Typically, aesthetic medicine providers are focused on treating patients’ skin from the outside. They might use surgery to tighten skin, lasers for resurfacing, fillers for volumizing or neurotoxins for relaxing. But some insist that is only half the battle, and that clinicians should look at what is going on inside, specifically at gut health and how it may be affecting skin and aging.
“Gut health and skin health go hand in hand,” said Shelena C. Lalji, MD, founder of Dr. Shel Wellness & Aesthetic Center in Sugar Land, Texas. “What happens on the skin is literally a symptom of what is going on deeper in the gut and the body.”
Shelena C. Lalji, MD
J.D. McCoy, ND
Mayha Patel, DO
Mark J. Tager, MD
Paying attention to the skin-gut connection should be a given in the field of aesthetics, according to J.D. McCoy, ND, a naturopathic doctor who specializes in aesthetic medicine in Gilbert, Ariz.
“Cosmetic medicine clinicians have the potential to change people’s lives for the better,” Dr. McCoy stated. “We want to make sure that we are doing everything possible to not just make someone look better but also feel better.”
Where Better to Start Than the Gut?
Gut health influences immunity, hormones and helps regulate inflammation. Whether gut health is good or poor can reveal itself on the body’s largest organ, the skin.
The gut microbiome has trillions of different kinds of bacteria living symbiotically within it. An overgrowth of bad bacteria in the gut due to poor diet, stress, over medication or lack of sleep, results in the skin becoming inflamed. “These patients present with skin diseases such as acne, rosacea, sensitivity, eczema, psoriasis, decreased elastin or collagen leading to sagging skin, and much more,” said board certified dermatologist Mayha Patel, DO, of Torrance, Calif.
There are so many barriers to good gut health, including the low nutritional content in store-bought foods that are part of the standard American diet, and exposure to toxins. Even the medications people take can deplete nutrients and increase gut permeability. For example, H2 antagonists for acid suppression deplete calcium, folic acid, B12, iron and vitamin D, noted Mark J. Tager, MD, CEO of ChangeWell Training Academy in San Diego, Calif., who presented on skin health from the inside out in November during The Aesthetic Show 2020.
“If you have a healthy and balanced gut microbiome, it reduces inflammation in the body and maintains the health of your intestinal barrier, which prevents harmful toxins from entering the bloodstream. However, when our diet and nutrition is lacking, it can result in that lining deteriorating, leading to leaky gut syndrome and gut dysbiosis,” Dr. Shel explained.
With leaky gut syndrome, gut microbes produce harmful byproducts that then leak through gaps into the bloodstream. The body’s immune system jumps into action, which can actually create autoimmune and chronic conditions including several skin issues, according to Dr. Shel.
A poor diet is one of the most common causes of this overall dysregulation between the skin and gut, Dr. Patel pointed out.
“A poor diet that produces bad bacteria in the gut leads to inflammation that triggers the release of inflammatory cytokines throughout the body. Our skin responds to this release of inflammation by breaking out into the various skin diseases we see in clinic on a daily basis,” Dr. Patel continued.
Foods high in sugar, dairy and gluten, as well as processed foods and vegetable oils are chronic inflammatory skin triggers. Ingesting foods with probiotics and prebiotics has the opposite effect. It allows the gut to produce good bacteria and can help prevent and treat skin disease and skin aging.
“Our skin is quite amazing. It acts as a true window to and reflection of our health and wellbeing on the inside,” Dr. Patel said. “It also protects us from the outside world and plays a large role in our immune system. It absorbs and secretes to stay hydrated to regulate our body temperature and detoxify various metabolites and waste it may come in contact with. It not only produces hormones like vitamin D, but also plays a role in regulating hormones within our body.”
Addressing the skin from the inside out not only helps patients feel better but can improve outcomes from their cosmetic procedures. Hormones and inflammation are good predictors of how well the skin works and how it will heal, according to Dr. McCoy.
