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

Where it Counts…

The next few posts are going to be some of my most difficult to write, so I apologize if they lack eloquence or if they take me a while to compose. I am still struggling with the nuclear fallout of my most recent relapse–especially because ED disguised itself (and sometimes continues to do so) as healthy living. Please bear with me as I get these words onto the page…

I reluctantly let my plantar faciitis heal through orientation in a desperate attempt to–please pardon the pun–start my school year off on the right foot.

The body I had…

The problem with my going back to school was that I was really, really good at it. Academia has always been my comfort zone, and reading and writing about theatre is an instinct that comes as naturally to me as does breathing. However. There is one thing that I am better at than being an academic, and that is doubting myself to the point of lung-crushing anxiety. And I was scared to death of failing.

Since I had not been a part of the New York theatre scene for many years, I put my entire heart and soul into playing catch-up. There were so many plays, so many actors, so many musicals and monologues and theatre critics who I felt that I should have just known. I didn’t want to look stupid in front of my brilliant classmates or the famous directors, writers, and other such high muck-a-mucks who ran my program.

The nail in the coffin for my anxiety attacks came from Lysander, whose daily phone calls usually included some sort of disparaging remark about my pursuit of a graduate degree in theatre. I could, he assured me, be doing something more useful, like law or business (and, coincidentally, he happened to be doing both). There was always something negative about my particular program encoded into our conversations. I was stuck between agreeing with him  and trying to prove to him that I was doing something worthwhile.

To ease my anxiety about my degree, I threw myself even more wholeheartedly into my physical transformation plan. I created an account on, and, for the first time in my life, not only logged my food, but also started counting calories. Calories were these mythical, magical little numbers that existed somewhere in food, and by controlling them, I could finally control how much I was eating–and therefore, how much weight I was gaining. I would weigh myself on my little red scale every morning and log the number on the site. I spent my days weighing and measuring my portions. I would then spend every night logging every morsel of food that I put in my mouth.

I also left J’s Big Gym and started using the university’s on-campus gym. Since I lived in Washington Heights (on 172nd St.), it was silly for me to go up to 181st and back, when I  still had to get down to school on 116th St. in time for class. I woke up every morning at 4:45, ate  1/3 cup of shredded wheat cereal (no Publix in NY!) with 1/2 cup of skim milk, took the subway to 116th, and did my Jamie Eason workout followed by an hour of cardio from 6 am until 7:45 am. Then I showered in the locker room (which involved about 30 futile minutes of trying to flat iron my curly hair in the dank, humid air), and then walked to class.

My awesome apartment on 172nd…and my awesome friend Ana (who I miss terribly!)

For lunch, I ate an apple and my usual peanut-butter-and-rice-cakes–until I saw one of my classmates eat an english muffin. Just seeing that bread-y goodness made my mouth water. I don’t know how to describe it without sounding crazy, but that day I ached for an English muffin. I started toasting Ezekiel gluten-free english muffins (120 calories per serving: 1 muffin) and slathering them with my all-natural peanut butter (also 120 calories per serving: 2 tbsp).

Although I absolutely adored my fellow classmates–absolutely adored them–I only rarely saw them outside of class. I was both scared to death that they’d see me for the inexperienced pretender I felt I was and that they’d want to go out to eat or drink. I couldn’t spare the calories if I wanted to be a fitness model by November, so I had another apple for a snack and then went home right after class most nights. I would sit in my apartment, eat a lite tofu (1/5 block, ~ 30 calories), black bean (1/2 cup, 57 calories), and Thai veggie (1 cup, 33 calories)  stir fry, and do my homework (and calorie counting) until my nightly cereal binge before bed. (And with the cereal binge, I’d fudge the numbers, because I didn’t want to admit how much I was actually eating.)

My beautiful bedroom…and self-imposed prison.

The good news was that I was finally starting to lose weight. I could see it reflected in the way my clothes hung on me, in the number on the scale, in the mirror. And my school anxiety, though still stressing me out to no end, at least motivated me to become an expert in all things theatre. I could discuss everyone from Eugene O’Neill to Nicky Silver without batting an eye. And with all of that positive feedback, I continued my destructive cycles of calorie restriction, exercise, and stress.

One of the few times I went out for a non-school event that semester–and saw FAME with some of my life-long friends.


Soy-Free Summer

How many foods can you name that contain soy? I can name thousands–and if you want to become as versed in the versatility of this (evil) little bean as me, then all you’ll need to do is walk up and down the aisles of your local grocery store and read the “nutrition” information on the back of nearly every processed food’s box.

Long before all the “eat real food” hype began permeating the blogosphere (hype that I stand proudly behind and don’t mind promulgating), I was introduced to soy’s insidious ability to hide in nearly all food by accident.

During the summer of 2001, just a few months after I gave up red meat, I found myself in the strange predicament of breaking out in hives on my legs every morning at summer camp. I hadn’t much changed my diet (other than giving up my near-subsistence on Steak-Umms–I just added in more tortellini, like the good little Standard-American-Dieter I was), and I had no indication that any external forces were causing a contact allergy. My mom was baffled too–and also tired of having to make emergency trips to my day camp with bottles of spray-on Benedryl. She has always been acutely tuned to both my and my little sister’s health, so she immediately began searching her inexhaustible mental Rolodex for clues as to why I should be suddenly allergic to nothing at all.

She landed on an allergy test I had when I was a baby. Nothing significant showed up at the time; however the test did expose a “heightened reaction” to soy. Why that should suddenly flare up now, especially when I was eating peanut butter sandwiches for lunch and macaroni for dinner, was a mystery to me, but I decided to roll with it, because I had no other indication of why my legs were breaking out.

That summer, the running joke at summer camp was that I couldn’t eat anything that didn’t have a “soy-free” sticker on the box. The sad part is, in truth, most boxes of food contain soy. Soy in the form of lecithin (an emulsifier), partially hydrogenated soybean oil (a trans fat that increases shelf stability), soy protein isolate, or textured vegetable protein (an additive that alternately provides a higher protein/lower fat supplement to food or changes the “mouth feel” of a food product), shows up in EVERYTHING. Seriously, go grab your favorite supermarket food, sit down and read the ingredients, and then let me know what you find. Then do that with everything in your pantry. I rest my case.

So that summer I gave up fruit snacks, M&Ms, processed macaroni and cheese, TV dinners, and nearly everything that previously comprised my daily diet. I also forewent any food that was served to me by friends unless I could read the nutrition information first. I mostly ate peanut butter sandwiches and summer fruits like plums. I started eating salads (dry–no dressing, just in case). I still had tuna, but was suspicious of mayo. I ate grilled chicken and turkey, but not if they had been basted in soy-filled barbecue sauces. Needless to say, I dropped a lot of weight that summer. (I’ll discuss the emotional, mental, and physical ramifications of the soy-free summer in another post.)

At the end of the summer, I was free of hives; however my food choices were not the only change I had made: I had also switched my shampoo brand around the time that the hives stopped. An allergy test before 9th grade started revealed that I was not allergic to soy, but did have a heightened reaction to tree nuts, like hazelnuts. And tree nuts were in my shampoo.

I slowly reintroduced M&Ms to my diet, but the effect of the soy-free summer was to make me more aware of what I was putting into my body–and what food manufacturers were trying to sneak into my body by pretending to actually manufacture food. This period was an intensely stressful one, but important in my understanding of why it’s so important to shop the perimeter of the grocery store…and it led to some of my recent discoveries about why I had to stop being a vegan and why I may have developed such treatment-resistant acne.

But, again, that’s all a story for another day… So I’ll see you then!