going keto the acne-safe way


going keto the acne-safe way

by kerry watson

the ketogenic diet, also called the “keto” diet is made up of high fat, moderate protein and very low carbohydrates. a basic ketogenic diet aims for a daily intake of 75% fats, 20% protein and only 5% carbohydrates. the ultimate goal is ketosis, a state when the body shifts metabolism to become efficient at metabolizing fat for energy instead of glucose. if, after reading this post you get inspired to try an acne safe ketogenic diet, this online keto calculator is a great resource for keeping track of your macronutrients. there is also a great guide and free recipe book on this site to help get you started on the diet.

(photo taken from www.perfectketo.com)

at least one study has shown that a ketogenic diet may have the ability to improve acne [1]. the understanding that high glycemic and high sugar diets can worsen both inflamed and non-inflamed acne lesions has become more widely accepted. it makes sense that by following a ketogenic diet, spikes in insulin are reduced and this may improve acne in people who are susceptible to breakouts triggered by sugar.

keep in mind that, like all diets, the keto diet is not going to be the best option for everyone. if you have any gallbladder or fat digestion issues then this diet is not for you. for most people, this is a safe and even beneficial lifestyle change. when our ancestors relied on a hunter-gatherer diet most of them spent a good part of each year in ketosis, especially those in colder climates when hunting was the only option during the winter. ketosis is not something new and our bodies have already evolved to tolerate and even thrive in this state.

before embarking on a ketogenic diet, do a little research to first make sure you know what to expect. start here for everything you want/need to know. just remember, unlike other ketoer’s you are doing it the acne-safe way which means, no dairy, soy or coffee 🙂 there are plenty of alternatives available so you won’t miss a thing!

my personal keto journey:

i decided to try this diet for many reasons. i have tried for years to lose weight with diet and exercise without much success. i have a chronic pain condition consisting of back, neck and shoulder pain and inflammation along with migraines. i also have had problems with blood sugar both too low and too high. after being on the keto diet for about 9 months now, i can say that it was one of the best decisions i’ve ever made 🙂

i don’t count carbs or calories. I just stay away from foods that contain more than 3-6 net carbs a serving and that has kept me in ketosis with no issues. click here to learn how to calculate net carbs. i’ve lost 15 pounds and my chronic pain flare ups are about 80% better than when i started. i don’t use any testing to make sure i’m in ketosis. i can just kind of feel when i’m in or out of it. there are subtle body changes that i can feel.

for folks who aren’t complete nutrition nerds like me, it might be a good idea to get some keto strips to test your urine to make sure that your body is getting and staying in ketosis. just keep in mind that these only work in the beginning because as your body becomes fat adapted, it releases less and less ketones in your urine as it becomes better at burning them for energy. however, in the first couple months these strips can help you make sure that you are staying in ketosis.

also, it’s easy to over do it with foods that are low carb. if you eat too many servings of low carb foods, the carbs will add up quickly. one example is nuts and nut butters. be careful to stick to very small quantities of these! look up the carbs in a single serving and see how big that serving is and go from there. you have to be really diligent with staying under 30 net carbs a day for this diet to do what it’s supposed to.

unpleasant symptoms are common at the beginning of embarking on a keto diet. personally, i was very tired, headachy and felt like i was walking through mud a lot of the time. these symptoms are known as the keto flu. this happens because glucose tells the muscles to hold onto water and electrolytes. without a steady glucose supply, these are flushed from the body pretty quickly. to combat this, especially in the beginning, it helps to supplement your electrolytes:

here are some guidelines:

  • supplement sodium 5000-7000mg
  • supplement magnesium 300-500mg
  • eat potassium rich foods 1000-5500mg a day or get this or this supplement
  • drink lots of water! you will be peeing a lot for a while until your body becomes fat adapted. this process took me a couple months but it’s different for everyone.

here’s my guide of tips and recipes to get you started:


