When my SIBO was at its worst, my skin was a complete DISASTER! I had horrible chronic cystic acne around my chin and mouth. To make matters worse, I also had very delayed healing. I knew if a new blemish popped up that it was going to stick around for a while. My skin also became very dry and sensitive to soaps/lotions.
Pre-gut issues I had very normal skin and only had the occasional blemish that would go away in a few days. As someone who never went through a bad teen acne spell, it was embarrassing to have bad cystic acne creep up on me in my early 20s. Not only did my gut feel like crap, but I also felt like I looked like crap!
My internal environment was manifesting on my skin. I see skin manifestations of gut issues all the time in my clients such as acne, psoriasis, dermatitis, rosacea, hives, rashes and keratosis pilaris.
When the gut is inflamed and imbalanced, the skin will also become inflamed and imbalanced. Throwing expensive topical treatments or even medication at skin symptoms might reduce skin symptoms, but it will not solve the gut issues that are driving the skin issues.
In many ways, these interventions can make matters worse in the long run. Many topical treatments contain antibiotics that can alter the skin microbiome. Oral antibiotics are often used for acne, which can make an imbalanced gut even worse. The second you stop taking the antibiotics the acne would come raging back.
Not to mention the bacteria that is often responsible for acne, Propionibacterium (P) acnes, has now developed resistance to many topical and oral antibiotics. If you want to successfully treat skin issues long term, you must treat and restore balance in the gut.
In this post, I want to outline how SIBO and gut imbalances can drive skin issues. Let’s dive into this a bit deeper! I will also be discussing the SIBO skin connection on a future episode of Jen Fugo’s podcast, The Healthy Skin Show. I will share it when it is released and you can check out some other great Healthy Skin Show episodes in the mean time 🙂
Why does SIBO cause skin problems?
Gut inflammation will drive skin inflammation
The gut environment has a modulatory effect on systemic immune function. Therefore, the gut environment can either promote or suppress skin inflammation. When the gut barrier breaks down, your immune system will become overly reactive and kick off a systemic inflammatory response that can negatively effect the skin.
Certain bacteria and metabolites from the gut will promote skin inflammation while others will have anti-inflammatory effects. Segmented filamentous bacteria promote the accumulation of inflammatory cells in the skin. Other gut microbes and metabolites that have anti-inflammatory effects include retinoic acid, polysaccharide A from Bacteroides fragilis, Faecalibacterium prausnitzii, and bacteria belonging to Clostridium cluster IV and XI.
In addition, short chain fatty acids that are produced when bacteria ferment fiber can also have an anti-inflammatory effect in both the gut and the skin. In particular, butyrate suppresses immune responses by inhibiting inflammatory cells’ proliferation, migration, adhesion, and cytokine production.
Adequate butyrate levels is needed to fuel regulate intestinal barrier function in the gut. Butyrate is critical for reducing inflammation and permeability in the gut that can drive skin inflammation.
Low amounts of butyrate is quite common in my SIBO clients especially if fibers are being restricted. Working on raising butyrate levels may help reduce gut inflammation and consequently skin inflammation.
A good example of how inflammation in the gut drives skin inflammation is the high prevalence of rosacea in SIBO patients. Rosacea is 10x more prevalent in those with SIBO than healthy controls. Treating the SIBO showed marked improvements in the patient’s rosacea.
To get the skin to calm down, reducing intestinal permeability and treating the SIBO is imperative.
Dysbiosis and a bad microbial composition in the gut appears to effect skin microbial composition
Short chain fatty acids produced by gut bacteria modulate the bacterial populations in the gut. There is growing evidence that SCFAs produced in the gut can modulate the composition of the skin microbiome. For example, propionic acid produced by Propionibacterium can have antimicrobial properties and can regulate the control of certain bacteria on the skin.
Newer evidence shows that the gut microbiome might have a more direct impact on the skin microbiome. Research has shown that when the gut barrier becomes leaky, bacteria and toxic metabolites from the gut can enter the blood stream, accumulate in the skin and disrupt the skin microbiome.
If you have SIBO, you probably have poor a microbial profile in your colon (low diversity, low levels of good gut bugs and pathogenic bacterial growth). As a result, your skin microbial profile will suffer.
Clearing the SIBO should help lower inflammation in the gut, but it is not enough to correct dysbiosis and poor diversity down stream in the large intestine. I often see many overtreating their SIBO with long term antimicrobial use and restrictive dieting. Both of which lower SCFA production and reduce diversity in the large intestine, which could negatively effect the composition of the skin microbiota.
Making sure to focus on repairing and rebuilding the composition of the gut following treatment should reduce skin issues. Probiotic and prebiotic supplementation have shown promising effects for skin conditions.
