Every now and then someone emails me asking if they should take probiotics for acne, and if so, what kind of probiotics? In this post I’ll do my best to answer those questions. I realize that this post will repeat some things I’ve said on other posts, but I wanted to write this to pull everything together and comprehensively answer the question: do probiotics help acne?
The short answer is that for some people acne is linked to gut problems and abnormalities in the bacteria that live in the digestive track. Studies show that correcting bacterial abnormalities can be helpful in resolving skin problems.
That said, bacterial imbalance is often a sign of other problems, rather than the root cause. Taking probiotics without resolving these deeper causes may not give you the results you are looking for. There’s also very little direct research testing probiotics on acne. The few published studies we have show moderate to good results, so we have a cause to be optimistic.
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At the moment the best we can say is that probiotics could be helpful for some acne patients. But they certainly aren’t miracle cures, and you probably get better results if you take a more holistic approach to solving gut problems.
Let’s dive a bit deeper and try to understand why probiotics could help and whether they are the right choice for you.
The gut-skin connection
Already in the 1930s visionary dermatologists Drs. John H. Stokes and Donald M. Pillsbury suggested “a theoretical and practical consideration of a gastrointestinal mechanism for ways in which the skin is influenced by emotional and nervous states.” They noticed that stress and anxiety aggravated acne in their patents, and through anecdotes and research suggested that stress has a negative effect on gut health, which then shows up on the skin. How could this be possible?
Stress, diet, and use of certain medications can affect the type of bacteria living in the gut. Under normal conditions healthy, or probiotic, bacteria account for the majority of the bacteria. However this balance can shift and unhealthy bacteria can become dominant.
The leaky gut syndrome
These pathogenic bacteria produce toxins that damage the protective lining of the gut, the lining that allows nutrients to pass into the body but keeps harmful substances out. Damage to the gut lining increases intestinal permeability, i.e. substances that would be normally kept out pass through the gut lining and into the body. This is also known as the leaky gut syndrome.
So far two studies have tested acne patients for signs of leaky gut. One showed that 66% of acne patients tested positive and the other study found 65% of acne patients tested positive. This is remarkable when you consider that in both of the studies none of the people with clear skin tested positive.
The substances leaking out of the gut increase inflammation in your body, which can show up as acne on your skin. I explained how and why this happens in detail in this article.
Can probiotics help acne?
So if imbalance of bacteria in the gut causes leaky gut syndrome and indirectly acne, then supplementing with probiotics should help, right? In theory yes, but in reality the situation is a bit more complicated.
First, bacterial imbalance is usually not the root cause of gut problems; rather it’s a symptom of other problems. In such a case taking probiotics could relieve symptoms but might not fix to deeper cause. Some of these deeper causes include:
- Small intestine bacterial overgrowth (SIBO). The small intestine is relatively sterile, but under certain conditions bacteria may migrate up from the colon. These bacteria compete for nutrients with you and may cause problems further down the digestive track. People with SIBO often also have leaky gut syndrome.
- Dietary gut irritants, such as gluten.
- FODMAP intolerance, often linked to SIBO. FODMAPs are poorly absorbed sugars and short chain carbohydrates. Because they are poorly absorbed bacteria can ferment them and cause digestive discomfort, bloating and constipation. FODMAP intolerance can encourage the growth of harmful bacteria in the gut.
- Low stomach acid, often a factor behind SIBO.
- Use of certain medications, such as antibiotics and painkillers (such as Tylenol).
Taking probiotics usually doesn’t solve those deeper causes, which of course limits their effectiveness.
Another problem is knowing what probiotics to take. Probiotics is an umbrella term that covers several different ‘species of bacteria’ and within each species there are many different varieties of bacteria. Unfortunately science is still at early stages and we don’t yet know which bacteria work the best. To make matters more complicated, each person has a unique ‘bacterial makeup’. So the bacteria that work for you may not work for me.
That said, bacteria from the lactobacillus and bifidobacterium genera have been shown effective. If I were to supplement, I would choose a supplement containing bacteria from them.
Skin problems are often linked to gut problems and people with skin issues have much higher rates of gut issues. These can lead to bacterial imbalance in the gut and weaken the protective lining of the gut. The end result is that toxins that should remain in the gut can leak into the body and wreak havoc, acne among them.
This doesn’t automatically mean taking probiotics (either as supplements or fermented foods) helps. There are only a handful of studies looking at the effect of probiotic supplements on skin problems. While these studies show probiotics could be helpful, they are by no means miracle cures.
Bacterial imbalance in the gut is often more of a symptom than the real cause. Without addressing these deeper causes taking probiotics is merely patching symptoms and as such may not work that well.
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