‘Stop with the crisps and chocolate, you’re going to get pimples,’ is something we’ve all probably heard at some point in life – whether from concerned mothers to their teens, between friends watching out for each other’s good looks, and of course, omnipresent well-meaning aunties at gatherings. You know, just keeping an eye out for you.
And, in recent times, this focus on diet and gut for healing skin has certainly been brought to the forefront – with probiotics such as kimchi, sauerkraut, kombucha and yoghurt being touted as the latest skincare secret based off their gut health benefits.
Good skin health needs to include good skincare, there’s no denying that, but it also needs to consider what’s going on in the inside.
Dr Emad Fayyad, consultant gastroentrologist at Medcare Hospital, Al Safa says, “As your largest organ, your skin needs as much TLC (tender loving care) as any other body part that you care for. Good skin health needs to include good skincare, there’s no denying that, but it also needs to consider what’s going on in the inside.”
Buckle up for the rollercoaster, as we take you through a deep dive on why exactly your next skincare issue could need a holistic assessment of your health, rather than reaching for the next miraculous serum – and the other side of skincare less-covered by the beauty industry: disease.
Gut, the underrated organ
Did you know that the gut contains around 100 trillion microbes, weighing approximately two kilograms?
As Guilia Enders, author of ‘Gut: The Inside Story of Our Body’s Most underrated Organ’ says, this long and winding food road is certainly underrated. It’s true that most of us don’t think of our gut on a daily basis – wondering whether these extensive pathways where our food travels slowly, becoming part of our body – are doing alright. The reality is that it is a keystone to overall health, affecting all organs of the body.
“There is a well-established relationship between gastrointestinal health and skin health, and we call it the 'gut-skin' axis, which has become an important topic in dermatological research,” says Dr Diane Maalouf, specialist dermatologist at American Hospital, Dubai.
There is a well-established relationship between gastrointestinal health and skin health, and we call it the 'gut-skin' axis.
She says that research has shown that skin and gut microorganism universes, or microbiota, are able to interact with our immune systems to help keep away inflammation by stopping the growth of ‘bad’ bacteria.
“On another hand, an imbalance in your gut’s microorganism universe, or microbiome (also called dysbiosis) has the potential to negatively impact the skin microbiome, which contributes to common skin disorders such as acne, atopic dermatitis, rosacea, hidradeinitis suppurativa and psoriasis,” adds Dr Maalouf.
A 2016 paper on the therapeutic implications of the gut-skin axis paradigm published in the peer-reviewed BioEssays journal (under the International Union of Biochemistry and Molecular biology), explores that the gut has a “huge capacity to synthesise molecules, with both beneﬁcial or negative effects, that could then access the circulation and affect distant sites such as skin”.
An imbalance in gut microbes can lead to production of toxins, which can escape from the gut along with the bacteria through a leaky gut barrier.
Dr Rakesh Sugathan, senior consultant and head of department of gastroenterology at PRS Hospital, Kerala, India, says, “This is all related to connective tissue and also inflammation – anything that affects the intestinal connective tissue can affect skin cutaneous tissue. When a disease affects one part of the connective tissue, it can also have manifestations in another part, for example, with activation of the Crohn’s disease – there can be skin lesions as well.
“Many, many intestinal diseases have cutaneous (skin) manifestations.”
A couple of well-known examples is the butterfly rash, tightening of the skin due to scleroderma.
So, how do these complex interactions reach us every day?
Spicy food can trigger rosacea
Some skin diseases are linked directly to the activity of those little bacteria lining your gut. Dr Amna Shah, consultant dermatologist at King’s College Hospital Dubai, says that although at this moment in time, studies have not delineated very specific links between gut health and skin health, there are some confirmed conditions.
She says, “Are there any skin conditions that are linked to the food that we eat? Yes.”
“Rosacea is an inflammatory condition that you can face, where you have redness and postules affecting skin, and it is known to flare with certain foods, like spicy foods, and definitely aggravate.”
Studies have also shown that those with rosacea have an overgrowth of a certain bacteria in the gut (ulcer-causing ones), with a potential link present.
Rosacea is an inflammatory condition that you can face, where you have redness and pustules affecting skin, and it is known to flare with certain foods, like spicy foods, and definitely aggravate.
Dr Shah adds, “For example, there is a dermatological condition called dermatitis herpetiformis (DH), where you can get very itchy spots in certain areas of your body.