– keto porridge:

  • 3 tbsp almond meal
  • 1 tbsp ground flax meal
  • some salt
  • couple droppers of vanilla stevia
  • tsp of ghee
  • 1 tbsp almond milk or coconut milk (optional)
  • 3/4 cup water

cook on medium low until it thickens a bit. the drop an egg in it and stir it up and into the porridge well until it cooks then add a couple frozen berries. sometimes i skip the berries to be super low carb 🙂

– project juice blue moon smoothie with no dates and then i stir in my own vanilla or plain stevia drops added (so good!!). i get this at least once a week on my way to work 🙂

– hard boiled egg, lamb sausage link or patty from whole foods pre-made and baked in the oven and avocado. or some organic bacon and avocado.

i like to save the bacon grease and bake these in it later for an amazing snack!

– i’m also loving poaching a pastured egg in bone broth and eating/drink both together with a little ghee and salt.

– since the weather has been so hot i’ve been having more salads for breakfast. i make a super large salad a couple times a week and keep it in a big container in my fridge so i can also grab some when i need a snack or a quick meal. i just keep it undressed and add dressing as i eat it. i also keep lots of hard boiled eggs around so that those are ready to go as well.


– often from postmatescalibur has organic beef lettuce wrap burgers (no bun) that are super yummy. and there are a few poke bowl places that have raw fish over kale or lettuce with acne safe toppings. instead of getting their sauce, top coconut aminos on it yourself to ensure it is acne-safe.

– if you are in the mission, mealmade delivers keto friendly meals. my favorite is this one.

–  leftover dinner or this keto bread (crackers) with tomato and avocado and bacon OR salami on it. instead of parmesan cheese, try using daiya shredded cheese. Also, I just found these at Rainbow. they aren’t amazing but they fit the bill for a pizza craving with some sauce, pepperoni and veggies baked on ’em.

– remember, any sandwich, burger, hot dog or taco can be enjoyed in the form of a lettuce wrap. so get some romaine leaves washed and keep them at the ready in your fridge. you won’t miss the buns and bread especially once you see your skin clear up and those extra pounds melt away 🙂


– i eat lots of low carb salads with some kind of yummy meat. i make this recipe at least once a week using various spice mixes

– of course i have lots of cauliflower rice and different stir fries and one pot instant pot meals over the cauliflower rice. i used to make the cauliflower rice from scratch using my cuisinart but now it’s so mainstream that you can buy it frozen at whole foods or trader joes!

– i really love this recipe. you can make it dairy free with kite hill ricotta and daiya shredded mozzerella instead of the dairy cheese it calls for. nobody will miss the pasta noodles.

– zuchini noodles are easy to make. you just need a good spiralizer like this one. here’s a recent turkey meatball curry dish i made to go over baked zucchini noodles.

– i don’t have a grill and i hate cleaning frying pans so i make lots of burgers in the oven and they always turn out great. here are my amazing baked bison burger and baked curried turkey burger recipes:

baked bison burgers:

  • 1 lb ground bison
  • 1 jalapeno
  • 1 tsp onion powder
  • 1 tsp smoked paprika powder

directions: preheat the oven to 375

char the jalapeno using a burner on your stove (gas works best). when it’s all black let it cool then peel the skin off under running water. then chop it up and remove seeds unless you like things super hot. chop the jalapeno up into a fine dice.

mix spices, bision and jalapeno together well in a bowl and form 4 patties. put them on a parchment paper lined baking pan and bake them in the preheated oven for 20-25 minutes turning once.

baked curried turkey burgers:

preheat oven to 375

  • 1 tbsp indian spice (can get a pre-made one or use recipe below)
  • 1 lb ground turkey thigh meat
  • few springs of cilantro

indian curry spice recipe: 2 tbsp onion powder, 2 tsp garam masala, 2 tsp coriander, 1 tsp salt, 1 tsp pepper, 1/2 tsp ground cinnamon. 1/2 tsp red pepper flakes

mix 1 tbsp spice mix with the 1 lb of ground turkey and form four patties.

