Gut Health and Skin Conditions – how to calm inflammation
By Christine Lewis
Eczema, rosacea, psoriasis, and acne are all being found to be linked to the health of your gut!
In the last few years, new research has been connecting the threads of many gut diseases and coexisting skin conditions. We can now begin to see how Hippocrates’ famous and ancient quote of 460bc, that ‘’All disease begins in the gut’’, plays out in the newly termed Gut – Skin axis.
Partial aspects of this connection are not new. It has long been known that coeliac disease often exists with dermatitis herpetiformis, a condition of blistering rashes seen affecting almost 25% of those diagnosed with coeliac disease. And less well-known, urticaria, also referred to as hives or nettle rash, is seen in up to 50% of patients with autoimmune conditions, including those with irritable bowel disease (IBD) (2). Fourteen per cent of patients with ulcerative colitis have skin conditions, while the percentage is consistently even higher (24%) with Crohn’s disease. Psoriasis is more frequently encountered in patients with Crohn’s disease than in healthy controls (3).
There are, however, plenty of people who don’t have a diagnosed gut condition but have intermittent or long-term skin conditions. Here’s the link; research is telling us that there is a significant prevalence of an underlying dysbiotic gut environment in almost all cases of atopic dermatitis - eczema (4), rosacea, psoriasis, and acne (5), compared to healthy subjects. It is understood that a dysbiotic state, which broadly means the translocation and overgrowth of gut bacteria into the normally sterile small intestine, causes an immune system inflammatory response. It is very likely that more mild cases of dysbiosis, the symptoms of which are regular gas and bloating after food and sometimes reflux, go unnoticed or ignored. One of the consequences of this inflammatory state is the breakdown of the delicate lining of the gut, known as gut permeability, or you may have heard it referred to as ‘leaky-gut’. It is known that gut permeability allows for bacteria and minute food particles to enter the bloodstream, which is believed to trigger immune responses and subsequent intolerances or allergies to foods and other environmental substances such as dust mites (6).
Food allergies are not consistent in all skin conditions, which suggests that upstream inflammation may be creating triggers that have genetic preferences. So, for some, their trigger is foods, this might be milk, and for others, their trigger comes from the environment. In almost all cases, we know that the immune system is being activated by dysbiosis in the gut, which causes these sensitivities and wider inflammatory responses (7).
What causes all this to happen?
In the 1930’s dermatologists Stokes and Pillsbury first proposed an overlap between emotional states of depression, worry and anxiety, and skin conditions. Their work concluded that these emotional states caused alterations to the microbial flora of the gut promoting local and systemic inflammation, particularly in eczema, dermatitis, and acne.
We now know from the work of several more recent researchers that correcting the gut microflora improves: rosacea (8), eczema, acne and psoriasis (9).
Rosacea suffers experience a 49% increase in the bacteria H.pylori according to a research team (10), which on clearing resulted in a 97% improvement in the condition.
Acne suffers experience more gut barrier breakdown with translocation of endotoxins, according to another research study in 2011 (11). Endotoxins are the toxic by-products of a particular group of gut bacteria and cause inflammatory reactions.
Eczema has been seen to be linked to gut lining breakdown. A study (12) found a strong correlation between a gut bacteria called Faecalibacteterium prausnitzii and atopic dermatitis, where all patents being studied had markers of gut tissue inflammation, which can lead to gut permeability (12). Short-chain fatty acids produced by a group of bacteria in the large intestine have the effect of reducing gut tissue inflammation and balancing immunity (13). Lower levels of short-chain fatty acids were found in children with eczema (14).
What can we do to help these conditions?
A good place to start is to get your skin condition identified, and your GP can help here. There are many supportive practices and foods that can be incorporated into your diet and lifestyle routine.
- Bacteria in the upper gut thrive on a diet high in sugars and refined carbohydrate foods. Try to increase the variety of foods you eat and incorporate more natural fibre into your diet.
- Known dietary causes of gut and or skin inflammation include regular consumption of alcohol and foods with artificial colours, sulphites and nitrates (15). It is worth exploring whether you have any food sensitivities, for instance, to gluten or dairy.
