Fix The Inside, Get Sexy Outside.
Exploring the Gut-Skin connection.
Let me ask you all a question: Would you like to relive puberty? Unless you’re one of the lucky ones who thrived during their hormonal roller coaster, most of you would probably say no. Reflect with me here, the voice changes, growing hair in places you weren’t used to, and my personal favorite, acne. I can’t imagine what it’s like for young children now with acne, scrolling through social media and seeing how perfect and clear-skinned everyone’s face looks.
I went to several dermatologists growing up for my acne issues. I remember trying all sorts of creams, topical antibiotic gels, and eventually, Accutane. I had to switch dermatologists in order to get a prescription for Accutane, because the first one I saw didn’t feel comfortable prescribing it. Now I know why (topic for another article). I don’t remember nutrition or lifestyle being brought up much, let alone the impact that gut health could have had on my skin. If only I had known that the best way to fix my skin issues, was to fix my gut issues.
Gut-Skin Connection
I’ve written previously about the gut-brain connection, and the gut-joint connection, but the gut-skin connection was always one of the more fascinating ideas. First off, the skin and gut both serve as barriers to protect us from pathogens making their way into the body. Skin being a barrier seems obvious; it’s literally our outer coating. The gut takes a little more thought; food and liquid we consume, along with whatever bacterial residue still present on it, has to pass through and get absorbed from our gastrointestinal tract before it has the chance of making it into our body.
Both the skin and gut have their own unique microbiome. Many of you have likely become familiar with the term “Gut Microbiome,” but not as many may know that our skin has its own microbiome, one that looks very different than the one in our gut. In contrast, if you were born via c-section, there’s a chance you got some of your gut biome from your mothers’ skin biome (1). The bacteria on our skin are partly responsible for our skin’s protective effect, helping fight off bad bacteria that try to colonize.
Skin Bacteria
The bacterial species within our skin thought to be responsible for acne formation is called Cutibacterium acnes (C. acnes). C. acnes is concentrated in the face and scalp, part of the reason for acne being so prevalent on the face, thanks evolution. It’s actually considered a commensal member of our skin bacteria, meaning it’s normal for it to be there. If it’s normal for it to be there, why doesn’t it cause acne in everyone? A) It actually might, as roughly 85% of adolescents and young adults are affected by acne, and if you’re reading this, you’ve likely been an adolescent or young adult in your life (2). B) What makes acne worse is the presence of inflammation and the abnormal growth of skin cells associated with puberty.
What’s the cause of the inflammation? Well, party, the overgrowth of certain C. acnes strains. Even though it’s a normal member of the skin bacteria, some strains are more harmful than others. Saying multiple “strains” of bacteria act differently is like saying two different German Shepherds act differently. Some unfortunately may grow up in abusive households, while others are cherished and loved by their owners. When harmful strains are allowed to overgrow, problems, aka acne, can arise. This begs a deeper question: What’s causing these different strains of C. acnes to outgrow the other guys?
Let’s Speculate
There’s no scientific consensus on what’s causing C. acnes to overgrow and cause acne, so I’m going to speculate here. We know that inflammation plays a role in the formation of acne, and we know that having gut dybiosis (not enough good bugs and/or too many bad bugs) can contribute to inflammation. What’s causing gut dysbiosis? Long-term antibiotic use, poor dietary habits, obesity, the extremes of exercise (too much or too little), chronic stress, and certain gut infections (H. Pylori, Candida, SIBO, etc).
Poor Diet, Mis-managed Stress, Exercise Extremes, Long-term antibiotic use, Gut Infections = Gut Dysbiosis = Inflammatory State = Acne Formation.
If the root cause of the inflammation is stemming from an issue in the gut, supporting the gut with probiotics, a nutrient-rich diet, stress management tactics like meditation and gratitude, and in certain cases, herbal antimicrobials may be used to help with the infection. I don’t think we should completely discount traditional western medicine either, in some cases, a short-term course of antibiotics may be needed to eradicate a gut infection.
I’m a big fan of using probiotics to improve overall gut health. Probiotics could also be a great support option for acne. As we talked about before, acne is partly driven by an overgrowth of harmful bacterial strains, and probiotics have antibacterial properties, so theoretically probiotics could help “kill-off” the harmful strains. Certain probiotic strains, in the lab setting, can be effective at preventing C.acnes from growing. Some human data has shown that topical probiotics may reduce the severity of acne (3).
Closing Thoughts
My childhood dermatologist always told me that if I kept “picking at my acne,” it would leave scars. He was right about one thing, scars are easy to come by. But not the physical manifestation of scars, rather the psychological scars. Everytime I get a new zit or acne flare-up, I’m reminded of my time in late middle-school and early high-school. My face was covered with so much acne it was hard to tell where my skin actually was. We all know how forgiving middle schoolers are as well…not exactly memories I want to relive.
I think back to my lifestyle at that time: eating whatever I wanted, staying up late to watch TV, not really drinking that much water, having zero stress-management tactics, and also not the best personal hygiene. All of these factors likely set the stage for my gut to be inflamed and my acne to thrive. Don’t neglect the personal hygiene aspect either, sometimes skin outbreaks could be the result of you not showering after a workout or not washing your pillow case for 6 months.
The “non-sexy” pillars of health: sleep, exercise, diet, stress management, and purpose, would have gone, and currently do go, a long way in regards to keeping my face clear. Your external health is a manifestation of what’s going on with your internal health.
If you are currently struggling with acne and could use some lifestyle strategies, I highly encourage you to seek out a Functional Medicine Practitioner, one who will help get to the root cause of where your inflammation is coming from.
As always, Trust in Your Gut.
Disclaimer: The contents of this article are for educational purposes only, and are not intended to diagnose or treat any condition. Do not apply any of the information in this article without first speaking with your doctor.
Text-References
- Rinninella E, Raoul P, Cintoni M, Franceschi F, Miggiano GAD, Gasbarrini A, Mele MC. What is the Healthy Gut Microbiota Composition? A Changing Ecosystem across Age, Environment, Diet, and Diseases. Microorganisms. 2019; 7(1):14. https://doi.org/10.3390/microorganisms7010014
- Xu H, Li H. Acne, the Skin Microbiome, and Antibiotic Treatment. Am J Clin Dermatol. 2019;20(3):335–344. doi:10.1007/s40257–018–00417–3
- Lee YB, Byun EJ, Kim HS. Potential Role of the Microbiome in Acne: A Comprehensive Review. J Clin Med. 2019;8(7):987. Published 2019 Jul 7. doi:10.3390/jcm8070987
