How Does the Gut-Skin Axis Work? - Dr. Michael Ruscio, DC

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How Does the Gut-Skin Axis Work?

Your Gut Health Can Greatly Influence Skin Conditions from Acne to Eczema

Key Takeaways:

  • For a long time, we believed that skin health was only related to the skin itself, but we now know that gut health can play a huge role in the manifestation of skin conditions. 
  • Some of this involves the presence or absence of certain microbes creating inflammation throughout the body, which can show up in the skin as rashes, acne, and other conditions. 
  • The gut also modulates the immune system, and an imbalanced gut microbiome can contribute to autoimmune conditions of the skin, like psoriasis. 
  • Your gut microbiome also produces metabolites like butyrate, a short-chain fatty acid, which lowers inflammation and protects the gut barrier, which can translate to better skin health.
  • Improving your gut health can definitely have a positive impact on your skin health, whether you’re looking to reduce acne or heal painful eczema. 
  • Consuming an anti-inflammatory diet is important, as well as taking broad-spectrum probiotics, and possibly using butyrate as an additional therapy to restore gut and skin health.

Many of the treatments available for skin conditions are topical in application. It would make sense that to treat a skin issue, you should apply a medication or treatment directly to the skin, right? But often, a skin condition is a sign of a deeper underlying issue in the body. 

Interestingly, research in recent years has noted the connection between the gut and the skin and how disruptions in the microbial communities of each organ can affect the health of the other [1, 2, 3, 4, 5, 6]. The field of dermatology has even acknowledged the importance of probiotics for skin health, and a growing number of skincare products feature probiotics as a star ingredient.



In this article, we’ll explore the connection between the skin and the gut, common skin conditions and their relationship to gut health, and how to heal your gut to heal your skin. 

The Gut’s Role in Skin Health

Your skin and your gut are intimately connected. Skin diseases, influenced by genes, lifestyle, and the immune system, often connect to the gut [1]. Both your skin and your gut have similar structures and bacterial populations as well [2, 3]. That’s right, just like your gut has its own microbiome, your skin has its own microbiome, too. And while there are some differences, there is a lot of crossover between the two.

Again and again, literature reviews show a strong link between gut and skin health [2, 7, 8, 9]. Imbalances in the skin microbiome and gut microbiome can lead to immune issues and contribute to skin disorders [4]. In particular, dysregulation of the immune system and the gut microbiome contributes to elevated oxidative stress and the release of inflammatory cytokines, both of which have been implicated in skin disorders [1].

In conditions like atopic dermatitis (AD) and psoriasis, imbalanced microbial diversity on the skin and in the gut can allow harmful bacteria to thrive on the skin, triggering inflammation [4]. Psoriasis patients often have gut imbalances, suggesting dysbiosis has a potential role in the disease [5, 6]. 

Overall, maintaining a healthy balance in both gut and skin microbiota is crucial to support the immune response and prevent skin diseases [1].

Common Skin Conditions and Their Link to the Gut

Skin conditions are quite prevalent, with 1 out of 3 Americans impacted, many of whom look for natural treatments like vitamins, minerals, and herbal supplements to soothe skin issues and restore a healthy complexion [10]. 

Common skin conditions linked to gut health include [2, 9]:

  • Acne 
  • Rosacea 
  • Atopic dermatitis (eczema) 
  • Psoriasis
  • Seborrheic dermatitis and dandruff 

Most, if not all, of these conditions, are associated with alterations in both gut microbes and skin microbes, usually a decrease in beneficial bacteria and an increase in pathogenic bacteria. 

Skin conditionAssociated gut microbiotaAssociated skin microbiota
Acne vulgarisFirmicutes, ↑ Bacteroides [1]Cutibacterium acnes strains [1]
RosaceaCan be associated with SIBO [1]↑ Acidaminococcus and MegasphaeraPeptococcaceae and MethanobrevibacterDemodex folliculorum (mites) [1]
Atopic dermatitis**Faecalibacterium prausnitzii, Clostridium, and EscherichiaAkkermansia, Bacteroidetes, and Bifidobacterium [1]↓ bacterial diversity; ↑ Staphylococcus aureus [1]
Psoriasis*Changes in beta-diversity; larger diversity changes from biologics (immunosuppressive drugs) [1]Staphylococcus and Streptococcus [1]
Seborrheic dermatitis & dandruffunknown Actinetobacter, Staphylococcus, and Streptococcus (bacteria)↑ Malassezia (yeast) [11]

*Autoimmune skin disease
**Unknown whether autoimmune in nature

Let’s take a look at a few of these conditions individually. 

