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. ↩
I went paleo for a few a month in 2013 and after that perioral dermatitis showed up. I have been working on gut issues for about 9 months. I use only steroid free products for cleansing. However, my skin condition recently flared up and I am in an acute state of perioral dermatitis with no end in sight. I take Jarrowdophilus and have for over five years and have gotten rid of yeast in my system. I’m not sure how long I can keep dealing with this and wonder if there is more I need to do to clean up my diet. I have changed it dramatically and eat fruits, vegetables, meats, bonemarrow soup, and sprouted grains but can not get to the bottom of this Leaky gut. Do you have any suggestions of what more I can do?
First thing you should do is cut out sprouted grains and anything to do with grains. Also all legumes.
I have vitiligo. I have done the paleo, autoimmune protocal 2x and each time after about 8 weeks I noticed some repigminting. I was also taking a probiotic and aloe juice. However, I lost so much weight and I had to add back in some grains and dairy to gain weight…I am 5’7 and was down to 95 pounds. I couldn’t gain weight no matter what I did and it got to the point of me having to force food down my throat. After adding foods back in, I have gained weight, but have subsequently noticed new spots and any repigminting has stopped. So…I know it is tied to what I am eating but I have no idea what and I obviously cannot sustain an autoimmune protocal forever…I have not been able to find a doctor who will work with me on this so I continue to experiment on my own. I wish there were more global studies on vitiligo and diet/nutrition/digestion…
Elizabeth I’m not sure what “Paleo” you are doing. Hopefully an individual one like Chris K recommends. Take a look at Jaminet and Jaminet Perfect Health Diet. I have autoimmune disease (vitiligo a few years ago too) I found that if I ate starchy vegetables at all meals and then brought some white basmati rice back in, I stabilised my weight and have even been gaining if I want to.
Thanks! I just recently heard about the perfect health diet. I will look into it. I have done the autoimmune protocal…elimination diet. No nightshades, dairy, grains, eggs, nuts, legumes or sweeteners. I actually felt great doing it. My joint pain subsided considerably, my brain fog went away and I had more energy. It also got rid of my “chicken skin” on my upper arms which doctors told me I would never get rid of. It was all great until it wasn’t:) Sounds like the perfect health diet might be what I need to keep the weight on. Thanks again
Im not sure teh PHD will be any different from what you were doing but (for me) it was helpful to hypothesize why no legumes etc. I went on a similar diet for lupus 25 years ago. I do want to say that the key to not losing too much weight is carbs. Thats why I said make sure you eat sweet starchy veggies at all meals and if you can tolerate it, white rice. The Jaminets and others are calling them “safe starches” or “gentle carbs”. Here is a post from Chris (since you are on his site already) http://chriskresser.com/is-starch-a-beneficial-nutrient-or-a-toxin
I added fermented vegetables and began reducing carbohydrates in my diet about 2 years ago. I’ve more recently added liver and bone broth as well. It is hard to pin point exactly what has affected my skin, but my skin is much clearer, and oiler (my hair is also oiler and stronger). Also, I suffered from dry patchy areas caused by a viral infection (like warts but superficial). These dry itchy areas are now gone.
I had undiagnosed stomach problems for 5 years, ultimately diagnosed celiac. During the end of those 5 years, I developed vitiligo on my forehead. Since going gluten free, the vitiligo stopped spreading.
You may want to look into a fecal transplant (nearly 100% effective from all that I’ve read), followed by something like the Gerson diet.
I tend to have skin blisters that peel and sometimes bleed. I have been diagnosed with eczema and psoriasis. Never had it TV before. Now when this happens, my digestions acting up or the skin happens months before I end up in ER. I have had c-diff. Skin cancer in the bowel. I need this to end. Last time had worse problems with bloody stool. Irritated lining of colon. I need help.
Huge pores not nearly a problem now with probiotics,in my Mid 50s, finally got rid of blotchy red skin ,it is almost totally clear now.
Do you mean that you had huge pores and it went away with probiotics?
