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.
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.
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
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
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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- Strickler A, Kolmer JA, Schamberg JF: Complement fixation in acne vulgaris. J Cutaneous Dis 1916, 34:166-78. ↩
- Zhang H, Yu L, Yi M, Li K: Quantitative studies on normal flora of seborrhoeic dermatitis. Chin J Dermatol 1999, 32:399-400. ↩
- Siver RH: Lactobacillus for the control of acne. J Med Soc New Jersey 1961, 59:52-53. ↩
Thank you for the information. I’m 52 and had what appeared to be normal teenage acne for most of my life. After discovering I was pre-diabetic and a change to a low carb diet, I realized, my skin was clearing up. What a bonus!!! After a couple of years my teenage sons who also suffered from horrible acne, also decided to make the change to a primal lifestyle. They too happily lost weight and their skin cleared up. I was at the grocery a few days ago and the clerk commented on one of my son’s weight loss. But she was really blown away by how beautiful his skin is now. We dont’ have a huge amount of probiotics in our diet. But we are grain free and kimchee is always in my fridge. We love experimenting with new things.
Hello Chris, all the way from Australia!
Firstly, I value greatly your posts as someone who is incredibly interested in wholistic healing. in light of your post, I thought you would like to know about my 22 year old daughter who has had type 1 diabetes for 11 years now and I am moved to write to you after reading this amazing post. She has necrobiosis lipoidica diabeticorum which is typical to diabetes. Considering the amount of sugar sadly that she must consume, this makes so much sense. Thought you may like to know about the condition to help your research just in case you hadn’t heard of it. It is still rare even in the diabetic community.
Thank-you for all you do. Kind regards from Di in Melbourne.
I have struggled with acne all of my life (now in my late 20’s) and have tried everything from Proactive, Cetaphil, Clinique (you name it for over the counter cleansers and moisturizers) as well as prescription topicals and pills. Nothing has consistently worked for me. I have been eating Paleo/Primal now for about 8 months and have seen a slight improvement (although I am not always perfect with my eating). I started taking probiotics a little over a month ago, along with Vitamin D + Calcium, and I have seen a huge improvement! My skin is almost completely clear now and I seriously think the probiotics have made all the difference. I was on prescription antibiotics for years (way too long!) for my acne which I’m sure completely screwed up my gut flora. I think doctors need to start recommending probiotics as treatment for acne.
I have been following paleo somewhat for about 6 months now and recently decided to get more strict with the Whole30. I am 40 years old and have lots of brown spots as well as the vitiligo which I absolutely hate and have been to a dermatologist for as we’ll as used creams for but nothing worked. However, I noticed that the brown spots are peeling off now. I would love to attribute this to Paleo and share with my friends that suffer from the same thing if it truly is making a positive impact like this.I have not noticed a difference in the white spots but really have looked at them too much. Perhaps after the whole30 I will notice something or is it even possible for them to go away?
Chris,
On the topic of gut health, I have a quick question about HCL supplementation. When I use HCL capsules I get a sensation of heaviness and discomfort. Could this mean that my stomach lining is damaged and the HCL is irritating it. I’d hate to stop using it because it does seem to alleviate my heartburn quite a bit. I’m also currently drinking bone broth daily to help rebuild the gut lining.
Thanks very much, Chris. I appreciate all the helpful advice you have provided.
Thank you for this article. I look forward to your session at the WAPF conference. As someone who has healed chronic hives by healing the gut, I know first hand the lack of information out there about the connection between skin and the gut, so I was so happy to see this article! It is amazing how the body, and the skin heals when you begin by healing the gut. Again – thanks!
Kerri,
I am trying to do the same at the moment, though its only been months so far rather than years. I don’t suppose you might have any pointers. At the moment I am actually speculating that probiotics are actually the cause, but wondering if it could be because of a leaky gut. I recently gave in and went to a ND on my own dollar and am awaiting some test results for more ideas. The short of it is it started after I stopped a 8 day raw milk fast. No troubles while on the fast. I think colostrum is helping. Tried no grains, no sugar, no fruit for over a month. Had one dose of coconut kefir the other night and had the hives come back stronger again.
