Episode 382: Struggling with Acne? How Your Gut Impacts Your Skin
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Could your gut be the missing piece of your skincare routine? If you’ve tried every serum, cleanser, and supplement under the sun but your skin still won’t cooperate, it might be time to look inward. Inflammation, imbalanced bacteria, and sluggish digestion can all show up on your face - and Erin and lead practitioner Rachel Heintz, MS, RDN are breaking down exactly how.
Instead of masking symptoms with topicals or medications, they walk through how stool testing and targeted gut support can reveal what’s REALLY driving breakouts beneath the surface.
Did you know low stomach acid, poor bile flow, and nutrient malabsorption can block your body’s ability to detox, process hormones, and maintain healthy skin?
If you’ve been “doing everything right” without results, this episode connects the dots between your gut and the glow you’ve been working for.
In this episode:
How hidden inflammation and bacterial imbalances in your gut can fuel acne, even if your digestion seems fine
The single enzyme that can be THE missing link behind those stubborn hormonal breakouts
Root cause healing, and why Accutane and birth control suppress breakouts without fixing the underlying imbalance
How functional stool testing can get you real answers about your microbiome, nutrient absorption, and gut function
An “inside out” approach to supporting the liver, gallbladder, and gut lining to get glowing skin
Resources mentioned:
Apply to work with us 1:1 here!
The Gut Panel is on sale for a limited time
Organifi supplement powder (save 20% on your order with code FUNK)
LMNT Electrolyte Replenishing powder (Use code FUNK and get a free sample pack with any purchase!)
OneSkin (Use code FUNK for 15% off your first purchase)
Qualia Senolytic (get up to 50% off and an extra 15% off your first purchase with link + code FUNKS)
Bon Charge (Use code FUNK to save 15%)
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Rachel:
When we think about inflammation as a whole, if there is inflammation in your gut, it can be one of the biggest culprits when it comes to acne and skin health. And so inflammation, it's regulated by your immune system. So much of your immune system is located in your gut. There's any type of imbalance there, it can show up on your skin.
Welcome to The Funk’tional Nutrition Podcast, spelled with a K, because we do things a little differently around here. I'm your host, Erin Holt, and I've got 15 years of clinical experience as a functional nutritionist and mindset coach, creating a new model that I call Intuitive Functional Medicine™, where we combine root cause medicine with the innate intelligence of your body. This is where science meets self trust. Your body already knows how to heal, and this show is going to show you how. If you're looking for new ways of thinking about your health, be sure to follow and share with a friend, because you never know whose life you might change.
Hi, friends. We're back with another show.
You guys know how I'm always talking about skin and how skin is an issue inside job. So there are a lot of different factors that can affect the skin, both internal and external. Obviously, here at The Funk'tional Nutritionist, we are focusing on more of the internal stuff. Today we're going to talk about skin, specifically the gut skin connection, and specifically, specifically with acne, because we are kind of seeing an increase of that in our practice, and we know that that can be a really emotional thing that a lot of people deal with. How we present our to the world can be a pretty big deal. And especially adults dealing with acne, that can feel all sorts of frustrating, particularly if you feel like you're doing everything right. So today actually is going to be a little bit of a quick and dirty episode because we're not going to do a huge, long, deep dive into the science or all the potential theoretical drivers of acne. Instead, we really want this to serve as a understandable resource for you if you are struggling with acne and you really want to just understand how your gut might be a part of that, maybe you've heard that before and you're not really sure what the connection is.
So our goal is to clear that up. And today I did bring in Rachel, our lead practitioner, so she can talk about specific things that she's seeing in practice. Again, this is not just theoretical talk. These are things that she's actually seeing with her acne clients day in and day out. So thanks for being here, Rach.
