018: SIBO-Skin Rash Connection w/ Amy Hollenkamp

It’s sometimes difficult to connect certain conditions on the skin with something that’s lurking underneath the surface, specifically in your intestines. But there are so many direct relationships between your gut health and your skin. My guest, Amy Hollenkamp, has expert knowledge of a particularly little-known condition, SIBO (small intestine bacterial overgrowth).


Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

Amy is a dietitian and holistic health coach. She helps SIBO sufferers find relief through diet and lifestyle changes. Amy takes a scientific approach to discuss SIBO, its symptoms, and treatments. I’m a huge fan of her work and so glad she could join us today!

In this episode, we break down the connection between SIBO and a host of chronic skin conditions. SIBO is often a difficult diagnosis to get, so we discuss what you should talk about with your doctor if you suspect you might have it.

Have you suspected you might have a condition like SIBO but struggled to get a diagnosis? Tell us about it in the comments!

In this episode

  • What exactly SIBO is, why it’s often misdiagnosed as IBS, and how it can cause skin manifestations
  • What to do if you think you have SIBO and why you shouldn’t try to treat it yourself
  • The six ways that SIBO can disrupt the skin



“Rosacea is ten times more prevalent in people with SIBO than healthy controls. You’re going to see more skin manifestations in people with SIBO versus people who don’t have SIBO.” [5:15]

“There’s this fine balance that you have to maneuver as a clinician to help people with SIBO. You have to be aware of each case and what root causal factors need to be addressed.” [12:24]

“If your gut is out of whack, your hormones are going to be of whack.” [15:50]



Why You Shouldn't Use Coconut Oil On Your Skin

Do I Have SIBO? Hidden Signs & Symptoms Behind IBS

Find Amy online at The SIBO Diaries

Amy's article — “The SIBO-Skin Connection: How An Imbalanced Gut Is Causing Your Skin Problems

Follow Amy on Facebook | Instagram


“Rosacea is ten times more prevalent in people with SIBO than healthy controls. You’re going to see more skin manifestations in people with SIBO versus people who don’t have SIBO.”

018: SIBO-Skin Rash Connection w/ Amy Hollenkamp FULL TRANSCRIPT

Jennifer:              Let's get started.

Jennifer:              Hi everyone and today I've got a really cool guest, someone whom I've spoken to on the phone and we've had a great little pen pal back and forth via email and then Amy actually wrote one of the best articles on a specific condition we're going to talk about today. That's over on one of my other websites, gluten free school.com and I'll link that in the show notes. Her name is Amy Hollenkamp. I met her actually by accident. I found her through a SIBO Facebook group and I just loved the information that she was sharing with everyone and if you're like what SIBO and why are we talking about that, if you even know what it is in relation to skin, just hold the phone a second because we are going to break this down, the connection between SIBO and chronic skin problems, but first I want to introduce Amy to you.

Jennifer:              She is a registered dietician and a holistic health coach with a passion for helping SIBO sufferers find relief through diet and lifestyle changes. She has an amazing blog which I will share with you. It's called sibodiaries.com we'll have that in the show notes where she shares her personal battle with SIBO and she also loves to use that as an opportunity to lead an evidence based discussion. Right folks? It's based on science, not on how we feel or you know, some stuff we just read online someplace. It's really evidence-based. There's research behind this about the various treatment options out there for SIBO, which I think is one of the more complicated GI issues to treat and work with, especially as a clinical nutritionist. That's what I found. It's really ,it can be very complicated and a long road, but there are skin manifestations that can be a sign that SIBO is brewing underneath. So Amy, thank you for joining us.

Amy:                     Thank you so much for having me. I loved your, your bio, the way you read that bio. I wish you could follow me around all the time and just introduce me to people.

Jennifer:              I'm a really big fan of your work. And part of the reason why I like you, I came to this because I had health problems. And it sounds like that was also your, you're like a similar story except you had SIBO or maybe you still have it, I don't know, but could you share with us a little bit about what your journey has been with SIBO and then it sounds like you've got some history with some skin stuff too that might be linked to that.

Amy:                     Yeah, I mean my health journey was just such a fiasco from the start. And I think it's because I went mainly the conventional route when I was starting to have a lot of GI symptoms. So I went to my conventional GI doctor and they diagnosed me with IBS. Well I was an analyst at the time and so that didn't make sense to me. I knew there was kind of a root cause to my IBS and I always kinda thought IBS was sort of a junk diagnosis. So I kind of went the more functional route and figured out that I had SIBO, which is small intestinal bacterial overgrowth. And kind of through this process I was having so much bloating, weight loss brain fog a lot of hormonal imbalances, just I was chronically ill having pain in my gut and this was kind of manifesting too as skin symptoms. So I definitely see the link personally and then both with clients that I work with between SIBO and skin issues. So for me personally, I was having really bad acne. Especially like hormonal type acne around my, around my sort of chin and draw line. That just wouldn't go away. And once I kind of treated my SIBO, a lot of my skin stuff resolved.