Would love to hear form Chris too if possible. Thanks!
So many of the comments and stories sound just like mine! I have had skin Rashes and skin irritations with No DIAGNOSIS for years! Along with all Skin biopsies and steroid creams, nothing got rid of this until I was gluten free and taking probiotics. I know when I have eaten gluten because within a few days I will have rashes on my elbows.
Thank you for all the informative education you share and can’t wait to purchase your baby code!
“I know when I have eaten gluten because within a few days I will have rashes on my elbows.” Wow, this is me exactly; it’s comforting finding others in the same boat (though I’m sorry you have it too – damn it’s an ITCHY boat huh?).
I *wish * I had known this years ago, when mine first started. All those years of damage from a gluten-filled diet, without a clue it could be connected to the rash. It’s so good to see the information disseminating, and knowing the others that will be helped.
I’ve actually been blogging a little bit about my Paleo-and-skin journey has been going at inmyskinnygenes.wordpress.com. I’ve been suffering from several forms of acne since I hit puberty, and it became violently worse when I transitioned from a high protein/low fat bodybuilding regimen to a vegan diet last year.
I’ve been eating “Paleo” since May, and, while things have improved significantly, my skin is still a mess. I saw the greatest improvement when I was eating Paleo but using estradiol to make up for the fact that I’ve had vegan-induced secondary amenorrhea (I’m blaming veganism, because I’m at normal body fat, and no longer do high intensity exercise OR steady state cardio–yoga works for me!) I was taking the estradiol to compensate for low estrogen and slightly low T3…but I hate the idea of putting anything synthetic into my body. Of course, the second I stopped taking the drug, my old skin problems flared.
I’m eating all the right things–bone broth, liver, egg yolks, raw sauerkraut and kombucha (not at the same time), coconut, etc., etc. and avoiding excess sugars–even from fruit. At this point, I don’t even know what to do to help regulate the ol’ hormones, fix my gut, and get my skin to give me a break.
Anyone have any thoughts? (Also, I’m trying the oil cleansing method, and it’s is making things EXPONENTIALLY worse, although I’m going to stick with it for another week or so and see if things get any better…)
Interesting, my high intensity workout was slowly killing me. Here I thought I was doing a good thing. It started with sweating out all my water soluble vitamins and mineral and not replacing them at the volume I was losing them and then not having the appropriate amount of proteins especially BCAA’s in order to repair the musculature in a timely fashion before I was at it breaking it down again. I’m wondering if you have lingering protein deficiencies brought on by all that high intensity workout you did.
High dose Branch Chain Amino Acids (10 grams) taken with P5P before and after a workout and then again before bed has restored me to my old self. You may have over trained until your body couldn’t handle it anymore like I did and then taking away the biggest source of BCAA’s with the vegan diet. Perhaps try high dose BCAA’s for a month since you may have lingering deficiency, see how it effects you and your skin. Sometimes when we think we are fixing a problem we are actually making it worse especially when we start these exclusionary diets… I was red meat free for years not good when muscle is being broken down daily.
Studies show that estrogen Controls Branched-Chain Amino Acid Catabolism in Female Rats. Whether that works with women as well remains to be seen but meager stores of BCAA’s could be a reason your body is regulating your estrogen in order to spare them?
I’ll definitely look into that! When I was training for a fitness competition, I was eating a lot of lean meat and supplementing with BCAAs after the crazy workouts…but I stopped once I started the vegan-and-yoga thing.
Thanks for sharing your experience!
Hi Kaila
You can investigate bioidentical hormones. No need to take synthetics.
