A year ago I told students at my friend’s Mohamed Ibrahim‘s school that a student of Allen Neuringer’s had gone on a camping trip and found that her acne went away. At first she thought it was the sunshine; but then, by self-experimentation, she discovered that the crucial change was that she had stopped using soap to wash her face.
Now Mohamed writes:
I told my classes about your friend who went camping without her face products only to discover that the face products were contributing to her acne, and that from that point on she only washed her face with water. It turns out that two of my students wash their faces with water! And their skin looks great! I started “washing” my face with water about a month ago, and [now] my face is acne free and soft as a pair of brand new UGG boots. [He had had acne for years.] The only additional thing I do is wipe my face with a napkin throughout the day to remove any excess oil.
So one cause of acne is using soap to wash your face.
Acne really matters. And it’s common. It now turns out that it has a pathetically easy solution, in at least some cases. Dermatologists don’t know this. Apparently hardly anyone knows it. Somehow the entire healthcare establishment, to whom we entrust our health in many ways, missed this. Dennis Mangan’s discovery that niacin can cure restless-leg syndrome is another example of a pathetically easy solution missed by experts. Likewise, the Shangri-La Diet is very different than anything an obesity expert has ever proposed.
What else has been missed?
More Imagine a med student in a dermatology class. The student raises his hand and asks a question. “I read in a blog that acne goes away if you stop using soap. What do you think about that?” What would the instructor say — after telling the student not to believe everything he reads on the Web?
I used to have some sort of psoriasis on my face and chest. I had it for 2 years as it got worse (going from minor bother to major problem). I went to my dermatologist, who prescribed topical corticosteroids. They worked really well. After about 2 years of using these, I asked my dermatologist “Am I going to have to keep using these forever? Are there any solutions to the cause and not just the symptoms?” He said nothing was proven. I went to the internet, and started reading. It looked like a certain kind of significant dietary change had worked for some people. I tried it out (it was basically cutting out certain things – refined sugar, wheat, red meat, nightshade plants, and a few other things – and replacing them with other things). About 9 months later, the psoriasis (or whatever it was) was significantly diminished (without using corticosteroids). It has now been about 5 years. The solution for me was long-term dietary changes (the changes took a while after implementation). While waiting in an airport, I found out that these dietary changes have recently been popularized in a new book. I don’t know if dermatologists generally suggest trying significant, long-term dietary changes for skin inflammation or not, but mine didn’t 5-7 years ago.
Anthony, that’s good to know. Thanks for your comment. What’s the new book?
While it would be nice to think that all we have to do to get rid of acne is stop using those expensive cleanser and just use water – this is just anecdotal evidence you present. It would require a large clinical trial to be conclusive.
Mickey, a large clinical trial isn’t needed for this information to be useful. Anyone can try this. It’s perfectly safe. You appear to find large clinical trials more interesting/helpful than the evidence in my post (“anecdotal”). But let’s compare. The info in my post, which comes from several people and includes experimentation, can help millions of people deal safely, cheaply and incredibly easily with something they care a lot about. (Moreover it cost nothing to gather, unlike large clinical trials.)Â Do you know of even one large clinical trial that’s been that helpful?
Hi Seth,
The book that presents similar dietary recommendations is called “The Ultramind Solution” (it presents a lot of other recommendations, too – I just skimmed it).
For me I did basically 3 things:
1. Eliminate refined sugar, white flour, red meat, nightshade plants (tomatoes, potatoes, bell peppers, eggplant, in particular).
2. Add more Omega-3s (fish and flaxseed oil – this is basically why I originally was interested in your blog).
3. Give a long time (in my case, about 9 months in I was noticing significant results).
Now if I go back to something resembling my older dietary habits, my old skin condition tends to start to come back.
I have now added in sourdough bread (freshly made locally, I can’t resist), and it seems to be fine.
My doctor just figured out that the cause of my acne was probably an overgrowth of candida yeast, leading to leaky gut syndrome.
After four weeks on the anti-yeast diet, my skin is completely clear for the first time in 8 years. I’ve also dropped 9 pounds. Turns out my digestive imbalance may have been the cause of countless other annoying but seemingly minor ailments–from mood swings to constipation to bad reactions to certain medications.