“This is really relevant in cosmetic medicine since a lot of the treatments we do on the skin initiate injury, whether on the micro or macro level,” Dr. McCoy said. “In a nutshell, there is a direct connection between the gut and wound healing. And things you can do to optimize gut health will influence the skin and the way a patient potentially can respond to a treatment.”
What to Look For; What to Ask
Gastro-intestinal symptoms are among the signs that a patient’s gut health is poor.
“If somebody comes in and says they have bloating, constipation, reflux, or have been diagnosed with irritable bowel syndrome (IBS) or Crohn’s, these are signs that there is inflammation in the gut microbiome and we have to look deeper,” Dr. Shel explained.
What clinicians hear in a patient’s history can help, as well as what they see when the patient presents in the office. According to Dr. Patel, the skin offers specific clues to what is happening with a patient’s gut health. For example, excessively dry skin indicates an unhealthy intestinal lining.
“Due to this dry skin, our body tries to compensate by triggering our oil glands to start producing oil, and oftentimes this can subsequently lead to problems of overproduction,” Dr. Patel said.
Tips for Treating Beyond the Surface
Dr. Tager recommends three clinical strategies for building skin health and beauty from the inside out: countering oxidative stress, decreasing intestinal permeability and improving dysbiosis.
Oxidative stress and assaults on skin arise from not only bad diets but also from environmental toxins. These toxins can lead to reactive oxygen species, altered DNA, cellular protein damage, collagen breakdown and more, according to Dr. Tager.
“The skin defends against these attacks by synthesizing enzymes, with uptakes of vitamins C and E and by utilizing antioxidants,” Dr. Tager said.
Dr. Tager cited research suggesting that to counter oxidative stress, clinicians should look for supplements that provide vitamins E and C, carotenoids, pycnogenol, resveratrol, selenium, magnesium, zinc, silicon and pure astaxanthin.
To help patients decrease intestinal permeability, clinicians should examine what the patient might be doing to increase the permeability.
“The gut lining is actually just one cell thick,” Dr. Tager explained. “It is easily damaged by long- and short-term non-steroidal anti-inflammatory drug (NSAID) use; opiates and other pain medications; toxins, such as glyphosate; and gluten or wheat for those who are sensitive. Other offenders are alcohol, birth control pills and antibiotics.”
To address intestinal permeability Dr. Tager cited the positive effects of bovine immunoglobulin, L glutamine, zinc carnosine, liquid herbal blends, digestive enzymes and herbal teas.
“Once you have addressed the gut permeability issues, clinicians can help patients with dysbiosis. The microbiota has 10 to 100 trillion symbiotic bacteria cells that have protective, structural and metabolic functions. They ferment dietary fiber into short-chain fatty acids, synthesize vitamins and produce neurotransmitters. Spore-based probiotics can help to restore the balance of helpful bacteria” Dr. Tager noted.
Dr. Tager encouraged aesthetic physicians to incorporate stool microbiome testing.
“A number of studies show that probiotics and prebiotics have a beneficial effect on skin health and disease. Two that we tend to focus on are Lactobacilli and Bifidobacterium,” Dr. Tager said.
Dr. McCoy makes some general recommendations to his patients. He tells them that from a preventative standpoint, eating diets that are rich in natural, non-processed foods will tend to have higher nutrient content. Nutrient dense foods that are not processed are important because good gut microbes need nutrition and eating healthy foods is like giving energy to the gut cell, he said.
“I’d say one of the big things that is lacking in North America is fermented foods,” Dr. McCoy added. Fermented foods, including miso, sauerkraut, pickles and Kombucha, can re-inoculate a lot of the good bacteria in the gut.
Dr. McCoy also recommends supplementation. At the top of that list is a good probiotic. “There are specific strains of good bacteria that can have specific effects on certain conditions and pathologies. For example, there is a strain of bacteria Bifidobacterium breve B3 which was studied in Japan that has been shown to directly affect skin inflammation, improve acne and make the skin look better,” he shared.
A supplemental probiotic is especially important if Dr. McCoy prescribes an antibiotic as prophylaxis after a full-field laser resurfacing procedure, for example. Antibiotics are among the medications that kill good gut bacteria. Dr. McCoy suggests that patients take the probiotics at a different time than the antibiotic to minimize side effects and improve outcomes.
