A beginner’s guide to the gut-acne connection

It’s no shocker that diet plays a role in how well you feel, but it greatly impacts how your skin looks, too. Beyond the advice of drinking a ton of water and getting plenty of fresh veggies, more and more dermatologists (alongside nutritionists) are advising their clients to carefully consider what’s making an appearance on their forks.

“I frequently tell my patients that the things they put in their mouths are just as important as the products they apply on their skin,” explains Miami dermatologist Roberta Del Campo, MD. “All the foods we eat go through our digestive tracts and are broken down into various vitamins, minerals and amino acids that the body can use to build healthy skin, strong muscles, and bones.”

Even deeper, these important building blocks give us the energy we need to be productive and feel good. “If you crash diet or eat highly processed foods, you will feel sluggish and your skin won’t be as strong, radiant, or supple as it could be,” adds Dr. Del Campo. “When I speak to my patients about diet and its link to acne, I keep it simple. Anything that causes a spike in blood sugar can, theoretically, increase inflammation and insulin levels, therefore leading to pimples and excess oil.” In turn, you can also see a result on your skin.

The notoriously inflammatory foods to know about

First off, it’s important to note that since everyone’s body is different and since foods affect people in different ways, there’s no one right answer to solving for food-related skin issues. Pro-inflammatory foods can be different and wide ranging, however, according to Dr. Del Campo, the most problematic foods for skin include cow’s milk, sugar, alcohol, and even gluten.

Cow’s milk is the best example, as it is the most clearly studied and talked about. “We know that some cow’s milk contains IGF-1, which is a growth hormone. This leads to inflammation, and inflammation is key to breakouts,” Dr. Del Campo says. “Cow’s milk, due to its natural sugars, also leads to an insulin spike, further increasing IGF-1 levels.”

According to nutritionist and owner of NAO Wellness Center, Nikki Ostrower dairy, gluten, and sugar also show up as top three pro-inflammatory ingredients in many boxed, bagged, or bottled products.

While this discovery is far from new, lifestyle changes are often pitched as a last-ditch effort for those suffering from adult or hormonal acne. Or at least…until very recently. “There is compelling evidence that diets that are high in the glycemic index can result in cystic acne. And high glycemic foods are not always obvious—and—not always ‘bad for you’,” explains Kavita Mariwalla, MD, FAAD, a Long Island dermatologist.

“For example, skim milk is high in the glycemic index as is cheese but these are considered food products that are part of a normal diet. Of course, you always want to make sure if you have cystic acne that you are looking at what you are eating and often what you are snacking on. Eliminating this often helps the intensity of the cystic acne,” she explains.

According to nutritionist and owner of NAO Wellness Center, Nikki Ostrower dairy, gluten, and sugar also show up as top three pro-inflammatory ingredients in many boxed, bagged, or bottled products. “In our experience, after even just a few weeks off those foods and beverages, clients can see a noticeable different in their gut and skin health. They are always amazed at how much those dietary tweaks alone can make a world of difference.”

But…a leaky gut could also be to blame

You may have seen an influx of research or articles pertaining to “leaky gut syndrome,” which is when things leach out of your small intestine into your bloodstream, and this can also cause inflammation. According to Charles Passler, DC a nutritionist (and founder of the Pure Change Program), there are two main categories of foods related to the gut-acne connection, which he describes as aggravators and feeders.

“Aggravators are foods that trigger inflammation in the intestines by an immune or allergic response,” he explains. “These inflammatory messengers end up in your skin, leading to acne and other skin disturbances. Foods that contain gluten or dairy are often the culprits in this category.”

On the other hand, feeders are foods that promote the growth of bad bacteria and fungi in your lower GI tract. “An overgrowth of these unfriendly organisms can also increase inflammation in your body and aggravate skin conditions like acne,” he says. “Foods that are sugary or easily convert to sugar, like sweets, soda, pasta, white rice, white bread, and even alcoholic beverages feed the overgrowth of these unhealthy organisms,” he shares.

You might wonder, how exactly will you know if you are being negatively affected by your gut? Sakara Life co-founders, Whitney Tingle and Danielle Duboise, say that you can find out by visiting your doctor for a stool analysis to analyze your bacteria levels, candida count, and the like or using uBiome (the first at-home gut microbiome sequencing test).

“We are incredibly passionate about transforming your gut, and by using uBiome you can monitor if you have different infections or metabolic conditions—even check if your gut bacteria is diverse enough,” the pair explains to me. “As far as signs you can recognize your own, a healthy gut means regular elimination, comfortable digestion, less bloat, clearer skin, and more energy.”

Digestion and elimination are critical for your overall health: What goes out is as important as what comes in. “If you are overly stressed, inflamed from foods that don’t work well with your system, not eating enough fiber, dealing with environmental toxins or toxins in foods such as GMOs and pesticides, and processed food, then your gut lining weakens,” Tingle and Duboise elaborate further. What does that mean for your skin? An inflammatory response, that depending on your skin type could spell acne or other skin problems.

The truth about pre- and probiotics

Other buzzwords like pre- and probiotics are often considered must-haves towards your quest for a healthier gut. “Probiotics are friendly bacteria that promote good health in your intestines and immune response. Prebiotics feed that good bacteria,” explain Dr. Passler. “If you have no intestinal symptoms or disorders, had a normal vaginal delivery at birth, do not take antibiotics every cold and flu season, and have a well formed bowel movement at least once a day; then you probably don’t need to concern yourself with either.”

As for the rest of us, an array of fermented options (think sauerkraut, kimchi, etc.), kefir, bone broth, and coconut oil are known to help promote good gut integrity.  He reminds us that despite being overwhelming at first, you can repair leaky gut with the right diet and lifestyle tools: “The gut lining is only a cell thick. Stress, food intolerances, and other factors can impair the gut lining and make it permeable—so food particles end up where they shouldn’t be, but with the right diet and lifestyle guidance you can health leaky gut.”

Dr. Passler also suggests patients pay attention to the quality of the water they are drinking, citing it can impact a healthy GI tract. “Too many of my patients initially come in thinking that sugary beverages, tea or coffee are good ways to hydrate, when they actually add to dehydration instead. Get used to drinking straight clean water. Your body will thank you for it,” he shares. The only hitch? “Chlorine is sometimes put in our drinking water to kill bacteria. It may also reduce our own healthy intestinal bacteria when consumed in high amounts. If your city’s water stinks of chlorine, use a filter to remove it.” Your skin will thank you.

If you want to go deep on the connection between dairy and acne, check this out and then read how one writer eliminated it from her diet and what happened.