I sense another myth in the making.
The media and natural health websites promote probiotics as the next big thing in acne. They are said to fix the bacterial imbalance in the gut and help with skin problems.
Or do they?
In this post, we’ll do a reality check on probiotics. At the first blush, taking probiotics seems like a reasonable idea. But as with so many things in medicine, initial promise often turns into disappointment.
I’ll share with you 3 little-known, science-based facts you should know before taking probiotics.
Probiotics don’t change the gut bacteria
The reason you are supposed to take probiotics, they tell you, is because your gut microbiome is imbalanced. The usual explanation is that you have more ‘bad’ bacteria than good bacteria, which leads to gut problems, inflammation, and acne. Taking probiotics is supposed to fix this imbalance.
There’s just one problem with this. There’s very little evidence that taking probiotics changes your gut microbiome.
In 2016, Danish researchers published a systematic review of all the studies that looked at the effect of probiotic supplementation on gut microbiome composition in healthy people. Their conclusion:
This systematic review of the pertinent literature demonstrates a lack of evidence for an impact of probiotics on fecal microbiota composition in healthy adults.
Kristensen, NB, Bryrup, T & Allin, KH. Alterations in fecal microbiota composition by probiotic supplementation in healthy adults: a systematic review of randomized controlled trials. Genome Medicine (2016). https://genomemedicine.biomedcentral.com/articles/10.1186/s13073-016-0300-5
In other words, taking probiotics doesn’t ‘balance’ your gut bacteria.
To be fair, these studies were done on healthy people, and the studies in this review were not rock-solid. So, we cannot conclude from this that probiotics are useless.
For example, 2014 systematic review of probiotics on irritable bowel syndrome (IBS) showed some benefits from probiotics. However, on average, probiotics showed only minor improvements over placebo. The researchers calculated that only 1 in 7 people who take probiotics notice real improvements in irritable bowel syndrome.
In contrast, low FODMAP diet has been shown to improve IBS in the majority of the patients. A 2016 review concluded “Unlike most dietary manipulations tried in the past to alleviate gastrointestinal symptoms of IBS, all studies on low FODMAP diet have consistently shown symptomatic benefits in the majority of patients with IBS.”
I’m not at all surprised by these results. The gut is an ecosystem with thousands of different bacteria, and you won’t find most of the core bacteria that make up the gut microbiota in probiotic supplements. So it’s not surprising that taking probiotics with a handful of different strains has little to no effect on the overall bacterial composition. Taking probiotics has been described as trying to plant corn in a jungle. Inevitably, the existing vegetation overwhelms the little corn plantation.
No good evidence that probiotics reduce acne
There’s good evidence to show that acne is often linked to gut problems (more on that below), and at the root of it, there’s usually some form of bacterial imbalance. So one would think that taking probiotics could help.
In her 2015 paper, Dr. Whitney Bowe goes over the relevant studies on probiotics and acne. Unfortunately, there’s not much to write home here. A handful of poor quality studies with a high risk of bias.
Most of these studies show that taking probiotics could have some effect on acne, but I would take that conclusion with a grain of salt. More often than not, small studies with a high risk of bias produce false positive results.
As I said above, taking probiotics for acne is not an obviously foolish idea. It could work. But if probiotics have, at best, a minor effect on the gut microbiome, then I remain skeptical that they would help acne.
Probiotics can make acne worse
People who uncritically promote probiotics often fail to mention that in many cases they make things worse, and even cause acne. Some people with acne have small intestine bacterial overgrowth (SIBO). In SIBO, the ‘good’ bacteria have migrated up to the small intestine. Bacterial fermentation in the small intestine leads to all sorts of problems – acne among them.
The bacteria that grow out of control in the small intestine are often the so-called probiotics, such as Lactobacillus that you’ll find in fermented foods. In such case, taking probiotics just adds to the problem.
I know this from experience. Anytime I take probiotic supplements I get more constipated and wake up with fresh pimples the next morning.
The gut-skin connection is real
Don’t get me wrong. The fact that I was critical of probiotics in this post doesn’t mean the gut-skin connection wouldn’t be real. It is. I just don’t think taking probiotics is the answer.
