Acne patients are often lost at what to do about their skin. Despite all the hard work and effort nothing seems to work. In some cases the problem is genetic and there’s not much they can do about it. But more often than not some hard to pin down problem aggravates the skin.
Quite often the problem is found in the gut. There’s a link between gut health and skin health; with acne patients showing higher prevalence of gut problems. And many people aren’t even aware they have gut issues. Because the symptoms can be quite subtle before the problem gets serious. And they are easily chugged off as normal rumblings from the tummy.
So in this post I’m going to show you 3 ways to get a temperature of your gut health. So you can know if this is an issue for you or not.
Are your bowel movements ‘natural’?
I’m not sure there even is such a thing as ‘natural’ bowel movement. The medical profession or other reliable sources haven’t defined anything of the sort. On the other hand alternative and natural sites are full of advice on what bowel movements should look like.
For example gutsense.org says natural bowel movement has the following characteristics. Note that I don’t want to endorse the site. They are correct in that fiber in excess can cause problems for some people, but that gem is buried under a huge pile of nonsense.
- Strong need to go. You should have a strong (but not necessarily urgent) need to go after each major meal or at least once a day.
- Small-size, soft stools. The stools should be fairly small and soft, types 3 to 5 in Bristol stool scale (see below).
- Small volume. The stool shouldn’t clog the toilet. Instead it should be no more than 100 to 150 grams per bowel movement (please don’t ask me how to weight them!).
- Effortless act. There shouldn’t be any straining or effort required. Everything should come out quickly and easily without feeling of incomplete defecation. #2 shouldn’t be any harder than #1.
Since there’s a lack of reliable information on the subject, I can’t vouch that all these characteristics are correct. But the bits about stool form and effortless act make sense. And what I’ve seen in medical literature these are used as signs of constipation.
Bristol stool form chart
Many natural health websites feature this stool form chart as a way to self-diagnose the health of your bowel movements. It’s known as the Bristol Stool Form Scale. It’s one of those rare things that I dismissed as just another self-diagnostic quackery (like the Candida spit test), but later on found that it actually has some scientific basis.
Researchers at the Bristol Royal Infirmary wanted to see if stool form corresponds to intestinal transit time (how long it takes for a food to pass through the digestive system). The answer was tentative yes. Stool form can give an indication of intestinal transit time.
Here’s the chart they produced.
The seven types of stool are (from Wikipedia):
- Type 1: Separate hard lumps, like nuts (hard to pass)
- Type 2: Sausage-shaped, but lumpy
- Type 3: Like a sausage but with cracks on its surface
- Type 4: Like a sausage or snake, smooth and soft
- Type 5: Soft blobs with clear cut edges (passed easily)
- Type 6: Fluffy pieces with ragged edges, a mushy stool
- Type 7: Watery, no solid pieces. Entirely liquid
The smaller the number the longer the intestinal transit time. For example type 1 stool spent around 100 hours passing through the digestive system, whereas the average for type 4 was 30 to 40 hours.
Of course a chart like this is not perfect, and researchers have criticized it as not being completely valid. And for each type there was quite a large variation in intestinal transit time. That said, it remains a useful indicator of gut health. When your gut works well most of the time you should produce types 3-5, with 4 said to be the ideal. On the other hand if you often find types 1 and 2 or 6 and 7 in the toilet, then you may have a problem.
Food and symptom journal
When a food digests properly you should experience little to no digestive symptoms. Digestion is like a referee in a sports match, it works the best when you don’t notice it.
Keeping a food and symptom journal is a great way to learn when your digestive system goes out of order. Journal also provides you contrast. Say that overall your symptoms are very mild and they only happen after you eat one or two types of foods (say apples and onions). Since you probably don’t eat those foods at every meal the symptoms are easy to miss. And even easier to dismiss as just normal rumblings from the tummy. Food and symptom journal helps you to pin down those, because you can see that the symptoms only occur after certain foods.
Here are some tips:
- Note down everything you eat
- Pay attention to any discomfort and rumblings from the digestive system for 2 to 3 hours after a meal. Sometimes the symptoms appear quickly; this is usually the case for abdominal pain. But sometimes they take a few hours, like in the case for bloating and excess gas.