Jennifer:              And so do you see that with clients? Do you find that there's the symptoms like with the skin, skin manifestations that are a sign pointing to, hey, there's something, you know, yes, they've got GI issues. I don't know anyone who has SIBO that doesn't have GI symptoms. But it's, I think it's important for people to realize that it can show up on your face, on your body, that there are things that are outside of the GI symptoms. You know, you don't just have to have diarrhea or constipation or bloating or a bad breath like, you know what I mean? There's, there's other things and I'll never forget our good friend Shivan Sarna. She, we were at an event together and there was a gentleman there and she, he, I don't know how they got talking about rosacea. He had rosacea and he had a history of getting really bad food poisoning and then the rosacea started. So does anything like that that's not, does that you're shaking your head no. It sounds like this is a familiar story to you.

Amy:                     Yes. Yeah, definitely. There's actually a study too that says that people with rosacea are 10 times more likely to have SIBO wait, let me double check that. Can I double check that stat? I wrote it down. Okay. I'm double checking it just to make sure, cause I might've twisted that. No, I'm kind of questioning myself. Oh, rosacea is 10 times more prevalent in people with SIBO than healthy controls. That was what it.

Jennifer:              So basically people that are healthy compared to those with rosacea 10 times. Say that again. So you got the healthy people and we've got the people with rosacea.

Amy:                     Yeah, exactly. So the people with rosacea are 10 times. Wait, now you're confusing me. Rosacea is 10 times more prevalent in people with SIBO than healthy controls.

Jennifer:              Okay.

Amy:                     So yeah, you're going to see skin manifestations and people with SIBO versus people that don't have SIBO.

Jennifer:              And rosacea is a situation where for people who have that redness across their face, and it doesn't matter, it may be amplified when you eat certain things. But this is really an interesting topic because people don't oftentimes connect this redness in their face with something that's lurking underneath the surface. So in the case of SIBO, for somebody who really doesn't understand what that is, has never heard of it, and by the way, that's likely the one of the hidden things that could be under an I B S put that in air quotes, IBS diagnosis. What is SIBO?

Amy:                     So SIBO is small intestinal bacterial overgrowth. And it's essentially when bacteria from the large intestine starts to overgrow into the small intestine. The small intestine is supposed to be relatively sterile compared to the large intestine, so they're supposed to be relatively low amounts of gut bacteria in the small intestine. And this is for our, this is for us to be able to absorb and digest nutrients. That's what the small intestine is designed to do. So when that bacteria starts to translocate from the large intestine into the small intestine, it causes food to ferment in the small intestine. And this causes inflammation and toxic byproducts to really damage the lining of the gut and the small intestine. And this damage can cause things like leaky gut, which start to kind of stimulate the immune system in a really pro-inflammatory way. And once this inflammation sort of kicks off that inflammation becomes systemic. So it kind of creates inflammation that then manifests in the skin. Cause if the immune system sort of going haywire because of SIBO and the small intestine, that starts to happen in the skin as well.

Jennifer:              And so this is one of those diagnoses that number one is hard to get through a GI doctor. At least that's what I found. How would someone go about finding out what is the best way for them to find out if they do say they've had IBS? So it doesn't matter by the way folks, if you have, if you're more diarrhea or teen constipation. Okay. So it doesn't matter. And you could have gas, you could have bloating, like serious belly bloating usually after you eat. Sometimes people will say you look like you're four months or five months pregnant. I've had clients with super bad breath, like they had brush their teeth five times a day and their breast still stinks. Anyway, belching that kind of stuff. Like, you know, things that we want to, we don't want people to hear or see or experience in our digestive system is just like thrown itself right into the mix and you're like, Whoa, that's too much information for everybody to know what's going on except you've got this situation in the gut that's not happy. So what's the best way for somebody to, if they can find out that they might have actually have SIBO and not IBS?

Amy:                     Yeah, I mean definitely there's clear signs and symptoms, but like you were saying before, and again, sometimes the symptoms and signs aren't super clear, so it's good to kind of try to get more diagnostic type testing. So there's a couple of different options. So really the gold standard would be like an endoscopy, an endoscopy where they take a culture of the small intestine and look to see if there's any bacterial growth going on in there. Again, that's pretty invasive. So unless you're kind of getting an endoscopy anyway, I probably wouldn't advise doing that. You can also do a breath test, which is kind of the traditional route because it's non-invasive. And again, there's some questionability on, on whether on how accurate they can be. Sometimes you can test, there's false, I'll start over I think on that one. Is that okay?

