266: Eczema-Gut Connection (PART 1)

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If you haven’t considered the potential gut connection to eczema, then this will be quite surprising to you!

Many of my atopic dermatitis clients struggle with chronic gut issues.

And some have extremely imbalanced gut microbiomes, but don’t even have any gut symptoms!

Testing and certain patterns that I see in my clinical practice have underscored the importance of considering the impacts that the gut has on the skin, so we’re going to start diving into that today!

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In this episode:

• Factors that impact the eczema-gut connection
• When gut microbiome imbalances can start (HINT: it’s earlier than you think!)
• Specific types of bacterial overgrowth I see in eczema clients
• Imbalances that current research is highlighting in the “eczema gut”
• What tends to be skewed in the gut microbiome of young babies + kids

Quotes:

Inflammation that impacts the skin often doesn’t originate in the skin… but actually somewhere else in your body.

The gut of someone with eczema may look different compared to someone who does not have eczema.

 

266: Eczema-Gut Connection (PART 1) (FULL TRANSCRIPT)

Welcome back to episode #266 of the Healthy Skin Show!

In today’s episode + in honor of Eczema Awareness Month, I want to start the journey of diving into the eczema-gut connection. This will not be a comprehensive episode which is why this will be Part 1 of a series because this connection is pretty big!

If this happens to be the first episode of the Healthy Skin Show that you’ve stumbled across + have only thought that eczema was triggered by allergies, environmental issues like laundry detergent or genes – this will probably be considerably eye-opening for you.

At this point in time, research has been presented at major dermatology conferences demonstrating that skin issues like atopic dermatitis are not JUST skin issues.

And there’s ample research already in existence as well as currently being done that supports this as well.

Some of what I’ll share today will connect dots between what experts I’ve interviewed have already shared that may be obvious to me + other practitioners, but not so clear to others (especially listeners who are patients or caregivers).

To better understand this, we have to look at a variety of factors or root causes that contribute to eczema that include inflammation, allergies, dysregulation of filaggrin (which is likely the genetic issue your doctor may have blamed your eczema on), nutrient depletions, liver detoxification challenges, environmental exposures and even hidden infections that might not be obvious.

So let’s dive in!

 

The Mess In Your Gut Doesn’t Stay In Your Gut

I don’t think anyone is arguing about the role that inflammation plays in eczema, but most people don’t actually know what inflammation is.

It’s a term commonly thrown around, but my guess is that if I asked you to stake your life upon explaining what inflammation is, many listeners would find this pretty challenging.

And it’s not your fault that it’s a hard term to define.

The health + wellness world hasn’t helped much, typically describing it as something silent and vaguely bad, or even disastrous.

To be fair, certain types of inflammation are good and helpful.

The problem that’s more concerning is the type of inflammation that is chronic, sustained, and unrelenting often requiring prolonged anti-inflammatory tools like steroids, immunosuppressants, biologic drugs, and JAK inhibitors for relief.

And this is what we commonly see (or perhaps you’ve experienced) along your skin rash journey.

These drugs forced me to dig into inflammation in a way that I was not trained (nor are most of my colleagues in the nutrition field). While I certainly wouldn’t consider myself an expert on immunology by any means, I love having people on the Healthy Skin Show like Dr. Heather Zwickey who is!

What I have come to learn is that the inflammation that impacts the skin often doesn’t originate in the skin… but actually somewhere else in the body.

So very much unlike the phrase “What happens in Vegas stays in Vegas”…

What happens in the gut most definitely doesn’t stay in the gut.

And it’s not uncommon to see symptoms originating from the gut that eventually show up as skin issues, brain fog, fatigue, joint aches, anxiety, etc.

This is partly due to the dysfunction that can be triggered when the microbiome becomes dysbiotic (or imbalanced).

Other reasons stem from waste products produced by unfriendly or overgrown bugs overwhelming your liver detox pathways, nutrients lost due to gut dysfunction, and inflammation generated as a result of this unbalanced ecosystem.

There’s plenty of research at this point that demonstrates how organisms within the GI tract trigger the cytokines (inflammatory mediators) which also in some cases happen to be the targets of drugs that I just mentioned.

 

When Your Gut Is Imbalanced…

While it’s tempting to talk about infections and organisms that eventually make their way into the GI tract to wreak havoc, I think the best place to start this conversation is to consider the impact of an imbalanced gut on your skin.

I say this because the bacteria in your gut microbiome are crucial to a healthy life. We cannot thrive without bacteria (and even the other organisms that live with them).

The balance of the gut microbiome is pretty much set during the first two years of life – for better or worse.

Imbalances can certainly be passed from mother to baby.

But they also can form with exposures to antibiotics, high starch and sugar diets, mold in the home environment, etc.

With time and increased exposures to various stressors, stomach bugs, medications, processed foods, etc. – your gut microbiome has changed, and that’s where the problems begin.