- It’s helpful to note down bowel movements also. Healthy gut should move fairly regularly, so if you notice irregularities that could indicate a problem. Note down approximate time and stool form, as per the above Bristol scale.
- Eat simplified meals. If your meals are complex it can be hard to pin down the culprit foods. Another reason for simplified meals is dosage. Eating 7 apples produces more noticeable symptoms than eating a single apple.
- To provide contrast, at times consider eating processed, unhealthier meals. These are usually much easier to digest.
Keeping a food and symptoms journal doesn’t have to take a long time. You need to only spend a few minutes a few times a day noting things down. And this miniscule investment can yield surprising returns in knowledge.
A management guru Peter Drucker says you can’t manage what you don’t measure. This holds certainly true for my gut. I’ve been aware of the link between gut and skin health for quite some time now, but always figured out it’s a problem for other people. Because there’s nothing wrong with my gut. But as I learn more about signs and symptoms of gut issues I’m proving myself wrong.
Using the simple tips outlined in this post I’m noticing some problematic signs, and have identified some problem foods. Time will tell if this is really a problem for me or just a temporary glitch.
I’d love to hear your thoughts about this. Did I miss something? Do you have your own way to tell when your gut gets cranky? Please share your questions and experiences in the comments below.
I Def. have some gut issues. They are getting better now since I quit all the fad diets…but something is still not right. I am 24 and I should be able to eat, digest. and eliminate whatever I want right?
Bri, you should, but unfortunately it’s not always that simple. We humans are imperfect ‘meat machines’ and occasionally have to suffer from our flaws. Hope you get your gut issues fixed, please keep me posted on your progress.
Hello! I have always had constipation problems ever since I was a baby. It’s genetic, my mum has the same problem. I need to start my meal with fresh fruits. While I was living in Bulgaria I used to eat plums (fresh or dried depending on the season) every morning and they really helped me. However, I’m in Korea now and plums are too expensive and those imported from the USA have no effect on my bowel movements whatsoever. I guess there is something true in all the talking about GMO and organic food because organic proons do make a difference but are too pricey. I have noticed that if haven’t been able to go to the toilet for 2-3-4-5 days my skin becomes a mess no matter what I do.
Fortunately, I discovered sesame seeds, I have a mix of white and black sesame seeds for breakfast every morning and it does make a difference. Also, I found some yoga exercises against constipation, I can provide you with a link if you wish, they are really simple and effective when you do them in the morning after drinking a cup of hot water.
Rumi, I don’t think there’s anything special about plums. You should be able to find other fruits in Korea that can do the same job. Or maybe those plums have just becomes a habit for you over the years and that’s what’s helping with bowel movements.
Well, sesame works for now but plums are the best when you have constipation. There are other fruits that also work, such as pears, but plums have the best effect. I have recommended them to many people and they say the same thing. However, people with stomach problems or diarrhoea should avoid them. Whatever food you take for better digestion, it’s important to eat it when your stomach is empty, preferably in the morning.
I’m with Rumi, plums, especially prune plums are the best fruit for relieving constipation. Another good one is licorice root, it is also a natural laxative but a little does go a long way.
I noticed you wrote gutsense in the article, what’s your opinion regarding that website?
I wasn’t too impressed. It has too much fear-mongering. It seems to be one of those sites that tries to link many health problems to a single cause, in this case fiber. Very shady, though he had some good points buried in the nonsense.
Hi, You wrote “To provide contrast, at times consider eating processed, unhealthier meals. These are usually much easier to digest.” Why would unhealthy, processed meals be easier to digest? I would think they would be much harder to digest? Is this a typo or am I missing something?
Thanks
Shirley
No, you read correct. Refined and processed foods are almost always easier to digest than ‘whole’ foods. Think about it. Processing food almost always means removing something from it. In many cases it’s removing fiber or other things that are harder to digest. Processed foods usually almost always have less substances that irritate the gut.
There must be a strong connection between “unnatural bowel movements” and the quantity of toilet paper you need: healthy animals – and primates too – always have a clean anus.