Fermented foods are prohibited on the initial phase of an anti-yeast diet. But since they can help prevent a candida overgrowth in the first place, I plan to introduce them fervently as soon as I can.
Kirsten, why are fermented foods prohibited on the initial phase of an anti-yeast diet?
Kirsten:
That’s great that you found a doctor who accurately linked your acne (and other problems) to candida yeast. Can you tell us how many other doctors you saw who missed this? What alternative diagnoses did they propose? How did you find the right doctor?
Regarding Mickey’s point about clinical trials being “required” before you can conclude something: I work in the investing industry, where return on investment, adjusted for risk taken, is the ultimate goal. Seth’s discoveries, and the “pathetically easy” other solutions he highlights on his blog, all have tremendously high returns on investment, with very little risk. A clinical trial, on the other hand, requires a huge investment of time and money, often with very little return in the form of new knowledge learned, and sometimes at significant risk to the patients enrolled. Furthermore, drugs that are discovered as a result of these clinical trials often themselves have low risk-adjusted returns for the patients who take them, when their costs, side effects, and the likelihood that down the road the establishment will revise its thinking about their efficacy are taken into account.
Just to take one example: compare the risk-adjusted return on investment for society of the Shangri-La Diet to that of Fen-Phen, both of which targeted the identical problem. There is no comparision, even if SLD turns out to work only for a minority of people.
https://mwilliamson.com/yeastdiet.htm
Due some digestive issues I recently had, I considered that candida might be the cause, so I looked into an elimination diet. Plain yogurt is included in the 1st phase, but no vinegar until the final phase. I don’t know the reasoning. First, though I just eliminated corn/wheat as it is a less restrictive diet. So far it has been working, so I am going to nevermind the yeast thing.
I have nothing against the kinds of self-experiments that Seth blogs about. I agree they can sometimes be useful in identifying new, effective treatments or methods. In fact these sorts of self-experiments (N of 1 trials) are published on occasion in the medical journals. But these are mostly useful as starting places for further research. And they are not at all easy. You’ll notice that the researchers conducting these clinical trials always take care in eliminating variables, which is very difficult to do when you have an N of 1.
Take this acne case for example. A proper self-experiment would require that all variable factors are controlled for – diet, exercise, sleep, medications, weight, other changes in health, etc. – before the experiment can be conducted. And the experiment would require more than washing the face with water and seeing what happens.
We’d also need a self-control, which would be washing the face with both water AND soap. But because we have an N of 1, the two experimental phases would have to be separated in time, e.g. I use soap and water for 6 months then just water for the next 6 months, meanwhile keeping all the other factors constant. And lets say the soap doesn’t help but my acne goes away with the water. Can we then conclude that the water cured my acne (or the soap caused it)? No, because the two treatments were separated in time. Its possible that just by factors of aging, I lost the acne as I got older, and the water/soap had nothing to do with it.
This is why I hesitate to conclude anything from a self-experiment. They are difficult to conduct and in general, unreliable. I believe they are good starting places for more rigorous investigation, but unfortunately, controlled, sometimes expensive clinical trials are how we advance our medical knowledge.
And they do yield results. Seth, you ask about clinical trials that are helpful. Pick up a copy of JAMA from the last couple years. There’s dozens of papers of randomized controlled trials that reverse the thinking about a medication or supplement, e.g. Vit B doesn’t slow alzheimers or reduce the risk of cardiovascular events, as previously thought from observational studies.
Ginkgo biloba, a supplement that for years had been thought to prolong the onset on dementia based on observational studies, was found to have no effect after a randomized control trial was conducted.
And one of the more famous (and incalculably helpful) studies was that done on HRT. Menopausal women were encouraged to take HRT because observational studies showed that women who took HRT had half the risk of heart disease as women who didn’t. So millions of women were taking HRT. But then they did an RCT and it turns out that HRT actually increases the risk of heart disease! Not to mention stroke, breast cancer, and colon cancer. This study saved lives. Scientific rigor isn’t always easy, cheap, or fun, but unfortunately, it is necessary.
karky, what do you mean by “nevermind the yeast thing”? You mean the yogurt thing? You mean you are going to ignore the instruction to not eat yogurt?