Best wishes
Allison
Thanks, Allison–I’ll definitely investigate. I really want to heal my body, and i just couldn’t see the value of eating real food but then shoving manmade drugs down my throat afterward…
I recently tried the oil cleansing method and had the worst cystic acne breakout I can ever remember having. I thought about sticking with it for a while but gave up when I read this http://www.cosmeticscop.com/the-oil-cleansing-method-for-oily-skin.aspx
Good luck!
Thanks for the link!! I thought maybe I was just going crazy…It kills me that I can’t just do something and get the same amazing results as everyone else, but I guess that’s also sort of the beauty of being human, right?
Have you tried it with extra virgin coconut oil? That should work.
I am a RN that works with young infants. A fairly substantial number of infants on formula have digestive difficulties with it and a very high percentage of these kids also have skin problems. However, I was most interested in your article from a veterinary standpoint. After over a year of trying dozens of dog foods including hypoallergenic varieties, my pup was diagnosed with IBD. Also during this time we battled “hot spots” almost constantly and had a difficult to conquer skin staph infection. Thanks to a well informed vet tech, we put him on a full meat diet and both the digestive and skin issues were reduced by 90%! Is also on a low dose of Flagyl so am interested in the new drug for psoriasis – will ask my vet about the availability for dogs.
The trend toward infant formula is tragic with the consequences you mention being the tip of the iceberg with lifelong problems. I wish more people knew about the importance of breast feeding, the importance of the mom’s diet and gut flora, and the alternative of homemade formula using the Weston A. Price recipe and corresponding kit available from Radiant Life Catalog.
Susan, do you know about the fantastic new book called Super Nutrition for Babies, by Katherine Erlich, MD? It would be a life-changing book for your patients. It is rich with information, and it includes the homemade formula I mentioned.
I have been doing the autoimmune protocol for a couple months and I am not surprised that my skin is the best it has ever been. Super soft and no more acne. I don’t wash or moisturize my face anymore with anything except occasional coconut oil. Its amazing! I am a firm believer that skin health reflects gut health.
Mickey
Did you hear this report on NPR the other day? http://www.npr.org/blogs/health/2012/10/15/162821580/doctors-strike-mutating-bacteria-in-teen-acne-battle Fascinating. They are linking acne with a surface bacteria, fight it with anti bacterial ointments, but of course the bacteria is becoming resistant, so they don’t know what to do! Now they are working on creating a virus that will break the membrane and thus destroy the bacteria. I would not even call myself a layman scientist, but this sounds very risky to me.
The discussion in the comments section is interesting, too. Lots of ancestral nutrition/diet.
Topical probiotics have been shown to be useful in some studies, and I just heard a report recently (on NPR, in fact) on a study where researchers used a probiotic nasal spray to successfully treat sinusitis in mice.
Blis technologies in NZ have developed a mouth probiotic for protecting against Streptococcus pyogenes (strep throat). I’ve used it for bad breath – very effective, and my husband uses it when he get a sinus infection which you can smell on his breath – again extremely effective.
http://blis.co.nz/probiotics.html
BlisK12 is for mouth and throat, Blis M18 for teeth and gum health
Here is a link to a skin probioitc for acne – I wonder if there is anyone who has tried this? http://www.probiotic-lab.com/probioticacnetreatment.html
Forgot to mention – raw milk kefir hasn’t affected acne or dermatitis, but my skin seems much smoother and healthier since I’ve been drinking it.
Thanks for this article Chris! I can definitely say that my gut and digestion have a big impact on my skin.
I’ve had seborrheic dermatitis basically since infancy, acne since puberty, then developed gut problems at 20 (9 years ago). I learned to treat my gut issues with diet, and more recently, I figured out which paleo foods trigger acne – unfortunately they’re fruits, nuts, and dark chocolate. I’m trying to heal my gut barrier so I can someday re-introduce them!
I still have the dermatitis and haven’t figured out what, (if any?) foods might contribute to that. Commenters – any ideas? I liked the cleansing with oil and honey idea above. I’ve had good short-term success with honey. I’ll have to try adding oil to my regime. Unfortunately the honey only works if I do it daily, which is a bummer when it comes to scalp dermatitis…
Bacon, mayonaise, chedar etc. cause my dermatitis to flare up. So I avoid those and all greasy food (anything that contains vegetable oil).