Rachel Heinz:
Thanks for having me. Like you mentioned, the gut can absolutely be a source of skin issues, especially acne. And for some people, this might seem obvious if they have a lot of digestive issues going on. Heartburn, diarrhea, gas, bloating. But the gut can also be a really commonly overlooked source of gut issues or a really commonly overlooked source for skin issues if you don't have digestive issues. I actually see this a lot in my work with clients. And so if you feel like your skin is breaking out for no reason, you're eating a healthy diet, you're drinking water, you have good skin care, it might be time for a deeper dive, sometimes internally. I'll refer to this as a dookie dive as well.
Erin Holt:
Why do you call it a dookie dive, Rachel?
Rachel Heinz:
Because it's a stool test. And so, first and foremost, a lot of the conventional acne treatments involve topicals or medications. The medications can be things like birth control, spironolactone, accutane, and these can definitely help with symptoms. They don't usually address the root cause. And so the problem is, after these medications or these topicals are stopped, women or men will experience a big uptick in symptoms again.
Erin Holt:
Yeah. And we are oftentimes seeing clients come to us either when they're on these meds or after coming off these meds and having like a resurgence of acne and symptoms, because we're going to focus on the gut. I do want to remind you, everyone listening, that when we work with our clients, we are taking a much more comprehensive approach than just looking at the gut. I like to say to our clients, the gut is one part of you. It's a really important part, and it's a part that can impact other parts of you, but it is one part. And so when we're working with our clients, we like to look at all of you. So today we'll talk about things that we can find in the gut or find specifically on stool testing. But that is not really the only thing that we're doing for our acne clients.
So just kind of keep that in mind with this conversation. We recognize at the same time that a lot of people feel as though they've been burned by other programs, other providers, other practitioners, other protocols. And you guys might not be ready to dive in head first. What we're doing in our one to one practice is taking that whole human, whole body, comprehensive approach. And that might feel like a little bit too much to dive into right out of the jump for some people. And we totally, totally understand that. And that's why we currently are offering our gut panel. And so when you do this, it is a stool test.
It's a dookie dive. I am looking at your gut, and so I can look at it and tell you exactly what's going on and basically let you know if we can help whether that's acne related, skin related, or otherwise. So I do just want to float that out there because right now they're on sale. We have a limited number of them on sale. Because I have a limited number of hours in my day, I can only do so many dookie dives for people, but definitely grab one while they're available. We'll link that up in the show notes. But I do want to float that out there to everybody that that is available. If you're listening to the show and you're like, I'd really like this information for myself, we have totally got you.
Rachel Heinz:
Awesome. And so we've established that your gut health plays this huge role in the condition of your skin. And this might be an oversimplification, but when we think about inflammation as a whole, if there is inflammation in your gut, it can be one of the biggest culprits when it comes to acne and skin health. And so inflammation, it's regulated by your immune system. So much of your immune system is located in your gut. There's any type of imbalance there. It can show up on your skin. And something we actually see a lot of in practice is a lot of dysbiosis.
Dysbiosis is bad bacteria that is overgrowing. And the problem with dysbiosis is a lot of times what happens in the gut doesn't stay in the gut. So toxins produced in the gut can escape into the bloodstream. This can trigger that inflammatory response that shows up on your face as acne. There are so many different types of bacterial overgrowths that can be related to acne. Something we see a lot is streptococcus as well. We see streptococcus H. Pylori.
Rachel Heinz:
A lot of different types of overgrowth.
Erin Holt:
Yeah. So it's not like Cabo. What happens in Cabo? Did you watch Laguna Beach?
Rachel:
No.
Erin Holt:
Okay. You're too young for that. What happens in Cabo? Staves in Cabo. Anyway, some people will get that reference. I digress. That is not your gut. But I like that saying, because if something's happening at the level of your gut, it can really impact everything. And so I think at this point, everyone's kind of hip to dip.
They know that gut Health affects a lot, but it's kind of hard to wrap your head around how what's going on inside your intestines can be reflected in your face. So just like Big Overview if there's inflammation, chronic inflammation is one of the drivers of acne. And so if there's one of the main drivers of inflammation in the body is coming from the gut and dysbiosis is a huge thing of that.
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Erin:
Now, something that we talk about a lot on the show is deficiency dysbiosis. And I talk about it so much just because we see it so much in practice. Can you explain what that means and how that can affect skin?
