SIBO and Acne

If you suffer from acne, you’ve probably investigated tons of potential causes and treatments. But, in this article, we’ll explain why you must address gut health in order to truly heal your acne, and how a gut condition called SIBO may be the root cause of your acne struggles. 

The gut is responsible for much more than digestion and nutrient absorption. 

It’s an ecosystem! Like any other ecosystem, your gut needs the right environment to flourish. Through a healthy diet and lifestyle, the collection of bacteria, viruses, and fungi (your gut microbiome) can thrive.

Your gut and skin communicate with each other through what is called the gut-skin axis.  

Since the majority of your immune system cells are actually located in your GI tract, your gut microbiome largely influences your immune system (1, 2). By influencing your immune system, the health of your gut microbiome also affects your skin health.

Imbalances in your gut bacteria can lead to leaky gut and inflammatory responses which may eventually present as acne on the skin.

SIBO stands for Small Intestinal Bacterial Overgrowth and occurs when too many bacteria end up in the small intestine. Normally, the small intestine is home to a relatively small number of bacteria. Most of your gut bacteria are supposed to live in your large intestine. When too many bacteria start to colonize in the small intestine, you can experience unpleasant symptoms, like acne, leaky gut, and inflammation.

A lot of people with SIBO suffer from GI symptoms like gas, bloating, diarrhea/constipation, and heartburn. However, this isn’t the case for all women. Some people with SIBO also (or only) present with non-GI symptoms like acne, eczema, fatigue, or nutrient deficiencies. In fact, one study reported SIBO is 10 times more prevalent in those with acne versus healthy controls (3).

One of the main causes of SIBO is called hypochlorhydria, or low stomach acid. Without enough acid in your stomach, microbes can survive digestion, camp out in the small intestine and feast on your partially digested food. Many people with acne also have low stomach acid (4). Coincidence? We don’t think so! 

SIBO can also be triggered from an episode of food poisoning or the stomach flu.The bacteria or virus from the illness releases a toxin into the GI tract that can damage the cells that control your “cleansing waves.” These cleansing waves are muscular contractions responsible for sweeping away debris from the small intestine. When the cleansing waves are disrupted, you can develop an overgrowth of bacteria.

Some conditions may not directly cause SIBO but are associated with it: irritable bowel syndrome, gastroparesis, celiac disease, Crohn’s disease, and hypothyroidism.

The main test to diagnose SIBO is a breath test. For this test, you drink a specific syrup and then provide breath samples at various time intervals. The bacteria in your small intestine feed on the syrup and produce hydrogen and/or methane gas. If the levels of gas are higher than the provided threshold, this may indicate a SIBO diagnosis.

A stool test can also be helpful in looking at the microbiome of the large intestine. This stool sample tells us if there are other issues in the gut like candida overgrowth, dysbiosis (an imbalance of good to bad bacteria), or parasites. 

We use an individualized approach with all patients, including those who may be suffering from SIBO and acne. This may include personalized lab tests, like food sensitivity testing, a full thyroid panel, and/or a comprehensive stool test. 

However, whenever addressing acne, we implement a targeted gut health program using what is called the 5R approach. Let’s review what this 5R approach for natural treatment of SIBO and acne may include:

The first step aims to reduce bacterial overgrowth and remove pathogens (the bad guys) with targeted supplements, like antimicrobials. This step also removes food sensitivities and foods that compromise gut health (added sugar, refined grains, alcohol, etc.). An anti-inflammatory diet is crucial to starve the bad bugs while feeding the good bugs. A Low FODMAP diet, specifically for SIBO and IBS symptoms, may also be beneficial. 

You can learn how to do a Low FODMAP diet here.

The second step restores everything your body needs for optimal digestion and health. We may replace stomach acid, digestive enzymes, and address any nutrient deficiencies at this time. We also want to optimize your cleansing waves which may include implementing set meals and time-restricted eating at nighttime.

The third step of the 5R process is repairing damage to the intestinal wall. Diet, lifestyle, and SIBO may lead to leaky gut which worsens acne. To address the root cause of your acne for good, we need to repair the gut wall to treat leaky gut and reduce whole-body inflammation. In this step, we may recommend helpful supplements like gelatin, bone broth, colostrum, or L-glutamine.

Once we have removed the excess bacterial overgrowth in the gut, we reintroduce beneficial bacteria to maintain a healthy balance. In this step, you may include fermented foods into your diet, like raw sauerkraut, kimchi, and kombucha. We may also recommend targeted probiotic supplements.

In the final step of the 5R gut health process, we aim to rebalance all aspects of your life to promote whole body health. We’ll address physical stressors, like lack of sleep, stress, and exercise. We’ll help you implement lifestyle interventions and may recommend supplements, like magnesium or adaptogens, that can help you relax and rebalance your life.

While it can be tempting to try random acne therapies and quick-fix creams, treating the root cause of acne with a gut healing protocol will ultimately save you lots of time, energy, and money. Plus, it may address other health issues at the same time!

Here are photos of the transformation of one of our Root clients who improved her acne through following a personalized gut health and hormone balancing approach. Shared with permission. This is over a period of 3-4 months: