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. ↩
Brown rice and sorghum causes psoriasis on my elbows within hours. Corn to a lesser extent. I’m guessing my receding gums were related to this as well. FWIW, my gums no longer receding. No obvious skin reactions from wheat, though. Prolong exposure to gluten causes arthritic pain in my fingers.
I think raw tomatoes may cause some issues for me as well. But, there may have been confounders the last time it happened. Not worth verifying at this point.
I suffered moderate acne from my late teens (it was especially bad when I was pregnant and after my daughter was born) until I went strict Paleo at age 34. I was 100% strict for only 1 month but it cleared up the acne on my face, and the red raised bumps that I always had on my upper arms. That was five years ago and since then I have followed Paleo eating with varying degrees of strictness/slackness. When I move further away from Paleo my skin starts to break out again. Dairy really affects my skin. Loren Cordain has a great e-book on Acne.
Hi Chris, I have personal interested in this topic for many years as I suffered from a terrible “itchy arms” syndrome. During the summer of 2003 I noticed I had a little itchy spot on my arm, without realizing it I would scracth til it bled! Over a few years it advanced to cover the entire front of both arms, from the wrist to the tops of my shoulders. No where else on my body. At times it was almost unbearable, often I would awaken at night with bleeding sores. If the itching was mild I could control it with antihistime ointments, if it was persistent I could take one, then two oral antihistimines (benydrl). I went to dermatologies but refused the treatment of steriod creams. Once I found that I could get relief from Accupunture I started using that approach. This condition escalated over a period of 5 years with the worst year being 2008.
Do a google search on “Itchy Arms” and stand back!!! WOW!!! With research I was able to eliminate all of the “usual” causes for having itchy arms. What was so odd was that it would onset in mid – late summer and resolve ON ITS OWN (??) at some point in the early winter (mid Nov – early Jan). So weird!! It would vanish almost over night!? I could not connect the itch directly to the sun but I do think there was some connection so I started using lots of sunscreen on my arms and keeping them well covered.
When I finally found your website and began learning about the gut brain connection I had my first AHHA moment, it all started to make sense. I used to get stomach aches, gas and indigestion, and have loose stools often. After a lifetime of antibiotics and a convential diet, I was learning something very new!
I began making MAJOR changes to our diet cause I discovered Dr. Weston Price and read his book. I began to think that I might heal! And I did heal —- Each year for the past 4 years the itch has diminished more and more. I did not itch at all this summer!! None, zero, zip!
Starting in 2007:
1. I have almost reach our goals of a GMO FREE 100% organic diet. 100% grass fed meat and dairy and pastured eggs (now from our chickens); ZERO industrial seed oils; We almost NEVER ever eat out. We still eat corn and gluten, but in small amnts and always properly prepared according to wise food traditions. Here are the other changes we have made:
2. I have been making and consuming raw milk kefir and other naturally fermented foods daily daily.
3. Supplements: FCLO/HVBO for the past 5 years. last falls began taking extra Carlsons Vitd3 (fall-spring) liquid minerals from Trace Elements, Dr. Rons Organ Delight 3 times a week in winter, Dr. Rons iodine supplement. Regular epsom salt baths late fall in to the spring, and I use Mag oil on my skin often.
4. This year I started purposefully getting more sun from mid March til now – I come home at lunch time and work in my yard in a skimpy tank top and short shorts for 30 minutes to an hour (shower 1-2 a week). I used to use tons of sunscreens and covered my skin with clothing for many years. I still cover up after I get my daily dose of mid day sun, and use mineral sunscreen on my face and back of hands (California Babies).
More good news –
Illness: Both me and my husband used to get sick all the time!! at least once sometimes 2 or 3 times a year with some kind of bug and often taking antibiotics for some intracable cough or sore throat. The year we started making the above changes we were both sick multiple times and on antibiotics – me 2x jeff 3x that year! In the past 4 years Jeff has not been sick at all!! I’ve had one mild strep infection that cleared on its own last winter. We both used to take antibiotics for infections like bronchitis that would not clear on thier own (we live in a very cold snowy climate) Neither of us has taken antibitoics is 4 years.