Has anyone ever tried Jarro-dophilus brand?
Hi, I would like to know if eating Greek yogurt with probiotics and raw milk on a regular basis would be enough for intestinal health, or if an oral probiotic in addition would be helpful. I’m not sure if any of these food products contain the two probiotics mentioned above (lactobacillus and bifido), but I have heard mixed things about oral probiotics making much of a difference in skin health.
Someone else here mentioned taking 5,000 mg glutamine, but don’t we get enough in dairy products, for example, if we eat a substantial amount in our diet? http://www.weighttraining.com/faq/which-foods-are-high-in-glutamine
Another person mentioned a bile-thinning product, but gave no recommendation of brand or name — that would be nice to know.
I don’t think we’ll know for sure what causes various forms of dermatitis, but we can share with one another what has worked for us. So, if anyone can tell me the answer to my first question whether probiotics might be indicated in addition to rich sources in my diet, I would be grateful, and do you have 1 or 2 brands you can recommend? Many thanks.
ps Johnny, perhaps you should find another forum for your thoughts. You don’t seem to be offering anything other than pessimism and negativity filtered through your own personal experience.
It’s well known medically that gluten intolerance can produce eczema symptoms. There is a medical term for it: Dermatitis Herpetiformis. Celiacs can react to the tiniest amount of gluten.
Oh and my “joyful throes of initial remission” lasted from age 21-45.
Hi, I’m 43 & I’ve suffered from bouts of eczema most of my life, until 3 years ago I was diagnosed with Coeliac disease. I changed my diet & within 2/3 weeks my eczema completely went. So I strongly believe that yes, there is a definite connection with gut & skin. I eat healthily, keep fit & drink lots of water, I also take vits & supplements. Recently though my eczema has made a reappearance, which concerns me as I haven’t changed anything in my diet but I’ve started taking organic supplements with no fillers or binders (pure). I take organic sulphur, vit C, B complex, calcium with vit D & biotin…..is it possible that one of the supplements are affecting me? Any suggestions as the eczema is on my shoulder blades & driving me mad!
“I changed my diet & within 2/3 weeks my eczema completely went… Recently though my eczema has made a reappearance, which concerns me as I haven’t changed anything in my diet…”
This is actually the classic scenario. Diets can and often do offer short-term relief but they are, in the end, ineffective as the cure they are purported to be, and promoted as. Inflammatory skin conditions such as various types of dermatitis, eczema, and psoriasis tend to be highly adaptive diseases and almost always reappear.
So much praise for various diets for various diets are often written by people in the joyful throes of that initial remission, thinking that a long term treatment has finally been discovered. Check in with them later down the road and you almost always find someone who is again dealing with the skin condition, which has resurfaced, sometimes with a greater vengeance and resilience than preciously witnessed.
Previously witnessed, that is.
Hi Soraya
I can relate, my eczema suddenly returned after years. For me, I’m pretty sure it was associated with perimenopause. Anyway, the obvious first step is to stop taking those supplements. Wait several months. See how you respond. The sulphur is a red flag to me. Good luck!
I have lichen planopilaris. I believe it was caused from trauma to my scalp. At the same time I developed gut problems/ irritable bowel-like symptoms. I wonder if skin/hair problems such as LPP can trigger gut problems, just as gut problems can trigger skin problems. It seems to make sense to me that if they’re linked, then any one component of the brain-skin-gut axis can trigger another component. If the LPP triggered gut problems, does it make sense to heal the gut in an effort to treat LPP? Many thanks for your response.
Hi Tammy
I can see the way you are thinking about the two way connection but I honestly think in this case, if you look at the way that the skin is an elimination system *after* the gut that your theory is probably not correct. In many modalities, you treat the gut/whole system and the skin improves as a result. In fact there are systems of medicine that suggest that if you suppress a skin condition (eg eczema with cortisone) it will manifest in deeper systems like asthma in the lungs. I know lichen planus is an autoimmune disease but haven’t heard of lichen planopilaris (dermatology is so often just taxonomy). Anyway if its AI then you definitely want to heal your gut/immune system/whole system and then your skin will respond.
