skin breakouts broken down with Georgi Dinkov
Many of you may already know of Georgi Dinkov. For those who don’t, let me introduce you! I have much respect and admiration for his tireless research into biochemistry and physiology, his dismantling of common misconceptions around health, and think it’s important to support his work. Here I ask the brilliant Bulgarian what his research has lead him to understand about acne and skin breakouts. He agrees wholeheartedly that acne is an issue to be treated from the inside-out, not the outside-in.
Georgi, if you could start by telling us about your background and the work that you do today
My academic background is in Computer Science but since 2002 I have been exposed to biochemistry and medicine. My first work after college was as a bioinformatics specialist at a biochemical outfit known as Protein Information Resource (PIR) that created and maintains the protein databases pir.georgetown.edu and uniprot.org and my job consisted of coding most of the backend search functionality for those websites. The team behind PIR and UniProt consisted of about 50 world-class biochemists, doctors, geneticists, endocrinologists, etc. I was one of the few IT people on that team and naturally the conversations and activities revolved around biochemistry and related topics. I became interested in the field and for the next three years took courses, seminars, lectures, etc on biochemistry, endocrinology, and physiology taught by people on the team at Georgetown University, NIH, NIST, etc. Those three years of more or less medically-related studying formed the needed background so that I can start reading the literature in the field.
Since 2005, I have been reading extensively all kinds of scientific studies and books, and that’s how the bulk of my knowledge (assuming I have any) came about. Over the last 6 months I started planning and implementing my own scientific studies. Some of them use IdeaLabs products (Georgi’s boutique range of supplements), and others are done just for the sake of challenging certain established but completely unfounded hypotheses in medicine such as androgens being a cause of prostate cancer, certain omega-6 (PUFA) fatty acids being “essential”, cancer being a genetically driven disease and as such impossible to reverse a “cancer” cell back to normal, metabolism being a small and largely unimportant downstream factor of genetic makeup instead of actually being the primary driver of health/disease, etc.
My day job is still as an IT professional, but every waking minute outside my IT work and family activities I devote to my biochemical “hobby”, the IdeaLabs clients, and trying to expand my knowledge in as many fields as I can. That last part is actually quite important. There was a time (the Renaissance) when “knowing a little bit of everything and one thing well” was considered an absolute requirement for intellectual enlightenment and enabling the progress of mankind. These days it is all about extreme specialization and we can see the result of that attitude. So, try to expand my mindset any way I can while focusing mostly on biochemistry and physiology.
Particularly in regards to skin issues such as acne and a propensity to pimples, there is more emphasis on treating breakouts with topical potions when the main cause is generally gut related / hormones / nutritional deficiency. From your research would you agree that small intestinal bacterial overgrowth / endotoxin are usually the major underlying culprits, and not androgens as we’re told?
digestion: to clear the skin, first clear the gut
Yes, so the two biggest things internally that affect skin health are digestive health and hormonal health, and they are directly linked. The way the skin looks on a person is actually a very direct indication of their intestinal health. Even a slight inflammation in the intestine will bring out these weird red spots and they can happen anywhere really but they mostly happen on the face and neck, and maybe the legs and arms. If they start happening on the torso that’s actually an indication that the situation is more severe. They tend to start at the extremities and then if it things worsen you start getting spots etc. on your back, your abdomen and your chest etc. Actually the same thing happens with psoriasis and other “autoimmune” conditions, although I don’t believe in autoimmune diseases, but the regions progress the same way; it starts on the extremities and if the condition worsens it presents centrally on the torso.
So first of all you have to address intestinal health if you want your skin to be healthy. You can be putting whatever you want on top of your skin, and it may be protecting you from the sunlight and these external pollutants, but if your digestive health is not optimal this will be reflected in the skin because the skin depends on the digestion for the nutrients that it needs, and also the digestive system is the only protection you have against endotoxin. (Endotoxin is a toxin that is released when bacteria die, explained further here)
So if endotoxin floods your bloodstream all hell will break loose and it will usually reflect firstly on the skin long before any systemic issues happen such as fibrosis, chronic inflammation, cardiovascular disease, or even cancer. These could occur later, but some of the early symptoms you might notice will be on your skin. So digestive health is very important, keeping the gut as clean as possible: both the colon and the small intestine. The small intestine is particularly crucial to keep clear. There should be no bacteria in the small intestine, that’s even by mainstream medicine standard recommendations that the small intestine should be clean. And that’s where the condition SIBO (Small Intestine Bacterial Overgrowth) comes in. It’s a major problem because this bacteria that’s in the colon is known to be pathogenic, it starts getting out of the colon and residing elsewhere. If it’s in your small intestine things are not working correctly. (the Wikipedia link here has a pretty good description of SIBO and not only mentions that unlike the colon the small intestine should have very little bacteria but also lists a number of diseases causally linked to SIBO).