Acne

Acne is a skin condition that can cause red pimples, blackheads, and whiteheads [2]. While hormonal changes can definitely impact acne breakouts, a literature review cited studies suggesting a significant connection between acne and gut issues: acne sufferers had lower levels of beneficial bacteria such as Lactobacillus species and higher levels of opportunistic microbes like Proteobacteria [2]. 

Certain diets, like high-sugar and high-fat diets, may also contribute to acne development. High sugar intake increases insulin signaling, and a high-fat diet can limit protective peptides in the gut, promoting inflammation [2].

Research indicates that improving the gut microbiome and reducing sugar intake can help alleviate acne [2].

Rosacea

Rosacea causes redness, pimples, and skin texture changes [2]. 

Some studies link rosacea to gut issues like:

H. pylori may contribute to rosacea by producing inflammatory molecules, leading to gut and skin inflammation. Eliminating H. pylori can reduce both rosacea and gastrointestinal issues [2]. Probiotics, especially when taken with antibiotics, can enhance the treatment’s effectiveness [12] and improve rosacea and gut problems [2]. 

Atopic Dermatitis (Eczema)

Eczema is a chronic and possibly autoimmune condition, usually starting in infancy, causing dry, itchy skin and lesions [13, 14]. 

Imbalances in the gut microbiome may contribute to eczema, but it’s likely caused by a combination of specific pathogens (in the gut or on the skin), immune system interactions, and diet [2]

Studies show people with eczema often have gut dysbiosis and reduced gut microbiome diversity [15, 16]. Observational research links poor gut health to increased odds of eczema [17], and healthier gut microflora in children is associated with lower eczema risk [18]. 

Strong evidence supports probiotics for improving eczema, with recent high-quality studies showing significant clinical improvement in both adults [19, 20, 21] and children [22].

Psoriasis

Psoriasis is an autoimmune skin condition in which the immune system mistakenly attacks the skin, leading to inflammation and scaly skin lesions, often on the scalp, elbows, or knees [23].

Psoriasis is linked to inflammatory bowel disease (IBD), and the gut microbiome plays a role in its development. People with psoriasis may have lower levels of beneficial bacteria and signs of leaky gut, impacting the immune system and skin health [2]

Therapies focusing on the gut, such as antibiotics, prebiotics, probiotics, and fecal transplants, may be helpful for psoriasis. Probiotics, in particular, have shown promise in improving the disease by influencing inflammatory markers, enhancing gut barrier function, and regulating immune pathways involved in the condition [2].

Heal Your Gut to Heal Your Skin

Now that we’ve established the gut-skin axis and the link between the microbial communities of the skin and the gut, the question remains: can you use gut-healing therapies to improve your skin health? Research is still ongoing, but there are promising studies that show the effectiveness of probiotics and diet modification for healing gut and skin conditions. 

Probiotics for Skin Health

Among all of the conditions we covered above, you might have noticed a common theme: probiotic supplements seem to have at least some positive effect in treating skin conditions via modulating the gut microbiome. 

For example, a 2023 non-randomized clinical trial compared the effects of probiotics against azithromycin, a common antibiotic acne treatment, in 75 people with acne [24]. One group of participants took oral azithromycin every other day. Another group took daily oral probiotics, and the third group took both azithromycin and probiotics. The study lasted 3 months. 

Compared to baseline, all patients had significantly fewer total acne lesions after treatment. The oral azithromycin group had 83.3% less acne. The oral probiotics group had 84.4% less acne. The group that took both azithromycin and probiotics had 90.3% less acne. 

Both the azithromycin-only and probiotics-only groups had similarly less acne, suggesting that probiotics may be able to treat acne as well as conventional antibiotics. Combining the two seemed to have the best results. While we need more research to confirm these effects, it’s safest to say that oral probiotics show the potential to treat acne as well as conventional antibiotics. In a time of increasing antibiotic resistance, trying probiotics first may be worthwhile [24].

