Updated April 4, 2019
One of the biggest motivations for clean eating is the longing to have good skin. People are looking for foods for healthy skin.
I get asked all the time if diet and nutrition has any real impact on skin health and skin appearance, a.k.a. a healthy skin diet.
In a word, YES!
Many people, of all ages, struggle with skin conditions such as acne, rosacea, dry skin, excess wrinkles, eczema, psoriasis and more.
Let’s face it, we all want to look the best we can and feel good about ourselves and our appearance. There’s nothing wrong with that. For those who struggle with skin health issues, it can be very upsetting when a solution to their problematic skin hasn’t been found.
Gut skin axis
The gut brain connection has been known about for decades but only now is it getting the attention, and legitimacy, it deserves. The health of your gut influences the health of your brain and vice versa. It really shouldn’t come as a surprise that gut health has an impact on other organs such as the skin.
In fact, over 70 years ago two dermatologists John H Stokes, and Donald M Pillsbury first suggested an overlapping connection between the gut, mood disorders such as anxiety and depression and skin conditions such as acne (1). The first leaky gut and acne connection theory was made!
Ahead of their time, by light years, they proposed that emotional stress (emotional states) might alter normal gut bacteria. This imbalance with gut microbiota increase intestinal inflammation and intestinal permeability (a.k.a. leaky gut), and contribute to systemic inflammation (whole body) .
One of the remedies proposed by them was to use Lactobacillus acidophilus, a common bacteria in cultured/fermented dairy foods at the time. They did, and used this probiotic with some success.
Gut health and skin conditions
Several lines of evidence have shown a connection between gut problems and common skin conditions.
A recent study found that those with rosacea were 10x more likely to have SIBO (small intestinal bacterial overgrowth) compared to those without rosacea. Eradication of the SIBO resulted in almost complete regression (elimination) of this common skin disorder (2). SIBO symptoms like rosacea are commonplace.
Inflammatory bowel disease
Similar findings have been found in those with inflammatory bowel disease (IBD). Between 15 and 20% of people with ulcerative colitis and up to 25 to 30% of those with Crohn’s will also have skin conditions.
A 2012 study demonstrated this unique connection between the skin and gut when a drug used to treat the skin disease psoriasis resulted in less disease activity in Crohn’s patients, a.k.a. improved their Crohn’s disease (3).
The gut skin connection doesn’t have to be explained to anyone with celiac disease (CD). The skin condition dermatitis herpetiformis (DH) is very common in those with celiac disease, about 25% have DH. The main treatment is the same treatment for CD; a 100% gluten free diet. The better controlled celiac disease is, the greater the improvement with DH (4).
Given the connection between the gut and the skin, many have theorized that gut dysbiosis may contribute to psoriasis. Both in terms of being a cause for it and for aggravating it. Even though psoriasis is one of the most studied immune-mediated inflammatory skin diseases, its pathogenesis is still not yet fully understood (5).
Like your digestive tract, skin bacteria play a role in the health and function of your skin as a main barrier to the outside world. Research has shown that the composition of the skin microbiota is related to many dermatological diseases including, but not limited to, psoriasis, atopic dermatitis, and acne vulgaris (6, 7).
Unfortunately, the direct link between the skin microbiota and the pathogenesis of psoriasis remains to be clearly established (5).
On the other hand, some evidence does suggest that gut bacteria may play a role in psoriasis. A fact of life is the fact that the intestines are home to a variety of microorganisms. These bugs release toxins such as lipopolysaccharide (LPS) which, if present in the blood stream in high enough amounts, is directly toxic to the liver and skin (8).
A robust and diverse gut bacterial population helps to maintain the gut barrier thereby reducing the risk for and improving psoriasis (9).
How does gut health affect your skin?
The gut provides a barrier between the interior of your digestive tract and your general circulation.
One layer of intestinal cells is all that separates the contents of your intestinal tract from the rest of you. Anything that irritates the lining of your gut can cause it to become inflamed.
Common gut irritants include food allergens (food allergies), alcohol, medications and antibiotics. Other contributors to gut irritation include common food ingredients of the modern diet like food additives and artificial coloring, as well as, food borne illness (a.k.a. food poisoning).
Diets low in fiber (especially prebiotic) and high in sugar, as well as, dysbiosis or SIBO also cause digestive issues and gut inflammation.
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When the gut gets irritated and inflamed, several things happen. The nerves that permeate the digestive tract are signaled to tell the body that war has been declared on the gut and it triggers the alarm bell. The body responds by ramping up the stress response to help ready the body to fight and no good fight can happen without a supercharged immune system.
Other consequence of gut irritation and inflammation is the loss of the tight barrier that normally keeps unwanted gut contents out of the circulation.
As a result, bacteria and other micro-organism can enter the blood stream, along with more bacterial endotoxin or LPS. Other immune system triggers that lip through the gut barrier include food proteins. All of which sets the stage for the immune system to go awry leading to systemic inflammation.
The innocent bystander in all of this?
Increased leaky gut, as evidenced by the increased levels of LPS, is more common in those with acne vulgaris. Studies have demonstrated that those with acne had higher levels of e coli endotoxin in their bloods compared to matched healthy controls (no acne) (10).
Leaky skin? Now I’ve heard everything
As I mentioned above, leaky gut has been know about for a looooooooooong time but leaky skin? Turns out stress and systemic inflammation can impair the integrity and protective role of your skin too.
When this happens, the skin produces less of the naturally occurring antimicrobial peptides (think anti-bacterial proteins) it normally makes as a first line defense. With weaken defenses skin infections can occur and worsen and weaken defenses will aggravate skin inflammation further (11).
Improving your skin via your gut
Considering how intimately the gut skin (and brain) are connected, good skin health and a great complexion can only be achieved when you take an integrative and functional approach. You need to consider all players and how they all work together.
As your largest organ, your skin needs as much TLC as any other body part that you care for. Good skin health needs to include good skin care, there’s no denying that, but it also needs to consider what’s going on in the inside.
This starts with your gut.
You need to minimize gut irritation and inflammation which requires looking at your food, beverage, supplement and medication use. You also need to assess your stress levels including sleep, consider any undiagnosed food allergies and do what you can to support a healthy gut bacteria population.
While eating nutritious food is important, it’s not what you eat but rather what you absorb that’s important when it comes to both skin and overall health.
This is why getting your gut health in order is priority number one. As the saying goes, you’re not what you eat, but what you absorb.
Only then can ensuring you’re getting enough of the skin-supporting nutrients vitamins A, C, E, K2, B3, B5 along with the minerals selenium, zinc, silica and sulfur and omega-3 fats make sense.
What about probiotics?
The gut skin axis, or connection, is further supported by the fact that probiotics have been shown to improve skin conditions.
One of the first observations dates back to 1961. Physician Robert Silver use the genus lacobacilli to treat various skin conditions. Those with acne had clinical improvement. Another example includes the addition of probiotics to usual care. The addition of actobacillus acidophilus and Bifidobacterium bifidum lead to better outcomes (12).
Acne improved in another study with the addition of a probiotic milk-based beverage fermented with lactobacillus over a 12-week period (13).
Probiotics may help because they improve various biomarkers involved in skin health, skin disorders and their treatment. Probiotics have shown to reduce pro-inflammatory cytokines and reduce levels of insulin-like growth factor 1 (IGF-1) (14, 15, 16, 17).
If you want to heal your skin, you have to heal your gut