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Our “gut health” remains one of the hottest topics under the broad umbrella that is all about wellness, and for good reason: The makeup of your gut microbiome, and all the “good” and “bad” bacteria that thrive in it, is connected to almost everyone else’s health factor including immunity, mental healthour environment, drug history, etc.
One connection between the gut and health that researchers are observing is the gut-skin axis. The reasons why skin problems often go hand in hand with gut problems are not fully understood.
“There are many diseases that overlap between the gut and the skin,” said Dr. Hadar Avihai Lev-Tov, a board-certified dermatologist and assistant professor of dermatology at the University of Miami’s Dr. Philip Frost Department. Dermatology and skin surgery. “The question is always, what is the root of this relationship?”
Some of these roots grow from the depths of our gut microbiome and, more importantly, from an imbalance or lack of diversity within it called “dysbiosis,” according to Niket Sonpal, MD, a gastroenterologist and clinical assistant professor at Touro College of Osteopathic Medicine. And as is true of many things about your health, the effects don’t stay confined to one organ or system—the gut, in this case.
“There are some studies that show that the gut microbiome in acne patients is actually less different and less diverse than those who don’t have acne, so we know that plays a role,” Sonpal noted, adding that there is also a relationship. between how the microbiome can affect the immune system and its responses in people with other conditions such as eczema.
However, he said the “exact mechanism” of how skin health may be linked to gut health is still unclear.
“It’s so diverse and the microbiome is as unique as each individual,” Sonpal said.
Here’s what we know today.
Acne, gut health and a limited number of acne treatments
Acne vulgaris is a common skin condition that occurs when hair follicles become blocked—it occurs in about 85 percent of adolescents, according to the American Academy of Dermatology, and continues into adulthood for many people.
Although acne has a variety of causes and varies in severity (some people’s acne may be mostly due to hormonal reactions, for example, while other cases may be more limited or aggravated by skin care products or sweat), people with acne may be more likely to experience intestinal problems such as irritable bowel syndromeaccording to one preliminary study from 2020 form Turkey. The researchers found that IBS was “significantly” more common in patients with acne than in those without.
Sonpal says “the majority” of his consultations are for irritable bowel symptoms, and he notices an overlap between them, the presence of acne, and other potentially gut-related symptoms, including fatigue. Asked why IBS is so common (between 10% and 23% of adults worldwide have IBS, according to a 2022 estimate), Sonpal pointed to a Western diet heavily reliant on processed foods, a lack of fiber and too many antibiotic prescriptions as some potential factors.
However, the relationship between gut health and skin is not one-way, and antibiotic use is another point where skin health and gut health can merge. Antibiotics are usually prescribed as a treatment of some cases of acne and approved by the AAD for short-term use. But since there is a well-known relationship between acceptance antibiotics and disruption of the gut microbiome (antibiotics kill the bacteria, including the “good” ones) in your gut), this means that people with acne may end up with gut health consequences if they are prescribed antibiotics as treatment.
Lev-Tov acknowledges the gut upset that comes from taking antibiotics, as well a public health problem with antibiotic resistance this comes from too many people being prescribed too many antibiotics. But he says that for some acne patients, antibiotic treatment is the best course of action, as many cases can cause pain, skin breakouts and generally impair someone’s quality of life. Antibiotics, for all their gut-wrecking properties, can help greatly.
“They need treatment and they deserve it,” says Lev-Tov, adding that dermatologists are limited in their ability to treat acne patients. For people with acne who benefit from treatment, avenues are mostly limited to drugs that block androgenic hormones such as testosterone (birth control pills and spironolactone); isotretinoin or Accutane (which according to Lev-Tov is highly regulated due to the risk of birth defects if taken during pregnancy); and some antibiotics.
“I would like the lesson from this to be that we need more innovation,” says Lev-Tov.
Read more: Who Should Take Probiotics for Gut Health?
Sourdough is one of the many foods that are good for the gut. (And potentially your skin.) See a list of 12 foods to get you started here.
Eczema, gut health and the role of the immune system
Some people with eczema can potentially reduce their symptoms or flare-ups by make changes to their diet, one of which involves adding probiotics or gut-friendly foods. According to Zoe, a health sciences company that studies gut health, the most common type of eczema (atopic dermatitis) can be linked to gut health because of the way the gut microbiome affects the immune system, which then affects skin inflammation and sensitivities like eczema.
Some studies have found that people with atopic dermatitis have higher or lower amounts of certain types of gut bacteria, according to Zoe.
The idea behind this is that microorganisms in the gut “cause an excessive amount of certain types of white blood cell responses,” Sonpal explained. “And those white blood cells react to a chemical that’s in the gut, and that chemical causes them to fight the barrier,” which in some cases leads to skin reactions.
A more severe consequence of the gut microbiome causing skin problems is in the case of patients with hidradenitis suppurativa (HS), a non-contagious skin and immune condition that often causes painful patches where skin rubs against skin, such as the armpits or groin. Lev-Tov, who is the president of XS Foundationsays that experts know that HS is linked to irritable bowel disease and that “improving the gut microbiome can actually help prevent the disease.”
‘Feels Like Hogwarts at Whole Foods’: What to Eat for Happy Skin and a Healthy Gut
While experts continue to work on solutions for the gut-skin axis, the simplest tool at our disposal to improve gut health may be adding the right foods to our diet. According to Sonpal, the first thing to do if you suspect your gut health is responsible for your skin condition is to take stock of your diet: Is it varied enough? Are you getting enough fruits, vegetables and plant-based foods compared to processed foods?
Naturally occurring prebiotics and probiotics are abundant in delicious natural foods like yogurt, sauerkraut, and more, and simply adding these foods to your diet can improve your health, especially if your diet doesn’t include a broad enough picture of all the “good” bacteria out there that your gut craves to maintain its microbiome. This means you don’t have to buy an expensive bottle of pre- or probiotics. Comparing supplements and marketed health foods to “potions” and “magic elixirs,” Sonpal says it’s easy to feel discouraged while walking down the grocery aisle.
“You feel like you’re in Hogwarts at Whole Foods,” Sonpal said. “This is extremely overwhelming.”
“A very simple sauerkraut that’s extremely cheap is just as good as that ‘million dollar’ pill in the freezer that costs extra,” Sonpal said.
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