The Naturopathic Co.
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If you’re experiencing acne, eczema, rosacea, rashes or unexplained skin flare-ups, you may have wondered whether what is happening in your gut could be playing a role.
The relationship between the digestive system and the skin is increasingly referred to as the gut-skin axis, a two-way communication network involving the gut microbiome, immune system, inflammatory pathways, hormones and the skin itself.
This doesn’t mean that every skin condition starts in the gut. Skin conditions are complex and can have multiple contributing factors. However, for some people, persistent skin problems occur alongside digestive symptoms such as bloating, constipation, diarrhea, food reactions or abdominal discomfort.
As naturopaths, this is where we often start looking at the bigger picture.
At The Naturopathic Co., we frequently work with people experiencing a combination of digestive, hormonal and skin symptoms. Rather than looking at the skin in isolation, we consider what else may be happening throughout the body and whether digestive health could be one piece of the puzzle.
If digestive symptoms are also part of your picture, our Gut Health Naturopath Melbourne service provides individualised naturopathic support in Melbourne and via Telehealth. We also provide gut health naturopath consultations in Sydney and Australia-wide via Telehealth.
Your digestive tract is home to trillions of microorganisms collectively known as the gut microbiome.
These microorganisms interact with the immune system, help metabolise certain nutrients and compounds, and produce substances that can influence other systems throughout the body.
The skin has its own microbiome too.
Rather than functioning as completely separate organs, research increasingly suggests that communication occurs between the gastrointestinal system and the skin through immune, metabolic, hormonal and inflammatory pathways.
This relationship has become known as the gut-skin axis.
Changes in the intestinal microbiome have been investigated in relation to several skin conditions, including acne, eczema and rosacea. However, the relationship is complicated: microbiome changes may contribute to disease processes, occur because of them, or share other underlying drivers.
For people experiencing acne specifically, you can read more about the connection between gut health and acne.
Having a skin condition does not automatically mean you have a gut problem.
However, we pay particular attention when skin symptoms occur alongside:
When constipation is a prominent part of the picture, our article on constipation and skin problems explores this relationship in greater detail.
One of the most interesting areas of gut-skin research involves the microbiome.
A healthy gut isn’t simply about having as many bacteria as possible. It involves a complex ecosystem containing many different microorganisms and the substances they produce.
Diet, medications, illness, stress, age, environment and other factors can all influence this ecosystem.
Researchers have identified differences in the intestinal microbiota of people with certain inflammatory skin conditions compared with healthy controls. That does not necessarily mean that correcting the microbiome will cure a skin condition, but it does provide an interesting avenue for understanding why gut and skin health sometimes overlap.
If microbiome imbalance is suspected, it can be tempting to immediately order every available test. However, testing should have a clear clinical purpose. We discuss this further in gut microbiome testing for skin problems.
The gastrointestinal tract is closely connected with the immune system.
The intestinal barrier needs to perform two seemingly opposite jobs: absorb nutrients while also helping protect the body from potentially harmful organisms and substances.
The gut microbiome also communicates extensively with immune cells.
Because eczema, rosacea and many other skin disorders have inflammatory or immune components, researchers are increasingly interested in whether changes within the gastrointestinal environment can influence inflammatory signalling elsewhere.
This is particularly relevant to eczema and gut health, where the relationship between the microbiome, immune system and skin barrier has attracted significant research interest.
You may have heard the term “leaky gut”.
The scientific term generally used is increased intestinal permeability.
The intestinal lining forms a selective barrier between the contents of the gastrointestinal tract and the rest of the body. Various illnesses and inflammatory processes can alter the integrity of this barrier.
There is ongoing research into whether altered intestinal permeability is relevant to certain inflammatory and metabolic conditions.
However, “leaky gut” should not become a blanket diagnosis used to explain every symptom.
Our approach is to assess the actual clinical picture rather than assuming that everyone with acne, eczema or rosacea has increased intestinal permeability. Read more about our approach to leaky gut.
Acne is often thought of primarily as a hormonal condition, particularly in women with cyclical or lower-face acne.
Hormones absolutely matter, but they are not the only consideration.
Sebum production, follicular keratinisation, Cutibacterium acnes, inflammation, genetics, medications, skincare, diet and metabolic and hormonal factors can all contribute.
Researchers are also investigating the potential relationship between acne and the gut microbiome.
For someone who has persistent acne alongside bloating, constipation, diarrhea or other gastrointestinal symptoms, it can therefore make sense to assess both areas rather than concentrating exclusively on topical skincare.
Read our full guide to the gut-acne connection and digestive health.
For women experiencing predominantly cyclical breakouts, we also explore the overlap between the microbiome, hormones and hormonal acne and gut health.
Eczema is another condition in which the gut-skin relationship has received considerable attention.
Atopic dermatitis involves impaired skin-barrier function, inflammation and immune dysregulation, with genetics and environmental factors also playing important roles.
The gut microbiome may influence immune development and regulation, particularly earlier in life.
This doesn’t mean that someone with eczema simply needs probiotics or needs to eliminate a long list of foods.
In fact, unnecessarily restrictive diets can create additional nutritional problems.
Instead, treatment should be individualised, particularly when eczema occurs alongside obvious digestive symptoms.