Mickey, thanks for your reply. “A proper self-experiment would require that all variable factors are controlled for.” That’s impossible. I have learned a lot from self-experiments that weren’t “proper” as you define it.
Your examples of helpful RCTs are revealing. Which is more helpful: finding that something incredibly easy (not washing face with soap) works or that something moderately expensive (ginkgo biloba) doesn’t work? Or that something cheap (Vitamin B) doesn’t work? I choose the first. I agree that the RCT about HRT was indeed really valuable. But it is telling that this example is a case where the research merely undoes harm done by other research. In other contexts that’s called a protection racket.
I don’t think “scientific rigor” is “necessary” for the info in my post to be helpful. If you have acne you can simply try it and see what happens. The evidence can be improved (as is always the case), but that doesn’t mean it’s worthless, which is what “necessary” seems to imply. If you had acne and washed your face with soap, would you — after reading my post — see what happens if you stopped washing your face with soap? Or would you wait for a large RCT?
Whether they realize it or not, aggressive advocates of randomized control trials as the only way to “conclude” that X causes Y belong to the medical branch of a larger philosophical tree whose trunk is the work of David Hume.
I’m not an expert, but I believe Hume was the father of what we think of as modern scientific skepticism.
What’s ironic is that if you examine Hume the person as opposed to Hume the philosopher, you’ll find a man much more concerned with improving his daily life and with “what works” than with the search for pure scientific rigor that he pursued in his professional life. Check out this famous letter he wrote as a young man to a noted doctor, in which he describes what is commonly referred to as his nervous breakdown. He was a self-experimenter (N of 1) par excellence:
https://serendip.brynmawr.edu/exchange/davidhume
My favorite excerpt:
“I began to think of something more effectual than I had hitherto tried. I found, that as there are two things very bad for this distemper, study and idleness, so there are two things very good, business and diversion; and that my whole time was spent betwixt the bad, with little or no share of the good. For this reason I resolved to seek out a more active life . . .”
Here is another excerpt, from his “Treatise of Human Nature,” in which he describes his practical cure for the psychological anguish caused by the kind of pioneering skeptical philosophy he pursued:
“I am confounded with all these questions, and begin to fancy myself in the most deplorable condition imaginable, invironed with the deepest darkness, and utterly deprived of the use of every member and faculty.
Most fortunately it happens, that since reason is incapable of dispelling these clouds, nature herself suffices to that purpose, and cures me of this philosophical melancholy and delirium, either by relaxing this bent of mind, or by some avocation, and lively impression of my senses, which obliterate all these chimeras. I dine, I play a game of backgammon, I converse, and am merry with my friends; and when after three or four hours’ amusement, I would return to these speculations, they appear so cold, and strained, and ridiculous, that I cannot find in my heart to enter into them any farther.
Here then I find myself absolutely and necessarily determined to live, and talk, and act like other people in the common affairs of life.”
These are not frivolous excerpts or digressions. Hume knew he had a big problem: He had already experienced one episode of major depression, and was committed to a profession, to a mode of inquiry (something approaching philosophical nihilism), and to a lifetime of unpopularity as a result of his attacks on religion that made him prone to even more depression (today it is thought that that those who have suffered one occurrence of major depression have an over 50% chance of recurrence, and I suspect that rate is ever higher among professional philosophers, notwithstanding the advances in psychiatry between now and then). But he set out to solve this problem Hume with self-observation and self-experimentation, and never again had another breakdown. In fact he became known as one of the most cheerful, likable, and personally happy philosophers who ever lived. I consider this a remarkable accomplishment.
I hadn’t thought of it, but when I started washing my face regularly and the acne went away, I was generally washing with just water. I wanted to start washing regularly but was busy and so just washed with water and a washcloth. It did the job so …
You’ve made me think.
Seth,
I decided it probably wasn’t candida, so I did not go on the yeast elimination diet. I only cut all corn/wheat products out.
I still am drinking my kefir and my ACV every day.
