Written by Kiera Nikolakakis
Interprofessional Practice & Providing a Holistic Approach
A skin condition is usually just the surface/visible evidence of an internal health issue.
With inflammatory skin conditions like atopic dermatitis and acne vulgaris, which are commonly seen within our scope of practice, we are able to create patient care plans to help manage the condition.
However, more and more research suggests that where skin inflammation has risen there is potentially also gut inflammation. This could be due to an imbalance between the good and bad bacteria in the gut and can either be a mixture of a normal amount of good bacteria, but an over abundance of harmful bacteria, or not enough good bacteria and a normal to high amount of harmful bacteria.
The following is an analogy we can use to make it easier to help our patients understand that it is more than just what is showing on the surface of their skin:
“When it comes to gut dysbiosis and inflammatory skin conditions, think about how bees make honey. The gut is like the bee. The bee needs the right nutrients from the pollen in order to make honey. Similarly, the gut needs to have a nutrient and bacterial balance for the skin to perform its functions properly.”
It is always important to remember that this research is in its infantile stages, and the exact mechanisms of the gut microbiota's influence on various inflammatory skin conditions are yet to be entirely and comprehensively understood.
Looking after the gut can assist our patients in achieving the most desirable results from our clinical treatments and prescribed home care routine. Dermal Clinicians are highly trained and experienced in treating the external manifestation of inflammatory skin conditions, however, it is vital that we educate our clients on internal health, including root-causes of a condition and the benefits of practising a holistic approach when treating the skin.
We want our patients to understand how lifestyle factors and diet have the potential to both negatively and positively impact skin health and conditions. It is therefore important that we are able to educate our patients on why we are recommending they see other healthcare professionals, and how this will assist in further determining and fixing the root cause of their skin conditions.
Implementing inter-professional collaboration and respecting other healthcare providers’ perspectives in healthcare can help improve the patient's outcome.
The treatment of inflammatory skin conditions is complex due to its multifaceted nature. Dermal Clinicians can go as far as educating patients on how the diet can impact the skin, and what the gut-skin axis is. We can provide our patients with information on how the results of our clinical treatments and home care regimes can be enhanced by treating the underlying causes of a condition by referring to additional yet complementary healthcare professionals in which the gastrointestinal tract and dietary nutrition are within the scope of practice. This includes such healthcare professionals like a:
● Gastroenterologist
● Dietician
● Nutritionist
● Naturopath
Generalised and Common Suggestions for Balancing the Gut Microbiome
It is now understood that there are some lifestyle and nutritional factors which ultimately affect the gut microbiome. The following are some generalised and common themes that have arisen from these published studies:
Sleep
Recent studies have actually shown that poor sleep quality or fragmented sleep correlates with poor microbiome diversity. In contrast, good sleep patterns are positively associated with a healthy, diverse gut microbiome.
Antibiotics
Inappropriate or overuse of antibiotics can significantly affect the gut microbiome, causing changes in the
gut microbiota composition and leading to gut dysbiosis. This can be by causing an overgrowth of harmful
bacteria or can lead to antibiotic-resistant bacteria and therefore the spread of these bad bacteria.
Diet
Put extremely simply, there are foods that support a healthy gut microbiome and foods that can lead to (or contribute to) gut dysbiosis when consumed in mass abundance.
An example of food ingredients that support a healthy gut microbiome is prebiotics & probiotics. I’m sure we have all heard of prebiotics and probiotics by now – but what do they actually do?
Prebiotic-rich ingredients include (but are not limited to) legumes, whole grains, garlic and onion, which ultimately serve as food for probiotics. Probiotics naturally contain good bacteria, in which they possess multiple ways of keeping the body healthy, like aiding in removal of excessive bad bacteria to aid in balancing and re-establishing the gut microbiome colonisation.
On the other hand, a diet rich in refined carbohydrates has been shown to have an effect on the gut microbiome, being a contributing factor in gut dysbiosis. This includes foods and ingredients such as white bread, sugar, white pasta, and white rice.
The above are just a few of the many complex factors involved in gut dysbiosis. These are just some examples to help our clients understand and make their own connections to what might be causing their skin inflammation whilst seeking the appropriate advice and care.
Reviewed by the Education Sub-Committee of the Australian Society of Dermal Clinicians.