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 an adverse effect on gut health, which then shows up on the skin. How could this be possible?
The leaky gut syndrome and endotoxemia
Stress, poor diet, and use of certain medications can affect the type of bacteria living in the gut. Certain drugs and lifestyle choices increase the number of harmful bacteria residing in the gut.
The harmful bacteria contain substances known as lipopolysaccharides (LPS). LPS are toxic substances that cause inflammation and have been linked to many chronic diseases. In large doses, LPS can lead to toxic shock.
The bacteria damage the gut wall, which allows LPS molecules to pass through. In other words, the gut becomes ‘leaky’. Once in circulation, they cause inflammation and cellular damage.
In medical terms, this is called endotoxemia – poisoning from within.
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 none of the people with clear skin tested positive.
Bacterial imbalance is a symptom – not to root cause
Bacterial imbalance is usually not the root cause of gut problems; rather it’s a symptom of other problems. Some of these underlying causes include:
- Stress.
- 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, antacids, and painkillers.
It’s possible that taking probiotics temporarily relieves symptoms, but it’s unlikely they will fix the problem – as the studies on people with irritable bowel syndrome show.
And that’s the reason why I don’t recommend probiotics. They are a simple, and usually ineffective, answer to a complex problem.
A better way to fix gut problems and acne
Fixing the gut, and any skin problems linked to it, often requires much more than popping a probiotic. A comprehensive program, like the one outlined in Clear for Life, needs to address both the bacterial imbalance and the deeper causes that led to it in the first place.
Often this requires:
- Dietary changes that for some time limit problematic foods, such as excess fermentable carbohydrates, FODMAPs, and gluten. This goes a long way towards balancing and killing off excess bacteria.
- Taking antimicrobials (herbal or pharmaceutical) to speed up killing excess bacteria.
- Supplements that support the digestive system and prevent the problem from recurring. These can include betaine HCL and herbs that stimulate the small intestine.
- Supporting the core bacteria in the gut with proper dietary choices and supplements, for example by consuming foods with resistant starch and taking some acacia gum.
This is how I rid myself of gut problems and acne linked to them.
I’m not saying probiotics can’t play a role in this, but they are likely to be a small sidekick rather than the leading star.
Conclusion
People with skin problems have much higher rates of gut issues than those with clear skin. These are often rooted in some form of bacterial imbalance in the gut, which weakens the gut lining and allows toxic substances to leak through.
As H. L. Menken said: “For every complex problem there is an answer that is clear, simple, and wrong.” For gut problems, this solution is probiotics.
While probiotics may help in some cases, they are unlikely to live up to their hype.
Bacterial imbalance in the gut is often a symptom than the real cause. Without addressing these deeper causes, taking probiotics is little more than patching symptoms.
Willy try probiotics, seems to be promising 🙂
Another valuable one is the tart cherry, has the highest anti-inflammatory potential – now this may come useful for the generally inflamed body of the acne sufferers! It has a study too!
https://www.treehugger.com/health/new-study-says-tart-cherries-are-highest-anti-inflammatory-food-can-ease-joint-pain.html
Take the tart cherry juice study with a grain of salt. I looked at the paper and it was quite underwhelming. It did show some improvement in markers of inflammation, but nothing significant. My concern is the amount of instantly-absorbed sugar you get with the juice. I would stick to green tea or an antioxidant supplement. Anyway, thanks for bringing it up 🙂
I’ve been taken antibiotics off and on since 2006 (when I was a teenager). Mainly minocycline. Could weaning off of antibiotics and taking a decent strain amount of probiotics resolve my skin issues since I now believe my acne is caused by candida or roaming bad bacteria that the antibiotics have caused?
It’s certainly possible that your acne is linked to long-term antibiotic intake. But it’s by no means a given fact. The alt-med proponents like to ‘diagnose’ everyone with Candida (or heavy metal toxicity) regardless of what the person might be suffering from.