“It is a condition where you have to exclude gluten from your diet. If you don’t exclude gluten from your diet, you run the risk of getting lymphoma in the gut, which can be life-threatening. If the patient had this specific rash, I would be sending them to the gastroenterologists for investigation.”
Atopic dermatitis, also called atopic eczema – a condition that makes your skin uncomfortably red and itchy - affects 15 to 30 per cent of children and two to 10 per cent of adults worldwide. Studies show that the risk of developing such atopic diseases increases in children who have a reduced diversity of intestinal microbiomes in early life stages (around one week to 18 months). This can affect how the immune system of the child matures, explains Dr Maalouf, leading to long-term inflammation.
Skin conditions like eczema may be related to a damaged gut.
“Skin conditions like eczema may be related to a damaged gut. Inflammation in the gut caused by a poor diet or food allergies may cause increased 'leaking' of certain proteins out into the body, which can in turn irritate the skin and cause conditions such as eczema,” says Dr Fayyad.
Dr Shah explains that for babies with eczema who are not seeing results despite steroid treatments, as dermatologists, they then investigate the possibility of certain foods aggravating the situation.
Ulcerative colitis – a type of a chronic inflammatory bowel disease (IBD) that causes sores and inflammation in the large intestine, but can also cause skin issues. These can include painful rashes, Dr Fayyad tells us.
“Skin issues affect about 15 per cent of all people with different types of IBD,” adds Dr Fayyad.
Our old enemy, acne
Thinking about acne brings to mind a scene in the animated movie 'Kung Fu Panda 2' that marks the hero and dragon warrior, Po’s, grave entry into the antagonist’s lair. He looks up at the lanky stone tower, noting the stairs circling the inner walls, and says, his eyes taking on a determined gleam under a frown:
“Ah, my old enemy…. stairs.”
As a prior member of the community, to me that summarises the endless, spiraling (and historical) struggles of an acne-ridden teen, barely emerging from a breakout to face yet another. Could diet then provide an answer for effective treatment?
A diet high in processed foods and refined sugars can aggravate acne through increased inflammation in the body.
“In terms of research between diet and acne, this has been an ongoing thing for decades,” says Dr Shah.
Dr Maalouf says, “A diet high in processed foods and refined sugars can aggravate acne through increased inflammation in the body.
“Examples include white bread, corn flakes, white rice, potato chips, white potatoes or fries, doughnuts or other pastries and sugary drinks. Following a low-glycemic diet and privileging vegetables, some fruits, beans and oats may reduce the amount of acne you have.”
There is thought to be a link as high-sugar foods can increase blood sugar levels and activate insulin pathways that lead to overproduction of sebum (natural oils) on your skin.
“Incremental insulin and some insulin-like hormones can result in sebum production which can be predisposing to a lot of skin reactions, pimples and allergies,” says Dr Fayyad.
“Drinking cow’s milk (whole, low-fat, and skimmed milk) has also been linked to an increase in acne breakouts. However, studies show that products made from milk such as yoghurt or cheese do not have the same impact on acne.”
A fine balance
This means that, as a fellow traveler in the uphill journey to glowing skin, you would need to maintain a healthy diet, balancing your nutrient requirements, giving your gut flora some TLC, and also ensure that you’re not stressed out enough for indigestion – for the best chances of success.
Dr Shah, “As a dermatologist, my general advice to patients would be, always maintain a healthy diet - full of fruits and vegetables, because that’s part of a healthy eating spectrum.”
A gut is healthy when a balanced microbiome diversity is maintained, Dr Maalouf tells us.
She adds, “It is evident that many environmental factors such as diet and psychological stress can influence the gut microbiome, which can directly or indirectly affect skin. To promote a healthy gut, it is important to lower your stress levels, get enough sleep, keep hydrated and maintain a balanced diet that includes pre- or probiotics.”
If you do notice that a certain food may be affecting your gut and skin, Dr Shah recommends trying to eliminate them from your diet for a short period of time – between four to six weeks and keeping a record of how your skin is. If it doesn’t make a difference, you can reintroduce it.
“If patients are thinking of restricting certain food groups, they do need the correct nutritional support because they could end up doing more damage than good,” she adds.
To promote a healthy gut, it is important to lower your stress levels, get enough sleep, keep hydrated and maintain a balanced diet that includes pre- or probiotics.