I agree that it makes sense to heal the gut. Definitely wise. I suspect that the relationship between gut and LPP is not so straightforward. I’m one of many who developed LPP and then got GI problems thereafter. It’s a system after all, and so it intuitively makes sense to me that there can be some bi-directional feedback involved.
I can testify to the gut-skin connection. I have rosacea and take probiotics. My rosacea is pretty much under control. If I stop the probiotics, the rosacea is worse. You must make sure you buy a good quality probiotic. If you are not sure yours is active, do like I do. When buying a new bottle, I use one open capsule and l cup of milk and make yogurt or kefir. If it ferments–your probiotic is alive!!!
I was diagnosed with acne rosacea by a dermatologist. I am 72 and have never had skin problems in my whole life until two years ago, when I became gluten intolerant, sugar intolerant, and preservative intolerant. The medical community in my town is totally clueless as to how to help me, and they are very resistant to anything that deviates from their textbook cases,, so I have had to do my own research to find the answers I need. A vein doctor, who is a health nut, referred me to your website. I feel like I am now on the right track. I have changed the way I eat, gone gluten free, milk free, and preservative free. My H-pylori is gone, and I am back to about 90% of what I used to be. I just wish the doctors would get on board with this. Thanks for the work you do. I read everything you write.
I was completely dairy free for about 3 years straight. This did absolutely nothing for my eczema. Then added to this, I went gluten free, then completely grain free, then nightshade free, and so on…
My skin never improved even slightly. Chronic inflammatory skin conditions are most often genetic in origin, which is why they never respond these types of interventions. Short of re-writing your genome, there is nothing that can be done in terms of reversing these conditions. Diet has absolutely no effect on a genetic condition. This is the equivalent of someone with dwarfism believing that a diet can make them grow to a normal height. It is absolute lunacy and I truly feel sorry for all of the credulous people that submit themselves to this nonsense. They are just inviting more frustration and dashed hope. People on this message board describing skin conditions disappearing after adopting a special diet or eliminating a particular food were clearly dealing with a type of allergy. I would call that psuedo-eczema, as it may present similarly but it is not the same disease process as an inherited case of eczema, psoriasis, xerosis, dermatitis, ichthyosis, etc.
Johnny, you experimented with diet and nothing appeared to affect your eczema, however this cannot be extrapolated to everyone else. No matter how much scientific language you use, it’s still not scientific. There are many many people who discover that dietary interventions make a difference to their medically diagnosed eczema and when they reintroduce a food, it flares up. Just as an example, my childhood eczema flared up terribly when i went to stay with my cousin’s who had just got a milkshake machine in the 70s and we were making lots of milkshakes. My skin settled down when I went back home to my usual diet with dairy products but much less milk (just 1/3 cup max on my cereal every day. Casein is a well known trigger for eczema as well as gluten and gliadin. That is not to say that all eczema is affected by dietary changes or any other single factor. But I feel sorry for anyone listening to you when their child has terrible eczema and they think that they can do nothing to help it. You may call something that doesn’t fit with your beliefs “pseudo eczema” but I am more likely to believe my dermatologist, who performed a biopsy before she confirmed my childhood diagnosis of “eczema” or “atopic dermatitis”.
“But I feel sorry for anyone listening to you when their child has terrible eczema and they think that they can do nothing to help it.”
There is something they can do to help it- use steroids, both topically and systemically. Yes, it will only help it, if it is not an allergic reaction. Genetic skin conditions cannot be reversed. If you believe they can, you set yourself up for a lifetime of the misery of frustration. Go and get a workup with an allergist. See if your skin inflammation is the result of an allergy. If it is not, diet interventions will make absolutely no long term effect. This may sound unduly harsh, but such is the reality of genetic disease.