There is also strong evidence supporting the use of oral probiotics to improve eczema. Systematic reviews and meta-analyses suggest that oral probiotics, particularly multi-strain products, can prevent children from developing eczema [25, 26, 27, 28]. The effectiveness is most notable when probiotics are given during pregnancy and infancy.

Diet Changes for Skin Health

The other lifestyle treatment we have the most research on is dietary modification to improve skin conditions. 

For example, two meta-analyses (compilation and analysis of many individual studies) have suggested that eating a low-glycemic diet and reducing your dairy intake might help you avoid acne [29, 30].

An additional study suggested that fatty foods and chocolate may promote acne risk, while a higher intake of essential fatty acids, fruits, and vegetables was associated with a potential reduction in acne risk [31].

Does this mean if you have acne, you can never eat anything fried or chocolatey ever again? Not necessarily, but it does mean being mindful of how many fruits and vegetables you consume daily and focusing on getting at least a few servings per week of foods high in essential fatty acids. Good sources of these healthy fats include salmon, herring, flaxseeds, and walnuts. 

Additional research found that for people with mild to moderate eczema, elimination diets may slightly reduce the severity of eczema, itching, and related sleep disturbances [32].

I’m a big fan of elimination diets used correctly, as a short-term intervention to calm inflammation and restore homeostasis to a body under duress from gut issues and autoimmune conditions. This is why we developed Elemental Heal, a nutrient-dense meal replacement shake, for those who need this kind of intervention. 

I’ve used Elemental Heal myself to support my gut health, and I recommend it to patients often. Most people use it for a period of two to four days to get their gut back to a good place, as it alleviates the work of digestion and allows the gut a chance to rest and repair. The next step is to reintroduce anti-inflammatory foods. A helpful diet template for this phase is something like a Paleo diet. If you want to try an Elemental Diet for longer than four days, I would recommend having your doctor’s supervision. 

Many people go on to use Elemental Heal as part of their ongoing treatment plan by using it as a meal replacement for one of their meals per day or using it periodically as a gut reset.

You can check out Randy’s story below to hear about how he used Elemental Heal to significantly improve SIBO, joint pain, and fatigue in just three days.

The Role of Short-Chain Fatty Acids

One final potential therapy I’ll mention is called short-chain fatty acids (SCFAs). While there are a few of these SCFAs taking up residence in your gut, the most popular one you might have heard of is called butyrate

Butyrate is a gut metabolite (basically a nutrient) made via fermentation by certain species of commensal bacteria in your gut microbiome. It’s created to fuel the intestinal barrier of your colon to keep it strong and healthy and keep intestinal permeability at the right level (not leaky). Butyrate may also have some antimicrobial properties and systemic effects, helping to control blood sugar and reduce widespread inflammation. Reduced inflammation and a more resilient gut lining could translate to better skin health. 

While research on butyrate is ongoing, it does seem to be quite helpful for certain individuals, especially those with inflammatory gut conditions like ulcerative colitis that are also causing skin rashes. There is also evidence that people with skin conditions have reduced levels of the microorganisms that make short-chain fatty acids in their guts [4]. I would still emphasize dietary changes and probiotics as a first line of defense, but adding butyrate could play an important role for some. 

If tolerated, increasing prebiotic fiber and resistant starch in your diet can also modulate gut bacteria and increase butyrate levels in the gut without a supplement. 

Microbes Link the Gut-Skin Axis and Influence Skin Conditions

If you take one thing away from this article, I want you to know that the gut-skin axis is largely connected by the communities of microorganisms living in the gut and on our skin. When these communities are disrupted by harmful organisms or simply over proliferation of normal bacteria, we see the pathogenesis of skin conditions (and gut conditions). 

You can begin to correct these imbalances by modifying your diet to support a healthier gut microbiome, adding probiotics, and in some cases, adding beneficial nutrients like short-chain fatty acids. 

If you’re interested in starting a healing journey to get to the root cause of your skin condition, reach out to us at the Ruscio Institute for Functional Health.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

➕ References
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