Hi Seppo, I have had gut issues (constipation) and cystic acne for many years, both of which I have not been able to resolve despite bucket loads of diets and research. I am just wondering whether trying to resolve the problem of constipation through the use of natural products or foods, and being diligent in ensuring that I am having regular bowel movements, may improve the cystic acne. Would just like your thoughts on that, as there are some good products around now, which seem to allow for more natural bowel movements (such as Oxy-Powder). I have had enough of changing my diet as I’ve tried many for good health and for acne.
Robyn, I can’t guarantee that. But I can say that there’s a link between acne and gut problems and that in some, many?, cases resolving gut problems also helps the skin. But I can’t guarantee this is the case with you as I don’t know what causes your acne. I do think it’s an avenue worth pursuing, however.
Thanks for your response Seppo. Much appreciated.
Hi 🙂
So I have been experiencing cystic acne for most of my adult life (I’m 28) and have just recently been pursuing the acne-gut relationship as the problem. I’ve tried every pill/cream out there and nothing has helped. I’ve talked to 5 dermatologists and all keep telling me that there is no evidence between acne and diet. Which I find very frustrating. Anyways I cut out gluten about 6 months ago and it has seemed to help. But not completely. I have had gut problems for many years (bloating,extreme gas) and always associated it with my vegetarianism. But now I think it could be from dairy? I’m very confused at this point…it seems like I’ve tried everything and can’t find a solution.
Any words of Advice?
Also I’ve heard that apple cider vinegar helps with gut problems..that is helps with low acidity and helps with acne..is this true?
Thank you for any help you can give! 🙂
Lexi
Most gut problems are caused by plant foods rather than animal foods, so it wouldn’t surprise me if vegans indeed have more gut issues. Have you looked into low FODMAP diet? FODMAPs are types of indigestible sugars found in many plant foods. Human digestive enzymes can’t break them down but the bacteria in the gut can ferment them. For some people this causes a lot of bloating, gas and other GI symptoms. FODMAPs are also a known trigger of IBS. If you haven’t explored low FODMAP diet yet, that’s where I would start.
Personal anecdote, I always get severe acne on my scalp and mild acne on my face when I eat certain FODMAP foods, like onions, grapes, strawberries, cocoa, etc.
I had cystic acne for 4 years before thinking my diet may be the cause. Cystic acne in the lower region of the face is caused majorly by hormones. I cut dairy out of my diet(because I was suspicious that the cow’s hormones were messing with mine) and within a couple days the 6 cysts that were on my face (and had been for 3 weeks) finally started healing and to feel less tender. It took them a couple weeks to completely heal and Sometimes I cheated and new ones would pop up. I had severe acne for 6 years, and now my face is nearly healed. It has improved so much over the last two months since I cut out dairy. I still have Many scars, but honestly there are so many that they just look like freckles lol. By eliminating dairy I actually ended up eliminating a lot of unhealthy, processed foods and felt healthier. I drank 9 cups of water every day. My skin is not only healing, it is looking a lot healthier and less “green”. I believe eliminating dairy helped my cystic acne and eliminating processed foods helped my gut and therefore, my surface acne.
I have also heard about ACV helping the gut! I think it’s worth a try, I plan to try it myself. Just be sure to keep it away from your teeth and brush thoroughly after ingesting it.
Lexi, google the candida acne connection. My daughter had lots of gas and a pear shaped tummy though she’s very thin. I’m intrigued by reading about this possible gluten connection but she definitely had candida and a naturopath helped rid her system of it. She has horrible acne and I’m thinking that she might have candida + gluten sensitivity. Either way the gas and bloating went away when the candida cleared. The acne cleared too but it always does in the summer when she’s out in the sun more. It’s fall and the acne is back so thank you author for this info on gluten.
Hi Mary,
If your daughter finds that spending more time in the sun helps clear up her skin, you should have her try vitamin d3 supplementation. I’ve read on some forums that peop who notice a connection between increased sun exposure and less acne have seen positive results with it. Let me know if you give it a shot!
