In this article, I’m here to tell you that the brain and digestion can be the answer to your acne and skin issues. Would you believe two dermatologists first spoke about the brain, gut, and skin connection in 1930?[1]
I’ve been excited to write this article. I feel that this relationship has been in the literature for a while; it’s only recently that the brain-digestion-skin link is helping people break free of their long-standing acne and skin issues.
And this is what it’s all about here.
Feeling free and inspired. Whether it’s from your digestion or skin issues, studies confirm that acne and other skin issues cause regular bouts of depression, anxiety and other stress-based conditions. Some studies suggest that depression is two to three times more prevalent in people living with acne.[2] This interaction is clear enough to combine the specialities to create psychodermatology, a combination between psychiatry and dermatology.[3]
What’s new, or at least when it comes to our understanding, is that the mental health conditions that develop as part of living with a skin condition can rebound and worsen through its effect on the digestive system.[4]
The connection between the digestive symptoms and people living with acne has been well-proven.
For example, a study containing thirteen thousand teenagers demonstrated that those living with acne were more likely to experience accompanying symptoms such as constipation, bad breath and reflux. Furthermore, abdominal bloating was thirty-seven per cent more likely to occur in people living with acne and other skin conditions.[5]
There is also a direct and indirect dietary connection to acne.
Studies in adolescent girls suggest that a standard western diet, classically containing red meat, dairy and high glycemic foods, may aggravate acne.[6] High glycemic foods compound this further by inducing insulin resistance, which can also worsen acne.[7]
This same diet can also be low in fibre, affecting the microbiome and worsening inflammation-based skin conditions such as acne. Some studies see corrective results with high levels of fibre, but these are small and need to be done again for confirmation.[8]
So this is super interesting, but it also makes sense.
The skin has its own biome or bacterial environment, which can be imbalanced in acne. Yep, there is a bacterial environment on the skin which consists of three main microbes, Cutibacterium acnes, Staphylococcus epidermis and Staphylococcus aureus, which is transient depending on the environment.
Different environmental factors such as soaps, skincare, antibiotics, temperature, humidity (vital if you live in Hong Kong or Singapore), and UV exposure can influence how the above microbes colonise your skin.[9]
C.acnes is a beneficial bacteria for your skin and accounts for ninety per cent of the microbes that make up the sebum rich areas such as the scalp, face, chest, and back.[10]
Whilst researchers are still piecing together the full extent of its role in acne, C.acnes completes some critical functions for the skin. For example, it helps keep the skin’s pH low and blocks other bacteria, which can worsen acne by setting up a colony on your skin.[11]
Current research points to an imbalance among these species of bacteria causing inflammatory acne.[12]Interestingly, this imbalance that makes acne worse occurs similarly in the digestive system. This imbalance is commonly referred to as dysbiosis and looks more like a diversity problem than one bacteria appearing at higher levels than another.
Different types of bacteria in the skin’s biome work together to maintain a healthy environment.
As is the case with digestion, the different bacteria on the skin keep the balance. So much so that when different strains of the C.acnes microbes lose their balance, acne severity increases. This particular microbe appeared in the faces of people living with mild to moderate acne and severe acne on the back.[13]
The importance of this change in bacterial diversity on the skin is now causing researchers to recommend using antibiotic courses and creams in a limited way as they can cause long-term issues like the dysbiosis mentioned above.[14] If not also because of the C.acnes becoming more and more antibiotic-resistant over time. Especially in acne patients.[15]
Correcting the effects of these prescriptions is the first place to start, especially when helping someone unlock the potential of digestion and the skin.
Even before testing digestion for small intestinal bacterial overgrowth, which we will look at later, patients attending their first visit are typically already using monthly courses of antibiotics.
Now I don’t want you to feel regret or shame for getting to the point where you felt antibiotics were the only way. Remember, at all times, it’s about you and getting better. Acne and other skin conditions are debilitating at best. If that antibiotic course offers some positive change, even momentarily in the context of how long you’ve been suffering, then that’s never a bad thing!
As you can read about here, these prescriptions need to be completed not to cause any unnecessary damage. I often prescribe an accompanying probiotic formula to take alongside the rest of the antibiotic course to ease some potential dysbiosis.
Interestingly, one particular study found that using a combination of antibiotics and probiotics, compared to a placebo, and probiotics alone had good results in reducing the lesions in acne.[16]
Probiotics play a massive part in acne, even back to the pioneers of the digestion, skin, and brain connection in the 1930s and earlier. Just not in the way you might think.
A case report from a doctor in 1924 demonstrated the value of the strain L.acidophilus for “improving the complexion” and “seemingly contributing to mental improvement.”[17]
In the modern-day, researchers have been able to focus on how strains of probiotics change the presentation of acne inflammation. An interesting accompaniment to oral probiotic use is the potential of topical probiotic creams for acne. The research here using strains such as L.plantarum is limited but suggestive of potential when reestablishing the balance of the microbes on the skin’s surface.[18]
Topical probiotics have also got another exciting function when it comes to acne. And it introduces the nervous system’s influence and a peptide called “Substance P”. We’ll touch on this in the next section linking the brain, digestion, and skin together.
