Beyond acne treatment – smart nutrition tips after taking Roaccutane

Living with severe acne can be tough on your self-esteem and mental health. This is why so many acne sufferers turn to a medicine called isotretinoin, commonly known as Roaccutane, as it can help to treat the most challenging cases of acne. For some teenagers and young people, it’s the only treatment that works for their acne, when nothing else has done the trick.

But this powerful medication can be tough on your liver and your gut, as well as your mood and energy levels. It may reduce a person’s sex drive and erectile dysfunction. Because of these risks, many people only turn to it as the very last resort.

I am often asked what you can do to help your body recover from taking it, once the course of Roaccutane is completed, so you can start to feel just as well as you look.

In this blog, I explore what isotretinoin is, how it works, why it can stress the body, and what nutritional strategies you can use to support recovery. All my recommendations are based on scientific research and my 30 years of clinical experience as a family naturopath.

Get our lovely Healthy Bites newsletter each week!

Each week, you’ll get an amazing recipe, a useful health tip, and an ingredient to jazz up your shopping basket! We don’t share your details with anyone else.

What Is Roaccutane and how does it work?

Isotretinoin is a powerful medicine derived from vitamin A, and it is part of the wider retinoid family. It’s been used since the early 1980s to treat severe and stubborn acne which hasn’t responded effectively enough to taking antibiotics or applying topical treatments.

So how does it work? The way Roaccutane clears acne is clever and multi-layered and here are some of the reasons why:

Reduces oil production – it shrinks the sebaceous glands, so your skin produces far less sebum. This means fewer oily pores and less chance for spots to form.
Keeps pores clear – Roaccutane helps to normalise the way skin cells shed, preventing the build-up that clogs pores.
Calms inflammation – it dials down inflammatory signals in the skin, which is why those angry and sore spots start to settle.
Balances the skin microbiome – by reducing the bacteria ‘Cutibacterium acnes’ which lives in the skin, it helps stop skin irritation from inside the hair follicles.

This combination of effects is why Roaccutane can be so transformative for people with severe acne. But because it’s derived from vitamin A (which is vital but in large doses can be dangerous), it’s also very potent and has the potential to be systemically toxic on the system, and that’s why it needs careful monitoring and a thoughtful recovery plan once treatment ends.

Why does Roaccutane stress the body?

Because Roaccutane doesn’t just work on the skin, it can have ripple effects throughout the body, which can be a problem for some people who are susceptible.

Liver overload – Roaccutane is processed by the liver, and this can sometimes raise liver enzymes which can lead to liver damage. For most people, this is a mild and temporary effect, but it is one reason why doctors monitor your liver function during treatment.

Oxidative stress – research shows that Roaccutane can increase oxidative stress in the body. This means there are more free radicals and less antioxidant protection against cell wall and cell DNA damage. Vitamin E is a particularly important antioxidant vitamin to prioritise in the diet after a course of Roaccutane.

Excess vitamin A build-up – because Roaccutane is a retinoid (a form of vitamin A), taking any extra vitamin A as a supplement during or after treatment can tip the balance and lead to vitamin A toxicity. This is why taking vitamin A supplements are a big no-no after Roaccutane, and you should avoid multivitamins containing high levels of vitamin A for at least 3 months afterwards.

Gut microbiome disruption – Roaccutane can alter your balance of gut flora negatively while it is being taken. This may in turn lead to a depletion in the beneficial bacteria that help dial down inflammation and support immunity. Some studies have explored links between taking Roaccutane and the onset of inflammatory bowel issues such as Ulcerative Colitis and Crohn’s Disease as well as generalised gut pain. This is why it is a wise move to support your gut health after treatment.

This acne medication may also affect the gut bacteria responsible for building the right balance of neurotransmitters such as serotonin for mood, GABA for sleep, acetylcholine for learning and memory and dopamine for focus.

How can you feel whilst taking the Roaccutane?

Physical fatigue – up to 12–25% of patients report fatigue during treatment and higher doses increase the likelihood of feeling even more tired and exhausted.

Mood changes – mild depressive symptoms and low mood occur in 4–11% of patients taking Roaccutane, while severe depression is rare at less than 1%. This is thought to happen because this medication has the potential to lower the ability to reuptake serotonin. Thankfully, these symptoms are often resolved within days of stopping the drug.

Brain fog and tiredness – Some people describe feeling “slowed down” or mentally foggy, which may relate to its effects on neurotransmitters and inflammation in the brain.

Sexual dysfunction – Roaccutane may affect a person’s sexual function by lowering testosterone levels in both genders and influencing male hormone receptors. This can lead to erectile dysfunction, decreased libido, vaginal dryness and orgasm difficulties, although the exact process still isn’t fully understood.

Musculoskeletal discomfort – Joint and muscle pain and stiffness can contribute to overall exhaustion and reduced activity levels.