But trying to meet our daily nutrient requirement doesn’t mean gulping down vitamin tablets (as I have been guilty of in university), clinical dietician, Mays Marwan Abelbaisi, NMC Royal Hospital, Sharjah says, “I have seen those taking multivitamins over the prescribed daily limits – and I wouldn’t advice to take these multivitamins over 100 per cent of the daily requirement, if not prescribed as a corrective one by a physician.”
Here are some general tips and advice as explained by Albelbaisi:
- Always plan your meals. Don’t eat large meals late at night.
- Skipping meals can be very harmful for your digestive system, she warns: “It can cause low mobilization of the gut, also called lazy gut, as well as bloating.”
- Water is also central to your diet, gut health and absorption – so make sure to keep hydrated.
There’s more to it – a healthy diet doesn’t stop at food itself. Dr Fayyad says, “While eating nutritious food is important, it’s not just what you eat but rather what you absorb that’s important when it comes to both skin and overall health, which is why getting your gut health in order is priority number one.
“Only then can ensuring you’re getting enough of the skin-supporting nutrients vitamins A, C, E, K2, B3, B5 along with the minerals selenium, zinc, silica and sulfur and omega-3 fats make sense.”
For this, he adds, you would need to minimise gut irritation and inflammation through food, food, beverage, supplement and medication use, assess your stress levels including sleep, consider any undiagnosed food allergies and do what you can to support a healthy gut microbiota.
Blooming gut flora
And so we return to the recent skincare recommendation – probiotics, and prebiotics (a non-digestible food ingredient that encourages the growth of beneficial bacteria in the gut). Is it time to slather some napa cabbage with a Korean red chili flake, soy and fish sauce mix and set to ferment for delicious kimchi?
“Probiotic foods are another way to improve both gut and skin health. Natural sources of probiotics are fermented foods and drinks such as yogurt, kefir, kimchi or miso,” says Dr Maalouf.
Dr Fayyad and Dr Sugathan also recommend probiotics for improving gut health. The 2016 study on the gut-skin axis also discusses that several studies have shown that pre- and post-natal feeding of probiotic species to mothers signiﬁcantly reduces the risk of developing atopic dermatitis in the children of those parents with a history of atopic disease.
Good sources of dietary fiber include oats, beans, pulses, whole grains, chia seeds, flax seeds, nuts, legumes, avocado, banana, asparagus and leeks.
However, Albelbaisi recommends caution as high bacteria content of some fermented foods may be dangerous for those patients whose immune systems are weak, such as those undergoing chemotherapy. Dr Shah adds that probiotics may not radically improve skin either.
Dr Maalouf also recommends a diet rich in fiber and prebiotics (all prebiotics are dietary fibers), as it is beneficial for the quality of bacteria in your gut flora – by eventually limiting the growth of harmful microbes.
“Good sources of dietary fiber include oats, beans, pulses, whole grains, chia seeds, flax seeds, nuts, legumes, avocado, banana, asparagus and leeks,” she says.
So wait, skincare by gut-care?
Not really, actually. You can’t skip your regular skincare routine (including sunscreen, of course) and prescribed medications by prioritising your gut.
“Changes in diet and balancing the gut microbiome certainly plays a promising role in the prevention and management of acne and other inflammatory skin conditions, however they do not replace other medical therapeutic measures such as appropriate skincare and medication,” says Dr Maalouf.
Instead, they could soon be used as an adjunct, or additional therapy that complements the medication and treatment prescribed. “I personally feel that that’s exactly where your food and gut plays a role, as adjunct therapy - it’s never going to replace standard treatment of skin diseases, which are prescription treatments,” says Dr Shah.
Your gut microbiota is what decides your immunity. If your immunity is good, then that means all your organs will be better – your skin, everything.
Dr Shah says, “If you go on the internet, there’s a lot of misinformation about probiotics, gut health and it’s important to be evidence-based about these things. A lot of the studies that you read about gut health and skin – the numbers in the study are small, with around 20 to 30 patients maybe but that’s not significant enough for us to make generalised conclusions about everyone.
“A lot of the time, studies have biases within them too and we need more large-size studies covering various ethnicities of the population to come up with significant conclusions about what impact the gut has on the skin.”
Thus, as a healthy gut is necessary for overall health, your best option for achieving good skin health and a great complexion is to, as Dr Fayyad says, take “an integrative and functional approach, by considering all players and how they work together, considering how intimately the gut-skin (and brain) are connected”.
Dr Sugathan has it summarised for us: “Your gut microbiota is what decides your immunity. If your immunity is good, then that means all your organs will be better – your skin, everything.”