Can Your Gut Microbiome Really Improve Your Skin?

Dr. Andrea Suarez, dermatologist, takes us through the science of what’s real:

The big picture of the little picture

First things first: the gut-skin connection itself is a real thing. By this we mean, the gut microbiome, a community of bacteria, fungi, viruses, yeast, and archaea, interacts with the immune system and can influence inflammatory skin conditions, including eczema, acne, rosacea, hidradenitis suppurativa, psoriasis, vitiligo, lupus, and more.

Next, a word on dysbiosis and skin disease: dysbiosis refers to changes in the microbial ecosystem, including reduced diversity, loss of beneficial functions, altered microbial metabolites, changes in intestinal barrier permeability, and modified immune signaling, rather than simply an imbalance between “good” and “bad” bacteria. Research has associated several skin conditions with changes in gut microbial diversity and function, but it still remains unclear whether these changes contribute to disease, result from it, or reflect other factors such as genetics, lifestyle, diet, and medication use.

In all likelihood, it’s a combination of the above, but with the current science, we can’t say that for sure.

This is because non-human animal studies are largely preliminary, and human studies show associations rather than proving causation. Findings vary with genetics, lifestyle, geographic location, environmental exposures, and testing methods. Further, Dr. Suarez tells us, current commercial microbiome stool tests cannot reliably explain an individual’s skin condition or identify interventions that will improve it, because validated evidence supporting these uses is (as yet) lacking.

So, what of probiotics, prebiotics, and postbiotics? Probiotics contain live microorganisms, prebiotics provide substances such as dietary fiber that nourish gut microbes, and postbiotics are products generated by microorganisms. some studies have found modest benefits from certain probiotic strains for atopic dermatitis, but results are inconsistent, and there isn’t sufficient evidence to recommend probiotics routinely for eczema, psoriasis, rosacea, or hidradenitis suppurativa.

In essence, the microbiome and potential interventions with regard to it have so much room for variation, that asking if probiotics will treat disease is a lot like asking “will medicines treat disease?”.

It rather depends on what medicines and what disease in what patient under what conditions!

What is unequivocally helpful though (barring some potential extreme cases) is paying attention to gut-healthy holistic good health, for example, in particular, eating a wide variety of minimally processed plant foods, including fruits, vegetables, whole grains, legumes, nuts, and seeds, as this provides dietary fiber that gut bacteria use to produce beneficial metabolites and supports microbial diversity. a Mediterranean-style eating pattern emphasizes these foods alongside fish while limiting red meat and processed meat, and highly processed foods and refined carbohydrates.

Beyond that, it’s good to avoid harmful influences on the microbiome: repeated or unnecessary* antibiotic use, smoking, excessive alcohol consumption, chronic stress, inadequate sleep, physical inactivity, infections, and more can affect gut microbial communities.

^{*Well, necessary use of antibiotics also harms the gut microbiome, but that can’t be avoided so safely.}

For more on all of this, enjoy:

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Take care!