So let’s talk about this because imbalances alone can both be problematic for eczema. I’m specifically talking about a state of undergrowth or depletion as well as when there is overgrowth or just way too much bacteria present (yes, this can happen!).

Despite what you’ve probably read, you can have an overgrowth of gut bacteria even if you’ve taken multiple rounds of antibiotics. These cases always surprise me because you would expect the opposite, but it can and does happen more commonly than you’d think.

Overgrowth can show up as Small Intestine Bacterial Overgrowth (SIBO) as well as Large Intestine Bacterial Overgrowth (LIBO).

Both patterns are problematic even though you might think that more bacteria is better.

In my clinical experience, SIBO is typically caused by insufficient acid within the stomach which can be caused by a number of issues including

• an h.pylori infection
• stress that prevents you from transitioning into what’s known as the “rest and digest” phase
• nutrient insufficiencies that include zinc, sodium + chloride
• autoimmune destruction of the parietal cells that make stomach acid (caused by anti-parietal cell antibodies)

Whereas LIBO is, in my opinion, what follows a possible SIBO situation with bacteria that’s been swallowed, but not killed in the stomach, traveling further downstream and landing in the colon.

I should mention that both of these situations may present with significant imbalances of both the “good and bad” gut bacteria. Research has shown many times that the gut of those with atopic dermatitis tends to have depletions of important healthy commensal gut bugs.(1)

 

Or When There’s Too Little Gut Bacteria…

Lower levels of good bacteria are equally common which is equally problematic.

One of the biggest issues I also see with eczema cases is candida overgrowth within the gut.

Unlike what everyone thinks, Candida is a commensal organism just as much as some of the more well-known bacterial strains.

But it must be kept in check by healthy gut flora which Kelsey Kinney discussed in episode 2 of the Healthy Skin Show). She likened our healthy gut bugs to bouncers in a club that help to control other organisms who are opportunistic (like Candida).

So with repeated exposures to antibiotics (or even excessive and inappropriate use of herbal antimicrobials) that clinically depletes healthy gut bugs along with a highly processed diet of starches + sugar, Candida will certainly take the opportunity to overgrow.

I want to be clear here – this issue typically starts in the small intestine since that’s where Candida normally lives.

If the issue is severe enough, it will begin to move further down into the colon.

This fungally environment is also further encouraged if you’re living (or working) in a damp or moldy environment.

Even children are not necessarily free from the risk of fungal overgrowth with some data noting a “higher abundance of particular fungi (Candida and Rhodotorula)” in the gut microbiome (which also could potentially reinforce the idea that microbiome imbalances may start even younger than we realize!).(2)

Aside from the Candida concern (which I commonly see in eczema clients – more on that HERE), healthy commensal gut bugs help to improve our immune function, produce byproducts of fiber called short-chain fatty acids, and even make some vitamins such as Vitamin K, “thiamine, folate, biotin, riboflavin, and pantothenic acid”.(3,4)

And as I’ve already mentioned, the presence of certain strains is really important especially when the gut microbiome can be skewed even in young children and babies with eczema.

Current research points towards low diversity and key depletions of Bifidobacterium, Bacteroides, Akkermansia, and Faecalibacterium strains as one facet of the problem coupled with low production of Short-Chain Fatty Acid production.(5,6)

One paper mentioned that early gut “colonization of Bifidobacteria subtly regulates the TH1/TH2 immune balance, reducing the risk of atopic dermatitis”.(6)

And a paper called “​​Microbiome of the Skin and Gut in Atopic Dermatitis (AD): Understanding the Pathophysiology and Finding Novel Management Strategies” published in 2019 in the Journal of Clinical Medicine stated that “The ‘leaky gut’ in AD patients propels skin inflammation by enabling the penetration of toxins, poorly digested food, and microbes, into the systemic circulation. As they reach the skin, a strong Th2 response is initiated, causing significant tissue damage.”(7)

So with that so succinctly stated, we have more to dive into, but that will be for a Part 2 and potentially even Part 3 of this discussion on the eczema-gut connection!

For now, it’s crucial to understand that the gut of someone with eczema may very likely look different compared to someone who does not have eczema.

Those differences may be very important so while research is still digging into this connection, to completely dismiss the eczema-gut connection at this point is, in my opinion, very short-sighted.

If you’ve got any questions or thoughts to share about this or if there are other connections you’d love for me to explore, leave a comment below so I can address them.

And please share this episode with anyone who is struggling with eczema and doesn’t realize that this skin condition points towards deeper imbalances which may be why only addressing the skin itself don’t yield lasting results.

Thank you so much for tuning in, and I look forward to digging deeper with you in the next episode!

 

REFERENCES

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6021588/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5053876/
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3144392/
4. https://pubmed.ncbi.nlm.nih.gov/16633129/
5. https://www.tandfonline.com/doi/full/10.1080/19490976.2022.2068366
6. https://www.mdpi.com/2076-0817/11/6/642/pdf
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518061/