put them on a parchment paper lined baking pan and bake them in the preheated oven for 30-35 minutes turning once. make sure the internal temp reaches at least 165.

top with cilantro and enjoy.

these books have some of my favorite recipes:

the keto diet cookbook: the slow cooked beef korma recipe is a big hit! try it over cauliflower rice.

primal blueprint:  pork fried cauliflower rice and the asian pork lettuce wraps are my personal faves.

the keto diet: i’m super excited about this non-dairy keto cookbook that one of our awesome clients told me about. here’s a photo of my book. you can see all the tags hanging out marking all the recipes that i want to try.


  • about 1 tbsp a day of almond butter on a few squares of low carb chocolate.
  • some of these ice creams are low carb.
  • avocado pudding sweetened with stevia and/or monk fruit (instead of dates) is a good option too. try to eat lots of avocados because they are loaded with potassium (more than bananas!)


for alcohol, i stick to vodka mixed with la croix 🙂 there is also this hard cider that is low carb at whole foods. it tastes like super yummy kombucha. read the label though, not sure they are all low carb.

here’s a couple tips for those nights out with the crew:

  • make sure you drink at least 3 quarts jars of water during the day.
  • take extra electrolytes during the day (sodium, potassium, magnesium) and take a b-100 complex capsule or tablet before drinking, and then again before bed and then in the am when you wake up. this will prevent a hellish hangover.
  • remember to go easy on the alcohol while on a low carb diet. it will hit you harder and faster than you are used to.
  • also, check out our blog post on hangover prevention.

1.) Paoli A, Grimaldi K, Toniolo L, et al. Nutrition and acne: therapeutic potential of ketogenic diets. Skin Pharmacol Physiol.2012;25(3):111-117; PMID: 22327146.

AAAAAND, WE’RE BACK! (episode 3: kim’s deal)

quick disclaimer: all the stuff i write about in my adrenal blog posts are relative to my own personal experience and recommendations.  what was recommended to and worked for me may not work for you, so please proceed with caution and enlist the help of a naturopathic doctor in your area for the best + safest results!

ok sorry guys for dropping off and lagging on this post.  we had some employee turnover that i had to handle, which left me little time, energy or motivation to completing and posting this post.  i am working on the mantra ‘done is better than perfect’!  here goes:

warning: this one is kind of long and boring (if you’re not into this stuff, and especially since it’s not about you! :)).  you can scroll to the bottom if you just want to skip the explanations of each test, and see a quick review of what my blood, spit and poop said, and dr. fig’s recommended plan of action for me.

so a month had gone by, and until i got my test results (which was around july 10, 2015)  been able to live like normal, more or less.  the impending doom of all the gluten i can’t eat and who knows what else is weighing on my mind, but i’m not that upset about it.  i just remember how shitty i feel and how awesome it’s going to be when i have more energy to be active, the much better mood i’ll be in, and how i’ll get to wear all my ‘skinny’ clothes again after losing 30 pounds – and i’m motivated.  when i see happy, healthy and fit and buff people out and about, it reminds me how these changes i’m making now will positively impact my longterm health and happiness, and that i can do it!

how does this not look amazing?!growing up chinese american, i never really ate much wheat.  we had bread in the house for my mom and grandparents (they’d have it soaked in their morning instant coffee) but i just never really got into it.  i suppose my body intuitively knew gluten wasn’t the best for me.  i was a rice girl.  my favorite comfort meals were (and still are) most always involve white rice at some capacity.  as i got older and started growing ‘healthier’, i switched to brown rice and quinoa – but relished eating white rice anytime i had it; what a treat.  rice bowls!  rice porridge! sushi rice and ribeye steak!  nigiri and sushi rolls!  rice crackers and rice noodles!  and of course, sake, which is distilled from rice.*

any leftovers got a fried egg on top; over easy so that yolk could sauce everything up.  especially with ones i get from local farmer to deliver free-range, organic eggs to me every other weekend**.   pastured eggs are one of our favorite, quick and nutritious forms of protein.  yum yum yum!

