Many of us have heard of the gut skin axis and are aware that if you are experiencing tell tale signs of digestive disturbances concurrent to a skin ailment there is likely a connection between the two. However the details of the actual link and how to proceed with dealing with the two entwined but separate health issues may be somewhat puzzling. I would like to demystify some common gut to skin connections, as to empower those with these concurrent issues to access preliminary treatment options and or further support where it’s needed.
Low Stomach Acid and Digestive Insufficiency
Digestion starts with stomach acid so it must be mentioned first, it is often not the whole picture of digestive disturbance but has a role to play in many digestive imbalances and concurrent skin issues. 90% of acne sufferers have been shown to have low stomach acid, the percentage is high in rosacea sufferers as well and in addition dermatitis has an established connection to increased pH or alkalinity in the stomach. We want the body as a whole to be alkaline but in the stomach acidity is key for optimal digestion trickling the whole way through the gastrointestinal tract (GIT). This acid also protects our GIT from infections, acting as a first line defence system to prospective pathogens looking to find a new home in your GIT causing dysbiosis. Low stomach acid or hypochlorhydria in the stomach also predisposes us to food allergies that cause eczema. If the stomach is lacking in acidic secretions we lack the cues for optimal enzyme production for digestion as well as bile release for fat breakdown, absorption and liver detoxification. If enzyme production is not adequate food proteins will lack the catalyst to be properly broken down and in some circumstances, allowed to slip through the gut lining to communicate with hyper vigilant immune cells in a large form that causes confusion to the gut immune system. Given the right genetic potential for immune dysregulation the result could be an acquired food sensitivity or allergy.
Ever heard the term leaky gut? This crude name for intestinal hyper-permeability sounds scary but is a very common situation, imbalances in the intestinal micro-biome, stress, alcohol consumption and medications can lead to a weakness in the structural integrity of the gap junction tissue lining the wall of the small intestine. This allows for compounds that should usually be monitored such as undigested food particles such as protein, toxins and even bacteria to pass through the intestinal wall and activate the immune cells as well as potentially entering the blood stream. This is why intestinal hyper-permeability allows food allergies and sensitivities to form. It’s also a source for toxicity and inflammation in the body in general and therefore connected to many other skin issues such as acne, psoriasis, rosacea and dermatitis. Leaky gut can also lead to a leaky skin barrier where local skin issues such as dermatitis occur. Research also suggests that in some cases leaky skin barrier may also affect gut barrier integrity.
This is why gut healing is so vital, it is however not enough to just focus on healing the gut lining without correcting the reason for the issue forming in the first place and it’s perpetuating factors. This can vary from person to person but often has a lot to do with microbiome imbalances, immune dysfunction and digestive insufficiency. In eczema and some dermatitis cases leaky gut and food allergies or sensitivities both occur concurrently therefore functional testing looking at all implicated food reactive antibodies rather then just the IgE true allergy reactions is essential to ascertain what foods are problematic. This is very different from your standard prick test. Once you know what foods are a problem for you leaving them out while you heal your gut lining means in some cases the food sensitivity can be reversed while also healing your skins inflammation this kind of testing is most easily accessed through nutritionists, naturopaths or integrative doctor who utilises functional testing.
Gut Flora Imbalances
Research into the gut-brain-skin connection over the last 75 years has clearly connected increased gut permeability due to inflammatory imbalances and changes in the intestinal micro-biome (diversity of microorganisms) to inflammatory skin conditions as well as mental health issues often occurring concomitantly to skin and gut conditions. The micro-biome in the gut is connected to that of our skin and imbalances in the gut can lead to altered skin immune function and changes in the skins micro-biome balance. The most common digestive disturbances today are classified under the irritable bowel syndrome (IBS) umbrella. Of this unexplained IBS 84% is in fact a condition called small intestinal bacterial overgrowth or just now being reclassified as SIBO and methane dominant intestinal overgrowth. We now have a strong research backed relationship between the occurrence of SIBO and acne as well as the inflammatory skin condition rosacea with 46-66% of rosacea sufferers testing positive for SIBO. We also now have a research confirmed improvement of rosacea with the treatment of this bacterial gut issue. Rosacea is also connected to Helicobacter (H. pylori) infection, a bacteria that lives in the stomach changing the pH to a more alkaline environment conducive to their healthy lifestyle and very unconducive to proper digestion. The effect of H. pylori on rosacea is due to it’s negative stimulation of the immune system causing production of a large number of inflammatory mediators, leading to the occurrence and aggravation of rosacea inflammation. These are a few widely researched connections between specific microbes and skin issues however many others exist for bacterial, yeast and parasite imbalances that are causing disharmony in skin conditions. Unfortunately there is no definitive way to really know the scope of what’s growing in your gut without a high quality functional stool test. Fortunately this testing is now available through a few specific labs. Deficiency in probiotics is however very common no matter the concurrent gut issues.
So if you experience digestive upsets even if they are mild and rosacea, acne, dermatitis and or eczema it’s worth thinking about how your gut dysbiosis is exacerbating your skins inflammatory state. This is also for all those avoiding lactose, fructose, gluten, legumes and polyols, your FODMAP foods, regardless of if you react to a few or all of them. SIBO or intolerances to these foods are caused by a treatable imbalance in bacteria and some times concomitant fungal overgrowth that must be resolved so you can reintroduce fresh produce into your diet and avoid secondary health issues such as skin complaints. Digestive disturbances no matter how mild they are or if they are maintained with dietary avoidances and supplements supplements may also indicate covert signs of gut imbalances causing havoc for your skin.
First Line Gut Support for Skin
Correct Your Stomach PH
A simple way of correcting a lowered production of stomach acid is though adding apple cider vinegar to meals as a dressing to salads or consuming 5tsp to 1tblspn in a small amount of water before breakfast and or dinner. This will also improve your protein digestion and absorption and support enzyme and bile production. Because apple cider vinegar has an alkaline ash it also aids in alkalising your system at large while acidifying the GIT, which is technically considered to be outside of the body. Only consume small amounts of water at meal times as to not dilute your vital gastric digestive secretions. Rinse teeth after consuming as the acidity is not ideal to sit on tooth enamel.
Healing Your Intestinal Lining
Slippery elm, glutamine, aloe vera, marmallow extract, curcumin, boswellia extract, zinc carnosine, vitamin D and vitamin A are all great nutrients for healing the gut barrier integrity. Many wonderful powdered products exist in Australia with varying nutritional and herbal ingredients to reduce inflammation while supporting repair of the intestinal barrier cells largely known as gut healing powders. If you have a medical condition or take medication it’s best to consult your GP or a naturopath before using these.
The one constant in all the functional stool tests I see is that we are deficient in probiotic bacterial species. The most widely researched of these being lactobacillus and bifidobacterium genus, generally speaking a mix of the two is best. Look for one that uses a variance in the number of researched species and contains a decent dose of positive flora (30+ billion), this differs if using a specific strain for a specific result. Consuming prebiotic with probiotics is the best way to establish a healthy colony in your intestines long-term. My favourite of these that is well tolerated is called partially hydrolysed guar gum. Most gut healing powders include prebiotic ingredients. You can also get these from food sources and should consume them daily if aiming for a therapeutic result.
If you react negatively to apple cider vinegar, probiotics, prebiotics or gut healing powder you should work with a naturopath to establish why this is, as it generally means you will need additional support for your gut and skin healing journey. If you have tried these therapies and have not seen the improvement you hoped for it’s best to also work with a practitioner as to evaluate your signs, symptoms, health history and potential functional testing to establish the root causes of your skin and digestive disturbances.