The Gut-Skin Axis: How Your Gut Influences Your Skin


The gut and skin are deeply interconnected. Your gut houses trillions of microorganisms that influence not only digestion but also immune function, inflammation, and hormone balance — all of which have direct effects on the skin. When the gut’s microbiome is out of balance, or when the gut lining becomes compromised (a condition often referred to as “leaky gut” or “dysbiosis”), systemic inflammation and immune responses can trigger skin issues. I often refer to the digestive track as your “inside skin“ and it is just as important to look after in the same way we do our external skin with our daily skincare routines. 


Dysbiosis, the disruption and imbalance in gut bacteria, is a common cause of skin conditions that I frequently see as an underlying link in poor skin health. Poor digestion, stress, underlying conditions and inflammatory diets can all disrupt the balance of good versus bad bacteria, leading to problems that may appear as acne, rosacea, eczema and other common skin conditions. We can also see this shift happen when we have too much of our ‘good’ bacteria, now leading to a pathogenic imbalance of the microbiome, triggering problems.


Common Symptoms of Disrupted Gut Health


  • Digestive issues: Bloating, gas, diarrhea, constipation, or heartburn
  • Skin problems: Acne, eczema, rosacea, rashes, hives or other inflammatory skin condition
  • Fatigue: Chronic tiredness or feeling sluggish, even after rest
  • Mood changes: Anxiety, depression, irritability, or mood swings
  • Food intolerances: Increased sensitivity to certain foods or difficulty digesting specific items
  • Autoimmune conditions: Increased inflammation or flare-ups of autoimmune diseases like rheumatoid arthritis
  • Frequent infections: Weakened immune response, leading to frequent colds or infections
  • Brain fog: Difficulty focusing, mental fatigue, or trouble concentrating
  • Unexplained weight changes: Difficulty losing weight or unexplained weight gain
  • Sugar cravings: Intense cravings for sugary or processed foods
  • Sleep disturbances: Trouble falling or staying asleep
  • The list could go on forever! 


Most Common Skin Conditions Linked to Gut Health


  1. Acne: Research shows that gut inflammation can lead to systemic inflammation, which may contribute to acne. Hormonal imbalances, often triggered by gut issues, can also worsen breakouts.
  2. Eczema (Atopic Dermatitis): The gut microbiome plays a significant role in the development of eczema, especially in individuals with food sensitivities or allergies. A “leaky gut” can allow undigested food particles into the bloodstream, which triggers an immune response and may manifest as eczema.
  3. Rosacea: This chronic skin condition has been linked to small intestinal bacterial overgrowth (SIBO). Balancing the gut flora can reduce the severity of rosacea flare-ups.
  4. Psoriasis: Inflammatory gut conditions are often found in individuals with psoriasis. Healing the gut can help manage this autoimmune condition.
  5. Hives and Allergic Skin Reactions: These may be triggered by food intolerances or imbalances in gut bacteria.


How to Approach the Gut-Skin Connection


In naturopathic medicine, skin care is never just about topical treatments, because this is only half, maybe even a quarter, of the puzzle. The key is to look at the body as a whole and recognize that glowing, healthy skin comes from a balance of internal and external factors. 


Internal Factors 


Assessing Gut Health: To fully evaluate what is happening within your gut, recommendations for testing options may include stool samples, GI map testing, food sensitivity panels, or other functional tests to get a clear picture. These tests offer a great deal of insight, however, your symptoms can still help to guide us in improving your gut function. This may look like: 

  • Addressing dysbiosis - gas, bloating, abdominal pain, constipation/diarrhea, acid reflux
  • Addressing underlying gut conditions such as irritable bowel syndrome (IBS), small intestinal overgrowth (SIBO), irritable bowel disease (IBD), parasites, bacterial infections etc. 
  • Healing and protecting the gut lining
  • Managing food sensitivities through individualized nutrition


Detoxification Superheroes: The liver, lymphatic system, kidneys, skin (sweating) all play a huge role in detoxifying the body, and sluggish or overburdened detoxification can lead to skin issues. All of these detox pathways are interconnected and often rely on each other to function. For example, the liver utilizes the digestion system to excrete bi-products and waste products. It the gut is not properly functioning, this impacts the skin. We can help to support our detox pathways through nutritional support, movement, improving sleep quality, stress management and where needed using nutraceuticals and herbs for that little extra support. 