Rachel:
The deficiency dysbiosis is a deficiency in your beneficial bacteria, in your good guys. And we love our beneficial bacteria for so many different reasons. But as it relates to skin health, our good bacteria, they help us produce ceramides. And ceramides, they really play a big role in locking in moisture into the skin and supporting the outer layer of the skin. So low levels of beneficial bacteria, we can see poor skin health, we can see poor hydration. A specific type of beneficial bacteria, Lactobacillus, can really help to regulate estrogen levels. And so if Lactobacillus is low, this could be playing a role in potentially hormonal acne. And then we also love our beneficial bacteria because they support our gut lining.
Rachel:
And when our gut lining is working really well, it helps to keep toxins from the gut and problematic bacteria out of the bloodstream and then as a result out of the skin.
Erin:
I mean, I think a lot of people know about leaky gut at this point. And one of the things that we're looking at when we are looking at stool tests and we see this low beneficial bacteria, we can basically assume that there's some degree of intestinal permeability or a leaky gut, since those bacteria do help to essentially keep the gut healthy and strong, keep the lining of the gut healthy and strong. And that's what part of what we mean when we say, like, if stuff is going on in the gut, it doesn't necessarily stay in the gut because it can gain access to systemic circulation via that lining of the gut. Now, you mentioned estrogen. And when we think about acne, I think a lot of people tend to blame hormones, and hormones can absolutely be a factor with acne. But what most people don't understand is that the gut actually is a huge factor in hormonal health. So can you talk to us about that a little bit?
Rachel:
Definitely. So gut health influences hormonal health because we detoxify and process estrogen and honestly, all of our hormones through our stool, and that's a very normal process. So our hormones get sent to our liver and then our bile, and then we poop them out. And that's why it's so important for us to be having a daily bowel movement. Another great marker that I love on the stool test is beta glucuronidase. Beta glucuronidase is an enzyme, and if it becomes too elevated, it can actually cause you to absorb estrogen that should have been pooped out.
Erin:
Yeah. And we did a whole episode on this last week, so you can go back to last week's episode if you want, like a full deep dive on beta glucuronidase.
Rachel:
And my Cliff Notes version is basically, if you have too much bad bacteria or not enough good bacteria, this can elevate beta glucuronidase. This contributes to estrogen dominance. And then you can have that hormonal acne that flares maybe in your luteal phase before your period, and potentially around ovulation as well.
Erin:
So we can have, like, multiple drivers of acne in this situation. So it can be hormonal. It can also be gut, because there's that dysbiosis present and inflammatory, because with the dysbiosis, we can see some degree of leaky gut. So it's a tangled web we weave in our bodies. We were just talking about this particular client case recently. A client came to. You had a lot going on, and kind of on paper, it looks like hormonal stuff. Two weeks out of the month, she just felt awful.
And you actually started rather than running right to hormone testing, rather than running right to Dutch testing, right out of the jump, you actually started based on her health history, in her other symptoms going on with blood work and a gut test first, rather than jumping right to hormones. And I think that that's an important thing to just float out there to people, especially now that we're talking so much more about female hormones, which is wonderful. I think people want to just rush right into fix the hormones. But we consider hormones kind of like the check engine light. So if there's hormonal symptom happening, the hormones are indicating that there's other things going on that need to be looked at. And so, you know, I just wanted to give that little insider scoop to folks. Something else that we see a ton on GI maps or the gut panel that we run is H. Pylori and H. Pylori. Infections can really flare up skin issues?
Rachel:
Oh, definitely. Research shows that there's absolutely a connection between the presence of H. Pylori and acne. This is likely due to the systemic response that's triggered by the H. Pylori. And H. Pylori can absolutely deplete stomach acid, which can also create skin issues, because if you have low stomach acid, you won't be able to absorb nutrients needed for your skin health, like zinc. Classically, the classic symptoms of H. Pylori, we think about stomach pain, acid reflux, a lot of burping, belching, maybe not tolerating protein, but for a lot of people, it can hang out in our bodies without creating a lot of upper GI symptoms.
