Unveiling the Gut-Skin Connection: How to Heal Acne, Psoriasis, and More with Hashimoto’s

The skin is the largest organ in the body and when there is inflammation happening in your body, it is likely your skin is affected in some way. It is super sensitive to inflammation wherever it is occurring.  There is not much your doctor will tell you when you have something going on with your skin- you might get a prescription for some kind of drug or topical cream and that is about it. There is no discussion of  diet and lifestyle changes happening in your doctors office.

What you might want to be thinking about if you are dealing with skin issues, is your gut health. Whether it be leaky gut, SIBO, dysbiosis, parasites, or fungal overgrowth. Any of these issues can affect the health of your skin. Changes in your gut may trigger both local and systemic inflammation in the body which can manifest in the skin.

What kinds of skin condition can be affected by your gut health?

Acne. A study from a very long time ago- early 1900’s showed that more than half the participants in the study had an increased reactivity to certain bacterial strains found in their stool compared to zero reactivity in the control group. It is thought that leaky gut was at play here, allowing bacteria to get through the gut and into the bloodstream and it manifested as acne in the skin.

More recently, there was a study of 80 patients with acne that had higher levels of reactivity to LPS, an endotoxin found in the membrane of gram-negative bacteria suggesting leaky gut  and bacteria crossing the barrier and getting into the bloodstream caused a reaction leading to acne. The control group had no reactions.

It is said that SIBO is 10 times more prevalent in acne rasacea and when the SIBO is treated, acne rosacea improves dramatically. This suggests a causal relationship between the two conditions.

In addition, 14% of UC patients and 24% of Crohn’s patients have some kind of skin condition. Both of these are gut issues. Psoriasis occurs more often in celiac disease patients, than healthy controls and many with this condition present with dermatitis herpetiformis. Celiac patients also have an increased risk for canker sores, alopecia, and vitiligo (loss of pigment of skin).

How does altered gut function impact your skin?

Let’s look closer at how a change in your microbiome can affect your skin. We have something called substance P that is a neuropeptide made in the gut, the brain and the skin. Altered gut microbiota promotes the release of substance P in the gut and the skin. Probiotics have been shown to attenuate or lessen that response.  Your gut microbiome also influences fats and the make up of tissue fatty acids which influence the production of sebum, that oily waxy matter made by the sebaceous glands in the skin. The microbiome influences what the sebum is made of and that alone can predispose you to acne.

Your gut flora change with every bit of food you take but also with antibiotic use, not being breast fed, being born by C-section, chronic stress, sleep deprivation, environmental toxins, and the list goes on. Most of us are exposed to much of this list. It seems to be ever present in our modern lifestyles.

Changes in gut flora predispose us to leaky gut and inflammation which then causes that inflammatory response in the skin. A study out of Russia found 54% of acne patients have a significant alteration to their gut flora and a Chinese study of patients with seborrheic dermatitis found alterations in gut flora in the participants.

Back in the 1930’s two researchers named Stokes and Pillsbury, who were dermatologists had a theory about the gut brain skin axis which suggested that emotional states like stress, worry and depression could influence how our skin behaves, like with acne, via the GI tract. They suggested that stress altered the gut microbes, causing leaky gut and systemic inflammation leading to things like acne, hives, skin reddening, or dermatitis. They also found that 40% of people with acne had low stomach acid. That can also contribute to SIBO and leaky gut which can cause skin issues. Their treatments included introductions of probiotics such as lactobacillus acidophilus, cod liver oil (EPA, DHA, vitamin A). Pretty cool to be so advanced so long ago- or maybe not advanced. Maybe just thinking outside the medicine box.

How can probiotics help improve your skin?

Certain strains of oral probiotics can improve skin by decreasing LPS- that endotoxin (a toxin made within the body) that escapes the gut and alerts the immune system which then affects the skin. I looked into this and any of the Florastor products can potentially improve acne. A study from 1989 showed patients with various forms of acne that received this product vs. a placebo over a 5 months period either healed or improved their acne by 80% compared to 26% in the placebo group. Another study of 56 patients receiving a fermented dairy drink with lactobacillus acidophilus improved their acne over a 12 week period.

So probiotics of certain strains are great for your skin but they can also improve how well your immune system functions. Kind of tuning it up keeping it in balance. This helps reduce inflammation, improve autoimmunity in addition to keeping your skin clear. Probiotics stimulate the production of T regulatory cells which are the cops of the immune system - they keep the immune system in check putting the brakes on active autoimmune attacks and helping to squash inflammation.

Your skins main job is to be a physical, chemical, and antimicrobial barrier or defense against everything you are exposed to. Chemicals that are rubbed on the skin are another story. Think about all the sunscreen or other toxic body care products used that are rubbed onto skin. These chemicals are absorbed through the skin and into the blood stream.

There are tons of bacteria on our skin that don’t enter the body because the skin is the protective barrier. BUT stress and inflammation in the gut can impair the protective barrier caused by a decrease in antimicrobial peptides produced by the skin. These peptides are made to kill microbes not meant to be there but when inflammation breaks down the barrier then you get issues with your skin, whether it be acne or something else. It is said that the bacteria Porpionibacterium acnes is what causes acne and when you have the broken barrier on the skin, it can lead to systemic inflammation. It’s called leaky skin- matches with leaky gut and leaky brain. Very scientific but they are all connected.

Someone who has psoriasis, a history of skin problems, messed up digestion, anxiety and poor sleep may not think any one of those things has anything to do with the other but I guarantee you they do. They are all connected. Our organs and systems are connected and when one is off, it does affect all the others eventually. If this person goes to a conventional doctor, they may get a steroid cream for their skin, maybe some kind of PPI for their digestion or something to help with constipation if that is their digestive issue, then maybe a sleep aid or anti-depressant for the anxiety and sleep issues. Is that solving the problem? No. These things are band-aids. My goal is to help you find out why you have these symptoms. I’m going to ask some questions to see what might be causing your digestive issues then do some blood work and maybe further testing depending on what is going on. Then we start addressing those issues- diet and lifestyle changes will be needed in 99% of cases along with some supplementation that hopefully is temporary.

Diet changes might look like an elimination diet or some kind of stricter Paleo style diet to help calm inflammation and remove possible triggering foods. Dairy is a big trigger for people with skin issues. Maybe you have to do a low FODMAP diet but you are for sure increasing your intake of nutrient dense real whole foods. You want to work on restoring your microbiome to be optimally working. Feeding those good guys with all kinds of varieties of vegetable fibers, bone broth to help heal leaky gut. You may need some botanical herbs to rid your gut of unwanted bugs. Sleep needs to be a priority, manage chronic stress with mindfulness or meditation- whatever works for you. Maybe do some Chi gong or tai chi or yoga.

An example of a healing story I can share is this. A man in his 30’s had been suffering with psoriasis since high school but it had gotten significantly worse. He’d tried every conventional treatment- high dose topical steroids, steroid medications and he was just done. He didn’t know what else to do and was willing to try anything else he could. He had no gut issues, regular bowel movements. He tested positive for intestinal permeability via a cyrex array 2 panel. He had antibodies to LPS and zonulin. I put him on a gut healing protocol, no dairy, 30 day elimination diet. He took some gut healing nutrients like bone broth, fermented foods, fermentable fibers. He started to better manage his stress, he worked on his sleep habits and in about 2 months, his psoriasis was 80% better. After about 6 months he was 95% better.