Gut Health and Skin Conditions – How to Calm Inflammation

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 begin to see how Hippocrates’ famous and very old quote of 460bc, ‘’All disease begins in the gut’’, plays out in the Gut – Skin axis.

Partial aspects of the gut-skin 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 (1). A less well-known statistic for 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). 14 percent of patients with ulcerative colitis have skin conditions while the percentage is consistently even higher (24%) with Crohn’s disease. Add to this that psoriasis is found more frequently in patients with Crohn’s disease than in healthy controls (3), and you can begin to see a pattern is unfolding.

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, a condition 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 certain foods and reactions in some to 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 dairy, or particularly cow’s milk, and for others, their trigger can come from the environment. In almost all cases we know that the immune system has been activated by dysbiosis in the gut which contributes to 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 (0). 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 seem to 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 certain 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 patients 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, your GP can help here. There are many supportive lifestyle practices and foods that can be incorporated into your diet that may help to calm the inflammatory response in skin conditions.

Diet:

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). Also, 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 which contain large quantities of beneficial gut bacteria. Fermented dairy products may be a better choice than pasteurised dairy products for people with acne as 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 a 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 feed bacteria that manufacture short-chain fatty acids. Legumes – peas, beans, lentils, chickpeas as well as root vegetables, beetroot, apples with their skins, leafy greens such as kale, Swiss chard, and spinach all feed bacteria that produce short-chain fatty acids. These acids contribute to the health of gut tissue and play an important role in the repair of lost barrier function. Don’t be put off if legumes cause a little gas and bloating when you introduce them to your diet. These symptoms simply mean you don’t have the right type of bacteria to break these foods down. Start gradually and after a week or two of incorporating legumes into your diet you should 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).