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Acne is More Than Skin Health - Part 1

Your Acne May Be a Reflection of Your Gut Health


“Try this cream”. “Take this pill”. “Don’t touch your face”. “Wash your pillowcase more often”. Are you tired of hearing these words of “advice” because you seem to have tried it all? If you struggle with acne, these suggestions are probably the LAST thing you want to hear. However, if you feel like you have tried everything, are generally healthy, and yet can’t seem to figure out the trigger for your skin condition, there’s something else to consider: the root cause may have less to do with your skin, and more to do with your gut health.

Acne is an increasingly common condition. In fact, 54% of women 25 and over have at least one type of facial acne.[1] Although acne is not life-threatening, if you are an acne sufferer, you know that it is a contributor to significant psychological disability! Acne affects self-esteem, social functioning, and self-confidence. Those with acne have higher rates of clinical depression and anxiety, anger, and even suicidal thoughts.[2]

There is one aspect acne of that is not discussed in the mainstream narrative: acne sufferers are at a higher risk for digestion-related conditions including constipation, bloating, bad breath, and acid reflux.[3] Additionally, people with acne have a significantly different gut microbiome compared to acne-free people.[4], [5] This shows that acne is closely tied to what is happening in our gut – and if you suffer from acne, you may want to explore your gut health!

This blog series will take you through an overview of acne and how it connects to our gut, as well as three common gut imbalances that may be the underlying cause of your acne. If you feel like you are at a loss with getting rid of your acne, keep reading! Let’s figure out if your gut health is the missing piece of the puzzle.

Gut and Skin Microbiome

If you follow wellness trends, you know that there has been a lot of talk about the microbiome. The gut microbiome is the trillions of microbes that reside in our small and large intestines. Most microbes are beneficial to the human body, but some can be pathogenic (meaning they promote disease). If you have a healthy balance, both the good and the bad microbes can co-exist. However, infections, certain diets, and long-term antibiotic use can disrupt the delicate balance and cause dysbiosis. With dysbiosis, the body may be more susceptible to disease, while a healthy microbiome will provide protection from pathogenic organisms.[6]

The first thing we might think of in relation to the microbiome is the gut, but our skin also has its own microbiome (also called the skin flora). Our skin acts as a physical barrier to protect us from the outside world, while the skin microbiome protects us from infections by fighting off pathogens and supporting our immune system.[7] External factors such as the use of soaps, cosmetics, oral and topical antibiotics, humidity, and sun exposure can cause an imbalance in the skin microbiome.[7] Because the skin microbiome is key in protecting us, it should not be a surprise that an imbalance in the skin bacteria is thought to cause or aggravate skin conditions![8]

So how does the gut microbiome connect with the skin microbiome? What is the relationship between these two seemingly separate systems?

Gut-brain-skin axis

“Skin is often referred to as the external reflection of what is happening in the GI tract.

If the gut is inflamed, the skin may be inflamed”[9]

As it turns out, anything that damages your gut microbiome will also influence what’s happening on the skin![10] The “brain-gut-skin theory” was first described in 1930 when emotions such as worry, anxiety, and depression caused changes in the gut microbiome. It was proposed that these gut microbiome changes promote inflammation throughout the entire body [7], including inflammation of the skin.[11] The “skin-gut axis” is an emerging idea that the gut microbiome influences skin health![12]

Diet and Acne

There is growing evidence that diet plays an important role in acne. There is no better way to change the health of your microbiome that to make specific shifts in your dietary choices.[1] However, it is important to determine if the acne is caused by the direct effects of food on the skin, or the food’s effect on the intestinal microflora.

This is where our gut imbalances come in! It might be more important to consider how the food we consume affects our intestinal microflora, since there is clinical evidence that suggests a close relationship between a disrupted gut microbiome and skin conditions.[12] And guess what? Most acne sufferers have an altered gut microbiome.[3]


So how does a gut imbalance end up expressing through the skin? I’ll cut to the chase and tell you the (very vague) root cause of acne: inflammation. I know, you may have been hoping for something more extraordinary, or maybe something more quantifiable. Turns out, inflammation is present early in the process of acne development.