There is little research on the strains of oral probiotics (probiotics that work internally) that might help acne directly, so let’s watch this space.
There does seem to be another way to improve the bacterial balance within the digestion to unlock acne.
Correcting small intestinal bacterial overgrowth has seen positive results that may last up to a minimum of nine months in some cases.
Previously in this article, we’ve touched on how an imbalance or dysbiosis within the bacterial environment in the skin can worsen acne and skin conditions. What about some of those other skin conditions like rosacea?
In preclinical studies, the answer may lie within the attenuation of small intestinal bacterial overgrowth or SIBO. If you’re new to SIBO, the American College of Gastroenterology defines it as the presence of an excessive amount of bacteria in the small bowel (small intestine) that cause digestive symptoms.[19]
The symptoms of SIBO include abdominal bloating, distension (sensation of feeling full), diarrhoea, constipation, and gas formation.[20] This symptom list can make it difficult to differentiate between digestive issues such as irritable bowel syndrome. Some studies now have the prevalence of SIBO up to around seventy per cent in IBS cases.[21]
Now, remember the study earlier in the article?
After assessing thirteen thousand school-age women with acne, results showed those living with acne to have a higher prevalence of digestive issues and an almost forty per cent increase in abdominal bloating symptoms.[22]
This connection is also the case in rosacea, with this skin condition connected to IBS, reflux, Helicobacter pylori infection, and SIBO. [23]
Researchers completed a small, excellent study outlining the potential of treating rosacea via the digestive system and SIBO in 2008. The results of the study demonstrated two things.
The first was that people living with rosacea had a higher prevalence of SIBO than the healthy group. The second is that those positive for SIBO via a breath test had an almost complete regression of their symptoms after correcting the SIBO![24]
An unexpected bonus of this study was the follow-up. Patients whose conditions improved during the initial trial saw their improvements maintained for at least nine months. A fantastic result that would help many people if reproduced with more significant numbers of people.
So, how does the brain link in with the digestive and skin connection?
Living with a skin condition such as acne or rosacea is difficult. It’s no wonder that people experience challenges to their mental health because of it.
Let’s bring together how digestion affects the brain to affect the skin. This connection is particularly significant because clear studies highlight how emotional stress worsens acne.[25]
It was only until recently that Substance P, the molecule we mentioned above, was confirmed as one of the contributing factors.[26]
What the hell is substance P?
Half sounds like something Robocop is clearing off the streets in the original movies in the eighties. Maybe I just showed my age too much there, but substance P is critical for how stress can negatively affect acne.
Substance P is called a neuropeptide, and stress and infection are among the things that cause its release. This molecule is highly inflammatory and participates in diseases across the respiratory, gastrointestinal, and musculoskeletal systems, and worsens acne.[27]
Just minor increases in circulating substance P levels worsen anxiety, depression and aggression.[28]Interestingly, people who have responded to antidepressant therapy have shown declines in the amount of substance P as their mood improves.[29]
What brings this into the digestion, brain, and skin conversation is that even minor alterations in the microbiome can cause a release of substance P.[30]
Substance P does a lot in the brain, digestion, and skin, but it does the one thing you don’t want in acne. It increases sebum production.[31]
Regulating substance P release is another avenue where probiotics come in to help.
We discussed the role of how topical probiotic formulas could regulate substance P earlier, but it seems specific strains may help also.
Lactobacillus paracasei has suppressed inflammation induced by substance P in culture-based studies.[32]This suppression is exciting and suggests that influencing the bacterial environment can calm substance P’s effect on the skin and the body.
An important note is that this particular study has a long way to prove helpful to humans but exciting nonetheless.
But wait, there’s more!
Probiotics may have an indirect benefit for acne in improving the levels of omega-3 fats in the blood when taken together. An exciting study in fatty liver saw benefits when taking a probiotic formula and omega-3 together.[33]
Omega-3 fats have good evidence for mild to moderate acne, using 2000mg for ten weeks.[34] Their use in acne is an example of one agent affecting the whole brain, digestion and skin axis.
Not only do omega-3 fats assist with acne directly, but being deficient in omega-3 fats can also increase SIBO. Still, it can also contribute to the development of other mental health conditions such as ADHD and depression.[35]
In conclusion, unlocking the brain, digestion and skin connection may be the way to end the cycle of antibiotics and corticosteroid creams for acne.
And unlocking this connection for acne is what this article is all about. Don’t get me wrong, the antibiotics and the anti-inflammatory creams have their place. However, we no longer live in a world where chronic diseases have one distinct origin. There are often multiple origins within various body systems contributing to the problem.
We now have the opportunity to deconstruct the entanglements of these different systems, such as the brain and digestion, to bring about a long-term benefit that might get you one step closer to feeling free from your acne and skin issues.
Hope this helps x
References
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