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Gut Health and Acne

Updated: Aug 9, 2021

In our second installment in Gut Health and the Skin, we are exploring the gut-related cases of acne. While most of us suffer through acne in our teenage years, long-lasting or chronic acne can be caused by imbalances and other gut-related problems.

Long-lasting acne can leave you feeling depressed, self-conscious, and hopeless, especially if you’ve tried many topical applications that just don’t work. And there’s a reason for that; skin creams and face washes are only part of the battle, the real war takes place down in your gut.

acne, gut health, pimples, skin

Gut-Skin Axis overview:

The connection between the gut and the skin is often referred to as the gut-skin axis. This term refers to the overlapping connection between the gut and skin conditions like acne.

One gut-skin axis theory relates to what happens when your gut becomes irritated or inflamed. The gut acts as a barrier between the interior of the digestive tract and the rest of your body. The lining of the gut can become inflamed by irritants like food allergens, alcohol, medications, diets low in fiber and high in sugar, and food additives.

When the gut becomes inflamed and irritated, the normally foolproof barrier that blocks gut contents from the rest of your body becomes weakened. As microbes and other bacteria pass through this weakened barrier, the immune system starts to respond, resulting in systemic inflammation throughout the entire body.

Systemic inflammation impairs the integrity and protective role of the skin. When the skin is weakened, it will produce fewer antimicrobial peptides that normally act as a first-line defense. Without these peptides, skin infections can occur and weakened defenses will further aggravate skin inflammation, leading to common skin conditions like acne.

To read a detailed description of the gut-skin axis, click here to read our previous blog on the subject!

Acne 101:

Acne is a skin condition we have all struggled with at least one time in our lives. Acne is formed when hair follicles under the skin become clogged by oil and dead skin. This will lead to an outbreak of lesions (also known as pimples or zits). There are several different kinds of such lesions:

  • Whiteheads- closed, plugged pores

  • Blackheads- open, plugged pores

  • Small red, tender bumps- papules

  • Pimples- pustules, which are papules with pus at the tips

  • Nodules- large, solid, painful lumps under the skin

  • Cystic lesions- painful, pus-filled lumps beneath the skin

Acne typically forms where the skin has the most oil (sebaceous) glands, these areas include the face, forehead, chest, and upper back, and shoulders. These oil glands are connected to hair follicles, and when they become blocked or clogged, it will result in acne.

Many different factors have been implicated in acne- such as age, hormonal changes, family history, greasy or oily substances, and friction or pressure on the skin. But in this blog, we will be focusing on the deeper causes of acne- which takes place in the gut.

Acne & SIBO:

SIBO stands for Small Intestinal Bacterial Overgrowth. This condition occurs when too many bacteria accumulate in the small intestine. Most of the gut bacteria reside in the large intestine, so a large number of microbes in the small intestines will result in health conditions. Symptoms of SIBO include gas, bloating, diarrhea, constipation, and heartburn. But for many people, especially women, SIBO can also cause skin conditions like acne and eczema. One study found that people with acne are 10 times more likely to have SIBO than people without acne.

One of the primary factors behind SIBO is low stomach acid, also known as hypochlorhydria. Too little stomach acid will allow microbes to survive digestion and accumulate in the small intestines while eating the partially digested foods. Researchers have also found that low stomach acid is also a common symptom for people with acne.

Several studies have tested the treatment of SIBO as an alternate method of curing acne. Such studies have found that there is a positive correlation in the treatment of the two conditions.

Acne & Leaky Gut:

Leaky gut is another common cause of gut-related acne. Leaky gut occurs when cells in the GI tract begin to develop cracks or holes. As the GI tract develops such gaps, harmful bacteria and toxins will escape into the bloodstream and organs. But leaky gut not only causes digestive issues, it has also been linked to depression, diabetes, lupus, psoriasis, eczema, and acne. This is due to the newly freed microbes and bacteria wreaking havoc across the entire body.

While the specific connection between leaky gut and acne has not been studied directly, many different studies have suggested a link between the two.

  • One study found that the blood of 66% of 57 acne patients displayed positive reactivity to bacterial strains isolated from stool. This is compared to 0% of the group without acne.

  • A later study found that 40 patients with acne showed the presence of multiple stool-related lipopolysaccharide endotoxins in the blood.

These two studies demonstrate that the patients with acne were having reactions to bacteria that had escaped from the gut and were circulating throughout the bloodstream. These gut bacteria, like lipopolysaccharide endotoxins, were facilitating an immune response and causing inflammation and acne.


Solutions to your gut-induced skin conditions involve first healing the gut. The gut is a dynamic system influenced by genetics, diet, and other environmental factors. Nearly 10 million genes have been identified in the microbiome. These genes support the human genome in performing many important functions, from immune regulation to protection from pathogens to producing vitamins.

While you can’t fix your genes, you can make special considerations in your diet to promote gut health in correlation to your unique genetic variations. Such steps are in an effort to support and balance the trillions of microbes that live in your microbiome.

Luckily, there are several universal steps everyone can take to promote good gut health. Such efforts include:

  • Increase fiber in your diet- Fiber provides your colon cells with fuel to function optimally. The best way to get fiber is through leafy and cruciferous vegetables, berries, and raw nuts and seeds.

  • Avoid inflammatory foods- Inflammation in the gut causes many gut diseases, including leaky gut, Crohn’s disease, and ulcerative colitis. Avoid vegetable oils and most processed foods, which are inflammatory. For most people with acne, dairy and gluten are major contributors. Instead, increase wild-caught fish and non-starchy vegetables like spinach and green beans, which normalize inflammation levels in your gut.

  • Eat foods rich in antioxidants and Omega-3- Oxidative stress, when too many free radicals overwhelm your body’s defenses, can damage the gut. Antioxidant balance can be improved by eating colorful plant foods like berries. Several studies have reported that omega-3 supplementation can be valuable in curing clinical-grade acne.

  • Consume spices that rid the gut of harmful bacteria like garlic, turmeric, and ginger- These spices are bioactives- chemicals, chemical molecules, and microbes that create a biological effect on our body. Studies on the effects of bioactives have indicated that high consumption of bioactive-rich foods has a positive effect on human health and could diminish the risk of Alzheimer’s, cataracts, heart disease, stroke, cancer, and diabetes.

  • Avoid artificial sweeteners- Saccharin, sucralose, and aspartame have been shown to have long-term consequences for microbiome composure and glucose intolerance. While they may be lower in calories, non-nutritive sweeteners ultimately do more harm than good for your body.

  • Consume more fermented foods like kefir, kimchi, and kombucha- These fermented foods are all probiotics. They aid digestion and have numerous positive effects on many biological systems including the immune system.

  • Supplement your diet with probiotics: Adding a pro-and prebiotic supplement to your daily routine will have great effects on your overall gut health, which will result in improvements across other skin or health conditions. Several studies have found that probiotics can be used as a treatment for inflammatory cytokines within the skin- which will assist in clearing up acne on your skin.

A great way to truly know if your gut is healthy is through microbiome testing. A healthy gut will have large biodiversity without an overgrowth of candida or other potentially pathogenetic bacteria that may lead to chronic health conditions. GI testing will also show inflammation, the ability to absorb fats, digestive enzymes, and immune response.

Specific therapeutic recommendations can then be recommended based on symptoms and testing. For further information about microbiome testing at the Johnson Center, click here to contact us!

The Johnson Center for Health services patients in-person in our Blacksburg and Virginia Beach / Norfolk locations. We also offer telemedicine for residents of Virginia and North Carolina!

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