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The Gut-Skin Connection: How Altered Gut Function Affects the Skin


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I’m preparing for my talk at the upcoming Wise Traditions Conference in Santa Clara, CA on November 10th. I’ll speaking on the “gut-brain-skin axis”, a fascinating topic that I’ve been exploring for some time. I hope some of you will be able to come to the conference, but I thought I’d share a little slice of my research here for those of you who can’t. (If you don’t make the conference and want to watch my entire presentation, I believe the Weston A. Price Foundation sells DVDs of the talks after the fact.)

I’ve discussed the gut-brain axis several times on my radio show, and I’ve at least mentioned the triangular connection between the gut, brain and skin. In this post I’d like to go a little deeper on the gut-skin connection.

Researchers as far back as 1930 suspected a link between gut and skin health, and modern research has now confirmed the importance of this relationship.

And as a clinician who works with people on these conditions, I’d go as far as to say this:

If you want to heal your skin, you have to heal your gut.Tweet This

Associations between Gut Disorders and Skin Conditions

Epidemiological evidence shows a clear association between gut problems and skin disorders. A recent report indicated that small intestine bacterial overgrowth (SIBO), a condition involving inappropriate growth of bacteria in the small intestine, is 10 times more prevalent in people with acne rosacea than in healthy controls, and that correction of SIBO in these individuals led to marked clinical improvement. (1) 14% of patients with ulcerative colitis and 24% of patients with Crohn’s disease have skin manifestations. (Interestingly enough, a study just came out showing that a drug normally used to treat psoriasis is also effective for Crohn’s disease.) Celiac disease also has cutaneous manifestations, such as dermatitis herpetiformis, which occurs in 1/4 of celiac sufferers. Celiacs also have increased frequency of oral mucosal lesions, alopecia and vitiligo. (2)

How Altered Gut Function Impacts the Skin

Intestinal permeability (a.k.a. “leaky gut”) causes both systemic and local inflammation, which in turn contributes to skin disease.

In a study way back in 1916, acne patients were more likely to show enhanced reactivity to bacterial strains isolated from stool. 66 percent of the 57 patients with acne in the study showed positive reactivity to stool-isolated bacteria compared to none of the control patients without active skin disease. 1 In a more recent study involving 80 patients, those with acne had higher levels of and reactivity to lipopolysaccharide (LPS) endotoxins in the blood. None of the matched healthy controls reacted to the e. coli LPS, while 65% of the acne patients had a positive reaction. Both of these studies suggest that increased intestinal permeability is an issue for a significant number of acne patients. (4)

Speaking of permeable barriers: most of you have heard of leaky gut by now, but what about “leaky skin”? The main function of the skin is to act as a physical, chemical and antimicrobial defense system. Studies have shown that both stress and gut inflammation can impair the integrity and protective function of the epidermal barrier. This in turn leads to a decrease in antimicrobial peptides produced in the skin, and an increase in the severity of infection and inflammation in the skin. (5)

The gut flora also influences the skin. Substance P is a neuropeptide produced in the gut, brain and skin that plays a major role in skin conditions. An altered gut microbiome promotes the release of substance P in both the gut and the skin, and probiotics can attenuate this response. (6) The gut microbiota influences lipids and tissue fatty acid profiles, and may influence sebum production as well as the fatty acid composition of the sebum. (7) This may explain why a Russian study found that 54% of acne patients have significant alterations to the gut flora (8), and a Chinese study involving patients with seborrheic dermatitis also noted disruptions in the normal gut flora. 2

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Probiotics Improve Skin Conditions

Another line of evidence suggesting a connection between the gut and skin is the observation that probiotics improve skin conditions. Oral probiotics have been shown to decrease lipopolysaccharide, improve intestinal barrier function and reduce inflammation.

The first formal case report series on the value of using lactobacilli to treat skin conditions was published in 1961 by a physician named Robert Siver. He followed 300 patients who were given a commercially available probiotic and found that 80 percent of those with acne had some clinical improvement. 3 In a more recent Italian study involving 40 patients, Lactobacillus acidophilus and Bifidobacterium bifidum in addition to standard care led to better clinical outcomes than standard care alone. (9) And another recent study of 56 patients with acne showed that the consumption of a Lactobacillus fermented dairy beverage improved clinical aspects of acne over a 12-week period. (10)

The beneficial effect of probioitics on skin may explain why pasteurized, unfermented dairy is associated with acne, but fermented dairy is not. I haven’t seen any studies on raw dairy and skin conditions, but my guess is that it wouldn’t be associated either. Orally consumed probiotics reduce systemic markers of inflammation and oxidative stress, both of which are elevated locally in those with acne. (11) Oral probiotics can also regulate the release of pro-inflammatory cytokines within the skin. (12) The fermentation of dairy reduces levels of insulin-like growth factor 1 (IGF-1) by more than four-fold. (13) This is significant because studies show that acne is driven by IGF-1, and IGF-1 can be absorbed across colonic tissue. (14) This would be particularly problematic when increased intestinal permeability is present, which as I mentioned above is often the case in people with acne.

