Gut health can play an important role in hormonal-type acne. Think of the digestive track as a long tube that runs from the mouth into the anus. In many parts, the walls of this tube are only a single cell thick. In the small and large intestine, this wall is called gut barrier, or intestinal barrier, and is the most important barrier protecting you from external influences.

Defects in the gut barrier, also known as intestinal permeability, allows toxic substances from the gut to ‘leak’ into the bloodstream. You may be familiar with the term leaky gut, a term alternative medicine practitioners use. Despite being mired in quackery, intestinal permeability is a real condition and an active area of research.

In short, faulty gut barrier allows bacterial lipopolysaccharides (LPS) to leak into the bloodstream. LPS are toxic molecules found on the outer cell walls of harmful bacteria. In large quantities, they can lead to septic shock and even death, in smaller quantities they cause systemic inflammation and insulin resistance.

To give you an example, a 2010 study showed an injection of LPS into bloodstream increased insulin resistance by whopping 46%.

In light of all this, it’s clear that maintaining a healthy gut barrier is essential for treating most acne types.

Fortunately, it doesn’t have to be a burden. It mainly comes down to having a healthy gut flora and supporting them with proper food.

You have two choices:

1. Do the full gut healing protocol (refer to the gut health chapter). Do this if, when identifying your dominant acne type, you ticked the boxes for many of the digestive symptoms on the inflammatory-type acne page.
2. Otherwise, do the barrier recovery program.

At the very minimum, I recommend doing the following:

• Eat a variety of fruits and vegetables to support healthy gut flora.
• Make sure you have some resistance starch sources in your diet, such as cooked-and-cooled potatoes, rice, or legumes. You can also supplement with a tablespoon of potato-, banana-, or cornstarch a day.
• Take two tablespoons of Acacia gum a day (just dissolve into water).
• If your diet is low in protein, take 5g of glutamine twice a day for a total daily dose of 10g.