.
Lastly, my adult acne has improved greatly, I used to get lots of small comodons and black heads, and i now enjoy excellent bowel health, no indigestion, no gas or bloating, an occassional loose stool.
This is a long post but I want to point out that I have healed immensely since adopting this approach to diet AND QUICKLY!! Esp. adding naturally fermented foods, eliminating all GMO foods, 100% grass fed meat, and taking our FCLO/HVBO!!
Shouldn’t we all just get a fecal transplant once in a while? Seems like it sure would save a lot of money on probiotics. I’ll skip the nasal route thank you.
http://www.cnn.com/2012/09/26/health/fecal-transplant/index.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+rss%2Fcnn_health+%28RSS%3A+Health%29&utm_content=Google+Feedfetcher
I’ve had acne since a teenager, not bad but at least a couple every day of my life for the last 12 years or so, kind of embarrassing as a 28 year old. I switched to Paleo eating earlier this year and within a month my skin cleared up completely. It’s been about 5 months now and I’m a firm believer. We went on vacation and I indulged in a lot of breads and the like, and by the time the week was over I had a little pimple on my chin. Back to grain-free eating and back to clean skin!
About a year ago, I discovered I’d been suffering from the parasite E. histrolytica. I was severely malnourished and underweight, and had leaky gut. Since ridding myself of the parasite, I’ve gained weight and am absorbing nutrients properly (I also still supplement with a high dose of probiotics). However, since I appear to have resolved my leaky gut, my skin has actually gotten worse! My forehead has had a permanently bumpy appearance for over a year, and my nose and chin often break out as well. I don’t have acne rosacea or a severe case of acne, but I am still frustrated. Is this a release of toxins I accumulated while suffering from the parasite? Or is it something else?
Julia, thanks for sharing your story. How did you determine you had this parasite, and what steps did you take to eliminate it?
Beth-
I was misdiagnosed with Crohn’s disease over four years ago. The SCD diet (very similar to Paleo) really helped alleviate my digestive symptoms, but I was emaciated and could not keep on any weight. I discovered an organism of “unknown taxonomy” through a stool test a few years later. If you are in the NYC area, I highly recommend Dr. Cahill if you think you have a parasite; he is one of the top parasitologists in the country. After three weeks of antibiotics (yes, I know, not ideal, but I offset this with lots of probiotics), I finally began gaining weight! I started absorbing nutrients properly again. Parasites can be difficult to kill, and I don’t regret taking antibiotics.
I guess I am still eliminating toxins I had stored up during the time I was infected. Not sure, though. Does anyone have any ideas as to why my skin is actually more prone to breakouts now that I’ve IMPROVED my gut function?
Possibly this: though the antibiotics killed the parasites and that improved your gut function overall, they also altered your intestinal microflora in such a way that is predisposing you to skin breakouts. It may be a question of rebuilding your gut post-antibiotic treatment.
That’s a good point, Chris. I actually supplemented the antibiotics with 1 packet of Probiotic 225 every day of medication (225 billion CFU a day). It’s been about a year since I went off medication, and I am still supplementing with 225 billion CFU every other day. Do you think my gut is still being rebuilt? I am 17, and my parents think my breakouts are just a “teen” issue. But I don’t think acne at any age should be considered normal.
Could that be due to an imbalance of the intestinal flora ? Maybe the problem is not a lack of the probiotic strains she is supplementing, and maybe they are even too much in her already, maybe she needs other strains and/or a better diet instead… Only speculating…
Diagnos-tech’s “Expanded upper GI panel” will name that “unknown” parasite. Dr Stuppy a parasite specialist here in Los Angeles believes that the stool tests that don’t name the parasite and list “unknown taxonomy” instead, are worthless.
