Are you bracing yourself before you look in the mirror in the morning to see what crazy pimples showed up overnight? Sometimes it seems that the pimples just keep coming!! Wasn’t this supposed to be over with after teenage years?

Pimple breakouts into adulthood can be one of the most frustrating things that happen to our skin. Especially if you have already eliminated inflammatory foods and have made strides in improving your stress and sleep habits.

The next layer to address as a potential root cause of your breakouts are hormones.

If you tend to get red, cystic pimples around the chin and jawline, it’s more likely your breakouts are hormone related.  Especially if your breakouts seem cyclical.

Many times per day I’m asked by patients in my clinic if there are any natural supplements they can take to address their hormonal breakouts.

Yes, there is!

I thought we would take a moment to discuss one of the supplements that can help address hormonal breakouts called DIM.

There are certainly several other supplements that may be worked into your personalized regimen to address your hormone imbalances when you meet with your integrative medicine physician, but we will start with talking about one of my favorite ones: DIM.


What is DIM?

Diindolylmethane (DIM) is a natural phytonutrient that can be found in cruciferous vegetables like broccoli, cauliflower, cabbage, brussel sprouts, kale, collards, radishes, mustard greens, watercress and turnips.


In these vegetables, it’s in the form called Indole-3-Carbinol (I3C). As our digestive system breaks down these cruciferous vegetables, it joins together two I3C molecules to make DIM. So DIM is basically two I3C molecules together.  

I’m usually asked at this point just how much broccoli do they have to eat to get enough DIM to help their breakouts. Bad news is that you would have to eat two pounds to get about 20-30 mg of DIM. And typically, starting dose is 100mg of DIM daily and some patients increase to twice daily. I like eating my vegetables, but this is a little much! Thankfully DIM comes in supplement form.



Estrogen Dominance and Your Breakouts

Breakouts occur for many reasons, but in reference to hormonal breakouts there are a few patterns that happen.

Our hormones tend to fluctuate depending on other hormones, nutrition, stress, exercise, emotions, etc.  Your balance of estrogen, progesterone and testosterone as well as cortisol are some of the key hormones that are related to pimple breakouts.

One hormonal trigger for acne is estrogen dominance.

Estrogen dominance is when your body has more estrogen than it needs, or it’s out of balance compared to your other hormones , or too much of the wrong kind of estrogen is in excess.

How does estrogen dominance occur?

Estrogen dominance has many different root causes but most commonly related to excess fat, environmental xenoestrogens, adrenal issues, stress, poor digestion etc.

What are the signs of estrogen dominance?
  • Acne breakouts
  • Irregular or heavy periods
  • Water retention, bloating
  • Headaches
  • Breast swelling and tenderness
  • Fibrocystic breast changes
  • Weight gain, especially around hips, buttocks and thighs
  • Premenstrual Syndrome (PMS)
  • Mood swings, irritability
  • Decreased libido


How does DIM work?

DIM works in two main ways to help your body better balance your estrogen. It can work to help improve the ratio of your “good” and “bad” estrogens and it also assists in the conversion of testosterone to estrogen.


Balancing ratio of “good” and “bad” estrogens

One way DIM assists with estrogen dominance is by helping your body to adjust your ratio of the type of estrogens in your body.  

There is continual controversy on the role of the estrogen metabolites, or breakdown products of estrogen (there are over 40 of them btw).

The two we will focus on here are the “good” estrogen or 2-hydroxyestrone (2-OHE1) which has been found to be anti-tumorgenic and the “bad” estrogen 16-alpha-hydroxy-estrone (16-OHE1) which is pro-tumorgenic.

2-OHE1 can be considered the good estrogen as it’s linked to lower body fat and higher lean muscle, and 16-alpha-hydroxy-estrone (16-OHE1) is considered the bad estrogen as it has been linked to breast cancer.

Typically these are discussed in ratio to each other of 2/16-OHE1. A higher level of 2-OHE1 compared to 16-OHE1 is more protective.

DIM helps your liver enzymes convert your estrogen metabolites to more 2-OHE1 and promotes a more desirable estrogen metabolism. Therefore, it does not produce more estrogen nor does it replace estrogen or mimic estrogen.

DIM also works in another way. When our bodies are producing larger amounts of testosterone, some of it can be converted into estrogen by the enzyme aromatase. DIM helps to inhibit aromatase and less testosterone is converted into estrogens.

This is good if your acne is related to estrogen dominance as you don’t want to increase your estrogens in that case. However, if you have higher levels of testosterone or are testosterone sensitive, this is one of the ways DIM can worsen your acne. If you notice after taking DIM that your acne becomes more cystic and you breakout more, stop DIM and discuss with you dermatologist other ways to address your hormonal acne.


DIM Dosing & Side Effects

Typically I have my patients start out on 100mg once daily of DIM. It will take several weeks of taking DIM before you notice a change in your skin. This is because it takes the skin around 28 days to create a new skin layer. Interestingly this is also the average number of days of a woman’s menstrual cycle.

You will see the greatest improvement after 2-3 months to allow your skin and your hormones to cycle a bit to implement the changes from the supplement for this reason.

Some women need more DIM and can increase the dose to 100mg twice daily. However, I do not recommend exceeding this as significant side effects are related to doses of 300mg or more.


Potential Drawbacks of taking DIM

Side effects you may notice when you take DIM are headaches and nausea. If you experience any unpleasant side effect just discontinue the supplement.

If you are pregnant or breastfeeding, trying to become pregnant, or have cancer or other hormone sensitive health issue, do not take DIM and consult your physician for recommendations. If you have health issues with your kidney’s you should also not take DIM.

DIM can interact with some medications such as  clozapine (Clozaril), cyclobenzaprine (Flexeril), fluvoxamine (Luvox), haloperidol (Haldol), imipramine (Tofranil), mexiletine (Mexitil), olanzapine (Zyprexa), pentazocine (Talwin), propranolol (Inderal), tacrine (Cognex), theophylline, zileuton (Zyflo), zolmitriptan (Zomig), and others.

Keep in mind that not all natural products are safe. Research your supplements and decide with the insights of your integrative physician if it is right for you.


Where can I get a quality DIM supplement?

There are several quality supplements you can purchase.  My favorite is DIM-Evail from Designs for Health. Another brand that some my patients have had some success with is Estroblock. Jane Iredale also has a supplement for acne called Accumax that has DIM as one of the active ingredients along with other micronutrients. Be sure to start with lowest dose possible and only increase after you have taken it for 2-3 months.

Keep me posted on your progress and how DIM works out for you!


Broccoli and Cauliflower