sure, i’d get bloated sometimes after eating rice, but it didn’t seem to happen so much (or cause pain) that it was a problem.  wheat and gluten, were on the same boat – but not only bloating, fatigue came along too.  sometimes i’d eat it and feel ok, and sometimes i’d eat it and yawn all day.  but upon discovering della fattoria’s delicious seeded wheat bread, i ate it more (and noticed feeling even more tired).  so i did my best to lay off the gluten – after all, after hearing so many tales of going gluten-free had changed lives, i suspected this would be a culprit for my body’s behavior right now.

sitting in dr. fig’s office, we go over the test results one by one.  she first started off with the adrenal test, which would have some questions the stool test could answer, which would have some questions the food allergy test could answer.  (happy to share the full reports to anyone that’s interested in seeing them, just ask! email frontdesk@skinsalvationsf.com).


‘energy graph’
looking at the cortisol test, the first page had a graph.  the graph has a ‘normal range’ lime green stripe, which shows the average cortisol output of a healthy human.  my line, a dark blue solid line, showed that my levels were on the low, if not lower than normal, end of the norm.  it seemed that as soon as i woke up, my cortisol was already at the low end of normal, which persisted, until about 4pm when my energy was it’s lowest – pretty much at the rock bottom of the chart.  then, i had a tiny energy boost right around midnight before going to sleep.  (this totally made sense, as i often complained of being tired upon arising, getting REALLY tired around 4-5, but then somehow getting a bit of energy at night before sleep; i had always attributed this to just being distracted at home with ‘home stuff’ – cooking, cleaning, socializing or being on the computer’).

along with this ‘energy’ graph, a few other hormones were detected and their roles explained.

my DHEA was on the high end of what’s normal (10 out of a range of 3-10).  DHEA is a “hormone made in the adrenal glands and in the brain, and leads to the production of male and female sex hormones..  typically, those with high DHEA can have oily skin, acne, among other more serious side effects.”

diabetes runs on the paternal side of my family, and after a borderline high blood sugar test a few years ago, i had been conscious of consuming sugar (both ‘sweet’ and refined grains kind of sugar) and making sure to have veggies with every meal.  exercising was on my mind, but lately i hadn’t had the energy to even go for a walk, let alone flat out work out.

i had tested just below borderline elevated (5 out of the borderline 6-25) so that was good; but not great.  the results explained that “insulin is tested because insulin activity is affected by the stress response.  chronic stress with cortisol elevation may counteract the effects of insulin, and may lead to functional insulin resistance.”

nothing to freak out about (right now), but something to keep watch of, and to be aware that my stress was a factor in this category.

total salivary SIgA
what is this thing?  the test says that “it’s the predominant antibody found on the mucosal membranes throughout the body.  one of it’s main functions is to bind to antigens and prevent their adherence/admittance into the body.  typically it moderates the mucosal inflammatory response…” and that it “may be associated with some autoimmune conditions, diabetes, gingivitis, ulcers, and inflammatory conditions.  in addition, acute physical or emotional stress can transiently raise values.”

and since i didn’t have any ofl the aforementioned autoimmune conditions,  here was another marker that my stress was an issue – so much that i tested abnormally high on this one – 39 mg/dl out of a normal 10-20, and borderline high of 21-25.

ok.  so “gladins are proteins found in wheat, rye, barley and other grains which may trigger an immune reaction in some individuals.  a positive response to gliadin may warrant further diagnostic workup and/or dietary elimination trial in some patients. lab results should be used in context of the entire clinical picture.”  (which is why the stool and food allergy testing was such a good idea – thanks dr. fig!).