A diverse microbiome also requires a diverse plate with lots of different plant fibers. It is ok to restrict your triggers, but try to eat a wide array of different plants to ensure you are feeding a wide array of gut bugs. Fibers will increase the production of SCFAs which can contribute to healthier skin!
Malabsorption and competition for nutrients can lead to skin issues
SIBO can derail your ability to digest and absorb food. SIBO can leave you depleted from a macro and micro nutrient standpoint. The skin needs to be nourished to flourish.
SIBO can deactivate bile leading to fat malabsorption. Fat is needed to absorb fat soluble nutrients like vitamin A, K, E and D. Vitamin A is especially critical for skin health and effects cellular turnover and wound healing in the skin. Its anti-inflammatory effects have also been shown to be helpful for acne, rosacea and psoriasis. Keratosis pilaris, little red bumps usually on arms and legs, are also associated with vitamin A deficiency.
In addition, omega 3 fatty acids can also become depleted if fat digestion is impaired. Omega 3 fatty acids can lower inflammation in the body and skin. They are also crucial for keeping skin hydrated and a deficiency can result in dry and rough patches of skin.
The bacteria can steal and feed on certain nutrients that are important for skin health. Zinc is a mineral that frequently can be thieved by our gut bugs. Zinc has anti-inflammatory and immune boosting benefits for the skin. Proper skin cell turnover and wound healing requires adequate zinc. Supplemental zinc has been shown to be helpful for acne sufferers.
Becoming depleted in these important skin boosting vitamins and minerals can lead to skin problems in many SIBO sufferers. Addressing the SIBO is key to restoring proper digestion and absorption.
You can give your digestion a temporary boost through supplemental enzymes, bile support or even bitters to better nutrient status while treating your SIBO. Correcting deficiencies with some supplemental vitamins and minerals may also be necessary.
Histamine Intolerance can inflame the skin
Histamine excess and intolerance is common in the SIBO world and can lead to rashes and hives on your skin.
Histamine is a compound produced by your immune system and can help protect you from foreign invaders if it is produced in the appropriate amount. But, in excess, histamine can promote an inflammatory response and is responsible for allergic reactions.
SIBO can often drive high histamine levels for 3 big reasons. First, intestinal permeability and inflammation can increase release of histamine in the gut. Second, histamine producing bacteria could be overgrowing in your small or large intestine. Third, GI inflammation reduces levels of the enzyme (DAO) responsible for breaking down histamine.
Treating the SIBO should help reduce histamine levels. Reducing high histamine foods while you are treating the SIBO can be helpful (total avoidance of all histamines is not typically required though). In addition, supplemental DAO enzymes can help reduce the histamine load while you are healing the gut.
Hormonal imbalances driven by gut imbalances can also cause problems
Hormonal imbalances driven by gut imbalances can lead to skin problems. In my case, hormonal imbalances were a huge player in my battle with acne during my SIBO days.
Many with SIBO have suboptimal or out right low thyroid hormones. Low thyroid hormones can cause dry, rough and flakey skin.
Eating enough carbs and calories during treatment is crucial for the production of adequate thyroid hormones. Clearing the SIBO and restoring balance in the gut will reduce inflammation in the gut, which can prevent the activation of thyroid hormones.
Gut bacteria also play a role in estrogen metabolism. The estrobolome is a group of gut bacteria that produce beta glucuronidase, an enzyme that can activate estrogen and prevent estrogen excretion. High levels of beta-glucuronidase producing bacteria in the gut can result in estrogen dominance.
Estrogen dominance can lead to hormonal acne, especially before you start your period. Hormonal acne is usually located around the jaw and mouth area. Calcium d-glucurate can block beta-glucuronidase activity and can help bring down estrogen levels while you are treating the gut.
Low Vagus Nerve tone can stress out your skin
IBS and IBD is associated with poor vagus nerve tone. Your vagus nerve is responsible for activating your parasympathetic (rest and digest) nervous system and shutting off your sympathetic (fight or flight) nervous system. Poor vagus nerve tone can lead to poor digestion and also lower your stress tolerance.
Not only will poor vagus nerve function increase dysfunction and inflammation in the GI tract, but it will also lead you to be hyper sensitive to stress and HPA axis activation. Basically, poor vagal tone can leave you stuck in fight of flight mode and your skin does not like chronic stress.
A large number of skin diseases, including atopic dermatitis and psoriasis, appear to be precipitated or exacerbated by psychological stress. A weak vagus nerve will make you more prone to psychological stressors.
Improving vagus nerve function with exercises like gargling, singing and humming can help build up your tolerance to stress and improve digestion. Daily stress management practices like meditation, yoga, journaling, walking, being in nature and laughing with loved ones will also inhibit the activation of your stress response.
If you have skin problems, you probably have gut problems too! Addressing the SIBO and repairing the gut will promote healthy skin.