ACNE & LEAKY GUT
Studies have shown that leaky gut is an issue for many acne patients.[1] Leaky gut, also called intestinal or gut permeability, is an increase in the permeability of the intestinal barrier, which could allow bacteria, toxins, and small molecules to ‘leak’ from the digestive tract into the bloodstream.[2] When functioning correctly, the intestinal barrier stops microorganisms, toxins, and large food particles from getting into our blood, but this barrier must also absorb essential fluids and nutrients.[3] This is how we get nutrients from our food into our body! However, when foreign substances like undigested food particles get through the barrier, they challenge the immune system to produce an immune response, leading to inflammation and oxidative stress.[4] As we discussed in a previous blog post, inflammation and oxidative stress are key factors in acne development!
Symptoms of Leaky Gut
Since leaky gut is not yet widely recognized by conventional medicine, there is no set diagnostic criteria. The signs of leaky gut can include[5]:
Digestive issues such as bloating, abdominal pain, constipation
Brain issues such as depression, anxiety, brain fog
Low energy, especially after meals
Joint pain and inflammation
Skin conditions like acne, eczema, dermatitis herpetiformis
Autoimmune disorders like Rheumatoid Arthritis, Celiac, Fibromyalgia, Food Allergies
Causes of Leaky Gut
Leaky gut can be caused by numerous diet and lifestyle factors. It is not necessarily a specific disease, but rather a side effect of other digestive issues. There are many underlying causes of leaky gut that can be related to diet, lifestyle, and gut health.
Diet related:
Poor diet and inflammatory foods – foods that are high in sugar and processed generally increase inflammation and will create intestinal damage. Additionally, food sensitivities and allergies can contribute to leaky gut [5]
Gluten – the proteins in gluten-containing foods have been shown to increase zonulin levels. Zonulin is a protein that increases intestinal permeability.
High alcohol consumption[6] – drinking alcohol increases endotoxins, which increase zonulin production and increases leaky gut[7]
Lifestyle related:
Stress[8] – stress can increase cortisol and other stress hormones that contribute to leaky gut.
Poor sleep[9]– chronic poor sleep hygiene (going to be late, waking early, insomnia) can impact gut health and lead to intestinal permeability
Use of NSAIDs[10] – non-steroidal anti-inflammatory drugs (e.g. Ibuprofen (Motrin, Advil) and Aspirin) can increase intestinal permeability
Antibiotics – antibiotics can negatively affect the gut bacteria populations, which can lead to leaky gut [5]
Gut-health related:
Intestinal dysbiosis – dysbiosis can be contributor to leaky gut by triggering the release of zonulin. Dysbiosis also reduces the protective mucous layer in the large or small intestine.[5] SIBO, a form of dysbiosis, has been associated with leaky gut, and it has been shown that eradicating SIBO by antimicrobial treatment can help restore the healthy intestinal barrier (i.e., leaky gut)[11]
How can I find out if I have Leaky Gut?
There are a few tests that can be used to determine if you might have leaky gut:
Lactulose-mannitol testing – this is the recognized standard for testing leaky gut. It requires to take urine samples after drinking a mannitol/lactulose mixture. Newer tests are simpler to do and are replacing the lactulose/mannitol test[7]
Zonulin testing - Zonulin is considered a marker of an impaired gut barrier.
Bacterial lipopolysaccharides (LPS) – LPS is something that is released when bacteria die, but these LPS are typically too big to cross over the lining of the small intestine to get into the bloodstream. However, if the gut is “leaky” some LPS can get through, so their presence indicates possibility of leaky gut[12]
Food sensitivity testing – if a high number of foods come back reactive, or if foods that you eat every day are reactive, leaky gut can be assumed (learn more about food sensitivity testing in the next blog post)[7]
Therapeutic protocols
The best strategy to improve leaky gut is to reduce gut inflammation and support digestive health. The timeline of healing is different for everyone, but leaky gut can improve in just a few weeks! Ideally, when suffering from leaky gut, it is important to stop the triggers that perpetuate the problem (see causes above). Overall, the right diet, lifestyle habits, and important nutrients can help improve leaky gut by reducing gut inflammation.
A diet to support the gut barrier would:
Avoid the energy-dense Western-style diet[3] high in industrial seed oils (e.g., canola, corn, cottonseed, soy, safflower), junk food, processed snacks, artificial sweeteners, and other low-quality foods
Include prebiotics/fibers[3] – these will help feed the good gut flora
Include probiotics[4] and probiotic-rich foods[7], such as kefir, kimchi and sauerkraut
Include glutamine supplementation (also called L-glutamine)[3] – glutamine is an amino acid and the fuel source for cells of the small intestine, so it is an important nutrient in repairing leaky gut[7]
Include gut-soothing foods such as okra, licorice tea, slippery elm tea, and marshmallow root tea[7]
Typically, a leaky gut diet is an anti-inflammatory diet that focuses on healthy, whole foods that you do not react to. There is no ONE diet that everyone should follow for leaky gut. Instead, it is a unique diet to each person. It is important to note that even a healthy diet could cause reactions if there are other underlying conditions in addition to leaky gut, e.g., a bacterial overgrowth like SIBO, or food sensitivities. Therefore, it is recommended to work with a qualified professional to assess if there are other conditions and how a slightly adjusted diet can benefit you best!
Below are some example diets that offer guidelines for addressing leaky gut.