I actually had a more comprehensive at examination with Dr. Cahill in NYC, who named the parasite E. histrolytica. He is one of the top parasitologists in the country, and I am parasite free now so I am not too concerned.
I have had Hidradenitis supporativa for a couple decades. It got worse as my overall health worse. Didn’t improve when I went gluten-free (though many other symptoms did go away). Didn’t improve when I went paleo/primal (I still have a bit of dairy). Then, while reading one of Mark Sisson’s books, I came across a story about a woman with HS…but it didn’t mention whether or how she got rid of it. Fortunately, I found her blog and learned that she has been able to put her HS in remission by following a nightshade-free diet. Of all that I’ve cut out of my diet, losing peppers and tomatoes has been the hardest, but I do notice that when I stick to it, I have no new breakouts and when I cheat, I have a break out within 24 hours.
Thanks for the info. If you don’t mind my asking, how long has it been since you cut out the nightshade? Are you still doing paleo-style, or just no nightshades?
Very good article, bu it seems that most of the information is “Borrowed” from another article I read some time ago: http://gutflora.com/?p=344
The gut-skin connection is very interesting:)
I’ve never once seen or read that blog.
Hey Alex – There are lots and lots of articles discussing the gut-skin-brain connection in the medical literature. Celiac, Crohn’s disease, and Ulcerative colitis (GI autoimmune diseases) all have widely characterized skin manifestations that are taught to every medical student in the world and each of these entities have associated neurologic disorders (headache, seizures, neuropathy, depression, etc). This is a well-established phenomenon. Just do a pubmed.org or more thorough google search and you’ll see that the “gutflora” site was not first posting on this. It’s been described in medical books for > 50 years. Chris does a great job though of digesting this information and sharing it to a broader audience. I think many doctors don’t emphasize the skin findings as much as they should because for people with gastrointestinal or neurologic diseases following a subtle skin rash can be a great way of self-monitoring their disease state. Looking at a rash improve with favorable dietary changes provides positive reinforcement and can help people adhere to a diet who have GI or neurologic/brain symptoms that improve only in a delayed manner. Cheers, Brittany
Hi, Chris,
Great article. I’ve learned so much from you.
What type or brand of probiotics would you recommend?
Thanks,
Wendy
I like Therbiotic Complete from Klaire Labs, VSL #3 and Jarro-Dophilus (for those who need a shelf stable option).
I hope one day you’ll come to Sydney, Australia to give a talk.
My face used to be red and blotchy but is now clear because I’ve stopped eating nuts.
that’s so interesting! i’m 13 and i use these prescribed facial creams given to me by my dermatologist, however i came across your article when my dad showed it to me and i wanted to know exactly what foods i should eat and which i should avoid to get rid of my acne (i’m vegan so i don’t drink or eat any eggs, milk, cheeses etc) also, if acne is caused by the gut, then how come my prescribed creams are working? finally, i’d also like to know when i’d start noticing changes? thank you 🙂
p.s. sorry if my questions were already mentioned in your article its just that i’d like clearer information on it.
Hello Chris, as always, great article.
What do you think about kombucha as a source of probiotics (to treat blemishes) for someone who prefers not to eat dairy? Or is dairy the best probiotic option? Should I be concerned about the sugar (in kombucha)?
Thank you kindly,
Des
Hi Chris- I have been doing paleo on and off for the last nine months. I use to also get acne and notice when I consume dairy, I tend to have more acne. One thing I had experienced, and wonder if you could speak about this, is when I consistently went paleo and cut sugar for two weeks or more I experienced increase itchiness, small bumps and what my doc explained was contact dermatitis on my chest, hands and feet. It was a scary experience for me, and initially wondered if it had something to do with my diet changes. I thought, maybe the toxicity is getting out of my body. The first time this occurred, I took medication and it lasted for a month. It has not occurred since that time, but I realized I go on and off paleo in fear it may occur again. Have you known anyone who has had this experience? Do you think this may have been related to my diet? Is doing paleo on and off harming me more than helping me? Any recommendations? Thank you so much for the education you provide!