The problem is Johnny, you seem to be very blinkered in your view. I HAVE BEEN a child with eczema and I have used topical steroids. So has my sister. She used more, she got asthma BTW. I have been a young adult with exczema and resolved it without steroids for about 30 years. Then is returned at 48 and again I have resolved it without steroids. I have also been to an allergist and as I said in my post, he was disappointed I had no allergic reactions whatsoever (only to the control). Not dustmite, not cockroach feces which is very common in Sydney Australia. So get off your personal hypothesis that its genetic and the ONLY thing that helps is topical steroids. And stop defining anything that doesn’t fit your own hypothesis as “pseudo eczema”. Nothing is purely genetic. Have you heard of epigenetics? Get with the new century dude and stop spreading falsehoods in disguise as “the harsh truth”. PS in Germany they treat it with Vitamin B12 cream and stress management. Then there is Omega 3, many studies… probiotics… I could go on and on. By all means enjoy your hydrocortisone but leave the rest of us to explore the wide world of alternatives and complimentary medicine. Most people who use steroid creams (especially on children) find that its only palliative and isn’t enough. That’s why people try everything else that you disparage.
Steroid use actually CAUSES skin problems such as perioral dermatitis down the road by thinning out the skin and making it susceptible to irritants and chemicals. That is a scientifically researched FACT. Stop spreading bogus information! Many people, including myself, have found diet and skin to be DIRECTLY related. A gluten free/lactose free diet doesn’t amount to squat if you are still eating processed junk (which includes gluten free alternative foods) fast food and/or lots of sugars. I noticed you didn’t mention those…
Johnny, I am sorry your dietary interventions did not work. I wonder if you have a reaction to chemicals or additives in products you are using such as laundry soaps, body soaps, lotions, maybe even the water supply to your home has been contaminated? Or the pipes that carry the water? What kind of fabrics are your clothes made of? Could their be some kind of industry near by (a factory) that leaks toxins into the environment? Many homes are built with toxic chemicals in furnishings such as the carpet, the furniture, etc. Maybe you suffer from chemical sensitivities.
Cutting out dairy made my eczema pretty much disappear.
Hi Chris,
I’ve been reading many of your posts regarding the gut skin connection. I’ve been dealing with a severe case of perioral dermatitis for almost two months now. I’m 100% committed to healing my gut, as I know it’s caused from leaky gut…I have lupus and have been on prednisone many years. I have completely eliminated sugar, dairy, wheat, all grains, fruit and am following a pretty strict GAPS diet. I’m basically eating vegetables, raw and cooked, meat, bone broths and eggs…lots of ghee and good fats as well. I’m taking probiotics and fermented cod liver oil faithfully. My question is why don’t I see any improvement with this radical adjustment to my diet and life style? I understand it will take time but I don’t understand why it’s not at least improving slowly? Is it just a matter of time or could there be something in the very limited foods I’m eating that is aggravating it? Any advice would be helpful. I don’t want to give up oh healing my gut but it’s very discouraging. On the flip side, my lupus is doing well, my hair and teeth and nails are beautiful, so why the continued terrible skin issues for 8 weeks…?
Hi Danika. Your lack of improvement is not unique. In fact, it is the norm. You are not improving because chronic skin disorders, such as dermatitis, are rarely caused by gut conditions. Furthermore, they are rarely ameliorated with these fad diets. I bought into this gut-skin connection early on in my own personal battle with a chronic skin disorder and through my own experience and extensive research from a wide variety of sources, I can confidently say that it is largely a fallacy. To present this supposed connection as though it is universal, even is an implicit way, demonstrates a serious misunderstanding of this issue. I can only assume it is propagated by people that have little experiential knowledge and are riffing off misapplied theory. The bottom line, chronic skin disorders do not respond to gut therapies for the vast majority of people that use them. It would be great if these fad diets and regimens like gaps, primal, paleo actually worked to reverse chronic skin disorders but they do not.
I found that 24 hour cortisol tests showed what time of day I came into contact with something that caused a stress reaction and the resulting cortisol spike. With you I could be something you’re eating or exposed to… helpful to know what time of day it happens or which meal.
