Holistic Nutritionist Maria Marlowe on the Link Between Gut Health and Acne

For years, Maria Marlowe struggled with acne. She tried every product and prescription she could find to clear up her skin, but nothing works. It was only when she began learning about nutrition that she understood the role that diet plays in skin health — and after changing what she ate, her skin cleared up in months. Today, Marlowe is a holistic nutritionist, author, and host of The Glow Life podcast, and helps others clear their skin through food. Watch the interview or read on to learn the link between hormones and acne, how gut health and acne relate, the best diet for acne, and more. 

*This is a short clip from our interview with Maria Marlowe. Click here to watch the whole thing.*

You can also listen to our interview with Maria Marlowe on The WellBe Podcast.

What Causes Acne In the First Place? 

Marlowe explains that for decades, the conventional wisdom was that acne is caused by bacteria; in the fifties, experts believed that acne was a bacterial infection. But in the eighties, new research began to emerge that said otherwise. Study after study accumulated, and they pointed toward inflammation as the root cause of acne. By the early 2000s, Marlowe says, acne was reclassified from a bacterial infection to an inflammatory condition. 

“Now, this is a huge paradigm shift in how we understand acne, and it should have caused a paradigm shift in how we treat acne,” says Marlowe. “But it hasn’t. We’re still treating acne like we were in the eighties, and even the fifties.” By this, she means that acne treatments still largely target bacteria rather than inflammation: most acne products are antibacterial, and antibiotics are the most commonly prescribed drug for acne.

In her work, Marlow says she’s identified six key factors that contribute to the development of acne — and none of them have to do with bacteria. However, all of them relate to inflammation, either explicitly or as a cause or result. The six primary causes of acne she sees are:

1. Chronic inflammation. Chronic inflammation has many causes, from eating a pro-inflammatory diet to lack of sleep and high stress levels. This high level of systemic inflammation makes people more prone to inflammatory conditions like acne.
2. Nutrient deficiencies. Marlowe explains that there’s good research that associates acne with certain nutrient deficiencies, such as low levels of vitamin A, zinc, and omega-3.
3. Gut dysbiosis. Gut dysbiosis, or an imbalance in the bacteria in your gut microbiome, contributes to inflammation, which, in turn, leads to acne.
4. Hormone imbalance. An excess of certain hormones can cause your skin to excrete more sebum (oil), a primary cause of acne.
5. Stress. “Your thoughts can actually cause your hormones to change in your body,” says Marlowe. These hormonal changes can increase production of sebum, as we mentioned above, as well as cause inflammation, both of which are contributing factors to acne. 
6. Overly harsh skincare products. “These are becoming more and more popular,” says Marlowe. “These ten step skincare routines, these very strong acids and peels and all these things.” But, she explains, they can have the opposite effect and actually do damage to your skin and dry it out, causing your skin to overproduce oil.

These are all unique factors, but, as Marlowe points out, they all relate to diet and lifestyle habits and almost all contribute in some way to inflammation. “So inflammation causes acne, yes,” she says. “But I think the most important takeaway is that you have so much control over your inflammation levels through your diet and lifestyle habits.”

The Connection Between Hormones and Acne

The emergence of acne is commonly associated with hormonal events, like premenstrual acne and acne during puberty (up to 95% of adolescents in the U.S. get acne!). But, Marlowe explains, the relationship between hormones and acne isn’t as clear-cut as many of us believe it to be.

“There are definitely periods in our life when acne seems to be more common, right? Like before our period, or during our period, and then also during puberty,” she says. “A lot of people make the assumption that because it’s so common, it’s normal. Like this is a normal part of being a woman. This is a normal part of being a teenager and going through puberty. But the reality is, it’s common, but it’s not normal. Acne is a sign of inflammation and imbalance within. Period.”

To illustrate the complex relationship between hormones and acne, Marlowe takes a woman’s menstrual cycle as an example. Not everyone who gets a period gets acne, she points out, and so obviously there’s something else at play here. During the average 28-day menstrual cycle, there’s a natural fluctuation of hormones: estrogen levels are elevated during the first half of the cycle, then progesterone levels rise during the second half, and then right before a woman’s period starts, both estrogen and progesterone levels plummet. When this happens, a woman’s testosterone levels are relatively higher than they are in other parts of the month. 

“So the common answer for why women get acne around this time is because of the high testosterone levels,” Marlowe says. “High levels of testosterone are associated with an increase in sebum (oil) production and increased cell turnover. So in other words, high testosterone levels clogs your pores, and this leads to breakouts.”