in this test, i had scored again, very high.  i got myself a 32 out of a borderline 13-15, and positive result of 15+.


interested to see what else my guts were doing with the really high gliadin response, we now moved on to the stool test.  this test was divided up into sections for each enzyme, each with its own job.

i had some good bacteria (but lacked lactobacillus, interestingly enough.  maybe because i don’t consume fermented dairy, and my probiotic doesn’t have this in it?  could also be because my gut’s environment couldn’t sustain it) and had some not so good (but not really bad) bacteria.  dr. figoski explained that this ‘not great’ bacteria could have been from any source – be it from trips involving drinking water or iced drinks in foreign countries, to eating ‘regular’ domestic food at home.  no real way to tell, but just to work towards cleaning it out and replenishing good bacteria.  luckily though, no really bad (dysbiotic) bacteria or yeast was to be found.

digestion + absorption, and all my short chain fatty acids
were all good!  woo!

lysozymes are enzymes that are excreted at sites of inflammation in the GI tract.

under 600 is normal; i had 1140 (!).

another enzyme that has to do with mucosal tissues, “secretory IgA” is the “first line of defense of the GI mucosa and is central to the normal function of the GI tract as an immune barrier.  elevated levels have been associated with an unregulated immune response.”  this meant that my body’s immune system was working extra hard, all the time, to fight off ‘invaders’, which could explain my terrible seasonal allergies (as well as responses to things like dust and molds).

the normal range of this enzyme is 51-204, and i had tested 1240.

intestinal health markers
lastly, the pH of my poop would tell us about how the fermentation of fiber by the beneficial flora of the gut was doing.  it was a little low (5.6, normal range was 6-7.8).  but dr. fig wasn’t too worried about this – we had other bigger problems to deal with.

so, what foods are physically irritating my guts, and causing so much inflammation?!  now the finale – the food allergy test.

us biotek's general food panel
the quick and easy test dr. fig administered in my office the day of my testing consult a month ago is based on a scale of 0-6.  ideally, of course, the foods we eat have little to no reaction in our blood.  the idea is that if you are constantly exposing your body to allergens that rate 4-6, it’s natural that things 3 and below are probably going to be really irritating too.   when this happens, the body treats the offending foods like allergens, and manifests in the body in different ways: rashes, headaches, fatigue, even acne, in some.

so, dr. fig’s got me on a conservative plan – not only because these foods show up as irritants, but are also inflammatory (because they are irritating my guts, but also – like for example, sugar and corn – inherently are) – but also maybe she sees it in me to be 100% compliant?

on a scale of 0-6:
0 – no reaction
1 – very low
2 – low
3 – moderate
4 – high
5 – very high
6 – extremely high.

the basic food test i took has a panel of 100 foods, and these are the only ones that showed up as irritating, and therefore are the foods i am to avoid for at least 2 months:

casein (3)
cottage cheese (3)
mozzarella cheese
milk (3)
whey (4.5)

chicken egg whites (5.5)
chicken egg yolks (5)
duck whole eggs (3)

banana (2.5)
cranberry (2)
pineapple (3)

sugar cane (3.5)


corn (4)
wheat gliadin (3)
wheat gluten (3)
oat (3)
write rice (3)
spelt (3)
whole wheat (3.5)


these restrictions sort of make up a diet close to the candida cleanse, except that i can’t have eggs.  and it’s also sort of like a gluten-free diet, but i can’t have rice or corn.  my beloved eggs and rice!  and no tortilla chips!  this makes it pretty challenging, since a lot of paleo recipes use a lot of eggs, and gluten-free alternatives are often based on rice or corn.

all the more diligent i must be, to 1. cook my own food, 2. and source responsibly.  i’ve got to read my labels even more, and have an even more watchful eye on not only cane sugar but also brown rice sugar/syrup – which is in almost everything that’s packaged.