Modified Mediterranean diet
Regardless of which diet one may choose while addressing leaky gut, the key is to include healthy, whole foods. The Mediterranean diet is a popular solution to supporting microbiota diversity and stability[13], thus it can be a great baseline for leaky gut. This diet is centered around fruits, vegetables, olive oil, nuts, legumes, fatty fish, and whole grains. It promotes regular consumption of healthy oils, polyphenols and other antioxidants from plants, a high intake of prebiotic fiber and low-glycemic carbohydrates, and greater consumption of plant proteins than animal proteins.[13] Overall, the Mediterranean diet is one where people can comply more easily making it a great starting point for leaky gut sufferers.
A gluten-free diet
Gluten has shown to increase zonulin, and zonulin increases intestinal permeability. Avoiding gluten sources may be helpful in reducing leaky gut. Regardless of what type of diet is followed for leaky gut, it is strongly suggested that all forms of gluten are removed (wheat, barley, rye, spelt, and kamut).[5]
Low FODMAP diet
Foods that are high in FODMAPs could feed the bad gut flora and make leaky gut worse. A strict low-FODMAP diet may not be necessary, but if a gut-healing protocol still present symptoms, this diet can be considered.[14]
Paleo
The Paleo diet is an anti-inflammatory diet that focuses on whole, nutrient-dense foods, including veggies, healthy fats, and clean proteins. There are some differences between the Paleo diet and Mediterranean: paleo is free of grains and dairy products, is gluten-free and is relatively low in carbs. The paleo diet focuses on including bone broths and fermented foods (such as sauerkraut, kimchi, and kombucha).
Elemental Diets
If you are starting with very severe digestive issues, an elemental diet may be helpful short-term. These diets have shown to decrease leaky gut in weeks[5]! An elemental diet is sold in powder form – it is a complete meal replacement that you drink as a shake, and it allows your digestive tract to rest. An elemental diet has been shown to decrease intestinal inflammation and digestive health problems in many studies.[15]
Do you think that leaky gut could be the underlying cause of your acne? Remember: leaky gut is not necessarily a specific disease, but rather a side effect of other digestive issues. It is crucial to make diet and lifestyle choices that support our gut health! In the next blog post, we will learn more about how food sensitivities are connected to gut health and how they could be an underlying factor in your acne.
Running a food sensitivity test is a common method to determine if leaky gut is an issue– connect with me on a 15min FREE discovery call to see if running a food sensitivity test would be helpful for you!
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REFERENCES
[1] Bowe WP, Logan AC. Acne vulgaris, probiotics and the gut-brain-skin axis - back to the future?. Gut Pathog. 2011;3(1):1. Published 2011 Jan 31. doi:10.1186/1757-4749-3-1 [2] Obrenovich MEM. Leaky Gut, Leaky Brain?. Microorganisms. 2018;6(4):107. Published 2018 Oct 18. doi:10.3390/microorganisms6040107 [3] Bischoff SC, Barbara G, Buurman W, Ockhuizen T, Schulzke JD, Serino M, Tilg H, Watson A, Wells JM. Intestinal permeability--a new target for disease prevention and therapy. BMC Gastroenterol. 2014 Nov 18;14:189. doi: 10.1186/s12876-014-0189-7. PMID: 25407511; PMCID: PMC4253991. [4] Lamprecht M, Bogner S, Schippinger G, et al. Probiotic supplementation affects markers of intestinal barrier, oxidation, and inflammation in trained men; a randomized, double-blinded, placebo-controlled trial. J Int Soc Sports Nutr. 2012;9(1):45. Published 2012 Sep 20. doi:10.1186/1550-2783-9-45 [5] Ruscio M. How To Heal Leaky Gut. Dr. Michael Ruscio, BCDNM, DC. https://drruscio.com/how-to-heal-leaky-gut/. Published April 20, 2020. Accessed December 1, 2020. [6] Bishehsari F, Magno E, Swanson G, et al. Alcohol and Gut-Derived Inflammation. Alcohol Res. 2017;38(2):163-171. [7] Lipski E. Digestive Wellness : Strengthen the Immune System and Prevent Disease through Healthy Digestion. Mcgraw-Hill; 2020. [8] Vanuytsel T, van Wanrooy S, Vanheel H, et al. Psychological stress and corticotropin-releasing hormone increase intestinal permeability in humans by a mast cell-dependent mechanism. Gut. 2014;63(8):1293-1299. doi:10.1136/gutjnl-2013-305690 [9] Swanson GR, Burgess HJ. Sleep and Circadian Hygiene and Inflammatory Bowel Disease. Gastroenterol Clin North Am. 2017;46(4):881-893. doi:10.1016/j.gtc.2017.08.014 [10] Utzeri E, Usai P. Role of non-steroidal anti-inflammatory drugs on intestinal permeability and nonalcoholic fatty liver disease. World J Gastroenterol. 2017;23(22):3954-3963. doi:10.3748/wjg.v23.i22.3954 [11] 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 [12] Erica Julson, Richter A. How to Test for Leaky Gut. Functional Nutrition Answers. https://www.functionalnutritionanswers.com/how-to-test-for-leaky-gut/. Published February 14, 2019. Accessed November 14, 2020. [13] Rinninella E, Cintoni M, Raoul P, et al. Food Components and Dietary Habits: Keys for a Healthy Gut Microbiota Composition. Nutrients. 2019;11(10):2393. Published 2019 Oct 7. doi:10.3390/nu11102393 [14] Ruscio M. Leaky Gut Food List. Dr. Michael Ruscio, BCDNM, DC. https://drruscio.com/leaky-gut-food-list/. Published May 9, 2020. Accessed December 10, 2020. [15] Ruscio M. Leaky Gut Diet Plan. Dr. Michael Ruscio, BCDNM, DC. https://drruscio.com/leaky-gut-diet-plan/. Published April 27, 2020. Accessed December 10, 2020.