You are what you eat

More people are adopting a whole-body approach to achieving healthy skin. Ellen Cummings speaks to skin and gut health experts about the relationship between gut health and skin health

The journey towards healthy skin has expanded beyond the traditional routes of skincare and beauty treatments, with more people starting to embrace a holistic approach. This is nothing new to beauty professionals, who know that good skin is down to more than just genetics and skincare; stress, sleep, environment and hydration all play a role.

Another factor that also has an impact on our skin is the health of our gastrointestinal system – this is known as the gut-skin axis.

“The gut-skin axis is a reference to the intimate relationship between the gut and the skin,” says Mariam Abbas, an advanced facialist based in The Clinic Holland Park, London. “Impaired gut health can have a direct and significant impact on immunity, which in turn causes skin disorders and disease, and an imbalance in the skin’s microbiome can affect the gut in return.”

“As 70% of our immune cells also reside in the gut, it makes sense that there is a link between our gut and our ability to respond to infection and inflammation within the skin,” adds Dr Emily Porter, a gut health specialist and registered dietitian at The Gut Health Clinic in London.

Gastrointestinal conditions like coeliac disease and inflammatory bowel disease are prime examples of the correlation between gut issues and skin health because these diseases often manifest with skin problems alongside gut-related symptoms.

“The skin is the last organ to receive any benefits from the diet because it isn’t a life-giving organ,” says Abbas. “However, it is also the first to be impacted by deficiencies and to show signs of disorder. Gut dysbiosis (imbalance) can impact immunity and cause systemic inflammation, resulting in skin barrier impairment and inflammatory disorders.”

Lorraine Perretta, head of nutrition at Advanced Nutrition Programme, agrees that particular skin concerns could be connected to gut health: “Although the exact mechanism is still unclear, researchers are finding that compromised gut flora may contribute to skin conditions including acne, eczema, psoriasis and rosacea.”

So, it would make sense that looking after our gut health could have indirect benefits for our skin, although exactly how the relationship works is still unclear.

“There is lots of new research being done,” comments Dr Porter. “Overall, we still aren’t sure which way causation lies; a poor diet can be associated with higher levels of inflammation, but which is affecting the skin – the diet, the inflammation or the changes to the gut microbiome resulting from reduced diet quality?”

Eating for healthy skin

As the relationship between the skin and the gut isn’t completely understood, there is no definite technique to managing it – but we can make efforts to eat a healthy diet and look after our gut microbiome. An imbalance in the skin’s microbiome (the community of microorganisms that live on the skin’s surface) can present with symptoms such as redness, dryness and sensitivity – and similar symptoms may occur when the gut is experiencing dysbiosis, or an imbalance in the microbiota.

Dr Porter explains, “Signs of dysbiosis in the gut can include gastrointestinal symptoms such as a change in bowel habit or more bloating and gas than normal. However, you may also notice other skin changes such as more breakouts, dry skin or puffiness.”

When it comes to the microbiome, Dr Porter says, “Diversity is key, and just as with our gut, we need a wide variety of microbes to optimise skin health. Lower diversity of the skin microbiome has been associated with flare ups of eczema, so eating a varied diet, full of different sources of fibre, is the best way to look after our microbes and to encourage increased production of those helpful short-chain fatty acids.”

Perretta further explains the importance of fibre: “Beneficial bacteria use fibre in foods as their fuel. For example, whole grains and inulin, found in numerous fruits and vegetables including bananas, asparagus, and berries, support our microbiome.

“These substances are called prebiotics as they promote the growth of our beneficial bacteria. Also, foods such as yoghurt, miso, kimchi, sauerkraut and kefir can support gut health.”

A balanced diet is key, as Abbas explains: “A good protein intake will promote cell renewal and collagen regeneration, while complex carbs provide energy for cell function. A healthy intake of good fats and oils is essential to provide the skin with free fatty acids that form part of the sebum and epidermal lipids in order to help the skin maintain its natural barrier function. Free fatty acids also help to maintain the pH of the acid mantle of the skin and prevent the development of inflammation caused by P. acnes bacteria found on the skin’s surface.”

Abbas adds that minerals and vitamins are vital to maintaining healthy cell function. Vitamins D, E and K play important roles in maintaining healthy tissue, providing antioxidant and anti-inflammatory support and maintaining a strong capillary network. Vitamins C and E provide antioxidants to fight free radical damage, while zinc and calcium aid healing.

“It is important to note the body cannot produce or metabolise essential fatty acids and antioxidant vitamins on its own, so it is essential to have an adequate dietary supply,” Abbas says.