Read more in our guide to eczema and the gut microbiome.
The potential relationship between rosacea and gastrointestinal health is particularly interesting.
Studies have investigated associations between rosacea and gastrointestinal conditions, including small intestinal bacterial overgrowth (SIBO).
This does not mean everyone with rosacea should automatically be tested or treated for SIBO.
However, when someone presents with rosacea alongside persistent bloating, abdominal distension, altered bowel movements or other symptoms suggestive of SIBO, further investigation may sometimes be warranted.
We’ve explored this in detail in rosacea, SIBO and the gut-skin axis.
You can also read our broader guide to SIBO and skin problems.
Histamine is a naturally occurring compound involved in immune function, digestion and nervous-system signalling.
Some foods contain histamine, while certain microorganisms can also produce or metabolise histamine.
People who experience symptoms such as flushing, itching, hives or reactions after particular foods sometimes wonder whether histamine intolerance is involved.
There are many potential causes of these symptoms, so histamine should not automatically be assumed to be the culprit.
Where histamine-related symptoms occur alongside gastrointestinal problems, however, digestive health may form part of a broader investigation.
Read our guide to histamine intolerance, gut health and skin symptoms.
People often ask whether being constipated can “cause toxins to come out through the skin”.
That’s an oversimplification.
Your liver and kidneys perform the major work of processing and eliminating many metabolic waste products. Your skin does not simply take over because you haven’t opened your bowels.
Nevertheless, regular bowel function remains important for digestive health.
Constipation can also be a clue that something else needs addressing, such as fibre intake, fluid intake, diet, medications, movement, pelvic floor function, thyroid function or changes to the gut microbiome.
It may also influence the enterohepatic circulation of compounds including hormones.
Read more about the actual relationship between constipation, bowel health and your skin.
The gut-skin connection doesn’t exist separately from the endocrine system.
Hormones can have profound effects on the skin.
This is particularly obvious with acne. Androgens influence sebaceous glands and sebum production, while changes across the menstrual cycle can affect inflammatory and hormonal signalling.
The gut microbiome also participates in the metabolism of certain hormones.
One area of interest is the collection of gut microbial genes involved in oestrogen metabolism, sometimes referred to as the estrobolome.
For someone experiencing acne alongside irregular periods, PMS, PCOS-type symptoms or other hormonal concerns, it may therefore be more appropriate to assess the gut-hormone-skin connection rather than treating acne as an isolated problem.
Diet can influence both the gut microbiome and skin health, but there isn’t one universal “gut healing diet”.
In general, a diverse whole-food diet containing adequate plant foods and fibre helps provide substrates used by beneficial gut microorganisms.
Protein, essential fatty acids and micronutrients are also important for normal skin structure and repair. Our nutritional medicine approach considers all of these factors together.
At the same time, individual tolerance matters.
Someone with significant IBS or SIBO symptoms may not initially tolerate enormous quantities of fermentable fibre, while someone with suspected food allergy needs a different approach again.
The goal should not be to keep eliminating foods indefinitely.
Probiotics are one of the first things people reach for when trying to improve their gut.
But “probiotic” describes an enormous category of different microorganisms.
Different probiotic strains have different properties. Evidence for one strain cannot automatically be applied to another.
There is emerging research investigating oral probiotics for conditions including acne and atopic dermatitis, but they should not be viewed as a universal treatment.
We’ve broken down this subject in probiotics for skin health.
Sometimes.
This is an area where we think testing needs to be used carefully.
A comprehensive stool analysis may provide information about gastrointestinal function, microbiological findings and other markers, depending on the test used. Learn more about our approach to gut microbiome testing and broader functional testing.
Breath testing may be considered when symptoms suggest SIBO.
But not every person with acne needs a stool test.
Not every person with rosacea needs a SIBO test.
And an expensive microbiome test isn’t useful unless the results have the potential to change what we do.
Our guide to gut microbiome testing for acne, eczema and skin problems explains when we may consider testing and when we wouldn’t.
One of the principles of naturopathic practice is looking for connections.
If someone has acne, constipation, bloating, irregular periods and fatigue, we don’t necessarily view those as five completely unrelated problems.
Likewise, if someone has rosacea and significant gastrointestinal symptoms, it’s reasonable to ask whether there could be common contributing factors.
That doesn’t mean blaming everything on the gut.
It means looking at the whole clinical picture, and where appropriate, drawing on evidence-based herbal medicine alongside dietary and lifestyle support.
At The Naturopathic Co., our practitioners work across gut health, skin, hormones, anxiety, weight and fatigue, allowing us to consider the overlap between different systems rather than focusing on a symptom in isolation.
If you’re experiencing digestive symptoms alongside skin concerns, you can learn more about working with a Melbourne naturopath specialising in gut health, including in-person consultations in South Yarra and Telehealth appointments.
For NSW clients, we also offer Sydney gut health naturopath consultations via Telehealth.
You may also like to read our related article, The Gut-Skin Connection: A Gut Naturopath Explains.
With 180+ verified five-star Google reviews, our naturopaths and nutritionists offer comprehensive 60-minute initial consultations, in person in South Yarra, Melbourne, or via telehealth across Australia. Book your consultation with The Naturopathic Co. today.