with a bit of pinterest-ing, i found that this diet more or less makes up what’s called an “auto-immune paleo” diet – one that’s meant to be eaten for a short while (1-3 months) to allow the body to “reset and heal”, before reintroducing foods one at a time to see how my body reacts (if at all).

in many ways, it’s a mirror image journey of the clearing process at sS – allowing the 3-6 months of acne purging, while abstaining from the potentially acne-causing aggravators, before getting to a clean slate (clear skin!) and reintroducing possible triggers to see what substance causes acne-formation, if any.

on the bright side, it’s very cool that we are in this together 🙂

my adrenal test said that i indeed was low on energy, and had certain hormones that get excreted when the body is (in my case) under a lot of chronic stress-related inflammation (i tested 39, when normal is 10-20), and exposed to gliadins (proteins found in gluten – i tested 32 and 15+ is considered reactive).  my blood sugar was also borderline high, but is probably attributed to the chronic stress.

my stool test revealed that enzymes excreted when inflammation in the GI is present and when the immune system is working at capacity at long intervals were abnormally high (one was double and other was 6 times the norm) – again probably due to the chronic stress and foods that were irritating my guts.

finally, the food allergy test showed the foods that my blood reacted negatively to; which probably were directly responsible for inflaming my gut so bad, and causing my immune system to work triple-time, which stresses the body out (and inflames it).

all in all, it’s a cycle of stress (mental and physical) causing irritation that’s causing inflammation, and it’s manifesting in my body via fatigue, depression, and frequent headaches, along with allergies.

basically, i need to take a ton of supplements to restore much needed nutrients that my body needs to run efficiently and heal itself, avoid the foods that are aggravating my guts (literally), and manage my stress (probably the hardest part of the plan).

pills pills and more pillz

this picture shows the different pills dr. fig has me taking, but doesn’t include the inflammation controlling glutamine powder, or adrenal support tinctures that are also part of the mix.  my daily supplement schedule is as follows:

AM (breakfast)
2 – active vitamin b pills
1 – vitamin c capsule
1 – omega 3 capsule
1 – hydrochloric acid (stomach acid to help digest food and prevent bloating, gas, etc)
1 – squirt of adrenal support tincture
1 – scoop of inflammation controlling glutamine powder, in water

1 – hydrochloric acid pill
1 – vitamin c capsule
1 – omega 3 capsule
1 – squirt of adrenal support tincture

2 – zyflamend (taken away from food so it can work better at managing inflammation vs. digesting your food)

PM (dinner)
1 – hydrochloric acid pill
1 – omega 3 pill
1 – vitamin c pill
2 – neurocalm (or relaxed sleep herbs) – this is so that i can get restful sleep, because i have had active, stress- and dream-filled dreams for weeks which makes for even more fatigue in the morning.

8/3/2015 – 3 weeks in
i definitely felt some detoxing in the immediate 2 weeks after starting the diet (headaches, muscle tension, light-headedness after eating, and changes in bodily fluids).  after an hour or two of serious road rage while in the ovulating days of my hormonal cycle, i could slowly feel i had a mild boost of energy and a generally more positive outlook.  managing stress though, is still a struggle – and i think it will continue to be.  but in the days following, i was in high enough spirits to buy a new bicycle, and motivated enough to ride it around on errands (ok, maybe one so far).

a couple of hours’ of shopping at sf’s beloved rainbow grocery co-op and carefully reading labels, coupled with lots of pinterest-ing and google-ing, motivated me further to keep on the food part of the plan.  food has always been a big part of my life, and it sucks that i can’t go out and eat sushi, have chips and salsa, eat chinese or just a burger so easily (for now), i look at these diet restrictions as a new way to get creative with eating even more healthily.  and luckily, i’ve found some delicious recipes along the way!  in the coming weeks i’ll be posting what i’ve been cooking and eating on our blog, facebook, pinterest and instagram.