Often the causative issue is insufficient stomach acid production (low thyroid being a possible contributing factor). The acid is the primary defence mechanism against SIBO. And then there is the ileocecal valve that connects the small intestine to the colon; periodically it can actually open and let some of the material from the colon creep back up. But if there is sufficient stomach acid being produced that acid is strong enough to keep this bacteria under control and keep it within the colon only. *Special mention about the importance of daily bowel movements too. If this is an issue for you, read here.
In healthy people it’s not that much of a problem because the colon, if it’s healthy, typically has good barrier function. So not much of the endotoxin ends up in the bloodstream. But over time because this endotoxin is such a potent inflammatory mediator and it constantly stimulates the cells in the colon (the chromaffin cells) they produce serotonin. *Serotonin is not the “happy hormone” by the way. More here. And the more the colon gets exposed to endotoxin, serotonin and nitric oxide overproduction, the weaker the gut barrier gets and eventually that endotoxin starts to creep into the bloodstream. This is when all hell breaks loose.
Bacteria from the colon can actually translocate to other body parts if the gut barrier is sufficiently compromised and this has been shown to be the cause of conditions such as periodontitis, fatty liver, liver cancer, pancreatitis, pancreatic cancer, fibrosis of heart, lungs, spleen, etc. In milder cases it manifests as acne and it is not surprising that it responds to antibiotics both due to direct effects of the antibiotics on the skin lesions and due to lowering of bacterial count in colon and small intestine and thus reduction of SIBO.
By the age of 35 most people have a weakened enough gut barrier to allow enough endotoxin into their bloodstream for it to be a problem. So the solutions are either fix the gut barrier, or better still solve the bacteria problem which is the root cause of the issue. If you only fix the gut, over time it’s going to keep happening again and again.
So really you have to keep the gut as clean as possible. You don’t have to do it on a daily basis but using the antibiotics that Ray Peat mentions once or twice a week is usually enough, or camphoric acid, or other kinds of antibacterial substances. Even aspirin’s actions are pretty good for this. Aspirin is actually a great antiseptic for the intestine, however regular aspirin absorbs very early in the digestive tract; mostly in the stomach and small intestine. So this makes aspirin a very good treatment for SIBO because if the bacteria ends up in the small intestine, aspirin makes it to the small intestine before it gets absorbed, and it will kill the bacteria there.
However, aspirin doesn’t have much effect on the colon because it gets absorbed before it reaches the colon. So that’s why the second ingredient in my new product CamphoSal is phenyl salicylic acid; together with the camphor, the salicylic acid (when bound to phenol) doesn’t get absorbed in the stomach and/or small intestine as pure salicylic acid dose, so it does reach the colon and it gets broken down in the colon (by the bacteria in the colon) into salicylic acid and phenol. It’s similar to that antibiotic they use for SIBO called Rifaximin; it works by being a non-absorbable antibiotic, so it reaches your colon and can kill bacteria throughout the entire intestinal tract. Camphoric acid with phenyl salicylate kind of works the same way.
Certain insoluble fibres (eg. Carrot, cooked mushroom, bamboo shoots) can do the same thing since the bacteria cannot digest it very well. The insoluble fibre literally sweeps your intestine clean. Sometimes your bacterial colonies can form these really tough to break spots called biofilm, they’re attached to the wall of the colon. But if you eat enough of the right insoluble fibre over time it’s going to make them detach and you’re going to pass it out. So insoluble fibre is great. Aspirin is great. Actually if you mix aspirin with fat, some of the aspirin may get to the colon.
That’s one of the reasons why Ray (Peat) recommends mixing coconut oil with the grated carrot salad (recipe here) because he sees that coconut oil has a very potent antibacterial effect but the problem is it gets absorbed very early so you have two choices: either do an enema with coconut oil which most people don’t want to do because it’s complicated and requires preparation and equipment etc. or, eat the coconut oil in a way that gets it all the way down to the colon. So Ray recommended mixing coconut oil with the carrot but I also found out that taking charcoal with coconut oil at the same time has a similar effect; the charcoal binds with the coconut oil and carries it to the colon to do its remarkable cleansing work. *You can mix activated charcoal with coconut oil, set it in the fridge then chop it into tablet-sized pieces, to take on occasion on an empty stomach.
So it doesn’t take much. In summary: coconut oil is a really potent antibacterial, the only downside is that because the body likes it so much it absorbs it before it’s able to do its good. So coconut oil just like aspirin, is great for SIBO because it does reach the small intestine, it just won’t be that helpful to the colon. But if you mix it with charcoal, carrot, well-cooked mushrooms or bamboo shoots, it will carry it to the colon.
hormones: don’t blame androgens
So the second thing: because digestive health influences hormones, the direct cause of most skin issues is actually hormones. So it’s the digestion firstly that messes up your hormones, but then it’s the hormones that cause these rashes or pimples or lesions or blemishes or spots or even moles. Most of these things on the skin are due to either histamine which is anything that involves redness, a rash or reddish lesion on it. Histamine, serotonin, nitric oxide and endotoxin promote all of these things. And then anything involving spots, moles etc. usually relates to estrogen, so basically the endotoxin irritates the adrenals and then the endotoxin stimulates serotonin and cortisol, and then cortisol stimulates the synthesis of estrogen.
