Abstract: The typical western diet has low consumption of omega-3 fatty acids, an excess consumption of omega-6 fatty acids and trans fatty acids, as well as a reduction in consumption of dietary antioxidant vitamins. The omega-6 to omega-3 fatty acid ratio in the western diet generally reaches a ratio of 20:1. Traditional hunter-gatherer diets are closer to a 1:1 ratio. Fish, wild game and wild plants have higher levels of omega-3 fatty acids than do refined western foods. Omega-3 fatty acids can reduce insulin-like growth factor 1 in healthy humans. A diet high in omega-3 fatty acids may be involved in the prevention of hyperkeratinization of sebaceous follicles. Leukotriene B4, which is proinflammatory, has been implicated in the pathogenesis of acne. A leukotriene B4 blocker has led to a 70% reduction in inflammatory active lesions. Arachidonic acid is the major dietary omega-6 fatty acid from meat and is the precursor for the manufacturing of leukotriene B4. Omega-3 fatty acids along with a low-glycemic diet may have a synergistic effect for reducing the risk of acne.

Commentary: The most powerful, natural blockers of the arachidonic acid cascade are the omega-3 fatty acids from fish oil-eicosapentaenoic and docosahexaenoic acids (EPA, DHA). By blocking this pathway you can effectively block overproduction of leukotriene B4 and other pro-inflammatory prostaglandins. When I spoke at the National Psoriasis Association, I presented compelling data on the use of fish oil with skin diseases-most notably psoriasis. Many of the participants including patients and doctors were familiar with this as well as the use of antioxidant supplements. Acne is not a tetracycline deficiency. And long term treatment with this powerful antibiotic seems inappropriate at best. Some of the newer high dose synthetic vitamin A drugs have some good data for acne-but they are teratogenic and we do not know the long term effects on reproduction. Having used fish oil and high-dose antioxidants with success, I would suggest first "doing no harm" to a patient and trying this first. Also, important is detoxification. I do combine this with bowel detoxification (using a psyllium or flaxseed mixed with liquid) as well as some dietary restriction-most notably fat. By reducing total fat intake to around 20%, you effectively can use less fish oil supplementation (4-6 caps/day). You may also need to consider a trial of dairy restriction, wheat restriction and perhaps even gluten. You can often figure out what to do first by examining a 7-day diet record.