Hi, im 32 and i dont know what to do with my acne issues…i have seen several Dermatologists and they gave me many things like antibiotics,ointments etc… after treatment acne disapear but only for a shot time and always come back again.
im planning to see a gastroenterologist in order to see whats going on with my gut, im really tired to fight with my acne problems, plase give me some advices or ideas, im sure my problem is not in my skin i mean something else is bad and the acne is only the reflection or consecuence of that.
Do you think an endoscopy would be usefull??… please Help me!
Sorry to hear that you have so many problems with acne. Antibiotics don’t really fix acne. They only make it go away temporarily. I’m not really sure it’s worth it because they can disturb the gut microbiota that can cause further skin problems.
It’s kinda difficult for me to give you advice based on so little information. Do you experience gut problems, like bloating, gas, indigestion or anything like that?
Seppo thank you for your answer, well…in fact after each meal its common for me to have gas, indigestion and malaise.
let me tell you that last monday i went to the Gastroenterologist to have a Endoscopy, fortunately the Dr only found a polyp, remove it and send it to the pathologist (he will give me the test results after new year…) So after all this i will go to the Dr again in order to have a treatment and see what happens.
maybe my diet is not appropriate i have heard that zinc is really usefull for skin problems, what do you think?? i would try an alternative solutions instead of antibiotics or drugs.
Thanks in advanced,
Best Regards JC
Sounds like you have some form of irritable bowel syndrome, possibly caused by bacterial imbalance in the gut. There’s not that much research on this yet, but there are a handful of studies that link skin problems to bacterial imbalances in the gut and correcting those imbalances have been shown to resolve skin problems. My cystic scalp acne was linked to gut problems. Now that I’ve, more or less, gotten those under control my skin is pretty much clear. At the moment I’m testing herbal anti-bacterial and gut healing supplements to see if they help. So far they seem to help, but it’s too early to say.
I don’t think you can diagnose these things with endoscopy. You need breath and or stool tests to see if you have malabsorption or bacterial imbalance issues.
Ask your doctor whether you have small intestine bacterial overgrowth, intestinal permeability or problems digesting FODMAPs. If he/she is reluctant to help you, contact me again and I’ll see if I can point you to the right direction.
Yes, zinc can help some skin issues, but if your acne is linked to gut problems it wouldn’t resolve the root problem.
Hi Seppo,
After reading some of your articles about gut issues/health I have a few questions. What exactly is considered excess gas? I know that probably sounds like a dumb question, but everyone passes gas, so what is considered too much? I’ve read that most people pass gas 14-30 times a day. I’m just trying to establish a baseline for what “normal” is. I’ve also read that gas is a sign of healthy intestinal flora, so I’m just a little confused. If I go to the restroom everyday and it’s normally 3,4 or 5 according to the Bristol stool chart, do you think I should be concerned with my gut health? The only time I’ve ever noticed excess gas (according to what I deem excessive) is when I was eating double fiber bread. I think it was just too much fiber. I don’t normally have stomach cramping or bloating, but I suppose it does happen every great once in a while. Would that be considered digestive issues if it occurs occasionally, but not daily?
I read your article about FODMAPS and I don’t think I have an issue with them, but I’d rather just have the breath test done than try to go through yet another elimination diet. How do I even approach this kind of topic with my doctor? I’d feel pretty silly and embarrassed telling him that I need a breath test in order to find out if it’s contributing to my acne. I have a feeling he might think I’m a little crazy lol or he might not know enough about the subject to even deem it necessary. I’m determined to explore every option before taking the Accutane plunge, so I’d like to pursue the gut/skin axis avenue further.
Thanks again for your help.
Good questions. It’s really difficult to have any objective standard on this. Some gas is absolutely normal. Healthy intestinal bacteria produce gas, so it’s just a sign that your digestive system is working properly.
I can only speak from my own experience, but I do get signs of irritable gut syndrome. That is, bloating after meal, some degree of constipation and straining at the toilet. And when my gut was working properly it was easy to see the contrast.
If you don’t have any gut or digestive symptoms, then it’s possible that the gut plays no part in your acne. Without any symptoms, it wouldn’t be the first place I look for. But if you are at the end of the road, then it might be worth investigating. I have read somewhere that some cases can cause little to no symptoms.
You can email me and I’ll tell you the gut healing regimen I’m currently testing.
