Acne and ED, Part IV: N=1 Is The Loneliest Number

 If you want to read the whole series in order, start here: 

Acne and ED, Part I: How Vegan Began

Acne and ED, Part II: The Never Ending Detox

Acne and ED, Part III: Un-Becoming Vegan

Acne and ED, Interlude: You Are What You Don’t Eat

I cannot even begin to articulate how frustrating it is to see improvement with acne only to find the “solution” to be ultimately lacking.

I saw definite improvement now that I wasn’t eating vegan. The massive, constant flare-ups began to slow, and I was able to wean off of the (completely ineffective anyway) Doxycycline. My face was finally starting to clear up, but I still had some pretty serious cysts on my chin. It didn’t make sense: here I was, eating squeaky clean paleo (perhaps too squeaky–I was still afraid of eating fats), eliminating nightshades, washing my face with nothing but baking soda and apple cider vinegar, and de-stressing to the best of my ability.

Dog on my head and acne on my chin

*Almost* clear skin

I racked the internet for answers, but all that was out there were glowing accounts of miraculous skin health reversals that read just as emphatically as the vegan transformation stories that had snared me months earlier.

I was fortunate enough to have a ton of time on my hands, so I began to do some more in-depth research. And it was during this time that I stumbled upon the concept of “n=1.”

As humans, our bodies were crafted by the same artist, but sculpted from different clay, fired in different kilns, and painted different colors…and so the best light in which to display our art cannot be found in a single gallery. Though we’re all part of the same species, we are each so unique–genetically, epigenetically*–that it’s almost insane to presume that there’s single diet (and by “diet” I mean lifestyle/way of eating) to which we’ll all respond the same. In other words, some people can eat dairy while others can’t. Some people seem to thrive on so many starchy carbs, while others can’t look at a sweet potato without having an adverse insulin response. Some people have great skin because they’re vegans, others because they’re chowing on beef liver.

For the non-science majors among you, n=X refers to the sample size of a population in any given experiment. So, if you did an experiment with 86 female runners, for example, “n” would equal 86; an experiment with 101 obese rats would be described as n=101, etc. When it comes to finding the diet/nutrition that works for you, you can’t necessarily look to the latest study out of Stanford or Harvard that touts results based on a sample size of n=100, 1000, 1,000,000 to get a personalized result. And so the concept of n=1 was born: instead of looking at what works for the group on average, figure out what works for you.

“Nutrition is for real people. Statistical humans are of little interest.”
Roger J. Williams, PhD (poached shamelessly from Eathropology.)

I took that to heart and turned away from the internet. Instead of posting in a Paleo Hacks forum, I asked myself about myself.

Self, I asked, what have you been eating consistently that could be causing such a reaction? I took an inventory…and suddenly it dawned on me, with all of the poetic grace of a Mack truck: what’s the one thing that I ate at least once (if not twice or three times) per day, whether I was “cleansing” in New York City, starving myself in England, training to be a fitness model, or avoiding animal products?

The answer? Apples. My favorite food.

As soon as I made the realization, things started to fall into place. I hopped back onto the internet and did a little investigating with Dr. Google. “Apples + Acne” returned this: Birch Pollen Allergies.

The explanation’s a little convoluted, but bear with me here: birch pollen allergens contain a protein that is similar to a protein found in certain fresh fruits, nuts, and herbs. Individuals who have a sensitivity to birch pollen, then, can find that allergy expressed as an oral food allergy when they eat those birch-pollen-similar foods. An oral food allergy can express itself in a number of different symptoms in varying degrees of severity: itching of the mouth and throat, swelling of the tongue, oral ulcers/blood blisters, anaphylaxis, etc. So…what does this have to do with me?

Do you remember waaaaaay back to the beginning of my eating disorder story, when I mentioned that I had to give up soy until an allergy test revealed that I had a “heightened reaction” to tree nuts (like hazelnuts and almonds)? Okay. Well, I ate tree nuts for years with nary an episode of anaphylaxis, so I disregarded that diagnosis.

In between said diagnosis and now, I developed a fatal attraction to apples. Not your horrible, mealy Red Delicious, but the big-as-your-head and juicy-as-hell varieties like Honeycrisp. During my freshman year in college, I became something of an apple connoisseur, able to distinguish between a Braeburn and a Gala with my eyes shut.

During the height of my second relapse into ED–the summer I went to England–I started eating two apples a day. Even after I started teaching high school, I kept up my two-apple habit, and that continued into my body building days…until I completely gave up carbohydrates. At that point, I started eating almond butter every night (and you’ll see why this is relevant in a second). While I was weightlifting, my acne wasn’t horrible, but it stayed present. Then, when I started working at the Kool-Aid store, I reintroduced apples, getting up to three apples a day by the time I went vegan (during which time I also relied very heavily on soy to keep my protein intake high).

Now, some of the “do-not-eat-if-you’re-allergic-to-birch-pollen” foods include: apples, almonds, hazelnuts, peanuts, peppers, and soybeans. And, according to at least one study I found on PubMed, a “secondary soy allergy may cause severe chronic besides acute symptoms” in children with a birch pollen allergy. So maybe the soy thing wasn’t completely off-base after all…

How do I know that this is my issue? Well, in the months leading up to my n=1 discovery, I had started complaining that my mouth and throat itched when I ate apples. Later, I started developing really painful blood blisters in my mouth after eating a snack of apples and rice cakes. At the time I thought maybe it was because the rice cakes were somehow irritating my mouth. I thought wrong.