But the relationship between hormones and acne just isn’t that simple. “We have to ask: if all women who are menstruating are going through a similar cycle, why is it that some people break out and others don’t?” asks Marlowe. “I think that comes down to how their body is metabolizing and dealing with those hormones.” 

Marlowe says that the primary reason that some people can’t effectively deal with their testosterone levels (and thus erupt into acne) is, surprisingly, constipation. Marlowe explains that once our body uses a hormone and it has completed its job, that hormone is sent to the liver to be broken down and packaged up to leave the body. From the liver, it moves into the gut, from where it exits as a bowel movement. “Now if you’re constipated, those hormones are sitting in your gut and they can get reabsorbed back into the bloodstream,” she says. “This contributes to hormonal imbalance and excess hormone levels.

Since this process of eliminating hormones also involves the liver, the relationship between hormones and acne needs to consider liver health. Marlowe explains that if you have a liver that is sluggish because it’s overloaded with toxins or you’re not supporting it with the nutrients it needs to optimally perform its detoxification functions, you could end up with an excess of used up hormones.

“But if you’re eliminating regularly and you’re getting rid of those excess hormones, you shouldn’t have a problem,” Marlowe says. 

What About Gut Health and Acne?

As we’ve talked about in many WellBe interviews and guides, poor gut health leads to inflammation — and so, if inflammation leads to acne, by the transitive property the link between gut health and acne is pretty clear. But still, it can be tough to connect the dots between what’s going on in your gut microbiome and what’s going on on your face.

In the simplest of terms, if you eat something that triggers inflammation in your gut — because you’re sensitive to it, or because it’s just particularly hard to digest — that inflammation makes its way into the rest of your body, and, ultimately, your skin. “Everything in our body is connected, right?” says Marlowe. “You know, your skin isn’t separate from your gut or anything else in your body.” To further clarify,  Marlowe helped us break it down with a brilliant analogy.

“Let’s use the example of pizza. Pizza was my favorite food. I literally ate pizza every single day of my life, probably for years, as a teen,” says Marlowe. “So what’s going on with pizza?”

In the case of pizza, the crust contains gluten, which can lead to increased intestinal permeability, Marlowe explains. “Research shows that when we ingest gluten — and the amount of this response really depends on your genetics, some people are going to have a stronger response, some people are going to have less of a response — but when we ingest gluten, it causes our body to produce a protein called zonulin.” she says. “This zonulin acts like a little key to open up the door between the cells in your intestinal lining. So the way that I like to explain it is if you think about a single-file line of people, right, and their arms are all linked, so they basically created a human wall where each person is one cell and when their arms are linked, that is the tight junction. That wall is keeping the food and the bacteria and the toxins in your gut, and it’s letting things like nutrients pass out into your bloodstream. But what happens when we eat gluten and our body produces zonulin, zonulin, can cause those two people — or those two cells — to unlink for a little while. And now larger particles can pass through your intestinal lining. So toxins, bacteria, these things can go into your bloodstream and they’re not supposed to be in your bloodstream. And this creates an inflammatory immune response.”

And because body-wide inflammation is the primary contributing factor to acne, the increased intestinal permeability explains the link between food, gut health, and acne. 

Of course, the relationship between gut health and acne is complex, largely because gut health is so complex and multifaceted. But the bottom line is that if you’re eating foods to which you’re sensitive (Need to identify a food sensitivity? An elimination diet will help.), or doing other things that throw off your gut microbiome (such as taking antibiotics), you’re setting yourself up for systemic inflammation, which can often lead to acne. 

Download our free guide to improving your gut health. 

What’s the Best Diet for Acne?

Because the connection between gut health and acne is so strong, it makes sense that what you eat makes a big difference in your skin. “Food is really powerful,” says Marlowe. “Most people would rather just put some cream on their face and call it a day. But the reality is that when you’re using topicals and things like that, you’re always going to need them to some extent. Most people use them for years. But with food, we think, ‘Oh it’s going to take me years for my skin to clear with food.’ No, it takes days, weeks, months. It actually works quite quickly. And people are often really surprised to see just how quickly they can see a change in their skin.” 

So, what should you actually eat? What’s the best diet for acne? The answer, as it is with so many health concerns, lies in cutting out processed and inflammatory foods and choosing whole foods instead. To illustrate just how powerful this choice can be, Marlowe uses the example of puberty-related acne.

“With puberty, there are certain hormonal changes that take place for everyone,” she said. “But why does almost every teenager in America get acne, but you go to other places in the world and they don’t? You look back through history, for example, the Inuits in Canada before they were forced by the government to assimilate into Canadian culture and eat Canadian food, they were subsisting on a traditional diet that included berries and greens and fish, and whole, real foods, a lot of Omega 3. Acne was pretty much nonexistent. Then once they were forced to assimilate, then they were eating cereal and cookies and all the foods that American and Canadian kids were eating, and their acne rates started to skyrocket.”