Hi Seppo,
I went to see a gastroenterologist and am having a breath test for bacterial imbalance next week and would love to know what gut healing regimen you are on. I’ve been on antibiotics for chronic sinus infections over 20 times over the past 4 years and am convinced my skin problems are related to poor gut health. Thank you
Hi Jim,
I did a program I created for Clear for Life, my acne treatment course. Basically, the main focus is to kill bacterial overgrowth that’s usually at the root of gut problems. This is done with a combination of diet that reduces fermentable carbohydrates and supplements that kill intestinal bacteria. This was very helpful in calming my gut and skin.
Hey Seppo,
Thanks for the reply. I have a few more question.
Is it possible to permanently fix gut issues? I read your other post about your 10 day binge and it made me wonder whether or not digestive issues can ever be healed? If we can reverse intestinal permeability then a binge shouldn’t cause issues, right? Or does the binge cause damage all over again and then you’re back at square one? I think I’m just trying to figure out if gut healing is a life long pursuit?
I think to some degree it probably is a life-long pursuit. It’s possible that the immune system is already sensitized towards certain foods, and eating those in larger quantities can always cause some gut damage. In that sense you probably have to be careful with such foods. It’s often the so-called harmful foods that cause, at least partly, intestinal permeability that then shows up on the skin and as other health problems. In my mind fixing intestinal permeability is more of a symptom than a cause. And while it’s important to fix it, I don’t think it should be the main focus.
Oh boy… gas. I’m genetically quite intolerant to anything like onions, leek, cabbage, sprouts,… Those things cause a major bowel disturbance in my family, we still eat them though haha, gas or no gas. Anyhow, I did find that apples are hard to digest without bloating in my stomach, which is on a whole other level of discomfort compared to bloating in the intestines. Weird enough I don’t have any discomfort from paprika (peppers in English I think?), soy sprouts, corn,… but I can’t digest them very well, they literally come out quite the same as they go in, sorry for the visual.
For anyone suffering from constipation and stuffing themselves with plums and prunes and apricots and what not. Just try eating two kiwis a day, works like a charm 😉 Consider drinking more water too and doing some lower ab exercises (it helps, plus, lots of people look seriously bloated and could do with some muscle strength of the lower and transverse abs).
I usually have problems with constipation right before my period (together with water retention), and then during my period it’s the reverse… it’s genetic as well I think, my mother told me she had it too, the bowels get overstimulated because it is the same nerve group or something. I’m afraid I might suffer from the worst constipation ever when I get pregnant but that’s not due for another couple of years^^’
I’ve tried cutting out dairy, and found it didn’t cause my acne (that I’ve had for about 12 years now), but I do feel fitter when eating dairy in moderation. Next on my list are carbs. But this is a very tricky one. In Belgium we eat bread twice a day as a meal… so before I cut it out I’d like to know how long you think it takes for the skin to adjust? I remember from birthcontrol that it takes up to six months for the hormonal system to balance itself after quitting, but I hope that with foods it doesn’t take as long?
It sounds like you could have FODMAP issues, and they might affect your skin. They do for me, and I suspect I’m not alone in this. My suggestion would be to try low FODMAP diet before cutting out carbs. Since dairy had no effect on your acne, it’s likely that you have inflammatory-type acne instead of hormonal-type. Cutting dairy and carbs works better for hormonal-type acne.
As to how long to try? I’d say 4 to 6 weeks minimum. 2 to 3 months would be better.
I forgot to ask… so when I get constipated before my period and the kiwis aren’t ripe yet (tricky fruit it is), I eat other fruits and things with fibers but I end up constipated anyway. At that moment I’ve noticed I ‘tear’ (anal fissure?) really really easily. I don’t think I used to have this problem when younger, constipated or not. Can it be a symptom of a deficiency?
I don’t know, but I suspect that straining and eliminating hard bowel movements could also cause tearing.
Thanks for the article.
I definitely have some digestive issues going on.
I can’t digest brown rice. 😛
I also get bloated really easily…sometimes I’m bloated for days & then one day I wake up and have a flat stomach again. Sometimes I also hear gurgling or wake up still feeling my body digesting from the day before.