Jennifer:              Fine.

Amy:                     Okay.

Amy:                     Okay. So in terms of testing, there's a couple of different options. So there's the an endoscopy where you can get a culture of the small intestine where they can look to see if there's bacterial growth that can be pretty invasive. So there's non-invasive options like a breath test. And again, you're going to drink a little solution of sugar and you're going to breathe into these bags and when you breathe or when the sugar kind of goes down, if you have SIBO, you're going to produce certain gases. So when you breathe into these little bags it'll collect the gases and you send them off to the lab and it can indicate if you have SIBO, if you're producing these types of gases. And that test is kind of the best non-invasive test we have. But there can sometimes be false positives and false negatives. So it's always good to work with a practitioner to really kind of help you sort of decide what the next steps are because maybe you have all the symptoms, but your test was negative. So there could possibly still be SIBO there. So it's important to kind of work with a practitioner to really see kind of what the best route would be.

Jennifer:              Yeah, and I agree with you. I would say that every client that I have worked with who, number one has fought me on doing a breath test because it's really hard to get. If your GI doctor doesn't know what SIBO is or they don't believe in it, good luck getting endoscopy or even for them to order a breath test that you could run through your insurance. You're probably going to have to pay for one yourself and there are sites and I can list them up here in the show notes of where you can go order a breath, test yourself. That said when you get the results back. This is not a DIY project. I mean Amy, you have spoken about this a lot and I don't want to go in depth on it, but a lot of people develop issues around eating an overly restrictive eating because they try and DIY treat SIBO themselves and this is a long, this is a scenic route problem like skin issues. I always say it's like taking the scenic route, but SIBO is a scenic route GI issue. It takes a while and you should expect slow, but hopefully steady progress. Sometimes there are setbacks, but this is why you have to work with a practitioner that really understands it. Like you do you know the ins and outs. Just for a moment, do you have like maybe a a word or two to say about just like this cautionary thing and being careful for overly restricting food?

Amy:                     Yes, definitely. And this is something that I'm really passionate about because I fell into that mindset too personally. Because there's this kind of idea that once that bacteria gets stuck in there that it can be starved and that a lot of times just isn't the case. So a lot of people put in their heads, you know, this bacteria is getting stuck in here. It's a bacterial problem. But in reality, SIBOs kind of a secondary condition. So there's always underlying root cause factors that you need to dig to the bottom of and correct so that that bacteria is not getting stuck there and translocating to the small intestine from the large intestine anymore. And once those underlying factors are addressed, then you can have a lot more prolonged success with SIBO because when you kind of get into this, this sort of mentality where you're starving the bacteria, you start starving all the bacteria which can affect the large intestine and you really can't have a, a healthy functioning small intestine if your large intestine is kind of out of whack because you're starving that as well.

Amy:                     So there's just this fine balance that you kind of have to maneuver as a clinician that's helping people see though you really have to be aware of kind of each case and what sort of root causal factors need to be addressed. And I often get the people that have tried the DIY approach, you know, that have sort of tried to treat this on their own and then they're like, oh shoot, I'm in this hole, like they dig themselves in a hole and it's, it's definitely harder to come out of if you of get stuck in a hyper restrictive diet.

Jennifer:              Yeah. And actually for everybody listening to this, if you'll recall, Kiran Krishnan on my interview with him and we'll link up that podcast if you did not hear that or if you skipped over the portion where we talked about how butyrate, which is a very important small chain fatty acid produced by gut flora in the colon or large intestine. We talk about how that's really important for communicating to the skin and building healthy skin. So if you starve off all the good bacteria because you're trying to get the bacteria that's not in the right spot, you create a problem for yourself amongst many other issues. But there is a lot of connections between that and I, I think it's worthwhile to also point out that there are complications with SIBO or issues with SIBO that can make skin issues worse. And you had mentioned to me like there are six ways how SIBO can really disrupt the skin. Do you want to just go through that list quickly so that people are aware of why, why looking for SIBO if you just have IBS would be important?

Amy:                     Yeah. And in a couple of these we kind of already discussed a little bit. So again, we kind of discussed how SIBO can sort of break down that intestinal barrier. So that's kind of the first factor, which causes systemic inflammation. Then we have sort of underlying large intestine imbalances. So moving on from the small intestine, usually people with SIBO have large intestine imbalances. So kind of like what you're talking about in your former interview. Like if your large intestine isn't producing short chain fatty acids, it's going to affect the skin and the environment on the skin and what's growing on the skin. So that's a huge factor in how SIBO can affect the skin. And then kind of the third factor is that SIBO causes malabsorption and a lot of those gut bugs start competing for nutrients. So you really start to develop a lot of nutrient deficiency issues.