I actually have a recent client who I started working with, and she doesn't have a ton of digestive issues. She has really cystic deep acne. She has tried the topical treatments, she's tried medications. She doesn't have a lot of GI symptoms. Nothing was really working for her. Her GI map came back, and there weren't a ton of imbalances. But the big standout result was she had really high levels of H. Pylori. And so we've gotten her started on a gut healing protocol. Lots of liver support. And this is taking, you know, the loose plan is 12 weeks, but it could be a little bit longer as well.
Erin:
There's really this, like, downstream effect with untreated H. Pylori. And this H. Pylori is not something that we necessarily have to address in everybody. It can exist in people without it causing problems. But one of the things that we see often, and we can actually screen for this on a gut panel, is, like Rachel said, it can begin to shut down the body's production of stomach acids. We can see low stomach acid, and I consider our digestion kind of like a game of dominoes. And that stomach acid is really the first domino that needs to fall for the rest of digestion to move along swimmingly.
And so we're always trying to swim upstream to the root cause. And so if we can identify poor digestive capacity, if we can identify, okay, this person really most likely has low stomach acid, why do they and we've addressed this multiple times on multiple shows, but H. Pylori can be one of those those factors.
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Erin:
Something else we've talked about bacteria a lot up into this point. Something else that we can see coincide with H. Pylori or just exist on its own is a fungus or a yeast called Candida. And we can definitely see Candida infections play out through the landscape of the skin. So talk to us about that.
Rachel:
The fungal acne or candida related acne definitely can show up on the back, the chest, the forehead. I mean, it can show up everywhere. Candida definitely affects the skin, but it's typically not the root cause. So when Candida overgrows, when we see it positive on a stool test, we always want to ask, why is this happening in the first place? And that's because Candida overgrows when the conditions are right. If there's not enough stomach acid, if there's poor digestion, if you don't have enough beneficial bacteria. Did you recently take antibiotics? Are you eating a lot of sugar? Or even just like a lot of chronic stress can weaken the digestive immune system that then allows Candida to overgrow. So the treatment is multifaceted. We typically want to address the environment that let that candida overgrowth happen in the first place.
So this is a little bit more comprehensive than what you can see marketed online of just do this Candida diet, do this Candida cleanse, and you'll be better. And four to eight weeks, we need to address you as a whole.
Erin:
Yeah, for sure. I mean, it would be great if it was that simple. We just haven't seen that really play out that well. When we're talking about gut health, I really think about four main factors and we could get, you know, even deeper than this if we really want to get into like the mind and the mind gut connection. But just to keep it simple, I think about it as digestion. So stomach acid, like we're talking about digestive enzymes, bile, small intestine. That's where most of absorption happens. We can see issues with overgrowths there, bacterial overgrowths, like sibo.
The third one would be gut permeability or the lining of the gut. We need a really healthy, strong lining of the gut to prevent that leaky gut, to prevent the inflammation and the immune response there, and then the large intestine in the microbiome. So all of These things are influencing each other to make up what we're kind of collectively calling gut health. Up until this point, we've really talked a lot about the microbiome. We've talked a little bit about leaky gut and the lining of the gut. But talk to me more about compromised digestion and absorption, which can happen even before we get to the place that we would be looking at on a stool test like the microbiome.
Rachel:
And so of course, you could be eating a really healthy diet, eating the most nutrient dense foods, but if you're not digesting them and absorbing them, you're not getting the benefits from those foods. And we need so many different nutrients to support healthy skin, to support glowing skin. Some of the big ones that come to mind are zinc. It's involved in sebum production. It regulates the production of inflammatory mediators, it reduces swelling. You know, when we think about skin health, the zinc is such a biggie. Vitamin D status is associated with acne reduction. Healthy vitamin D can be associated with less acne.
