The link between gut health and acne

Medically reviewed words Annie Hayes, Dr Louise Wiseman MBBS, BSc (Hons), DRCOG, MRCGP
Photo credit: Westend61 - Getty Images

From Netdoctor

As those with acne-prone skin know all too well, there’s no one-size-fits-all approach to treating and preventing breakouts. This can be incredibly frustrating and often people feel as though they’ve tried every skin-clearing cleanser, cream, tincture and treatment going.

Advances in research of the gut microbiome – the collective name for the trillions of microbes, or bacteria, that reside in your gut – have enabled scientists to examine the link between gut health and acne more closely than ever before. Their findings indicate we should look to the contents of our dinner plates, rather than our bathroom cabinets, in search of a remedy.

We speak to doctors, nutritionists and microbiome experts about the link between gut health and acne, pre- and probiotics, and which foods are best for boosting your gut health.

Does gut health and leaky gut affect skin?

The intimate relationship between your skin – your body’s largest organ – and the microbes that live in your gut is referred to as the ‘skin-gut axis’. ‘Both are important organs for keeping the body in a stable state and protecting against the invasion of infectious organisms,’ explains Dr Aisling Dwyer, gut microbiome expert at OptiBac. ‘Often people with gastrointestinal illnesses such as inflammatory bowel disease have corresponding skin issues, which shows how closely linked gut health and skin health are.’

While this relationship works both ways, the gut microbiome is the key regulator. ‘Gut microbes help to maintain the intestinal barrier, which limits bacterial by-products, undigested proteins and toxins from entering your blood circulation and potentially reaching the skin,’ explains Claire Barnes, nutritional therapist at Bio-Kult. The barrier has to open naturally to let nutrients through after a meal. In this way it is normal for the gut to 'leak'. But when there is an imbalance between beneficial and harmful bacteria that live in our gut – called dysbiosis – the barrier is weakened.

‘Dysbiosis can lead to inflammation and the release of inflammatory messengers called cytokines, which can contribute to the development of acne,’ Dr Dwyer explains. ‘This inflammation can also damage the lining of the gut, allowing the bacteria to pass from the gut through the bloodstream to the skin, where it can locally affect skin health, enabling the growth of bacteria that can trigger acne.’

The byproducts that are produced by our gut microbes also have the potential to alter skin microbes, says Barnes. ‘In a healthy gut, these by-products could have beneficial effects on our skin, whereas gut dysbiosis and ‘leaky gut’ could increase harmful by-products into the circulation and promote the overgrowth of harmful skin bacteria such as Cutibacterium acnes,’ she says.

The link between gut health and acne

Many inflammatory skin conditions have been directly linked to disruptions in gut microbes, including acne, rosacea and eczema psoriasis. While poor gut health is unlikely to be the sole cause of the development of acne, digestive issues are more common in those with acne than those without, says Dr Dwyer.

Acne occurs when excess skin cells line the inside of a hair follicle, blocking sebum from being excreted. This allows bacteria to grow, eliciting an inflammatory response from your body’s immune system. Interestingly, approximately 70 per cent of your body’s immune cells reside in the gut, where they are influenced by the gut microbiome.

‘Certain beneficial strains of microbes appear to stimulate more calming immune cells, which could help to regulate the immune system throughout the body including the skin,’ says Barnes. ‘Whereas more harmful microbes can lead to an immune reaction, increasing inflammation both within the gut and potentially elsewhere in the body.’

When it comes to ascertaining whether your gut health could be a contributing factor, it’s down to trial and error, says Dr David Jack, skincare specialist at Harley Street. ‘If you have acne, it might be worth trying to increase your intake of prebiotic foods – the foods that the ‘good’ gut microbes like to eat – and also taking a probiotic supplement (i.e. the bacteria themselves),’ he suggests.

How can I improve my gut health for acne?

To optimise your microbiome and readdress any imbalances between gut microbes, you need a two-pronged approach: firstly, focus on adding ‘good’ bacteria through a probiotic supplement. ‘Look for a supplement containing about 30 billion colony forming units (CFUs) and a blend of Lactobacillus and Bifidobacterium sp,’ says Dr Jack.

Next, you’ll need to feed those ‘good’ bacteria with prebiotics, so they flourish and multiply. ‘Prebiotics include fermented foods such as pickled vegetables, kombucha, kefir, raw vegetables – particularly chicory root – leeks, onion, Jerusalem artichokes and asparagus, as well as raw garlic,’ he adds.

Photo credit: Kseniya Ovchinnikova - Getty Images

Supplementing with pre- and probiotics alone isn’t enough. ‘Focus on eating a whole foods diet, high in brightly coloured fruit and vegetables, healthy sources of fats, and good quality protein,’ says Barnes. ‘Low glycaemic index diets have also shown improvements in acne symptoms, so avoid sugary and processed foods and refined carbohydrates.’

Fill your fridge with foods high in antioxidants including vitamin C and E, omega-3 fatty acids, retinoids (vitamin A) and trace metals such as zinc, says Dr Jack. ‘It’s important to take a holistic viewpoint and think about the diet as a whole and how this could relate to inflammation in the skin.’

Oily fish such as salmon, mackerel and herring are excellent sources of omega-3 fatty acids, which play a ‘significant role’ in soothing inflammatory skin conditions, says Sana Khan, nutrition consultant and founder of Avicenna Wellbeing. If you’re vegan or vegetarian, opt for walnuts, flaxseeds, chia seeds and soybeans.

Top up on anti-inflammatory spices such as turmeric, black pepper, ginger, cinnamon, clove, garlic and cayenne. ‘Being largely plant based wherever possible is a good approach when it comes to maximising the levels of antioxidants and anti-inflammatory chemicals in foods,’ says Dr Jack.

Meanwhile, animal-based products – particularly dairy – have been shown to trigger acne, as well as foods that are high in processed fats and sugars. This is due to the formation of advanced glycation end-products (AGEs), says Dr Jack. ‘The sugars bind to structural proteins in the skin and other tissues,’ he says.

‘These are thought to activate the immune system, driving inflammation. Similarly, foods that have been cooked with dry heating processes such as frying and grilling are generally high in reactive molecules and AGEs, so cooking techniques such as steaming are thought to be better.’

In parallel to these theories studies are also starting to suggest that milk rich diets and a diet with a high glycaemic load (sugar load) results in a higher level of insulin and 'insulin-like growth factor 1' (IGF-1) and this may be a direct link with worsening acne. In puberty IGF-1 is raised due to increasing levels of growth hormone and this may be one of the common triggers for acne in these two scenarios. Some patients see improvement on a vegan diet but of course there are many other health considerations before making huge changes with your diet.

Any dietary changes should be on a background of a suitable skincare regime and consultation with your doctor if your acne is concerning you, not getting better or if there is any persistence above the mildest spots.

Last updated: 03-06-2020

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