Hey, Chris. I’ve connected my seborrheic dermatitis with greasy food. So I avoid mayonaise, chedar, bacon and anything with vegetable oil.
Chris-
I know I have a bit of dysbiosis going on, and I have been eating homemade yogurt and fermented carrots with very slight improvement. However, when I have kefir, I *always* get some cystic acne. as well as constipation for a couple days. I don’t notice any signs of dairy intolerance with other forms of dairy. Could this be a bit of die-off from the kefir, or instead a sign I should lay off the kefir?
When I tried homemade raw-milk kefir for my IBS made from A1-beta casein milk, my issues always got worse including constipation. I don’t think the fermentation was enough to adequately break down the opioid in this type of casein. I had much better luck using kefir made from A2 sources like goat milk or Jersey milk.
That said, only 1% of bacteria in fermented products makes it to the intestines assuming you have proper levels of stomach acid and if you don’t, you have bigger problems to deal with. So while I personally consume fermented foods and recommend them for most, I’m afraid you’re going to wait a long time before they resolve your issues, if ever. You will have to find a probiotic and prebiotic that works for you and some sort of antibacterial if you have small intestinal bacterial overgrowth.
It’s a tough call in that situation. I had severe reactions to kefir early on, but I chose to stick with it because I had confidence it would help me over the long term. I literally started out with 1 teaspoon a day, and it took me about 6-7 months to get to where I could tolerate 1/2 cup. Now I can drink as much as I want without any ill effects. If you’re willing to be this methodical about it, you could continue. Otherwise it might be best to remove it for a while.
Thanks for the reply! I live in Latvia, so I’m not sure if the kefir is a1 or a2 type, but kefir is definitely abundant here, so I might try a bit at a time and build up as you did. I’m taking ACV and HCL to help with the stomach acid issue (recovering longtime Prilosec user), and I will also try to eat the dairy apart from other meals to see if that helps. As far as probiotic supplements go, if they are taken around the same time bitter/ACV/HCl are taken, do you think this makes a difference in their effectiveness? I’ve read that increased acidity from ACV/HCl can clobber the bacteria from the pills, but it would seem that I need the extra acid to help digest them as well.
I have been struggling with psoriasis for years. I went Paleo a few years ago and saw a dramatic 60% improvement. Went to see Chris (luckily, I’m very close by) and he put me on an immune system diet, just a few modifications of my existing paleo diet. My skin is at about 80-90% normal now. When I “cheat”, I see it within a few days.
2 YEARS AGO I UNDERWENT A SURGICAL PROCEEDURE WHEREBY 9 INCHES OF MY INTESTINES WERE REMOVED. I HAD A COLOSTOMY, WHICH WAS REVERSED AFTER 5 MONTHS. I HAVE SO MUCH GUT PROBLEMS. JUST RECENTLY I STARTED TAKING PROBIOTICS, ANTIOXIDANTS, YOGURT, NUTRIENTS UP THE YING YANG. I NOTICED SOMETHING DIFFERENT IN MY SKIN. I USE TO GET LITTLE BUBBLES ON MY ARMS THAT SEEM TO RUPTURE FROM THE SUNLIGHT, SO I THOUGHT. THEY HAVE ALL BUT DISSAPPEARED; I ALSO HAVE THESE WHITE SPOTS ALL OVER MY SKIN, WHICH I AFFECTIONATELY REFER TO AS FAT, COMING TO THE SURFACE. I AM WATCHING TO SEE IF THIS TOO WILL DISSAPPEAR. I KNOW MY DIET SUCKS, I CAN’T SEEM TO CONTROL MY EATING, AND MY STOMACH IS TERRIBLY GERGILLY AND GASEOUS; SO MUCH SO I FEEL MY INTESTINES EXPAND. IT’S PAINFUL. I SEE HOW THE PROBIOTICS IS MY SALVATION ON THIS SCORE. I AM SCHEDULED TO HAVE, (VSG) BY-PASS SURGERY, WILL THIS CAUSE ADDITIONAL PROBLEMS FOR ME?