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  1. Strickler A, Kolmer JA, Schamberg JF: Complement fixation in acne vulgaris. J Cutaneous Dis 1916, 34:166-78.
  2. Zhang H, Yu L, Yi M, Li K: Quantitative studies on normal flora of seborrhoeic dermatitis. Chin J Dermatol 1999, 32:399-400.
  3. Siver RH: Lactobacillus for the control of acne. J Med Soc New Jersey 1961, 59:52-53.
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Join the conversation

  1. I have not noticed any connection between food, gut and pustular rosacea. The ONLY connection is what I put on topically and as of yet have found nothing I don’t react to.

  2. I have recently finished a round of IVF and had severe symptoms throughout the medication phase. Pre-IVF I knew I already had gut issues, fructose malabsorbtion, slight lactose intolerance. I am certain the IVF medication has made my conditions a lot worse. The IVF doctors didn’t mention anything about gut related side effects, only that I may experience pregnancy like symptoms and flu symptoms. The past 3 weeks, I have had severe gut pains, my face / throat skin has dried up, I look 20 years older ( wrinkles) and I feel like my face / neck are being sucked in from the inside – i.e.moisture is being zapped from my body. My gut also feelings like it’s pulling inward. I feel weak, have regular head tightness / numbness (migraine like) and episodes (daily) of severe heart throbbing that is hard to slow down with deep breathing.
    I’m certain the drugs have affected my hormones, my gut and my flight or fight response.

    I’m having heart tests and my doctor is checking for a particular gut bacteria, but so far I’ve not been offered anything to relieve the symptoms. I’m drinking bone broth daily, and trying more warming food / vegetables, but so far nothing is really helping.

    I’d be interested to know if anyone has experience anything like this from IVF medication and how they dealt with it.

    I’m about to start another round of IVF as this last one was unsuccessful, but I’m nervous about the drug impacts again.

    I would greatly appreciate some advice.

    • Jen hi
      It must have been the most horrible experience especially as you were trying to concieve. I’m sorry I haven’t been through ivf treatment. But I am suffering with leaky gut. I definitely can relate to some of your unpleasant symptoms. I hope you had a successful pregnancy. If you didn’t I’m sure you will soon. The only thing I can add is yes you probably have leaky gut, along with some of the horrible side effects. And I know to be healthy you must heal your gut. Then if you haven’t already conceived you will after you give the body the right conditions to heal and thrive. I just wanted you to know there are things you can do other than ivf . X

  3. Hi you guys,
    My friend started using a product a year ago and her friends commented about her skin and hair without her telling them she was using an all natural plant-based product. This product helps people with skin problems, losing weight, diabetes, and restores gut health. It is a probiotic that also contains enzymes which remove unwanted microbes (unlike other probiotics). I’ve been taking it a week now and have noticed I sleep better, have reduced sugar cravings, and my baby is moving around a lot more in my womb. Anyway, if anyone is interested just let me know and I’ll take you from there. I truly want to help other people be healthier and happier. I want to start this business from home to eventually helps the orphans, widows, and poor. Have a blessed day.

  4. I have a sense of hope after reading everyone’s posts, and for that, I thank you. I have a skin condition, yet to be diagnosed or officially named, where I develop extreme itching after being exposed to water. This can be a shower, pool, ocean, (I don’t go into lakes, as I live near the ocean), and even sweating, particularly in humid weather. I have tried elimination diets of sugar, glutens, meats, coffee, etc. Nothing has helped. But…the confusing part is that there are times when I can shower without the an itching episode, but those are rare, and a clue to the difference remains unknown. I have tried benadryl, xyzal, loratidine, and hydroxyzine (aka vistaril), but the best remedy is an ice pack. Seriously an ice pack directly on the skin is the only real relief I get until the episode subsides. I have been to an allergist, primary care physician and dermatologist, as well as acupuncture, all with no relief. I had my gall bladder removed, which I had actually hoped was the real cause, but it was not. I have had every kind of test for cancer and liver disease imaginable, and thankfully have none of the diseases typically associated with pruritis (itching). So this leads me to start thinking about leaky gut syndrome.

    New to the leaky gut idea, all these posts have been helpful in helping me decide my next step, which I think should be some kind of detox, and good probiotics. I would be very appreciative of anyone’s comment or information on their experience with this or something similar. By the way, I drink a lot of water, and have absolutely no problem with water ingestion. Weird huh?

    Anyway, I look forward to comments, and thank you in advance!

    • Hi Peggy,

      I’ve been fighting nighttime itching for 25 years, which seemed to start after a trip to Mexico, but that’s also when I took a 6-month course of antibiotics for minor acne, so I’m not sure what caused what, but my gut got messed up, and it affected my immunity and caused bad cystic acne. I eventually got rid of the acne by cutting out processed foods, grains, dairy and bad oils, but I still had the itching. I tried every elimination diet possible to find a food cause. Cleaner foods caused it less, but nothing completely stopped it.

      I do some armchair microbiology research, and I ascertain that our bodies are full of microbes, and that everyone has a different population- their own signature. The ones we really know about are the ones that can kill us, because that’s where the research interest and money goes. All of the others (viruses, yeasts, bacteria) are considered harmless, but I don’t think that’s actually true. I think they just aren’t deadly, and some people are somewhat harmed by them.

      I’d like to suggest the possibility that you have a population of microbes in your gut (and perhaps in other parts of your body) that are causing a modest allergic response in the form of itching. We all know that skin manifests a wide variety of allergic responses.

      What we still need to learn is whether or not strengthening the immune system OR killing certain microbes is the best approach. It’s probably a little of both.

      I hope this serves as welcome food for thought.