My issue stopped the first day I cut out the corn/wheat, so I concluded that was causing the problem. I talked more about it over on my thread.
I also have no acne and only wash my face with water, I have washed my face with only water for at least 20 yrs.
In high school I used soap and water and zit cream and had plenty of acne.
“I hesitate to conclude anything from a self-experiment.”
This is nonsense. You’re concluding things from self-experiments all the time – you just don’t call them “self-experiments.”
Google “acid mantle”. Some people (like my wife) just can’t wash their faces with soap and keep their skin in shape. Most can, though you still don’t want to overdo it.
I guess I’m a bit of a counter example to the ‘wash with water’ acne cure. In my teens and 20s I had terrible acne over my face, chest and back. My face and chest were washed daily with soap (in the shower), but never my back, which was only rinsed by water. The acne was pretty much the same everywhere. Nothing much helped it till I took a course of accutane in my mid-20s.
A very expensive call girl of my acquaintance was carded in nightclubs at age 40. She never used soap.
In response to Mickey’s comments about controlling for confounding variables, the less time-expensive solution is randomization, just like with larger clinical trials. For the acne case, the self-experimenter could flip a coin at the beginning of each week to decide whether to wash their face using or not using soap and record results at the end of each week. Any variable not connected with the presence or absence of soap has an equal chance of acting in any given week. If any unknown variable correlates with the use of soap, who cares? The experiment is less interested in proving or disproving “Washing without soap causes less acne” than demonstrating that “there’s less acne when washing without soap.” Further, such self study may demonstrate a solution that works for an individual, but may not work for a larger population as would be necessary for a definitive conclusion from a clinical trial. The trouble with the randomization I described is that it requires that the self-experiment be both disciplined and organized, but flexible enough to not fall into a routine — but alternating 6-month samples fails to control for seasons as a variable, so that’s one for one.
Jeremy, in practice much simpler designs work fine. For example, suppose you have recorded your acne daily for six months. You stop using soap and all of a sudden the measurements go much lower than usual and stay there. That’s almost proof right there. If after a few weeks you resume using soap and then the acne comes back, that’s all a sane person would need.
Hi all–
Seth: They keep fermented foods out of the diet for the first phase because your gut is irritated and is leaking food into your bloodstream, which causes problems in other areas of the body. The theory is that fermented foods (or even just acidophilus) will irritate you further until you kill the yeast and heal your gut–at which point, they will become essential. (Spicy foods are prohibited too, for pretty much the same reason.)
NNM: I have an *extremely* good doctor who I started seeing only about a year ago–and he spotted this during a chat about something else completely. The interesting thing is that I had discussed many of my yeast-related symptoms with other doctors over the years–including acne, terrible reactions to birth control pills (including anxiety and mood swings), allergic reactions to allergy medications (steroids), persistent stomachaches that weren’t helped by stomach remedies. But the doctors had no answers, and I felt these were annoying rather than important ailments. Really, I thought of myself as a very healthy person.
I was in for something else and my doctor was prescribing me an antibiotic, so we were discussing any other medications I was on (none), compared to what he’d prescribed me in the past. The trigger was when he asked how I was doing with the low-dose Prozac he’d prescribed to treat PMDD. I told him I’d used it for about two months, but that the issue had gotten much better when I removed white flour and white sugar from my diet. Then he started looking at my reactions to medications and some of my medical complaints, and realized they formed a pattern.
Most doctors don’t do this or listen anywhere near as closely. A friend of mine has gout, which his doctors tell him is triggered by red meat, organ meats, and wine. In his experience, though, it seems to be triggered by sugar, and not at all by those other things.
Seth, as with so much else in life, there’s often a tradeoff between how sure an experimenter wants to be and how much effort and resources the experimenter is willing to commit to that certainty. The method I presented was merely an answer to Mickey’s desire to rule out the influence of confounding factors with only one research subject, at the expense of simplicity for that subject’s experience.
I’d be impressed if anyone has a method that works for undisciplined self-experimenters who are neither prone to the organization to randomize and record their washing habits or routine to stick to either method for any length of time.