References (for both part one & part two):
Barko, P. C., McMichael, M. A., Swanson, K. S., & Williams, D. A. (2018). The
gastrointestinal microbiome: A review. Journal of Veterinary Interna Medicine, 32(1),
9-25. https://doi.org/10.1111/jvim.14875
De Pessemier, B., Grine, L., Debaere, M., Maes, A., Paetzold, B., & Callewaert, C. (2021).
Gut-skin axis: Current knowledge of the interrelationship between microbial
dysbiosis and skin conditions. Microorganisms, 9(2), 353.
https://doi.org/10.3390/microorganisms9020353
Duan, H., Yu, L., Tian, F., Zhai, Q., Fan, L., & Chen, W. (2020). Antibiotic-induced gut
dysbiosis and barrier disruption and the potential protective strategies. Critical
Reviews in Food Science and Nutrition, 62(6), 1427-1452.
Ellis, S. R., Nguyen, M., Vaughn, A. R., Notay, M., Burney, W. A., Sandhu, S., & Sivamani, R.
K. (2019). The skin and gut microbiome and its role in common dermatologic
conditions. Microorganisms, 7(11), 550.
https://doi.org/10.3390/microorganisms7110550
Faits, T., Walker, M. E., Rodriguez-Moraro, J., Meng, H., Gervis, J. E., Galluccio, J. M.,
Lichtenstein, A. H., Johnson, W. E., & Matthan, N. R. (2020). Exploring changes in the
human gut microbiota and microbial-derived metabolites in response to diets
enriched in simple, refined, or unrefined carbohydrate-containing foods: a post hoc
analysis of a randomized clinical trial. American Journal of Clinical Nutrition, 112(6),
1631-1641. https://doi.org/10.1093/ajcn/nqaa254
Lee, S-Y., Lee, E., Park, Y. M., & Hong, S-J. (2018). Microbiome in the gut-skin axis in atopic
dermatitis. Allergy, Asthma and Immunology Research, 10(4), 354-362.
https://doi.org/10.4168/aair.2018.10.4.354
Olvera-Rosales, L-B., Cruz-Guerrero, A-E., Ramirez-Moreno, E., Quintero-Lira, A.,
Contreras-Lira, A., Contreras-Lopez, E., Jaimez-Ordaz, J., Castaneda-Ordaz, J.,
Castaneda-Ovando, A., Anorve-Morga, J., Calderon-Ramos, Z-G., Arias-Rico, J., &
Gonzales-Olivares, L-G. (2021). Impact of the gut microbiota balance on the health-
disease relationship: The importance of consuming probiotics and prebiotics.
Foods, 10(6), 1261. https://doi.org/10.3390/foods10061261
Salem, I., Ramser, A., Isham, N., & Ghannoum, M. A. (2018). The gut microbiome as a
major regulator of the gut-skin axis. Frontiers in Microbiology, 10(9), 1459.
https://doi.org/10.3389/fmicb.2018.01459
Sanchez-Pellicer, P., Navarro-Moratalla, L., Nunez-Delegido, E., Ruzafa-Coztas, B.,
Anguera-Santos, J., & Navarro-Lopez, V. (2022). Acne, microbiome, and probiotics:
The gut-skin axis. Microorganisms, 10(7), 1303.
Seo, Y, S., Lee, H-B., Kim, Y., & Park, H-Y. (2020). Dietary carbohydrate constituents
related to gut dysbiosis and health. Microorganisms, 8(3), 427.
Sinha, S., Lin, G., & Ferenczi, K. (2021). The skin microbiome and the gut-skin axis. Clinics
in Dermatology, 39(5), 829-839. https://doi.org/10.1016/j.clindermatol.2021.08.021
Smith, R. P., Easson, C., Lyle, S. M., Kapoor, R., Donnelly, C. P., Davidson, E. J., Parikh, E.,
Lopez, J. V., & Tartar, J. L. (2019). Gut microbiome diversity if associated with sleep
physiology in humans. PLoS ONE, 14(10), e0222394.
https://doi.org/10.1371/journal.pone.0222394
Thursby, E., & Juge, N. (2017). Introduction to the human gut microbiota. Biochemical
Journal, 474(11), 1823-1836. https://doi.org/10.1042%2FBCJ20160510
Wilmanski, T., Rappaport, N., Diener, C., Gibbons, S. M., & Price, N. D. (2021). From
taxonomy to metabolic output: What factors define gut microbiome health? Gut
Microbes, 13(1), Article 1907270. https://doi.org/10.1080/19490976.2021.1907270
Comments