The thing is that the gut microflora is fairly resilient. It’s certainly possible that long-term antibiotic treatment allows pathogenic bacteria and fungi to take over the gut, but it doesn’t happen to everybody. Are you suffering from any gut or digestive problems?
The worst thing you can do is to jump into premature conclusion that Candida is causing your acne. It’s possible that your acne is caused by something else, but since you’ve already ‘decided’ that Candida is to blame you can end up chasing one Candida cure after another without getting any results. I’m not kidding when I say that people have wasted years of their lives and thousands of dollars trying to cure imaginary Candida infections.
You can always talk to your doctor about getting tested. Testing for Candida overgrowth in the gut is relative simple. I’m fairly certain you don’t have systemic Candida infections – since they are known to only occur in severely immunocompromised patients.
Without further details it’s hard for me to say anything beyond this. I would suggest looking into the dietary and topical skincare posts on this site. Those should give you plenty of material to work on.
Thank you for your response!
I’m not a doctor so I can’t say for sure if I had/have candida or not but I can definitely state that I used to have a white coating on my tongue that was likely caused by yeast build-up in the body (at least that’s what it seems like from what I’ve read anyway). I’ve also cleaned up my diet and don’t eat anything that I fear could potentially feed my candida/bacteria and allow it to maintain its stay within my body..
I rarely have any stomach issues (at least since beginning the probiotics anyway) so I don’t think I’m totally doomed just yet. But I know that in the long-term that the antibiotics are going to cause a lot more problems for me and could shorten my lifespan with issues pertaining to my kidneys, liver, or gut..
I’m nervous about weaning off of antibiotics because I also don’t want to lose out on the reasonably clear skin I currently have. I don’t want to go off antibiotics and then realize that the bacteria within me is now unbeatable and that I’m doomed to have acne forever because of my last few years of off-and-on antibiotic usage. I try to keep reminding myself that I’ve altered my diet to a very anti-candida lifestyle and with the probiotics now in my possession things might be different for me but it’s still a very hard concept for me to embrace.
What would you suggest Seppo? Thank you for your time and incredibly helpful responses!
If you check out my Candida posts here, you’ll see that I don’t actually believe into the whole ‘Candida epidemic’ hype. All the evidence points to Candida, the version that natural health folks promote, is a made-up disease. There’s no evidence to show that any undiagnosed Candida epidemics even exists.
That said, it’s possible that long-term antibiotic use causes skin problems. I just did a post about a yeast infection that’s commonly misdiagnosed as acne. In that case antibiotics wipe out the resident bacterial population in the skin and allow the yeast to grow. But even in such cases it’s highly unlikely that the yeast enters systemic circulation. All the evidence suggests that only happens in severely immunocompromised patients, such as people undergoing chemotherapy or people with HIV. So I wouldn’t freak out too much about Candida.
And even if you’ve taken antibiotics for a long-time, it doesn’t mean your gut flora wouldn’t bounce back. All the evidence I’ve seen shows it’s highly resilient and recovers in most cases.
There are no actual evidence that the leaky gut actually exists, it’s just a hypothesized condition being held as the culprit from everything from M.S to Autism. I believe it to be bogus personally, sorry. I bought into this theory for a LONG time and my skin never improved.
I think the real reason people get rather inflammatory acne is because of several genetic flaws that generate the perfect storm for a pizza face. The fact is, genetics do RULE in a way. You can try to solve them, beat them, manage them but they may still find I way to outsmart you. My mother for example is the healthiest eater and is slim yet she still developed Diabetes Mellitus. Why? Because of genetics. Even a healthy diet, low BMI and other natural treatments didn’t prevent her from developing the disease.
While I do agree that ‘leaky gut’, as it’s commonly talked in the alt-med circles, probably doesn’t exist, there is research showing *intestinal permeability* is a real issue in some medical conditions. And it may also be a factor in acne and other skin problems.
As to genes, I wrote about how they influence acne here. While I do agree that genes affect your skin a lot, I wouldn’t go as far as to say they rule above everything else. There’s a lot one can do to mitigate and minimise the damage ‘acne genes’ cause.