And then we also need vitamin A just to regulate our digestive immune system. And so if you're not absorbing these nutrients, it can really affect your skin. And this could be due to the low stomach acid, low digestive enzymes and, or poor bile flow. And so sometimes it's one, sometimes it's all of the above. When it comes to deficient digestive juices, I feel like it kind of starts with, with low stomach acid, like you mentioned, and then it kind of progresses too.
Erin:
Yeah, it's like the domino effect. And one of those dominoes that needs to fall is bile, which you just mentioned. And I know this is a big thing that comes up in a lot of our clients. What's the connection between healthy bile flow and acne specifically?
Rachel:
So bile, it is involved in the removal of toxins and waste products from the body. It's produced by the liver, and then it's stored in the gallbladder. It gets released in our digestive tract. When we consume fat, it helps us break down fat. And when we release bile in the digestive tract, it's moving toxins and hormones into the gut again for us to poop it out. So when the liver is burdened, when detox pathways are burdened, the skin then becomes a detox organ. So if we can't produce healthy amounts of bile and we can't detoxify appropriately, those toxins are going to get sent to the skin and it can show up like acne. And, you know, circling back to hormonal acne.
If we aren't producing healthy amounts of bile, then we are going to probably see issues with how we're detoxifying our estrogen and more of those hormonal imbalances, too. So right now I am seeing this acne client, and she has taken Accutane twice. It will work for her. She'll get this glowing skin, and then six months to a year later, she will relapse. She's prone to constipation. We decided, let's run a stool test. Let's see what's going on underneath under the hood. And she had no bad bacteria, overgrowing, no H. Pylori. She did have low levels of her good bacteria. And her stool test actually showed us that she had undigested fat in her stool. And so undigested fat in the stool is usually associated with poor bile acid production. For her treatment, we're placing just a lot of emphasis on bile support. Bile's also helping with her constipation. She's just like, detoxing and emptying out her bowels more effectively as well. And so again, we're thinking about, let's support bile flow to help with the absorption of vitamins, detoxification, and then just moving things through the gut.
Erin:
Yeah, and I think that's an important note here, is that everything that we're doing is pretty targeted treatment. I mean, by the time somebody comes to work with us, they've tried a lot of stuff on their own, and they're like, look, I. I've done X, Y and Z. And so we're at the point where we really want to bring in targeted support and really make it individualized and cater to the individual sitting directly in front of us. And so that's where lab testing can come in. Things like the GI MAP or what we call the gut panel. So we can just be like, okay, this is what's going on with you, because we don't.
We can't predict if it's H. Pylori, if it's a fungal overgrowth, if it's low bile. There's no way to really, really know that sometimes based off of symptoms. But like Rachel said, sometimes H. Pylori doesn't have symptoms. Sometimes people have heartburn without an H. Pylori infection. So the testing really does help us laser focus into exactly what's going on, which is why we really encourage folks, if, again, if you don't know if this is the right fit for you, start with the gut panel, and then we can really help you decide that. But I think the big thing, the overall takeaway message here is that if your skin is breaking out, it's a sign that your body is trying to tell you something.
We believe that symptoms are messages coming from our body, and so we're not just trying to, you know, snuff out the messages by masking the symptoms. And I totally understand from something that, you know, that's so visible, like acne, I really get the appeal of wanting to deal with it externally and just make it go away. And you can still do that. But we're also trying to approach it from the inside out. And one of those things are or can be imbalances in the gut. It's not always the only root cause, but it's definitely a major player.
Rachel:
Oh, definitely. And if your skincare isn't cutting it, I think it's time that we look inward for sure.
Erin:
And if you, if you need help, reach out.
So we're going to link up everything. In the show, notes, an application to work with us one on one, and then also that gut panel, if they're still available. So hopefully this cleared up some confusion about acne Gut Connection. Thanks for joining us and we'll see you next week.
Thanks for joining me for this episode of The Funk’tional Nutrition Podcast. Please keep in mind this podcast is created for educational purposes only and should never be used as a replacement for medical diagnosis or treatment. If you got something from today's show, don't forget, subscribe, leave a review, share with a friend, and keep coming back for more. Take care of you.