Dr. Patel recommends patients nourish their bodies with nutritious whole foods and balance blood sugar levels with protein and good fats, such as omega-3s. She also recommends a few supplements for patients, including vitamins D and C, green tea (for its potent polyphenols and protective effects against UV and environmental toxin exposure), as well as supplemental probiotics.
Dr. Shel offers options for advanced testing at her practice to evaluate gut health. One is the previously mentioned stool-based gut microbiome testing on patients to check their micro-environment, checking for inflammation, leaky gut and dysbiosis. She also checks for nutritional deficiencies, thyroid, adrenal and hormonal imbalances and heavy metals and mold to determine the true culprit of her patients’ symptoms, both inside and out.
“Once I have all the information, I come up with a customized protocol to enhance their gut health, achieve hormonal balance and lower toxicity and inflammation, which then leads to incredible skin health and vitality,” she said.
Dr. Shel has co-formulated and markets her own product line, specifically to address gut health and skin health. She often recommends patients take the products in her Digestive Wellness Pack, including probiotics, digestive enzymes and protease, which breaks up the inflammation in the body, gut and skin, she said. Dr. Shel also incorporates her Omega Beauty product, which features omega fatty acids, coriander seed oil and more to increase antioxidant levels, along with GI Revive, which includes agents that heal leaky gut syndrome.
A Win for Patients & Providers
Incorporating gut health testing and treatment in practice can be a practice builder and most patients are candidates, according to Dr. McCoy.
“From my experience, unless they are actively doing things to support their gut through diet or supplementation, we can always improve it,” Dr. McCoy declared. “But especially if patients have skin dryness, erythema, poor wound healing or acne, there is a lot we can do to optimize skin health.”
Aesthetic providers should care about addressing nutrition and gut health for four reasons, according to Dr. Tager. Doing so responds to patient interest, creates better outcomes, distinguishes practices and adds a revenue steam. He recommends that practices consider an online dispensary for gut and skin health products.
Dr. McCoy not only educates patients on how to make healthier choices but also makes specific recommendations that he believes help achieve optimal gut and skin health and better post-procedure outcomes, such as much shorter recovery times.
It is a practice differentiator, Dr. Shel reiterated, who said her patients are happy and grateful that although they might come in for skin tightening, body sculpting, wrinkle treatments or collagen support, she also addresses the body’s “ecosystem and terrain.” A more complete approach to care helps patients not only look great but also feel more energetic, rested, lean and vibrant in the long term.
“I’m a huge fan of using many different lasers and have just about every laser you can think of in my office, but I combine that into an inner vitality, outer rejuvenation approach,” Dr. Shel revealed. “If you just focus on the outside, you may not give your patients all they need to make them feel overall happy, healthy and harmonious. With this combined approach, you will win over your patients’ trust for life.”
Dr. Patel suggests and even offers her patients some of these easy and accessible nutrient gut boosting snacks that can help leave skin radiant and nourished.
Chia seeds and flax seeds: Packed with antioxidants and omega-3 fatty acids.
Nutritional yeast: High in fiber, vitamin B, thiamine, folate, niacin, magnesium, copper and manganese.
Avocados: This super-food regulates the release of sugar into the bloodstream and is high in vitamins C and E. This healthy fruit will help keep your skin radiant and youthful.
Spirulina: A small algae packed with nutrients. It is full of vitamins, minerals and amino acids, which help support gut health by providing good, healthy bacteria.
Greek yogurt with blueberries: Gut- friendly Greek yogurt mixed with blueberries, which are loaded with fiber and disease-fighting antioxidants serve as the perfect breakfast.
Dark chocolate-covered almonds: Rich in magnesium, which is vital for cellular func- tion, and packed with antioxidants to boost complexion and strengthen hair and nails.
Bananas, nuts, whole grains and legumes: High fiber, prebiotic- and selenium-rich foods decrease the growth of harmful bacteria in the gut.