- Incorporate fermented foods such as raw sauerkraut, kombucha, and kefir. Fermented dairy products may be a better choice than pasteurised dairy products for people with acne because fermentation significantly reduces a substance called insulin-like growth factor 1, a molecule in dairy products that increases inflammation and blemish-causing sebum production prevalent in acne (16). Please note fermented foods contain more histamine, so if you have known histamine intolerance, please avoid fermented foods. This is the same for mast cell activation disorder (MCAD).
- Increase the type of fibre in your diet which feeds bacteria that manufacture short-chain fatty acids. Legumes – Peas, beans, lentils, chickpeas, root vegetables, beetroot, apples with their skins, leafy greens such as kale, Swiss chard and spinach. Don’t be put off if legumes cause a little gas and bloating when you introduce them to your diet, and this means you don’t have the right type of bacteria to break these foods down. After a week or two of incorporating legumes into your diet 2 or 3 times a week, you will find these symptoms disappear. You will have effectively grown this very beneficial group of bacteria in your gut.
- Try to reduce grazing between meals to allow for normal feelings of hunger to develop. This feeling develops the production of strong digestive enzymes for food digestion.
- Eat food mindfully. Slow your mind down at mealtimes and chew for longer to promote better food absorption. Undigested foods often promote dysbiosis.
- Mixed strain probiotics have been shown to be effective at reducing inflammatory skin conditions. Recent studies have highlighted the strain Lactobacillus salivarius LS01 to be particularly supportive in moderate to severe atopic dermatitis – eczema cases (17).
- The following vitamin and minerals are particularly helpful for skin conditions (18):
- Omega 3 fatty acids
- Vitamin E
- Vitamin B3
- Work on a plan to build more relaxation into your day-to-day schedule with regular 3 x 3-minute daily breathing exercises.
- Create a sleep plan that allows for more restorative sleep hours before 12 pm. Aim for at least 8 hours of uninterrupted sleep
The information contained in this article is for informational purposes and not intended as a substitute for advice from your GP.
Stokes J. H, Pillsbury DH. (1930) The effect on the skin of emotional and nervous states: theoretical and practical consideration of a gastrointestinal mechanism.
(1) Colin P, Reunalat T. (2003) Recognition and management of the cutaneous manifestations of celiac disease: a guide for dermatologists.
(2) Chang TW, Chen C, Lin CJ, Metz M, Church MK, Maurer M. The potential pharmacologic mechanisms of omalizumab in patients with chronic spontaneous urticaria.
(3) ( Christodoulou DK, Katsanas KH, Kitsanou M, et al. Frequency of extraintestinal manifestations in patients with inflammatory bowel disease in Northwest Greece and review of the literature.
(4) Pike M, G. et al., (1986) Increased Intestinal Permeability in Atopic Dermatitis.
(5) Bures J. et al. (2010) Small intestinal bacterial overgrowth syndrome.
(6) Salmi H. et al., (2010) Cow’s milk allergy is associated with changes in urinary organic acid concentrations.
(7) Carelli, C et al. (1993) Elimination diet and intestinal permeability in atopic eczema: a preliminary study.
(8) Parodi A. et al. (2008) Small intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradication.
(9) Volkova, L Khalif, L (2001) Impact of the impaired intestinal microflora on the course of acne vulgaris
(10) Gravina A, G. et al. (2015) Helicobacter pylori infection but not small intestinal bacterial overgrowth may play a pathogenic role in rosacea
(11) Bowe, W. Logan, A. (2011) Acne vulgaris, probiotics and the gut-brain-skin axis – back to the future?
(12) Song, H (2015) Faecalibacterium prausnitzii subspecies-level dysbiosis in the human gut microbiome underlying atopic dermatitis.
(13) Mark, J. et al. (2014) Short-chain fatty acids induce both effector and regulatory T cells by suppression of histone deacetylases and regulation of the mTOR-S6K pathway
(14) Kim, H. et al. (2015) Probiotic supplementation influences faecal short chain fatty acids in infants at high risk for eczema
(15) Garcia-Gavin, J et al. (2012) Allergic contact dermatitis caused by sodium metabisulfite: a challenging allergen: a case series and literature review
(16) Kim, H. et al. (2017) Insulin-Like Growth Factor-1 Increases the Expression of Inflammatory Biomarkers and Sebum Production in Cultured Sebocytes
(17) Drago, L (2012) Changing of faecal flora and clinical effect of L. salivarius LS01 in adults with atopic dermatitis
(18) Katzman M. (2007). Acne vulgaris: nutritional factors may be influencing psychological sequelae