Amy:                     Things that are really important for healthy skin can be depleted like fat soluble vitamins, vitamin B6 . Um the B vitamins can start to become deficient, zinc can start to become deficient. So all these things that are really important for skin health can start to become depleted. The fourth cause is histamine issues. So there's a really strong connection between histamine and SIBO. And, and part of that is because when your immune system's kind of out of whack, you're going to produce more histamine. And then with SIBO you can have bacteria that's producing more histamine. And then on top of all that, the damage to the intestinal lining can lower enzymes that break down histamine. So you can have really high histamine levels and that can cause things like hives, rashes. So that's another factor. And so the fifth factor is hormonal things that can happen from gut issues.

Amy:                     So I always kind of say, if your guts out of whack, your hormones are going to be out of whack. And so a big piece of that is because gut bacteria can affect how we're detoxing estrogens. So there's gut bacteria produce enzymes that help you detox estrogens. So if you're having a certain level of bacteria that are producing an enzyme called beta glucuronidase, you can't detox estrogens properly and they start to kind of recirculate in your system. And that can cause things like estrogen dominance, which can cause hormonal acne. And that was kind of a big player in what was going on with me, I think is a lot of hormonal type acne driven by gut issues. And kind of the sixth real connection between SIBO and gut health or SIBO and skin health is that there seems to be a low vagus nerve function in patients with SIBO and IBS. And so the vagus nerve is super crucial and getting into kind of a parasympathetic rest and digest state. And people that don't have proper vagal nerve tone can sort of become stuck in a fight or flight state and are really stressed out state and that can produce a lot of skin manifestations as well. So those I would say are the six causes, causes or factors that kinda connects SIBO to skin and I can kind of run back through them too, if, if that's helpful.

Jennifer:              I think that, you know, I think it's good to touch on these because you know, a lot of people don't have any idea that there is a connection between their gut. I think actually anyone listening to this podcast is, and if you have not heard this before, there is a, there are so many direct relationships between gut health and your skin. It's not even funny. So the fact that dermatologist a don't run any labs except maybe, maybe a skin biopsy once in awhile. Or that the fact that they're not looking for other symptoms that could correlate with inflammatory issues, histamine mark, any sort of things that could be triggering these ongoing skin issues. The fact that you know, this is a bigger picture than just your skin. I think that's one of the biggest lessons that I have taken away from having had chronic eczema myself on my hands.

Jennifer:              It's not just about where the eczema is and that I have eczema or that I have a skin rash. It's that there's something underneath the surface and the fact that so many people don't even know that there's a connection between the SIBO and chronic skin problems, astounds me and I am glad that we are starting to write that ship, especially here at The Healthy Skin Show. And excuse me now that we're starting to write that at The Natural Skin Show and also that we're able to have friends like you, Amy on to share all of this with us. And yes, there's plenty of other things as far as treatment and whatnot. But I want to encourage you to go over to Amy's website to check that out because it is a fantastic website and she's done an excellent job of breaking things down, doing lots of research and finding good references. That to me is so critical because a lot of what's out there today is not based on good research. And Amy, I, I'm like you, I pride myself on good research and I know you're the same, so I feel very comfortable in sending people over. So your website's sibodiaries.com. Is that the best place for people to come check you out?

Amy:           Yeah, my website, you can check me on my website and I'm usually pretty active on my Facebook page. So those are kind of my two ones that I'm super active with. I just started Instagram so you can find me, but I'm little less active on that. So usually Facebook's a good place for me to kind of interact with you too.

Jennifer:           Yeah. And yeah, and I will put both a Facebook page and [inaudible] website right in our show notes. So it's super easy to find. You can click through and check her out. So Amy, thank you so much for joining us and hopefully we can have you come back sometime.

Amy:           Yeah, that'd be awesome. I really enjoy that.

Jennifer Fugo, MS, CNS

Jennifer Fugo, MS, CNS is an integrative Clinical Nutritionist and the founder of Skinterrupt. She works with women who are fed up with chronic gut and skin rash issues discover the root causes and create a plan to get them back to a fuller, richer life.

Follow Us

Medical Disclaimer

Skinterrupt offers health, wellness, fitness and nutritional information which is designed for educational purposes only. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnois, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other health care professional. Do not disregard, avoid, or delay obtaining medical or health related advise from your physician or other health care professional because of something you may have seen or read on our site, or in our advertising, marketing, or promotional materials. The use of any information provided by Skinterrupt is solely at your own risk.

Nothing stated or posted on our site, or in our advertising, marketing or promotional materials, or through any of the services we offer, as intended to be, and must not be taken to be, the practice of medicine or counseling care. For purposes of this disclaimer, the practice of medicine or counseling care includes, without limitation, nutritional counseling, psychiatry, psychology, psychotherapy, or providing health care treatment, instruction, diagnosis, prognosis, or advice.