Might be relevant: https://www.sciencedaily.com/releases/2013/12/131205141900.htm
By the way, I’m currently trying a probiotic diet (yogurt,sauerkraut,kefir,kimchi) ** fingers crossed **
Is Kimchi good for acne. I know it has probiotics and theres many different ways to make it. Can you write a recipe for it please? Also what other foods have probiotics and are good for acne? Thanks (:
Hey, do you think I could strategically take antibiotics while taking beneficial probiotics at same time to counter act negative effects of antibiotics when it comes to acne. Also is using a retinol cream plus BP run a risk of over dosing Vitamin A?
Were I to take antibiotics I would definitely also take probiotics with them. I can’t tell you whether you should take antibiotics or not. I would avoid them as far as possible. Given how we are at some point going to run out of effective antibiotics and people are going to start dying of simple infectious diseases.
I don’t think you’ll run a risk of vit A overdose if you combine BP with retinol.
It’s not uncommon for derms to prescribe tretinoids and BP together. My mistake. Using BP and retinol at the same time is probably not a good idea. The BP most likely destroys the retinol before it has a change to do any good on your skin. I suggest using BP in the morning and retinol in the evening. That’s what I do on the rare days I use BP, retinol I use almost every evening. And retinol makes your skin sensitive to sunlight, so you don’t want to use it the mornings anyway.Can you tell me how to repopulate the skin flora? After intravensous antibiotics I have blackheads everywhere (from head to torso- anywhere oily). I can get mild reduction from bifidus probiotics but think I need to repopulate the skin.
Also can you provide link to your article on topical yeast infection.
thanks
I’m not sure that IV antibiotics would have any effect on gut flora. Even if it did, your gut flora will most likely recover by itself. My #1 advice would be to eat plenty of fruits and veggies that feed beneficial bacteria in the gut. You can try fermented foods and probiotic supplements but they seem to be a hit and miss affair.
Here’s the post about yeast infections: https://acneeinstein.com/yeast-infections-misdiagnosed-acne/
I recently started following Stefani Ruper based on some of your previous advice specifically, on estrogen levels in underweight women. She uses a topical probiotic spray and a simple cleanser. Do you know of any research done on topical probiotics? I recently applied it and have been advised not to use any other topical treatments or my blue light. If one only uses a probiotic topically how will the skin slough off and not build up? The only research I could find was on eczema, average of 20% reduction. To me, that doesn’t sound statistically significant compared to the blue light research touting claims of a 50% reduction.
Aimee, topical probiotics is not an entirely whacky idea. In fact, there’s decent evidence to show it could work. Probiotic bacteria, when applied on the skin, can produce substances that reduce inflammation in the skin and inhibit the growth of harmful bacteria. The problem is that all of this is still fairly theoretical and there have been only a handful of human studies.
Dr. Bowe summarized the research on topical probiotics in her 2011 paper on gut-skin axis. I recommend you check it out here:
https://www.gutpathogens.com/content/3/1/1
I don’t talk about topical probiotics much because it’s hard to make good recommendations on what to do. We don’t really know which strains work and which don’t – and I’m wary of potential side effects of applying live bacteria on the skin.
After months of taking 50 billion probiotic capsules everyday (thanks paleo world for telling me I needed that,) I realized they are causing my acne on my chin. Obviously I’m going to stop taking them but have I done damage..? Do the probiotics eventually just leave the system ? Have I literally given myself SIBO? My bathroom habits are fine (I think). How do I get the probiotics out of my system!
Yeah, probiotics are controversial in acne and gut problems. They help some people but they cause problems for others. I’m also one of those for whom they cause problems. I don’t think you’ve done long term harm to your gut. The gut flora usually returns to normal after you stop messing with it. Worst case, you might have to take some herbal antimicrobials to correct SIBO.
i must highly disagree with your statements. I know that when i take probiotic’s my skin clears up…the results are pretty amazing..it’s usually with-in 24 hours…if i stop taking them though…with in a day even, my skin flairs back up. I can say 100% that probiotic’s help clear up acne. At least with me.. i’m sure there are others that can say the same.