Self-experimentation is the only way to deal with acne, IMO. All the standard advice (wash more, it’ll go away when you’re older, use acne cream, don’t pick at it!) is totally useless. I discovered long ago that I did better by not using soap on my face. And later, I used the RPAH elimination diet to experiment until I pinned down the remaining causes of my acne: wheat and chocolate. My face has been wonderfully clear for a couple of years now, except the two or three times I have been lured into eating baked goods over the holidays. But talking with other people who’ve eliminated their own acne… not everyone’s acne is caused by the same things. So since there’s no uniform cause, it’s a cinch there’s no uniform cure either.
Seth,
Could the washing with soap be changing the ratio types of bacteria so that the acne bacteria runs amok? Sort of like the inverse of your fermented food idea.
Walter
Walter, that’s an interesting possibility. The usual explanation is that washing your face with soap washes away oils that are then generated in too-large amounts to try to make the face oily again.
Actually, standard advice is to never use soap, never use bar cleansers of any type because solids leave behind residue that is hard to wash off that irritates the skin, and to not use any type of cleanser more than 2 times per day because it dries. Instead, the recommendation is to use a gentle liquid cleanser such as Clean and Clear, Cetaphil, Suave’s facial cleanser, or a few similar ones, as simple as possible, no additives and clear in color if possible, and never anything that tingles because that means the skin is being irritated. See Paula Begoun’s book.
I got rid of my acne based on clinical trial results. Initially I was using benzaclin, a prescription cream that is a mixture of antibiotics and 5% benzoyl peroxide. It worked well but I read the package insert and noticed that the t was barely significant between the prescription and just plain 5% benzoyl peroxide, so I started using just plain 5% bp and that was equally effective, though slightly more effective because it was cheaper by an order of magnitude so I felt okay using lots of it. I buy it for $2 a tube online, versus $20 as my prescription copay.
There was a self-experimentation aspect, in that I started using the benzaclin in large amounts because I noticed it was close to the end of its effectiveness date and I wanted to use it up, and it was more effective that way. Turns out that using a lot of b.p. is a common way to get rid of acne, as a guy who owns acne.org turns out to have also “discovered” the same thing.
Seth, wasn’t sure where to post this, but you’d find it interesting I think. It supports the dirt hypothesis. PMID: 19177167
“Crohn’s disease and early exposure to domestic refrigeration.
BACKGROUND: Environmental risk factors playing a causative role in Crohn’s Disease (CD) remain largely unknown. Recently, it has been suggested that refrigerated food could be involved in disease development. We thus conducted a pilot case control study to explore the association of CD with the exposure to domestic refrigeration in childhood.
CONCLUSION: This study supports the opinion that CD is associated with exposure to domestic refrigeration, among other household factors, during childhood.”
Also, this https://www.pnas.org/content/105/43/16413.long “Therapeutic correction of bacterial dysbiosis discovered by molecular techniques” states that “Molecular analysis of fecal and mucosal samples have increased culture-based estimates of 200—300 individual colonic bacterial species to as high as 1,800 genera and 15,000—36,000 species (7). “
thanks, Dennis, a fascinating study about refrigeration.
Water is one of the powerful solvent in earth. did’nt you ever notice that God created us in NATURE way.meaning to say like adam and eve way back long time ago,they don’t use soaps,they just use water for cleansing.
I use organic aloe gel to wash my face. It isn’t drying & I rarely get acne. Aloe is moisturizing & the water just sort of dries things out worse if that is all you use.
For people who don’t wash their faces with soap: do you continue to use benzoyl peroxide? Do you use shaving cream when you shave?
My classmate once told me that she was weird out by knowing that most girls usually have face cleansing soap in their bathrooms. Then I asked her, what did she use then? She only washes her face with salt( of course with water also..) & I can say that her face is flawless ( like baby’s skin) . She only gets a zit when she has her period though but her skin is flawless most of the time o.o
Fascinating discussion – glad I found it. To play devils advocate though, what about the health risks of poor hygiene, which were conclusively proved at hospitals during the 1800s?
I’m all for using less soap on the face, but its still important on your hands.
I’m all for using less soap on the face, but its still important on your hands.
I agree. I still use soap on my hands several times/day.