I had also started using raw apple cider vinegar on my face a few months into the vegan experiment. Apparently that exacerbated my problems.

Although it pained me to stop eating my daily apples and almond butter, I managed to almost completely heal myself from the inside out. My skin cleared up. I struggled, for the first few weeks, not to unconsciously reach for my beloved apples or mix up a couple of tablespoons of almond butter and chocolate for dessert, but over time I stopped craving them.

There were still other issues to be addressed with my hormones, but, by and large, the acne problem became a thing of the past.

Acne Free

Much better.

Out of curiosity a few days ago, I decided to test the efficacy of my experiment after a few months. So I bought an apple at Trader Joe’s. Three bites in and my gums started bleeding. Needless to say, I’m convinced. No more apples.

I’m so glad I discovered n=1 and stopped looking to others for the answers. And I so appreciate hearing about the acne cures you guys have shared with me through the comments and offline: it reaffirms for me that we’re all wired differently, and that we have a duty to take care of ourselves based on what works for our individual genetic and epigenetic makeup. And I think this extends beyond acne to other issues, in the realms of fitness, nutrition, and mental health. I challenge each and every one of you, the next time you decide to try the latest fad (be it nutrition, fitness, etc.), go into it with an n=1 mindset and make changes based on how you actually feel, not how someone says you should be feeling.

Now, all of that said (and I apologize, ‘cause I realize I said a lot), after I made my acne discovery, I still had a ton of self-realization awaiting me as I stared into the seeming abyss of life after veganism.

– K.

P.S. Just so you know, the saga is far from over. A few days ago, my chin broke out again, and I had no change in my diet. I had to seriously consider what might have changed to have provoked such a reaction. I realized that the only change I had made was the introduction of biotin into my supplement regimen. (I started taking it, despite its dubious ability to expedite hair growth, because I’m desperately trying to grow out a horrible haircut.) I stopped taking it about a week ago, so we’ll see if that cures my problem. After I stopped the biotin, I stopped my hormone replacement therapy (more on that in another post) because I’m tired of feeding my body synthetic hormones, so I’ve started getting acne on my forehead and hairline again. It’s a never-ending struggle for balance, but I think I’ve at least gotten closer to understanding the mechanisms that make my skin react the way it does. And hopefully I’ll have clear enough skin to begin dealing with the horrible scarring soon…


I cannot recommend more highly this series on n=1 nutrition at Eathropology. These articles are well written and meticulously researched. They’re long, but they’re so worth the read. (Especially if you’re interested in public health, nutrition, and epidemiology!)

 N of 1: Same Old Tools

N of 1: Biochem and Nutrition Policy

N of 1: Walter Willet

N of 1: The Elephant in the Room

N of 1: A Different Question

*Epigenetics: how our genes express themselves

2 thoughts on “Acne and ED, Part IV: N=1 Is The Loneliest Number

  1. I discovered your blog after the post on The Whole30’s FB page. I, too, struggle with acne. It was pretty well under control, until this summer when I started a routine of healthy eating and regular exercise. When I started that routine, I replaced my granola bar addiction with a combination of organic pink lady apples and raw almond butter. In the same month, my clear skin went haywire. I started breaking out, and it was worse than ever. i even had acne on my forehead, and that had never happened before. I realize your n=1 concept, and I hate the idea of applying your theory to myself after your statement. However, it seems that there may be something to your theory that may help me, even though there are other factors that likely play a part. After struggling for a couple months on antibiotics and prescription topicals, I’m sadly going to eliminate my two favorite foods to see if it helps.

    • Hey Cherie!

      I’m so sorry that you’re dealing with the acne thing too…It’s definitely awful to deal with, and I really hope that your n=1 experiment works.

      And I’m glad you’re trying my n=1 for yourself–no need to feel bad about finding a ready-made hypothesis! When I speak about n=1, I don’t mean having to pull answers out of the sky, since nothing that worked for anyone else can ever work for you. What I meant was that just because it worked for someone else, you can’t assume that it will work for you. N=1 experiments are great because you’re able to take a credible hypothesis and apply it to your life, without making an assumption that someone else’s hypothesis is automatically going to be your answer.

      For example, just because one woman cured her cancer with a juice fast, doesn’t mean that all women can cure cancer with a juice fast. Nor does it mean that all women can prevent cancer AND live a generally healthier life with juice fasting, but someone wrote a book about it, and I believed it. (That’s how I ended up with the acne problem in the first place.) It’s the same with intermittent fasting. It worked for Dr. Berardi, Brad Pilon, and the Bulletproof Executive, so everyone in the Paleosphere tried it, and a bunch of women gained weight, got sick, or suffered from hormonal problems. (There’s a great post about that here: Anyway, point is, n=1 means you get to be a Paleo-narcissist (in the best possible way) and focus on your own body, mind, and health. 🙂

      So I absolutely encourage you to try eliminating birch pollen and see how you do. (See if you can eliminate all birch pollen allergy triggering fruits and nuts, not just apples and almonds. After 30 days, try putting foods back into your diet (one at a time) to see how you do!)

      And please write back and let me know if it worked for you–and if not, what your next experiment will be! I wish you so much luck, and can’t wait to hear more!

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s