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From the Inside Out: How Gut Health Impacts Anti-Aging and Aesthetics

Article-From the Inside Out: How Gut Health Impacts Anti-Aging and Aesthetics

It Takes Guts (To Have Beautiful Skin)
Science reveals a symbiotic relationship between a healthy gut and the brain, immune system and skin. The next forefront of gut health medicine leans into aesthetic medicine to enhance outcomes. Understanding what is happening beneath the skin, at the gut level, impacts how the skin and body function, age and respond to aesthetic interventions. Physicians now recognize that a balanced gut is critical for optimizing procedures that run the gamut from wrinkle-reducing injectables and fillers to modern-day facelifts and beyond.

Understanding the Modern-Day Gut


As the digestive health market is expected to expand to an estimated value of $104 billion by 2032, the medical community’s understanding of the chemical and neurological connections between the gut, brain and skin will grow stronger. The gut, which runs from the mouth to the rectum, regulates food intake and output as the first line of nutrition absorption and delivery of digestive enzymes. But, unbeknownst to many, it is essential in overall body regulation and functions. As many as 45% of Americans say their daily lives are affected by digestive issues stemming from gut imbalances.


Billions of bacteria exist within the gut (the microbiome), which play a role in immune system health, optimizing digestion and elimination, and producing B vitamins and vitamin K2. Yet, when the gut microbiome experiences dysbiosis, more bad bacteria than good outnumber it, and an imbalance occurs. Lifestyle choices, inflammation, environmental toxins, stress levels, antibiotics, alcohol consumption and diet, all cause changes to the gut balance. According to Derrick DeSilva, MD (Edison, N.J.), an internal medicine physician, diet is the leading cause of a weakened gut, followed by overconsumption of antibiotics, acid blockers and environmental toxins. “After taking an antibiotic, it takes three to six months to rebuild the flora in the gut,” he shared.

Dysbiosis manifests as inflammatory skin conditions like acne, eczema, psoriasis, chronic depression, anxiety, weight gain and loss, diabetes, fatigue, and insomnia. In more extreme cases, dysbiosis results in cardiovascular disease, irritable bowel syndrome (IBS), Crohn’s disease, ulcerative colitis, cancer and obesity. “Leaky gut syndrome, where chronic inflammation increases permeability and toxins flow into the bloodstream, correlates with dysbiosis,” explained Francisco Llano, MD, a specialist in nutrition and anti-aging in Mexico City, Mexico.


“Conversely, when bacteria are missing, pathological bacteria surface, resulting in severe health conditions,” he added. For example, research shows insufficient gut bacteria impacts brain chemistry, leading to anxiety and depression.

Jennifer Pearlman, MD (Toronto, Canada), who focuses on women’s health and wellness, says non-celiac gluten sensitivity – a systemic condition accompanied by skin inflammation, impedes gut health. “Gluten dismantles the tight junctions that hold the gut lining cells together. Non-gluten sensitivities are more common and determined through high levels of zonulin proteins in blood tests, indicating gut permeability and leakiness.”

Mark Tager, MD, CEO of ChangeWell Inc. (San Diego, Calif.), cites two barriers that protect the body – the skin and the gut, which is one cell thick. “Microbiome disturbances break down the gut lining, which is vital for retaining minerals and vitamins and limiting permeability,” he explained.

The Gut and the Skin

Inflammatory skin conditions like acne, eczema, dermatitis, dandruff and psoriasis are related to poor gut health. Commensal bacteria are responsible for routine processes and acetate production, which benefits the skin. “An additional benefit is production of short-chain fatty acids that are important for skin integrity. On the contrary, patients with lower levels of skin acetate exhibit signs of acne,” Dr. Tager reported. There are advancements in emerging research surrounding the skin microbiome. Dr. Tager mentioned a product that features a specific enzyme which is able to break down the bacterial wall of bad bacteria while sparing the good. “There is also a spore-based probiotic that upregulates good bacteria to produce more acetate and reduce acne lesions.” In Dr. DeSilva’s experience, compromised skin is likely accompanied by a ‘dirty’ gut because the skin mirrors what is going on inside. Therefore, he first treats patients with skin problems by cleaning their gut and liver. “A problematic gut affects anti-aging, medical and aesthetic therapies, delaying healing and potentially compromising results.” Beyond the skin, poor gut health will also reflect in the hair and nails.

The Road to Rebuilding a Healthy Gut

Individualization is critical in rebuilding a healthy bacterial balance, as multiple factors generate gut imbalances. Dr. Llano relies on nutrigenomic and nutrigenetic tests to reveal nutrient levels, inflammatory triggers and food antibodies.

Dr. Tager recommends physicians evaluate gut permeability and microbiome levels to understand and improve dysbiosis in each patient. After identifying allergen triggers, various actions can lower gut inflammation, such as a healthy diet, supplements, probiotics, prebiotics, exercise and stress limiters. However, Dr. Tager stressed that supplements are never a substitute for replacing a poor diet.