Addressing the Hormone Rollercoaster: Gut microbiome dysbiosis can lead to systemic inflammation, which affects hormone regulation. An overgrowth of pathogenic bacteria can lead to an increase in endotoxins in the bloodstream, triggering an inflammatory response that worsens acne. Gut inflammation can trigger hormonal imbalances by affecting the production and elimination of key hormones such as estrogen, progesterone, and testosterone, further contributing to the skin issues linked to hormonal fluctuations. Estrogen metabolism is also greatly influenced by the gut microbiome. The gut helps break down estrone (an estrogen metabolite) into forms that are more easily excreted. A disrupted gut microbiome can impair this process, leading to an accumulation of estrogen, altering the ratios between your hormone. This shift of hormone balance is often associated with hormonal acne, particularly in the lower face and jawline. 


External Factors 


Nutrition: A bright and colourful diet rich in whole foods, fiber, and protein to support gut health. Removing common inflammatory triggers like sugar, dairy (specifically Whey*), and processed foods can make a significant difference.


Herbal and Nutraceutical Support: Depending on your skin condition and underlying root cause (gut, stress, detox pathways, underlying conditions, hormonal etc), there are certain research driven herbs, vitamins, and minerals that can support both the gut and skin. A few to mention include zinc, omega-3 fatty acids, vitamin C, lactoferrin, probiotics (certain strains for depending on your body’s needs), and herbs like milk thistle, burdock root, ashwagandha, saw palmetto and more!  


Stress Management: Stress plays a massive role in both gut and skin health. Chronic stress can lead to increased cortisol levels, which may trigger acne and other skin issues. Managing stress with mindfulness (breath work, journaling or whatever your form of meditation may be), setting boundaries, adaptogenic herbs, and relaxation techniques are essential to a balanced gut-skin connection.


Topical Treatment: While internal treatment is crucial, I also don’t ignore the power of topical skin care. Depending on your skin type, skin condition and goals, there are a wide variety of topical options out there. You do not need to have a 15+ step skin care routine for it to be effective, however you do have to give it time. Skin cell turnover takes about 4-6 weeks to complete and your skincare products can often take 3-4 cycles of this skin cell turnover to begin to even see minor results! Give your routine time, nothing is an overnight fix. When developing a skin care routine - my goal is to find the products that work best for your skin & your budget! 


Treating the Skin from the Inside and Outside


Achieving healthy, radiant skin requires understanding how the body interacts and how each system is influenced. By addressing the gut-skin connection and treating the body both internally and externally, we can create lasting change. As a naturopathic doctor, I take pride in helping you achieve glowing skin by supporting the health of your entire body. Not only does your skin benefit, but you are also left with more energy, better mood, reduced PMS, smooth daily bowel movement, less brain fog….! 


If you’ve been struggling with persistent skin issues, it may be time to look beyond the surface and consider what’s happening inside your body. Healing the gut could be the key to achieving the healthy, beautiful skin you deserve.


References:

  1. Fayed, M. A., & Younes, M. A. (2020). Gut–skin axis: Current knowledge of the interrelationship between microbial dysbiosis and skin conditions. Journal of Clinical Medicine, 9(7), 2101. https://doi.org/10.3390/jcm9072101
  2. Bowe, W. P., & Logan, A. C. (2011). The gut microbiome: Human health and inflammatory skin diseases. Dermato-Endocrinology, 3(4), 218–224. https://doi.org/10.4161/derm.3.4.16108
  3. Zhai, H., & Zhang, H. (2022). Gut-skin axis: Unravelling the connection between the gut microbiome and psoriasis. International Journal of Dermatology, 61(2), 222–229. https://doi.org/10.1111/ijd.16185
  4. McKeown, N. J., & Nierenberg, J. (2019). The gut microbiome as a major regulator of the gut-skin axis. PMID Central. https://doi.org/10.1002/jgh3.123
  5. Kuo, A., & Sharma, S. (2020). The role of gut microbiome in inflammatory skin disorders: A systematic review. PMID Central. https://doi.org/10.1002/jgh3.1227
  6. Kim, S. Y., & Lee, J. W. (2021). Impact of gut microbiome on skin health: Gut-skin axis observed through the lenses of therapeutics and skin diseases. PubMed. https://doi.org/10.1136/bmjopen-2021-060301
  7. Timm, H. C., & Franke, P. (2016). A randomized controlled trial for response of microbiome network to exercise and diet intervention in patients with nonalcoholic fatty liver disease. Nature Communications, 10(4). https://doi.org/10.1038/s41598-019-54457-x
  8. Ogawa, M., Saiki, A., Matsui, Y., Tsuchimoto, N., Nakakita, Y., & Takata, Y. (2016). The gut microbiome as a major regulator of the gut-skin axis. Frontiers in Dermatology. https://doi.org/10.3389/fnins.2016.00407