How Your Gut Health Can Affect Your Skin

The Gut-Skin Axis

In addition, gut health can affect the function of every organ and body system—including skin. “Microbiota in the gut have broad effects in the body that extend beyond the gastrointestinal tract,” Cices says. “Changes that disrupt the microbiome can result in inflammatory changes that promote adverse changes in the skin. These changes can disrupt the skin barrier, damage skin cells, and prevent the skin from performing optimally—meaning protecting itself from extrinsic damage (sun, pollution, toxins, etc.) and maintaining skin health.”

In her practice, Cices often sees patients with skin diseases—like rosacea and atopic dermatitis—that are associated with gut problems including inflammatory bowel disease (IBD) and celiac disease. “Many of these complex diseases are thought to result from an abnormal response to environmental triggers, most likely related to the gut microbiome in genetically susceptible individuals,” she says.

Treatment involves an individual, multifaceted approach. “Generally, there’s no one cure-all for the skin,” she says. “But combining dietary modifications with dermatologic therapies can optimize skin health.” Here, she outlines what she thinks are the best foods for skin and gut (plus a few to avoid). She’s also got some favorite skin care—all clean.

Lifestyle—including Food—Makes a Real Difference

Cices has always believed that food can be medicine. “The gut-skin axis was discovered in 1930, but it wasn’t until the 21st century that sequencing technology allowed for large-scale research of the microbiome,” she says. “This has vastly expanded our understanding of how the microbiome and gut health contribute to overall health.”

Depending on her patients’ skin issues, Cices might recommend a combination of dietary modifications, supplements, and a referral to gastroenterology or a dietitian, along with dermatological treatments. She uses elimination diets in the short term to help identify patients’ triggers. “But it’s important not to be overzealous and needlessly limit intake in the long term,” she says.

She recommends to just about everyone an anti-inflammatory, whole-foods-focused diet that relies heavily on vegetables and avoids processed foods, as well as one that includes both probiotic and prebiotic foods. “They’re gut superfoods,” she says. “Probiotics are good bacteria that can shift the microbiome composition. Prebiotics feed that good bacteria and promote the formation of anti-inflammatory compounds such as short-chain fatty acids.” Below, she outlines her favorite probiotic and prebiotic foods for skin; note of course that what foods work for you (or don’t) is totally individual.

DR. CICES’S TOP 10 PREBIOTIC FOODS FOR SKIN

DR. CICES’S TOP 6 PROBIOTIC FOODS FOR SKIN

Minimize Alcohol and Sugar

Certain foods are more clearly linked to skin complaints, it turns out. While most of them vary by individual—gluten, for example, is out if you’ve got dermatitis herpetiformis (a condition that can appear in people with markers for celiac disease)—alcohol and sugar aren’t helpful for anyone’s skin. “Alcohol is a toxin, which increases oxidative stress and free radical damage—and it consumes and depletes antioxidants,” says Cices. “It also causes dehydration, which can leave your skin dry and dehydrated, and it impairs barrier function of the skin.” Worse than that, she says, alcohol creates a proinflammatory environment in the gut. “Evidence suggests it promotes dysbiosis. Inflammation and activation of the immune system within the gut affects distant sites—including the skin—and can exacerbate skin issues, particularly inflammatory skin disease.”

People with rosacea should be especially careful. “Alcohol is the trigger I have found to cause the most severe flares,” she says. “It can be very difficult to keep the skin controlled in people who heavily consume alcohol.

Sugar can be a problem, too. “Foods with a high glycemic index can cause sugar spikes, which are associated with acne,” says Cices.

Dietary changes can change the composition of the microbiome in as little as 24 hours. “But those changes are temporary in that if the diet reverts, so does the microbiome composition,” she says. “Studies have shown the microbiome returns to baseline within three days if the dietary changes aren’t sustained.”

To see the results of dietary changes on skin, though, the wait is longer—according to Cices, typically a minimum of 4 weeks. “People can take 12 to 16 weeks to begin seeing significant changes in their skin,” she says.

Consider Supplementation

“As the daughter of a dietitian, I’ve always preferred whole foods to supplements,” says Cices. “But as the science evolves, we’re seeing improvements in the quality of supplements that can make a great addition to a healthy gut-care routine.”

Cices often looks at patients’ vitamin D levels. “Vitamin D deficiency is linked to gut dysbiosis, multiple autoimmune diseases, psoriasis, vitiligo, alopecia areata, atopic dermatitis, and other inflammatory skin diseases,” she says. “In my experience, the deficiency is also more common in patients with more-severe disease. And supplementing with vitamin D can improve response to conventional treatments.”

For Skin Care, Focus on the Skin Barrier

Skin care naturally contributes to the health (or lack thereof) of the skin; Cices is a fan of clean, barrier-supporting, results-oriented formulas.

More Proof for the Gut-Skin Axis

If people doubt the gut-skin connection, Cices cites the autoimmune disease dermatitis herpetiformis as a great model for understanding it. “In patients genetically susceptible to celiac disease, ingestion of gluten results in the formation of transglutaminase antibodies, directly causing the gastrointestinal signs and symptoms of celiac. But these antibodies can cross-react with epidermal transglutaminases, which are involved in protecting the skin from the outside environment,” she says. “This results in a chronic, recurrent, extremely itchy rash that can be controlled by maintaining a strict gluten-free diet. And importantly, patients with this rash may have changes seen with celiac disease in their gut even if they have no symptoms beyond the skin.”

Another more common example is the association of rosacea with a wide variety of gastrointestinal diseases, including small intestinal bacterial overgrowth (SIBO), IBD, irritable bowel syndrome (IBS), and H. pylori overgrowth. “We don’t fully understand what causes rosacea or why it is so highly associated with a variety of gastrointestinal diseases, but it’s likely due to underlying gut and skin microbiome alterations,” Cices says. “But treating underlying gastrointestinal disease such as SIBO or H. pylori with the appropriate antibiotics in patients that also have rosacea can drastically improve the appearance of rosacea.”

People with IBD have increased rates of associated skin diseases, including psoriasis, rosacea, and atopic dermatitis, as well as less common diseases, she says: “We have a lot to learn about how the microbiome is altered in IBD—as well as in these individual skin diseases, which have also been associated with microbiome shifts independent of their association with IBD.”

The Future Looks Bright

As the science continues to evolve, Cices says to look for new topical and oral prebiotic and probiotic treatments, some of them tailored to the individual. “As our understanding improves, we can develop targeted microbiome therapeutics that will allow us to shift away from using antibiotics and immunosuppressive medications,” she says. Instead, she predicts, we can focus on harnessing the power of the microbiome by encouraging an anti-inflammatory environment in the body. In the meanwhile, pass the sauerkraut.