I’ve been on Paleo for over 6 months now and I must say that bad skin on my shoulders significantly improved. I get a pimple or two during my period time. I also wanted to say that I had been struggling with bad skin on my shoulders for almost 20 years. It had started when I was 14 and stopped after being on Paleo for only 4 weeks.
What’s even more interesting for me is my eyes are getting better, too. I’ve had miopia since I was 6. It’s a pretty bad case because my left eye is -7 and the right one -6.5. I’m not saying that my contacts are too stong (not yet , but I hope they will be 🙂 )but sth really positive is going on with them . I’ve never experienced such clear vision before. Is there anybody that that could share the same experience with me? Is it possible that my eyesight will improve?
What is the Autoimmune Protocol, please?
The autoimmune protocol, from a Paleo perspective, can be found on many sites. I have referenced ThePaleoMom.com most often for my own education. Click on the link “Autoimmunity” and you will see several articles.
I’ve always had soft and fairly blemish-free skin, even when I was a teenager. I got a gift of a facial once and the woman who worked on my face said I had great skin and great pores and that I was blessed because I’d never had a facial in my life and didn’t really need the one I got. I’m 58 now and younger women envy the smooth softness of my skin. If gut problems and skin problems are related, can I think that my gut’s in good shape based on my skin?
I had what was diagnosed as severe rosacea that triggered by exposure to sunlight. I would get red patches on face and arms, that would itch a little and go away on their own after 5 to 6 days.
I went Primal two and half years ago. This condition simply went away in about six months.
Recently, I went on a cruise to the southern Caribbean, nothing happened for the first 3 days, despite eating a bit poorly. On the 4th day, I had some local food from a beach shack, and I had a severe reaction on my arms, not face. I have since returned, went back to my eating habits and it has completely gone without any medical intervention.
I had a small single patch of eczema on my elbow for 5 years before I developed GI symptoms, was treated with antibiotics for SIBO, got worse on antibiotics and eventually was diagnosed with “Idiopathic malaborption.” Nonetheless, I suspect that I have an autoimmune process/inflammation, like celiac. I started SCD-Paleo-GAPS and my eczema disappeared x 2 years by narrowing my diet to veggies and meats (no dairy, no nuts, no fruit, no grains, no sugar, no nightshades, no coconut), but despite these changes, I’ve still had GI symptoms all along. I now have lots of work stress and despite adhering to my ridiculous diet, my GI symptoms are worse and my elbow eczema is back for the first time! I wish I could break this “vicious cycle.” 😉 It is nice to hear about everyone else’s experience and glad I’m not only one with the gut-skin autoimmunity. Thanks to Chris Kresser for this forum and great dialogue.
I’m not precisely what in the paleo approach has ‘cured’ me, but after 7 years of chronic hives, 2 years of alopecia and 12 years of psoriasis and bouts of rosacea, I am now skin disease free. I eat primal rather than paleo, and I heavily supplement with probiotics. I don’t care which specific alteration, whether its grain elimination or the probiotic supplementation taking care of the SIBO, or a combination of both. I don’t care. It’s worked, where every single other approach from immunologists, or endocrinologists, or general practicikners couldn’t solve, despite their best efforts. There is definitely a gut, skin axis…now I just need the brain to kick into action 🙂
I have been on a strict diet ( meat, fish, eggs, shellfish, vegetables, fruit, water ) for 6 years and my eczema ( which I have suffered from since a baby had gone ). However I do believe the effect of stress on the nervous system has a very important part in skin problems. Due to the fact that I have high levels of anxiety at the moment my skin has broken out in dry, red, itchy patches particularly on my face, hands and legs. What helps me the most is calming the nervous system with meditation / yoga.