Dr. Pamela Smith discusses the gut microbiome, general gut health, and its relationship to skin disease.
Pamela W. Smith, MD, MPH, MS, is Medical Director of the Center for Precision Medicine, Bingham Farms, Michigan.
“Seventy percent of the immune system is related to the GI tract, so the patient is not healthy to begin with unless their gut is healthy,” said Pamela W. Smith, MD, MPH, MS, who discussed the gut microbiome and its relationship to skin disease at South Beach Symposium II.
“And with today’s world and how people eat and the amount of stress they have, it’s really hard to have a healthy gut without working on it.”
Not only does is the GI tract responsible for producing vitamin D12 and 90% of the body’s serotonin, it is also a contributing factor for skin disease, including acne, rosacea, atopic dermatitis, psoriasis.
“There’s now a lot in the medical literature to show that”—in fact, references, she said, span the past 80 years.
“References go back 80 years… the references now have become stronger and stronger, and there is more of a discussion in the literature. Unfortunately, it’s kind of piecemeal: some of its in the dermatological literature; some of its in the gastroenterology literature; some of its in the rheumatological literature, because of psoriasis and psoriatic arthritis. So it’s hard to find unless you actually read all of those.”
Patient Approach
According to Dr. Smith, initiating the conversation about the skin-gut connection with an acne patient, for example, can be as simple as: “New studies have been done, and we now know that the acne that you have has a component that is related to how healthy your gut is. I’d love to do a little bit of testing and see if this is something that can help your acne.”
And if the idea of testing is overly complex (for the physician or patient), about three-quarters of dermatology patients would benefit simply by starting a pharmaceutical-grade probiotic.
“…probably 75% of [a dermatologist’s] patients would be better if they were just started on a good pharmaceutical-grade probiotic. And then a month later, give a prebiotic food for the good bacteria.”
The is especially true for younger patients with skin issues, including acne and rosacea, said Dr. Smith.
“When it comes to something more extensive, like rheumatological illness psoriasis, for example, then you probably do want to actually test.”
Many good gut health tests are available, said Dr. Smith, and while you have to learn how to read them, they are easy to understand.
Alternatively, “Most compounding pharmacists actually are used to talking about gut health with patients [and] a lot of dermatologists already have a relationship with a great compounding pharmacist.”
Overall, Dr. Smith believes everyone should be taking a probiotic for general gut health.
“It should be pharmaceutical grade, meaning that it is bioavailable, it gets into the body, and does what it’s supposed to do.”
For Further Reading:
Ashley K, et al. Edible plants and their influence on the gut microbiome and acne. Int Jour Mol Sci. 2017; 18(5):1070.
Kober M, et al. The effect of probiotics on immune regulation, acne, and photoaging. Int Jour Women’s Derm. 2015; 1(2):85-9.
Bowe W. Probiotics in acne and rosacea. Cutis 2013; 92:6–7.
Bowe W, et al. Acne vulgaris, probiotics and the gut-brain-skin axis: back to the future? Gut Pathog. 2011; 3:1.
Kido M, et al. Helicobacter pylori promotes the production of thymic stromal lymphopoietin by gastric epithelial cells and induces dendritic cell-mediated inflammatory Th2 responses. Infect Immun. 2010; 78(1):108-14.
Galadari I, et al. The role of Helicobacter pylori in urticaria and atopic dermatitis. Skinmed. 2006; 5(4):172-76.
Ayres S. Gastric secretion in psoriasis, eczema and dermatitis herpetiformis. Arch Dermatol Syph. 1929; 20:854-59.
Kuitunen M. Probiotics and prebiotics in preventing food allergy and eczema. Curr Opin Allergy Clin Immunol. 2013; 13(3):280-86.
Isolauri E, et al. Probiotics in the management of atopic eczema. Clin Exp Allergy. 2000; 30:1604-10.
Majamaa H, et al. Probiotics: a novel approach in the management of food allergy. Jour Allergy Clin Immunol. 1997; 99:179-85.
Rosenfeldt V, et al. Effect of probiotic Lactobacillus strains in children with atopic dermatitis. Jour Allergy Clin Immunol. 2003; 111:389-95.
McCann M. Pancreatic enzyme supplement for treatment of multiple food allergies. Ann Allergy. 1993; 71:269.
Ryle J, et al. Gastric analysis in acne rosacea. Lancet. 1920; 2:1195-96.
Usher B. Gastroscopic observations in rosacea. Arch Dermatol Syph. 1941; 41:251-55.
Iijima K, et al. Long-term effect of Helicobacter pylori eradication on the reversibility of acid secretion in profound hypochlorhydria. Aliment Pharmacol Ther. 2004; 19:1181-88.