I thought the Small Intestine was packed with bacteria (both beneficial and opportunistic) and wonder why you say (see below) that it “should normally be sterile.”
“A recent report indicated that small intestine bacterial overgrowth (SIBO), a condition involving inappropriate presence of bacteria in the small intestine (which should normally be sterile), 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.”
It is not packed with bacteria. At least it shouldn’t be.
True, but not sterile either. Commensal gut flora is not evenly distributed throughout our digestive tract. In the stomach and duodenum, the number of cells per gram of contents is much less than what is found in our colon. Here, commensal gut flora ranges from 10 to 1,000 cells per gram of contents.
Further down the digestive tract, bacterial counts progressively increase reaching their highest counts in the colon where numbers range from between 10 to the power of 11 to 10 to the power of 12 cells per gram of contents.
Yes, I overstated the case with the word “sterile” (which I’ll change now). But the amount of bacteria in the stomach and duodenum is orders of magnitude smaller, as you pointed out.
Hi Chris,
I hope you didn’t take my suggestion the wrong way. I just want people to understand how pivotal these gut microbes are to the health of the enterocytes lining the small intestine. While the state of our commensal colonic gut flora is very important, I feel it’s crucial to stress how the state of the friendly bacteria that reside in the small intestine is equally important. Without them proper digestion is impossible.
One more thing..I have a white tongue which is I am guessing (no doctor has ever said anything to me about it), thrush or a candida overgrowth. I do crave sweet things over salty. I don’t drink sodas daily, but do drink them more than twice weekly. I don’t seem to digest beef very easily. I like eating vegetables and wish I could be a vegetarian or just eat fish–and don’t eat protein often enough–not even daily. When I am blocked up, I may eat one day and skip eating at all on the next.
Hi Chris, love your work. Despite trying EVERYTHING, nothing ultimately has worked at clearing hormonal acne. Eliminating cooked dairy helped immensely, and I’m six months into raw (75%) vegetarian diet now (i was a mostly raw meat eater for well over a year before switching), which made no difference in acne but has other benefits. Low sugar, avoid grains, avoid all oils except cold pressed olive, organic produce, focus on greens, organic coffee enemas, filtered water, exercise 5-6 times a week, yadda yadda doing everything right but still. Break. Out. Have probioticked for months and months and months, eat fermented foods yet STILL. Started maca for a week on the advice of another vegetarian and two weeks after stopping am still recovering from one of the worst flare ups I’ve had in awhile. However, I am well aware of the likely damage from having taken a prophylactic antibiotic for over a decade for post-coital urinary tract infections, which finally seems to have been corrected by adjusting pH and taking MSM crystals to rebuild tissue. However, I’ve been dealing with acne since late teens (43 now), and while it’s better than ever, this latest setback is depressing. Maybe it’s just genetic damage? Both my grandmother and mother gestated with a heavy sugared diet and both have been overweight and diabetic for most of their lives and altho I was never overweight, I realized in my 30s that I was having symptoms of insulin resistance and made changes. I’m well-versed in alternative approaches and have had some success but not with this. Any advice?
I might add that I am also insulin resistant and have been diagnosed with a fatty liver. I lost my gallbladder in an emergency surgery due to gallstones which I did not know were that bad. I have had hormonal problems including removal of an ovarian cyst. My feet and legs have nerve damage due to spinal surgery. I don’t know if the numbness and lack of feeling to the top layer of skin is due to this or to something else. I have very low energy. I am in post menopause and in my late 50’s. Thank you for your help and time taken to read this.
Phosphatidylcholine will reverse your fatty liver. Google it.
Thanks!