Hello, can you tell me where I could buy herbal antimicrobials please? I have searched the Internet but can’t find anywhere that sells anything like that. Or do you mean to make our own? Thank you in advance
You can buy them from Amazon, iHerb or other stores. They are usually sold as anti-Candida or anti-parasite supplements.
I broke out in severe acne/rosacea at 13 and still have it 37. Ive just lived on a gluten free, suger free, dairy free diet for a year which has returned results. However eating anything, pasta, sweets, dairy breaks me out. while on leave recently, i started taking pro biotic suppliments on the first day, and ate cheese, pizza, chocolate. You can’t imagine the 20 years of testing ive performed to clear my acne/rosea. I ate half an ice cream cake in a deliberate attempt to break out.. now its only been one month, so it may fail yet, but im getting excited. i can live with being red permanently, but the pimples hurt my performance at work.
What probiotic supplements did you take?
Can mastic gum capsules be substituted for acacia gum? I started taking a probiotic and suddenly developed acne I have never had before. Now I’m worried that the probiotic caused some overgrowth or SIBO that you mentioned.
I haven’t looked into mastic gum, but the reason I recommend acacia is because it ferments very slowly and is very good for the probiotic bacteria in the gut. If mastic gum also ferments slowly, then it might be a substitute, but I cannot say for sure.
This was literally what happened to me! I started getting acne and took probiotics and my skin cleared!
Not too long after, my skin started breaking out again and got ten times worse! I took even higher doses of probiotics and my skin went haywire.
It wasn’t until my dietician recommended that I stop my probiotics and literally in a week my acne was GONE. With a gut healing diet and a couple of supplements my health has made a 360 turn around.
I have a question though? Does that mean I don’t need probiotics ever again? I ate yogurt and my skin broke out lol.
I generally don’t recommend probiotics. I’m not saying they are never helpful, but I think most people get far better results with a gut healing diet and taking acacia gum.
I’m a 20 year old female and refined carbohydrates, dairy, processed foods, ans basically anything that isn’t considered “healthy” breaks me out. Initially, I enjoyed eating and cooking 99% of my meals from home and consuming a lot of fish, chicken, eggs, steel cut oatmeal topped with fruit, brown rice, green smoothies, sweet potatoes porridge (white potatoes break me out as usual), and even veggie burgers, and only drinking water (lemon in the morning) But I can’t take it anymore. I feel like if I don’t treat my acne permanently instead of restricting myself from only eating “healthy” foods, it will turn into an eating disorder. I’m already slim to begin with and most of the foods I eat on a daily basis will make me lose even more if I continue. The fact that I can’t even eat once a year on 4th of July, Memorial Day, and any other holidays with finger foods because they’ll break me out is ridiculous! This is not healthy in the lobg run. I want to be able to eat whatever I want without feeling anxious about eating crackers, hamburgers, or french fries at parties and get togethers without a pimple forming on my face. All of my other peers eat so horriblly, drink alcohol every weekend, smoke cigarettes, party until 2 a.m., and their skin are flawless and clear. You can’t say that they’re healthy on the inside because they eat out 3-5 days every week, barely drink water but drink sugary coffee, barely eat fruits and vegetables (exception being from a fruit platter at a restaurant). I take FARRR better care of my body than most people my age but I have to suffer. Water is literally the ONLY beverage I drink, I don’t eat out AT ALL, I get more sleep, I do yoga, bike ride, and still nothing. I’ve been prescribed birth control and Spironolactone but they harm your body in the long run. My dermatologists/endocrinologists are more into prescribing drugs to TREAT the SYMPTOMS instead of addressing and solving the ROOT CAUSE of my hormonal acne. It’s been like this for 10 years.
Please contact me Seppo Puusa by email if you get the chance to because I want a solution for my hormonal acne without having to go on a restrictive diet that can feel like an eating disorder. I enjoy eating healthy but I need to fix the aggravator that’s exacerbating the acne so I can eat as I wish. This just isn’t fair.
Why is my comment still awaiting moderation????