These are my notes from the blog radio podcast on Revolution Health Radio with Chris Kresser, L. Ac., in which he discusses natural approaches to healing from skin issues, as well as gut health and mental health issues, which are related to each other because they share the link with the gut.
He tends to approach healing skin disorders (such as acne, rosacea, dermatitis, chronic urticaria) in a similar way, with the exception of psoriasis and eczema, which are often considered to be auto-immune conditions. Some of the underlying conditions that these skin issues share are low stomach acid, SIBO (small intestine bacterial overgrowth), and leaky gut, and gut dysbiosis. Psoriasis and eczema also share this but have the added dimension of immune dysregulation so may require additional help to heal.
Knowledge of the Gut-Brain-Skin axis has been around for a long time. Over 100 years ago, Stokes and Pillsbury published work on this connection. They connected mental health issues like anxiety and depression with altered gut function, they knew that changes in the gut flora resulted in local and general inflammation that could be expressed as skin problems. Quoting from this work "There's an important linkage of emotion with cutaneous outbreaks of erythmia, urticaria, and dermatitis by way of physiology and bacteriology of the gastrointestinal tract". In discussing their work, Kresser gives us this amazing quote:
"There's a difference between being skeptical and conservative, and just being uninformed." "It's interesting to me how, when people encounter something that they don't understand, or that seems strange or foreign to them they dismiss it as being irrelevant or quackery. But in the medical literature, which is supposed to guide clinical practice, it's right there and it's been there for over a hundred years."
One of the mechanisms of this connection is low levels of stomach acid, which allows bacteria to migrate from the colon where they belong to the small intestine, where they don't. When this happens it's called SIBO (small intestine bacterial overgrowth). They also knew that stress can induce permeability in the gut.
Here are the remedies they discussed- probiotics and cod liver oil.
Kesser's theory of why low stomach acid causes acid reflux and GERD is because too little stomach acid allows bacteria and yeast to grow in the stomach, which produces gas that pushes up against the top of the stomach and the sphincter forcing it open, and allowing the acid to splash up and into the esophagus. 50% of patients on medications that reduce stomach acid (PPIs) have SIBO. SIBO is also associated with Fibromyalgia and CFS, suggesting an inflammatory connection (which is supported by a lot of other evidence). When you heal SIBO, the permeability of the gut heals.
Recent studies show that emotional stress can cause constipation, SIBO, and gut permeability. Also, that SIBO is associated with both depression and anxiety. Healing SIBO leads to improved mental health.
Studies that support a link between leaky gut and acne. Several found that people with acne were likely to be reacting to bacterial byproducts that should have been in the gut, but that had leaked out into the bloodstream. These people are then having an immune reaction to the bacterial toxins, which results in inflammation, and thus the acne. What they were reacting to is called LPS (lipopolysaccharide) endotoxin, a powerful toxin produced by certain bacteria that causes the body to mount an immune response, which can be against anything and cause auto-immunity.
There are also studies showing a link between acne and constipation. Other studies have already showed that people with constipation have altered gut flora (he often uses high doses of magnesium glycinate as a short-term way to address constipation). 70-80% of the dry weight of stool is bacteria, so which bacteria you have in your gut is a big part of your ability to form a normal stool. Chronic constipation leads to gut permeability because the toxins from the dysbiosis (which are already more plentiful) have more time to sit in the gut and cause damage to the gut wall.
The connection between stress and gut health is very important, as he says the gut is basically one big nerve plexus (in another post I link to a TED talk about how the gut is essentially a second brain). Long-term activation of the sympathetic nervous system (fight, flight or freeze) will break down the gut lining and causes a shift towards pathogenic bacteria in the gut. He also says that the parasympathetic nervous system (rest, repair, and digest) must be activated for stomach acid to be produced, and he has already discussed above how important adequate stomach acid is for gut health. Most of us, in the modern world, are in this state of chronic low level sympathetic nervous system activation because our bodies don't differentiate between actual threats to our survival and other types of stressors.
The last third of the podcast covers clinical experiences that Dr Kresser has had with specific patients. His dietary suggestions generally begin with a modified paleo approach (like auto-immune paleo), which eliminates dairy (except ghee), nightshades, sometimes eggs, FODMAPS (foods with excess fructose or fructans, sugar alcohols such as xylitol), di- and polysaccharides, and limit insoluble fiber because it can irritate an inflamed gut. Bone broth and glycine-rich foods provide the necessary ingredients to rebuild the gut wall. He also mentions that he has another diet to address migraines, that is a low tyramine, histamine, and arginine diet, and that this diet can also help clear up skin issues. This is not surprising as many people with rosacea and chronic urticaria have already ntoiced a connection with these, especially the high histamine foods.
