy vegetables, fermented vegetables, and vinegar, as well as spices like turmeric, oregano, thyme. Also practice good oral hygiene.

This could be caused by your fish oil supplements. Fish oil is known to cause breakouts and I have seen people who never had acne break out once they began using it. As I understand it has something to do with the fact that it is not the easiest oil to digest and this causes the skin to react. I am not a fan of fish oil, it is highly processed, stripped of the vitamins and then often has synthetic vit. A and D added back into it. I love my fermented cod liver oil, it is an unprocessed traditional food, it never gives me indigestion (which fish oil has) and it never causes me to break out. If you check out some articles on the WAPF site about the difference between fish oil and real cod liver oil you will be a convert- it is so much better for you. Also, nothing in your diet looks like it could possibly cause breakouts. I have researched this topic exhaustively when I began getting acne in my mid 20's. I have been lacto-paleo (only raw dairy and butter) for about 3 months now and my hormonal acne flare-ups are gone. I really believe this diet is the best for controlling acne and balancing hormones, but most of us were pretty out of whack from the SAD before we started eating this way so it may take a long time to get back in balance.

I read a story recently about some newfangled way of treating acne with gold nanoparticles that released lauric acid. Here's the link.

This got me to thinking about lauric acid. Is there some way to achieve this with out nano-bombs? The article alerted me to coconut oil as the lauric acid powerhouse. I've since started eating more coconut oil everyday. It's been a week, so not really able to say anything about effects one way or another. But if anyone else knows, I'd be interested in hearing about it.

You might want to try a strict elimination diet. This has worked well for me. Cut out the fruit, nuts, olive oil and beef jerky/pork rinds. Eat only meat, low starch veggies and coconut oil or coconut milk. Try to get your body in full blown ketosis with protein staying at a moderate level and plenty of fats. If this works you can try adding things back in one at a time to see how they effect your skin. After experimenting with low carb and paleo eating over the last two years in an attempt to clear my skin and balance hormones, this approach has been the most successful for me.

My intake on this.

• don't stress about it. I know this can be a hard one but the more you'll be into the "I have acne, I must fix it" the longer the ride shall last
• try probiotics
• stop with the nuts (Brazil, walnuts are just Omega 6's)
• stop with the topical treatment (creams, lotions, ...). Controversial I know.
• cold shower stress

I would refer you to Loren Cordain's book The Dietary Cure for Acne and to this website for testimonials. http://www.thepaleodiet.com/acne.shtml

When Cordain wrote this book he was not advocating eating any saturated fat...but has moderated somewhat in the last couple of years.

In the testimonials, there is one person that experimented with changing the percentage of protein to fat and found that eating more sat fats and less protein worked for him.

I believe it is true that hunter gatherers and tribal peoples studied in the last century didn't have much, if any, acne. But, getting to that happy place may be a longer term proposition for us modern people who have been eating industrial feed for decades. For example, it takes years to replace the polyunsaturated fat in body tissue so n-3/n-6 balance is not a quick fix at all. Cutting back on linoleic acid and ensuring a gram or so of long chain omega 3 is the solution, in my opinion, but it will take time. In the meantime, it sounds like you're already avoiding sugar, so that should help eventually. Have you tried a probiotic? Read the coolinginflammation blog about gut flora and acne. There may be something there worhht trying...

Be strict and go only good fat (coconut oil, butter, olive oil), meat, and veg. No fruit, no nuts, no grain, no starch. Pure clean fuel only, bro. You need more than three weeks I'd say though. These things take time and especially if you've been beating on our body for a while prior to going paleoprimal with "normal" eating. Go pure/clean fuel for a good three months dude. You can do it! Be patient, be strong, have faith in your ability!

I find that when I eat more than 1 egg a day my acne comes back - but then again I knew that was a cause of my acne before going paleo. Did you start eating more eggs? I disagree with the stress Paleo places on eggs - I think they were seasonal and not as common as everyone thinks, but that's just me.

Acne can be caused by a lot of things other than just diet, average inflammation levels etc. Other, harder to control or identify factors like chemicals (such as dioxins) or psychological stress can be even more major factors. Over the course of a couple of weeks therefore, it needn't be the case that your diet and exercise are the major determinants, even if controlling excess inflammation is the main driver over the long term. Certainly you could probably make a dent in your acne by downing enough fish oil to completely numb your inflammatory response, but not advisable.

As an acne sufferer myself I notice that I can have flare-ups when I eat too many eggs, nuts or fruit. But I also know that it takes me about three months for my skin to clear up after I start eating paleo again. Dr Cordain suggests in his book "The Dietary Cure for Acne" that it should take about one month for skin to clear after adopting paleo but amends this in later interviews saying that most people seem to experience a three month turn around period instead. I have also heard Robb Wolf mention in his podcasts that he has seen nuts and possibly eggs (can't remember if I heard the latter from him) cause clients to break out. Sorry, I can't remember which episode it was that mentioned this as I don't think acne was the actual topic of the question he was answering.

I went paleo around February. It is always hard to tell exactly what is causing my acne breakouts but I did not have an improvement for a while and it even got worse for a bit. I've really cut out the dairy recently and made a bit of a point about getting more sunlight. I haven't had a major breakout in 2 weeks now and I'm at the 3 month point in the paleo diet.

I've also been using the oil cleaning method and stopped using the 3 topical medications I was on prior to going paleo. So there have been a number of changes. It's hard to know which one is making the acne go away but all of the changes are healthy anyway so I'll stick with it. I'd like to start eating a little more dairy and hopefully I will see whether there is a direct connection with breakouts.

Are you taking any protein supplements? I stopped drinking muscle milk about a month ago and that could have played a role for me also.

test oranges to see if you break out from them

Many people are intolerent to eggs. specially when they are cooked.. so try to go off them and see if thats works. Also lower your fruits. especially excess dried fruits can make me get acne, proberly because of the big sugar load

It's clearly the salicylates in coconut oil or the fish oil

Simiar story. I started paleo, my skin improved, then after two weeks I broke out again. That's when I read about "Nightshades" and their pro-inflammatory ways! I immediately cut them out (potatoes, tomatoes, all peppers, and eggplant). Since then my skin has only improved. That was about 4 weeks ago and my skin is very clear now with only small, smooth red marks that are healing.

Stick with Paleo! Just cut out nightshades. Good luck!