Meanwhile, Dr Porter’s most important tip for beauty professionals to pass on to their clients is to eat more plants. She says, “We know that having a diet with lots of diverse plant foods has significant benefits for health, with some studies showing that eating more of the super six (fruits, vegetables, wholegrains, beans and pulses, nuts and seeds, and herbs and spices) may see up to a decade added to their lifespan.

“Fuelling your gut bugs with different types of plantderived fibres will not only help improve skin health, but will also benefit other areas of the body linked to the gut, such as the immune system, brain, liver and metabolic health.”

Potentially triggering foods

Meanwhile, other foods may have the opposite effect, compromising the health of the skin. “Common culprits that have a negative impact on skin are inflammationinducing sugary foods and processed foods, testosteronestimulating and oestrogenmimicking dairy sources, greasy foods and gluten,” says Abbas.

“Sugary foods can cause inflammation and collagen glycation. Glycation is the formation of crisscross lines on the surface of the skin when sugars bind with collagen proteins, making them brittle and stiff. The hormones in dairy foods have been linked to higher production of testosterone and the formation of acne.”

Abbas continues, “A processed diet can lead to inflammation and exacerbate skin conditions. Alongside the above, a liquid diet high in alcohol and caffeine can cause dehydration and dryness, leading to the formation of premature lines and wrinkles. A diet high in salt can cause water retention and puffiness on the face along with the rest of the body.”

Certain foods might also exacerbate existing skin conditions, as Dr Porter explains: “If you suffer from conditions such as rosacea, you may notice that some foods and drinks, like wine, spicy foods, cinnamon or hot drinks, can worsen facial redness or flushing, even in the context of a healthy balanced diet.”

Dr Porter says that it’s important to consult an expert before making any significant changes to the diet. She says, “Unless you are absolutely certain that any food group is linked to your skin symptoms, no food groups should be restricted long term because this can increase the risk of nutritional inadequacies. Advise clients to check with a nutrition professional before cutting out any foods as there can be many other factors at play when considering skin issues.”

Supporting with supplements

While supplements can’t replace a healthy diet, they can support nutrient intake to ensure that more of the benefits get to the skin. Dr Porter comments, “In my opinion, it is most important to focus on gut health and digestion when considering supplement intake. Taking detox supplements and pro and prebiotics for healthy gut function will enhance food absorption and nutritional intake from foods.

“It is also important to include supplements where a diet may be restricted in certain important food groups, such as omegas and healthy fats. However, just like skincare, diets and responses to foods are different for each person. One size doesn’t fit all.”

As Dr Porter mentions, taking pre and probiotics might be helpful, and Perretta agrees: “There are trillions of bacteria in and on our body and over 2,000 species of gut bacteria have been identified so far. A wide diversity of different strains of bacteria may be associated with good gut health, and having a healthy gut allows us to absorb the nutrients from our diets better, which is beneficial for the skin.

“Evidence also shows that specific strains of bacteria within the gut could directly benefit the skin in a variety of ways. Therefore, maintaining a diverse, healthy gut microbiome via additional probiotic supplements is an important factor for skin health.”

Other supplements that can benefit the skin include omega-3 and vitamin D. “Conditions such as psoriasis have been linked with lower vitamin D levels, as well as a higher intake of saturated fats and lower fibre intake, showing that it is important to look at overall diet quality alongside single supplements,” says Dr Porter.

Helping clients with their gut health

Asking about diet and lifestyle should be an important part of beauty professionals’ treatment consultation process with clients, and although beauty professionals can’t advise clients about gut health in depth, they can offer advice regarding a healthy diet.

Abbas says, “Beauty professionals can give general guidelines on food groups that are known to cause inflammation and exacerbate skin conditions. However, it is important to refer clients to a qualified professional to advise on gut health if the beauty professional is aware of possible gut-related issues that are affecting the skin.”

While skin health and gut health are intrinsically linked, they are two entirely different areas of expertise. Abbas advises that specialists in either field should be mindful of advising on issues that are not within their scope.

Dr Porter agrees, saying, “We all need support from others who are experts in their field as we can’t know everything, and it is always better to speak to an experienced, trained healthcare professional rather than relying on other sources which may be less evidence based. Registered dietitians learn how to critically analyse scientific research and translate this into easy-tounderstand, practical advice, meaning you can be confident you are getting the right information.”

If you’re looking to work with a gut health specialist in your business, Dr Porter says to look for an expert who is registered with a professional body, such as the Association for Nutrition (AfN), which is a voluntary register for nutrition professionals and requires them to meet set standards of practice. Dr Porter adds, “‘Dietitian’ is a protected title in the UK, so you can be sure that this expert has a degree in nutrition. All dietitians should be registered with the Health & Care Professionals Council (HCPC), so look here to check their credentials.”