Further more, endotoxin burdens the liver and leads to accumulation of estrogen as the liver is the main estrogen-detoxifying organ. Unopposed estrogen keeps the adrenals chronically overactive and they start pumping out DHEA which in women gets very easily converted to the male hormone dihydrotestosterone. To this day the doctors still think that acne is an androgenic disease but in reality is actually driven by estrogen and that’s why acne, when you give people anti-estrogenic chemicals, their acne tends to disappear even though we haven’t touched the androgenic angle at all. A good example is the treatment of hormonal acne with tetracycline antibiotics (tetracycline, doxycycline, minocycline). Those antibiotics are not given with the goal of killing bacteria but because they have hormone balancing effects. They are known to lower estrogen (see here) while at the same time raising the levels of DHT (see here), the most potent androgen in the body. So, if hormonal acne was caused by androgens alone then these antibiotics by raising the levels of DHT should have made people break out like crazy. Yet, they actually successfully treat the acne in the vast majority of cases, confirming once again that estrogen and not androgens are likely primarily involved in the pathogenesis of hormonal acne.
Ray wrote several times that acne and its occurrence in “syndromes” like PCOS is an estrogen-driven phenomenon. However, the medical profession is firmly holding onto its idea that it is androgens like DHT, DHEA, testosterone and androsterone alone that are causing the acne and the insulin resistance in PCOS.
This study found no link between any androgen and acne (that they were ‘permissive’ but not causative). It concludes that previous studies linking acne and androgens suffer from methodological flaws.
My simplified visual summary of Georgi’s take on acne
So again the digestion is, more often than not what causes the hormonal imbalance. So if you’re going to fix the ”cause” it’s the digestion that you need to fix. But if you also want to address the hormonal imbalance directly, aspirin is good because it has a potent anti-estrogenic effect. So too do Vitamins A, D, E and K, and everybody knows the importance of vitamin A for the skin (dairy and liver being the best dietary sources): they all help you move away from estrogen dominance and cortisol dominance, and tend to improve skin health as well. Of course you can also use things like pregnenolone and progesterone.
Cholesterol also has for some reason a very protective effect. This study shows that progesterone, a potent anti-estrogen, is capable of directly binding and deactivating endotoxin, but it also showed that it’s not just progesterone that can do this; it’s any steroid molecule with a similar structure, called a Pregnane. Cholesterol is also a pregnane molecule, so it also may be capable of directly binding and deactivating endotoxin. Therefore in addition to applying it straight to the skin, ingesting foods that are rich in cholesterol may have a very powerfully soothing effect on your gastrointestinal tract by reducing endotoxin and thereby improving skin health that way too, even it you’re not actually rubbing it on your skin directly. So eat your eggs, don’t skimp on eggs! Eggs are important. Also eat nice, juicy, prime Australian beef, don’t skimp on that either, it’s really good for you! Steak and eggs are a great meal, I love it! It terrifies my doctor though. Even though my blood cholesterol is lower than his and he’s on statins!
What about green smoothies and salads?! ; )
That’s what my doctor wants me to do!
For anyone who says eggs ‘break them out’?
It means there’s too much bacteria in their small intestine and when the eggs get there … I mean there’s no good food that will protect you if you have bacterial overgrowth; anything can be food for bacteria. So if some kind of a food gives you a problem, it’s typically not the food itself, it’s that you’re feeding it to the bacteria and then it’s generating a lot of these toxic by-products.
Thank you Georgi!
I hope this reminds you to recognise skin breakouts of all sorts as simply a symptom of internal unrest, and not something to attack from the outside as it will only continually return and worsen. Here’s further confirmation to get in the carrot salad, cooked mushrooms, bamboo shoots, keep the bowels regular, support your thyroid, keep your protein up, eat / take liver, and eat enough nutritious and digestible food.
You can find more of Georgi’s work at:
his research website
on the Ray Peat Forum posting as @Haidut
* To this I would like to add a mention about well aged Cascara. Read all about it here. It’s incredibly helpful at supporting bowel motions. Without a complete bowel emptying daily, endotoxin will only accumulate and worsen skin and hormonal issues.
Disclaimer: My posts are not meant to be individualised treatment plans, protocols, etc. I share what I research and use, and that is it. They are meant to spark thought based on the normal anatomy, physiology and biochemistry of the body. The information contained in this blog should not be used to treat or diagnose disease or health problems and is provided for your information only.