Diagnos-tech expanded GI panel stool test checks for anti-bodies to a number of food proteins, bacteria levels and parasites. Its a very useful test if you think you have leaky gut. You should be taking 5000 mg of L-glutamine daily as well to help rebuild the stomachs mucosal layer.
Both doctors that helped me reverse my leak gut recommended Mediclear plus by Thorne. I use it to this day for upset stomach. Its like a fire extinguisher. Good luck!
Don’t listen to Johnny… he’s a downer.
Hi Danika,
I only just saw your post and I want to encourage you to persevere. I have SLE and a few years ago my childhood eczema just flared up horribly. It was disturbing my sleep and I would get up and put ice on it for awhile and try to go back to sleep. I almost went nuts eliminating different things from my diet (I have been on a diet for lupus for 26 years but had slacked right off). I also started getting perioral dermatitis and eczema on my face. It looked so bad that some doctors thought it was allergy but I had no reactions to the allergy tests. Its a detective job living with autoimmune disease and I want to encourage you to completely ignore Johnny who is not really offering anything constructive to this forum. Take heart in the fact that your lupus is doing well and you feel better in yourself and your skin and nails etc. A healthy gut is paramount to someone who has AI and I’m sorry to say, my eczema took months to improve and was quite confusing. I started getting paranoid about food (and dust and other things) but I persevered and am now completely clear. Remember that eczema is also AI so it’s connected to lupus but we don’t know how. For me I think it was perimenopause hormones that triggered this but I really don’t know for sure. The Perfect Health Diet (Jaminet and Jaminet) seemed to confirm and extrapolate on my Dr’s original diet for SLE from the 80s. I currently eat no seeds grains legumes or nuts except for some white basmatic rice that I brought back in after 8 months. I recently brought (home made organic high quality) ghee in as well but that is my only dairy product. If you want to hear about my diet in more detail you could email me if you like. let me know on here if you are interested. I’m following this thread.
ps. try eliminating eggs. Eggs have proteins that can be triggering for SLE… and eczema.
Hello, I have what looks like eczema only one my face. Itchy rash that never goes away. It’s horrible. I think menopause could be a trigger? I used to have cystic acne and was on accutane 3 times in my life. My face was so bad that I have to be on Prednisone. I’m tapering after 7 days and the flares are coming back. I only eat organic and am in good shape. Never thought about rash/gut connection… This facial rash just came on last year and I was wondering if any women had this happen to them and what to do about it.
I had severe acne as a teen and it lasted well into my thirties. I saw a skin specialist that put me onto roacutane but I still suffered from both rosacea and outbreaks. I’ve been experimenting with eating half a cup of raw sauerkraut and taking probiotics in the last month and have already noticed a huge improvement in my skin.
I developed seborrhoeic dermatitis at 19 years of age. It was very severe and I lost most of my hair as doctors would not refer me to a specialist for something as “simple” as hair loss. I have had a great deal of abdominal surgery and it is now clear I have suffered from SBIO most of my life. I have always noted a one-to-one relationship between the health of my scalp and the health of my gut. I try probiotics but with limited success. Happy to hear of any other treatments for SBIO that might be recommended. Could you send me a copy of the Chinese research article?
The *only* truly noticeable side effect of a paleo-kefir (decently high fish) diet was improvement in skin condition. On a mostly vegetarian diet I was using hand lotion 15x a day, and less than a month after changing the diet “hey! I’m down to once a couple of days” and 5 years later, I use hand lotion maybe once every two or three months.
As you can tell from the above comments that reflect the rest of the medical field, there are many diseases that share certain similar symptoms. The cause of your skin problem may not be diet. I had a rash that turned out to be laundry detergent sensitivity. My daughter had a rash that was strep. Other kids have a rashfrom poison ivy. My Dad got a rash from yellow food dye. I would be extremely surprised if acne or dry skin had only single causes. Best wishes, don’t give up.