Let’s talk about inflammation. Inflammation has two sides – it is both good and bad. The good type of inflammation is our body’s natural healing mechanism to help us recover from illness or injury (e.g. a scraped knee or a virus). The problem arises when inflammation is chronic – if the immune system is permanently running, the inflammatory substances begin to harm healthy cells throughout the body. Furthermore, this inflammation does not stay in one place. The bloodstream allows the inflammation to spread to every part of the body making it systemic.[1]

This is why it’s important to look into sources of systemic inflammation. Any type of systemic inflammation can manifest as skin conditions. Each person’s underlying vulnerabilities and genetics[13] will determine what kind of skin condition appears – some may be prone to acne or rosacea, while someone else can might struggle with psoriasis or eczema.[1]

Some of the sources of systemic inflammation that can lead to acne include[9]:

  • Dysbiosis (disrupted gut microbiome) – e.g., gut fungal infections, parasites, small intestinal bacterial overgrowth (SIBO)

  • Leaky gut

  • Food allergies/sensitivities

  • Infections – H. pylori, gut infections

  • High sugar/carb diet

  • Exposure to toxins, heavy metals, molds

  • High intake of inflammatory fats

Do you see a pattern here? Everything has to do with our gut health or what we ingest!

Other causes of acne

Before we dive deeper into the connection between gut health and acne, I do want to point out that there are many other contributors to acne, such as insulin resistance, sex hormone imbalances, and non-gut sources of inflammation. This blog series will focus on gut microbial dysbiosis as the cause of acne, but it’s important to note that these other contributors are related to chronic stress, increased sebum production, poor detoxification, hormone imbalances, and more - all of which can also lead to acne.

Additionally, there is an entire body of research focused on external methods for skin health through supporting a proper pH, a balanced and diverse skin microbiome, avoiding excessive use of topical antibiotics, and reducing external sources of inflammation (over-drying, cosmetics, bacteria, etc.).[9] Supporting the healthy skin microbiome externally is also a crucial part of the puzzle when tackling acne.

In this blog series, we are going to learn about the symptoms, causes and therapeutic protocols of three common sources of inflammation that originate in the gut and can lead to acne: SIBO, Leaky Gut and Food Sensitivities. But before we learn more about these gut conditions, the next blog post will discuss how inflammation impacts the skin. As I mentioned, inflammation is at the core acne. Let’s learn what it is, how it affects our skin, and what we can do about it.

Do you know someone struggling with acne who also has digestive issues? Share this blog post series to help them discover the connection between skin and gut health!



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[1]Bowe W, Loberg K. Dirty Looks: the Secret to Beautiful Skin. New York: Little, Brown Spark; 2019. [2] Rubin MG, Kim K, Logan AC. Acne vulgaris, mental health and omega-3 fatty acids: a report of cases. Lipids Health Dis. 2008;7:36. Published 2008 Oct 13. doi:10.1186/1476-511X-7-36 [3] Bowe W, Patel NB, Logan AC. Acne vulgaris, probiotics and the gut-brain-skin axis: from anecdote to translational medicine. Benef Microbes. 2014;5(2):185-199. doi:10.3920/BM2012.0060 [4] Volkova LA, Khalif IL, Kabanova IN. Vliiane disbakterioza kishechnika na techenie vul'garnykh ugreĭ [Impact of the impaired intestinal microflora on the course of acne vulgaris]. Klin Med (Mosk). 2001;79(6):39-41. [5] Deng Y, Wang H, Zhou J, Mou Y, Wang G, Xiong X. Patients with Acne Vulgaris Have a Distinct Gut Microbiota in Comparison with Healthy Controls. Acta Derm Venereol. 2018;98(8):783-790. doi:10.2340/00015555-2968 [6] The Microbiome. The Nutrition Source. Published 2020. Accessed November 11, 2020. [7] 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 [8] Palm NW, de Zoete MR, Flavell RA. Immune-microbiota interactions in health and disease. Clin Immunol. 2015;159(2):122-127. doi:10.1016/j.clim.2015.05.014 [9] Considerations in the Causes and Treatment of Acne (webinar lecture). The Great Plains Laboratory, Inc. Released October 31, 2020 2020. Accessed November 9, 2020. [10] Salem I, Ramser A, Isham N, Ghannoum MA. The Gut Microbiome as a Major Regulator of the Gut-Skin Axis. Front Microbiol. 2018;9:1459. Published 2018 Jul 10. doi:10.3389/fmicb.2018.01459 [11] Clark AK, Haas KN, Sivamani RK. Edible Plants and Their Influence on the Gut Microbiome and Acne. Int J Mol Sci. 2017;18(5):1070. Published 2017 May 17. doi:10.3390/ijms18051070 [12] Vaughn A, Notay M, Clark A, Sivamani R. Skin-gut axis: The relationship between intestinal bacteria and skin health. World Journal of Dermatology. 2017; 6. 52-58. 10.5314/wjd.v6.i4.52. [13] Zeichner JA, Baldwin HE, Cook-Bolden FE, Eichenfield LF, Fallon-Friedlander S, Rodriguez DA. Emerging Issues in Adult Female Acne. J Clin Aesthet Dermatol. 2017;10(1):37-46.



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