Never any pain, but the bloating is so annoying. And my stools aren’t always in the healthy category either (sorry tmi).
Today I had a green smoothie and oatmeal for breakfast (healthy right?) but just feel bloated.
Maybe I need to go on the paleo diet although I would miss bread. 😛
I will try keeping a journal like you suggested!
Sounds like you have similar gut issues I used to have. I got them under control with diet and some herbal antimicrobials to kill off excess growth. Paleo could work, but paleo still contains many fruits and veggies that can irritate the gut. FODMAP diet would be a better choice.
Hi Seppo,
Thank you for your help, let me tell you that i went to the Dr (Gastroenterologyst) and after a colonoscopy everything seems to be ok except a couple of polyps, he took a sample, send to the pathologyst and the results were ok…i mean nothing relevant.
i realized that i can not drink milf or any dairy, i dont know why, because if i drink it after some days i got pimples.
Can you recommend me the Herbal antimicrobials that you mentioned?..please keep in mind that some US branches are not available in Mexico.
Thank you in advanced!
Best Regards
JC
Thank you!
I have found a certain link between taking antibiotics and shortly after having a huge span of indigestion lasting possible years if untreated. Restoring proper gut health via probiotics is so important!!!!
If your boday doesn’t have the bacteria to break down the food it’s very difficult. Especially if you eat something like a lot of dairy. Absolutely painful! I’ve found this anyways with my experiences.
On a side note. When I eat more dairy I notice my skin gets oily and I break out, if o decrease my intake and drink more water it’s a big difference!
Thanks for sharing your experience, El. I’m not convinced that probiotics are the right choice for most people. In some cases, they can be helpful, but in general it’s better to use prebiotics and fiber to support the good bacteria in the gut.
Hello Seppo!
Do these gut issues include issues like lactose intolerance? I don’t drink milk, but I do have cheese from time to time. I know that eating gluten does physical damage to (flattens?) the microvilli that line your small intestine. But lactose intolerance is just cuz your body’s not producing enough lactase to break down lactose into glucose and galactose (which can then be absorbed), right? So it shouldn’t cause permanent damage to your gut, just feeling uncomfortable because your gut’s having a hard time breaking down the lactose.
However, if this is the case, does that mean that eating lactose when you’re lactose-intolerant wouldn’t contribute to acne? Or it would? Or are the above assumptions incorrect?
Thanks,
F
I don’t know specifically about lactose intolerance. As far as I understand, among the root problems in the gut are bacterial imbalance and migration up to the small intestine. Eating FODMAPs (a group of poorly absorbed sugars) creates a lot of gas in the intestines. Depending on what gasses are produced, these can lead to secondary problems like constipation of loose stools. Nobody knows for sure why or how this leads to skin problems, but there’s evidence to show it does.
I don’t know whether lactose intolerance would lead to similar problems. I suspect it does.
Hi Emily,
Its good for me to read your experience with the type of Acne that i think i have too…in my case since the dairy is out of my diet is really good for my face and skin.
Also, i am trying with chlorophyll in my water, it really helps me to improve with my problem, you should try it and see whats happens…
I am almost 65 years old….female. about a year ago I began using probiotic made by plexus. Shortly after beginning the probiotic, my face began to break out. No black heads….just pimples. Mostly on my nose but can be anywhere on my face. I have had stomach issues for some years now. Gastritis, candida yeast, etc. Could this be the problem causing the acne at my age? It’s very frustrating. Help!
Yes, it’s possible. Probably even quite likely, as the levels of hormones that cause acne in younger people go down with age.
Digestion plays a big part personally. I tried Keto again recently & despite having an immaculate diet full of quality vegatables/fruit/meat/dairy I still suffered with some cystic acne due to constipation.
Introduced a breakfast of rye bread with real butter & black coffee with a splash of double cream & coconut oil. Regular ever since & all blemishes healing / cysts shrinking.
Extrelmy useful stuff thankyew.
I am suffering from mild acne since graduation..however later I started facing a lot of gut issues.upon investigation it was found dat I had IBD I.e Inflammatory Bowel Disease….im getting cystic acne all over my face….Plz suggest