This example, Marlowe says, shows just how important a nutrient-rich and anti-inflammatory diet is to clear skin — and why, besides hormones, teens might see higher rates of acne. “When we think of a teenage diet, it’s a lot of packaged, processed foods, typically,” she says. “So, pro-inflammatory foods. Nutrient deficiencies. Again, if you’re eating mostly processed and packaged foods, you’re not eating enough fresh fruits and vegetables, not enough whole foods. You could be missing out on a lot of critical nutrients.” 

Dairy is another big culprit of acne. While some people can tolerate dairy, it is known to cause skin issues for others. “Dairy is one of the most well-established acne triggers. There are plenty of studies suggesting that dairy intake is associated with an increased risk of acne,” she says. “It doesn’t matter the type of dairy — increased intake of dairy is associated with increased risk of acne.”

The reason for this, Marlowe explains, is that dairy products have a high glycemic index, which means they cause a blood sugar spike and cue your body to produce insulin to break down the sugar. “When our insulin increases, this sets off this cascade of hormones, which can turn on those oil spigots in our skin and prop up those sebaceous glands to produce more oil,” she says. “That clogs your pores, which leads to breakouts.”

The WellBe Takeaway on Holistic Acne Treatment

Acne affects nearly everyone in America — but, as Marlowe explained, it doesn’t have to be that way. By thinking about your skin as part of a holistic system rather than spot-treating pimples, you can heal current skin issues and prevent future ones. Here’s what to remember about acne and your health:

• Acne was traditionally thought of as a bacterial infection, but research in recent decades have shown that it is actually an inflammatory condition. Having high levels of inflammation in the body can make someone more susceptible to developing acne.
• We often think of parts of our body as separate from one another, but it’s all one system. In this way, your overall health is directly related to what’s going on for your skin.
• In her work, Marlowe has identified 6 primary contributing factors to acne: chronic inflammation; nutritional deficiencies; gut dysbiosis; stress; hormone imbalance; and harsh skincare routines. What all of these factors have in common is that they all contribute to inflammation, and all can be controlled by diet and lifestyle choices.
• Hormones play a role in acne, but that doesn’t mean that hormonal events (like puberty or a menstrual cycle) need to trigger a breakout. If your body is properly removing hormones that have been used up, you will not have an excess of any one hormone and shouldn’t experience acne.
• Gut health and acne are deeply intertwined, which makes sense because poor gut health can lead to inflammation, and inflammation can lead to acne. To support your gut health, and thus your skin health, it’s important to eat the right diet for acne. This means choosing a whole foods-based anti-inflammatory diet, and avoiding trigger foods such as processed foods, gluten, and dairy.

Watch our whole interview with Maria Marlowe to learn why acne is virtually nonexistent in certain parts of the world, why some teenagers get acne during puberty and others don’t, why inflammation manifests as acne for some people and other skin conditions like eczema and psoriasis for others, how long it takes for something you eat or do to have an impact on your skin, how food allergies relate to skin problems, how to know which of the six contributing causes of acne to start with, what might cause baby acne, and more.

You can also listen to our interview with Maria Marlowe on The WellBe Podcast.

Do you notice your skin react (negatively or positively) when you eat certain foods? What have you observed? Tell us in the comments below! 

Citations:

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2. Pappas A. The relationship of diet and acne: A review. Dermatoendocrinol. 2009 Sep;1(5):262-7.
3. Martinez JE, et al. Unhealthy Lifestyle and Gut Dysbiosis: A Better Understanding of the Effects of Poor Diet and Nicotine on the Intestinal Microbiome. Front Endocrinol (Lausanne). 2021 Jun 8;12:667066.
4. Skroza N, Tolino E, Mambrin A, Zuber S, Balduzzi V, Marchesiello A, Bernardini N, Proietti I, Potenza C. Adult Acne Versus Adolescent Acne: A Retrospective Study of 1,167 Patients. J Clin Aesthet Dermatol. 2018 Jan;11(1):21-25. Epub 2018 Jan 1.
5. Guan YS, He Q. Plants Consumption and Liver Health. Evid Based Complement Alternat Med. 2015;2015:824185.

The information in this article comes from our interview with Maria Marlowe, holistic nutritionist. Maria received her health coach certification from the Institute for Integrative Nutrition, and has been working with private clients since 2012. You can learn more about Maria on her website.