Evidence-based nutritional strategies

So, what can you do once you have finished the Roaccutane to feel well and vibrant again? These diet, supplement and lifestyle changes can make a difference both to how you feel and they might even help to prevent your acne from coming back, as they are all interventions which can also help acne sufferers.

Support liver detoxification

Your liver has worked hard processing isotretinoin. It’s good at healing itself but that means a rest and a spring clean to help it function well. A highly nutritious diet and gentle supplement support can really hel, so:

Eat plenty of cruciferous vegetables such as broccoli, kale, Brussels sprouts, cauliflower and rocket (arugula) to help reduce raised liver enzymes. These foods also encourage glutathione production, which in turn helps to reduce oxidative stress.
Clinical trials show that the herbal remedy milk thistle (known as silymarin) at 140–420 mg daily can lower ALT and AST liver enzymes and protect your liver cells from oxidative damage. This can easily be taken as a supplement.
Knobbly turmeric & ginger spice roots have anti-inflammatory and antioxidant compounds which support your liver health and help to reduce inflammation. Try grating both into your food and drinks.

Restore your antioxidant balance

Isotretinoin depletes your natural antioxidant stores which help to keep your body and brain cells healthy, so replenishment of these antioxidants is key. Here is what I recommend:

Vitamin D is found in eggs, outdoor-reared meat and fish, as well as from sunshine. It is vital to supplement, especially during the winter months. Vitamin D and vitamin A rely on the same receptors in each cell, so if the ingestion of vitamin A has been boosted during the acne treatment, then it is likely that you will need some vitamin D to help rebalance things out.
Vitamin E-rich foods are vital and you can find them in nuts, sunflower seeds and avocado to help restore your antioxidant defences.
Omega-3 fatty acids are found in oily fish, chia seeds and flax seeds. These omega-3s reduce both gut and skin inflammation and they help to support skin barrier function.
N-Acetylcysteine (NAC) is a supplement that is a powerful antioxidant. It helps our body to make glutathione, which is our natural home-made antioxidant, and it reduces inflammation and oxidative stress.

Heal your gut

The gut microbiome often shifts towards a more pro-inflammatory balance of gut bacteria during isotretinoin therapy, and therefore it is important to work on restoring your gut microbiome and healing your gut lining. I therefore recommend you try the following:

Eat plenty of live yoghurt and kefir and experiment with eating more cultured and fermented foods such as kimchi, water kefir and pickled cucumbers.
Live bacteria supplements including Lactobacillus and Bifidobacterium strains improve your gut microbial balance and may help to reduce any gut symptoms following taking Roaccutane.
Prebiotics feed the probiotic strains of bacteria in the gut and include garlic, onions and asparagus as well as slightly underripe bananas. The fibres in these foods are fermented in the gut and help to nourish the gut’s natural ecosystem.
Bone broth & collagen are great gut healers and help to repair any damage to the gut lining. So enjoy eating lots of soups and slow cooked stews as well as risottos or add collagen powder to a hot drink, some porridge or a smoothie.

Avoid extra Vitamin A

Since isotretinoin is a vitamin A derivative, do not take vitamin A supplements post-treatment for at least three months. Excess vitamin A can lead to hypervitaminosis which might look like a yellowing of your skin, especially the soles of your feet and the palms of your hands. Too much vitamin A may also lead to liver toxicity and damage the liver.

Habit changes

Here are some diet and lifestyle habits to get into whilst taking Roaccutane, and for three months afterwards:

You will want to keep alcohol to a bare minimum when you are taking Roaccutane. Also, skip alcohol for at least a month post-treatment to reduce strain on the liver and to bring down the raised liver enzymes.
It is vital to stay well hydrated by drinking at least 8 glasses of water or herbal teas daily to help support liver function.
Aim to eat a rainbow of plants daily, such as fruit, veg, salads, nuts, seeds and pulses. The brightly coloured pigments in these foods have antioxidant properties which support liver and gut function as well as repair any cell damage.
Protect your skin from strong sun exposure for at least 4 weeks after finishing isotretinoin, as your skin can become sun-sensitive during and after a course of Roaccutane. This might look like covering up from the heat of the sun with a hat and long sleeves in the middle of the day, or applying a good quality sunscreen.

Round Up

Now that you have zapped that acne with Roaccutane, it is your time to help you feel amazing as well as look amazing. So, invest in your overall health and wellbeing with these post-Roaccutane tips for at least one month and ideally three months after you have completed the course.

If you need extra help with optimising your skin, or experience any of the symptoms associated with taking Roaccutane, such as fatigue or low mood persist, then our experienced NatureDoc clinical team can help to run some lab tests and work out a bespoke health plan so you get back to feeling your sprightly self again – from the inside out.

Send me Lucinda's supplement tips for your post-Roaccutane journey
I have a different question !

Beyond acne treatment – smart nutrition tips after taking Roaccutane

Get our lovely Healthy Bites newsletter each week!

What Is Roaccutane and how does it work?

Why does Roaccutane stress the body?

How can you feel whilst taking the Roaccutane?