Acne can feel mysterious until you zoom out and see the pattern: your skin is responding to signals from blood sugar, hormones, inflammation, stress, and even your environment. Dr. Shannon C. Trotter sits down with board-certified dermatologist Dr. Katie Varman of Shine Functional Dermatology to unpack what’s happening under the surface, and why treating acne is often about finding your biggest driver rather than hunting for a single “bad” ingredient.

We dig into the science linking insulin to acne, including how frequent high-glycemic foods can activate growth pathways (including mTOR and insulin-like growth factor signaling) that increase oil production and pore-clogging skin buildup. We also talk dairy and why it can be a powerful trigger for some people, plus how a continuous glucose monitor (CGM) can help you personalize what actually spikes your blood sugar. If you’ve ever wondered why one person can eat pizza and be fine while another breaks out overnight, we explain the “threshold” concept and how to test changes without living on a permanent restriction plan.

From there, we connect the dots on gut health and the gut microbiome, probiotics and postbiotics, and why processed foods can quietly undermine skin health. We also get real about stress and acne, breaking down the HPA axis, cortisol, and how your skin can behave like an endocrine organ. Finally, we cover endocrine disrupting chemicals like phthalates and BPA, why synthetic fragrance is a common exposure, and simple swaps that can reduce your load without panic.

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