Breakouts should magically disappear once you enter adulthood, right? Not necessarily. According to the American Academy of Dermatology (AAD), adult acne is on the rise with reports of it affecting 15 percent of women. Acne treatment options run the gamut from prescription and over-the-counter topicals to in-office peels and lasers, but, lately, a somewhat under-the-radar supplement is gaining traction. Enter diindolylmethane (a.k.a. DIM). Here’s what you need to know.
What Is Diindolylmethane (DIM)?
Diindolylmethane (DIM) is a naturally derived compound sourced from cruciferous vegetables, like broccoli, cauliflower, and cabbage. Studies tout it for its potential anti-cancer benefits (especially estrogen-centric cancers), yet DIM also receives credit for its anti-inflammatory abilities. “Not only can DIM better your metabolism by adjusting your hormones to avoid hormonal imbalance, but studies have also shown that increasing your intake of DIM can balance estrogen levels as well,” explains Dendy Engelman, MD, a board certified dermatologist in New York City.
As consumer focus continues to lean more towards natural products and options in every sense of the word, it makes perfect sense that DIM supplements are earning attention as a ‘natural’ way to combat hormonally induced acne.
DIM in Action
In the quest to achieve healthy, clear skin, clean eating that minimizes processed foods and maximizes skin-friendly greens is undoubtedly part of the equation. Research has shown that consuming cruciferous greens allows for Indole 3-Carbinol (or I3C), which is the precursor to DIM, to metabolize into DIM. But your favorite Sweetgreen salad isn’t going to cut it. “To get the level of DIM in vegetable form, you would have to eat two pounds of greens every day,” says Ava Shamban, MD, a board certified dermatologist in Beverly Hills. “That’s too tall of an order.”
So, what’s a more realistic way to reap the benefits of diindolylmethane? Taking DIM in pill form provides the body with enough of it to “change the balance of estrogen in women to make estradiol (a type of estrogen) more dominant,” Dr. Shamban explains. This hormonal modulation is similar to oral contraceptives. “When women go on birth control, there is a change to the balance of estrogen, which helps with acne,” she says. “Birth control increases the production of the sex-binding hormone globulin, a protein in the blood that picks up excess cortisol, estrogen, and testosterone.”
DIM Supplements vs. Prescription Acne Medications
For those looking to treat adult acne, there are a few gold standards that dermatologists commonly prescribe, including spironolactone (a blood pressure medication that is used off-label to treat hormonal acne in women) and isotretinoin (you may know it by its brand name, Accutane). If you are wondering how DIM supplements measure up, it’s not a straightforward comparison. “They are completely different,” says Angela Lamb, MD, a board certified dermatologist in NYC.
As she explains, “Accutane is an oral vitamin A derivative that makes oil glands smaller,” while “spironolactone is an oral androgen blocker.” Considered by some to be a more natural alternative to spironolactone, anecdotal reports show DIM to effectively decrease breakouts — albeit more gradually. Unlike spironolactone, which typically generates results in six to eight weeks, DIM supplements may take upwards of four months to show improvement.
DIM “appears to have more of an impact on estrogen, but the research is not overwhelmingly strong,” Dr. Lamb notes. As such, she “would not” compare it to a true androgen blocker (like spironolactone), but she does offer this of the logic: “Androgens do promote acne, so the thinking is that the less potent form would be less acne-inducing.”
It should also be noted that a DIM supplement won’t do much to improve comedonal acne (i.e. whiteheads or blackheads). Instead, this OTC supplement tends to work best on inflammatory papules, pustules, and hormonal acne. “Taken in higher doses, DIM can block androgen receptors, such as testosterone, by saturating the body’s tissues and inhibiting the protein synthesis, which essentially stops the anabolic effects of testosterone on the body itself,” Dr. Engelman explains. “When androgens and hormone receptors bind together, it can cause imbalances within the skin that can ultimately lead to acne. By blocking that binding, those imbalances that can lead to acne are less likely to occur.”
What to Expect from DIM Supplements
Taking one pill, one time won’t do the trick. You need to be consistent with consuming the supplement and aim for around 150 milligrams per day. “The issue with almost all supplements is what dose is the right dose, who is making the supplement, and are you getting the level that is what is listed on the bottle,” Dr. Shamban cautions. “The supplement industry isn’t regulated at all.”
But that doesn’t mean DIM doesn’t work — it’s just not scientifically validated yet. “For someone who wants to try it, it’s not a bad idea,” she says. “A DIM supplement won’t harm you, and, across the board, it’s probably well tolerated by almost everyone.” With that said, you should (as always) consult with your dermatologist before incorporating it into your routine, and don’t expect your results to look like everyone else. “Usually, the first indication that the supplement is working is minimized appearances of clogged pores and decreased oil production on the face,” Dr. Engelman says.
In terms of side effects, Dr. Shamban says DIM supplements may make you nauseous, and she warns against wishful thinking. After all, there are no silver bullets in medicine. “Think twice before you start on a supplement that may or may not work,” she says. And don’t underestimate the ‘plateau effect’ either. According to Dr. Lamb, it can happen with any hormone adjuster.
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