The Brain-Gut-Skin Connection Series: Introduction

You must have noticed that your acne tends to flares up around stressful times—before a big test, a big meeting or during travel.  Often, the skin problems are accompanied with bowel movement problems.  I have experienced the phenomenon all my life and have heard many similar experiences from others.   For a longest time, I have been wondering if there is a connection between our skin, gut and stress.  Well, it turns out that the brain-gut-skin connection has been proposed by two brilliant scientists Stokes and Pillsbury over 70 years ago. Drawing on the experimental evidence and clinical anecdotes similar to ones you and I have experienced, Stokes and Pillsbury hypothesized “a gastrointestinal mechanism’ in which the skin is influenced by emotional and nervous states. They proposed that emotional states such as depression, worry and anxiety could alter gastrointestinal tract function that leads to the alterations to the microbial flora, which in turn promotes local and systemic inflammation.  Citing research showing that as many as 40% of those with acne have hypochlorhydria, a condition that the production of hydrochloric acid in gastric secretions of the stomach and other digestive organs is absent or low, Stokes and Pillsbury hypothesized that less than adequate stomach acid would set the stage for migration of bacteria from the colon towards the distal portions of the small intestine, as well as an alteration of normal intestinal microflora.  Further, Stokes and Pillsbury suggested that stress-induced alterations to microbial flora could increase the likelihood of intestinal permeability, which in turn sets the stage for systemic and local skin inflammation. Based on the above hypothesis, Stokes and Pillsbury discussed the remedies for treating the skin conditions could include the “direct introduction of acidophil organisms in cultures such as those of Bacillus acidophilus”—basically taking pills of lactic acid bacilli tablets. They also proposed using “an acidophilus milk preparation” (basically yogurt) and “cod liver oil” (basically omega-3 supplements) to treat the skin conditions. This is amazing considering that the gut microbiota was only recognized as a big part of human health in the past 10 years and only in the recent years that prebiotics (such as yogurt) and omega-3 supplements are recognized as healthy gut promoting means.  We will discuss more about evidences of brain-gut-skin connection in my next blog. Thanks for reading. Dr. Connie Wan