The Role of Probiotics and Prebiotics

Probiotics incorporate live cultures to balance a dysbiotic microbiome by harmonizing the ratio of good to bad bacteria. Dr. Tager suggests taking probiotics with a fiber-rich diet, which good bacteria prefer as food, to further institute symbiosis.

According to Dr. Tager, evidence links probiotics to improving dry skin, acne, UV-induced damage and eczema. “They also boost the skin’s production of ceramides and lipids to trap moisture and act like glue between skin cells to prevent leaky gut,” he said.

Popular strains include Lactobacillus, Bifidobacterium, Saccharomyces, Enterococcus, Streptococcus, Bacillus and Akkermansia, which are beneficial for skin sensitivities stemming from rosacea and eczema. When taking antibiotics, Dr. DeSilva recommends always taking a probiotic and separating the two by four to six hours.

However, probiotics alone are not enough to balance the gut; prebiotics – insoluble fiber that feeds bacteria – are critical. Good prebiotic sources include fermented foods, inulin, kombucha and Jerusalem artichokes.

While Dr. Pearlman said the science has yet to evolve to where physicians can customize probiotics like other nutraceuticals, it is advancing slowly. “There is talk of psychobiotics, strains of probiotics associated with psychiatric benefits as opposed to antidepressants.”

You Are What You Eat

Food preservatives extend a product’s shelf life by killing bacteria and fungi, but they also fill the intestines with damaging bacteria that promote gut imbalances and other issues. As a result, clinicians recommend patients incorporate dietary changes to promote healthy gut flora, especially to control inflammatory skin conditions. For example, many of Dr. Pearlman’s acne patients respond positively to a dairy-free diet or supplementation with vitamins, omega-3 and zinc.

A gut-cleansing and skin-beautifying diet should be rich in complex carbohydrates, insoluble fiber and fermented foods with minimal sugar and fat, which disrupt the microbiome. Gut-beneficial foods such as yogurt, fermented foods like Kimchi, kombucha, olives, pickles, sauerkraut, kefir, miso, tempeh, fiberrich fruits and vegetables, whole wheat, oats, and flax seed, balance the gut to improve the skin and its barrier function.

Elimination diets help identify foods that cause sensitivities and disrupt the gut flora. Scientific evidence links a low gut bacterium count with obesity since a lack of bacteria affects the relationship between hormones and energy, contributing to slower metabolic function and weight gain. Dr. DeSilva noted that the biggest issue with weight management when dysbiosis exists is irregular gut flora and bloating. “Probiotics normalize digestion to resolve bloating and improve nutrient intake, allowing the body to burn fat efficiently.”

The Gut Health-Aesthetic Treatment Connection

According to Dr. Pearlman, gut health and aesthetics are now intertwined. Stigmata of diseases or endocrinopathies, like hormone imbalances, nutritional deficiencies, inflammation and stress, affect the skin, face and body and compromise results. “The more in tune providers are, the better they can use tools like lasers, fillers and injections,” she shared. “I see many patients with gut health issues that affect their skin, as well as aesthetic procedures and treatments due to inflammation that impacts wound healing.” For example, Dr. Pearlman explained that lasers inherently produce inflammation in the skin, so decreasing systemic inflammation improves the patients’ ability to detox so they will respond better to the treatment.


Dr. Llano advises patients to fix the gut in order to get the body optimally healthy before considering aesthetic treatments.

Some physicians, like Dr. DeSilva, work with plastic surgeons to improve gut health for better healing and outcomes. His pre-surgery prep includes a probiotic, vitamin C and zinc supplements, and a liver cleanser like milk thistle to “remove ‘garbage’ from the gut.”

Implementing Gut Health Services into an Aesthetic Practice

Dr. Pearlman recommends practitioners who want to implement gut health into their practices start with low-risk interventions, such as food sensitivity testing, elimination diets, science-based probiotics and gut-friendly dietary improvements as an entryway to exploring the world of functional medicine.

Dr. Tager actually offers an online training program, which teaches clinicians about gut health and beauty from within. “Patients want professional guidance to improve their skin via the gut, and practices can distinguish themselves by serving these demands for better clinical outcomes,” he expressed. Dr. Tager suggests gently inquiring if patients want nutritional guidance to achieve better aesthetic results. “Offering your patients a curated guide of nutraceuticals provides a great service and revenue for the practice.”

The Gut of It All

Bacteria is all around us, and the body is constantly under their attack. As a result, many physicians are implementing gut health therapies into aesthetic practices and treating the gut first in order to optimize patient response to treatments for better results and healthier healing. Dr. DeSilva put it simply, comparing the gut to the control center of an interconnected system: “If the gut is malfunctioning, all other systems will eventually fail too.”

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