The connection between spots and gut health: Sarah’s story

Sarah, aged 32, had been struggling with her skin since she was a teenager. When she came to visit me, she had spots along her jawline, forehead and cheeks. Her outbreaks were always worse during the week preceding her period.

In the past, she had tried traditional medicines, like antibiotics, but never had any lasting reprieve. She also found that the antibiotics disrupted her gut health, causing irregular bowel movements and loose stool.

At the time of her first consultation, she was suffering with poor digestion of proteins and fats, finding that certain foods caused digestive discomfort and abdominal pain.

It’s not unusual for skin and gut symptoms to come hand in hand. Just like your gut, your skin has a microbiome, and good and bad bacteria live on its surface. Different strains of bacteria live in your gut, compared to those that live on the surface, but an overgrowth of bad bacteria in the gut can lead to harmful species thriving on the surface.

Your skin is a master communicator, and disruptions on its surface is a message that something is out of balance beneath the surface – whether that’s your gut health, or capacity for detox.

Sarah’s preliminary treatment

After taking a thorough history of Sarah’s symptoms, and performing a physical exam of her skin and her stomach, we decided to run a DUTCH test, which would give me a comprehensive view of her hormones, and a GI-Map to assess the bacteria on her skin and in her digestive tract.

While waiting for the results, I began the initial phase of treatment which supported healing, energy, detox and liver health.

If your liver isn’t processing toxins effectively, your skin functions as a way for your body to purge toxins in the bloodstream, leading to breakouts.

All of the choices we make - from what we eat, to where we live contribute to our body’s toxic load. If you imagine each of these being added to a bucket - fast food, environmental toxins, emotional stresses, it fills up fast - especially in Hong Kong, where we already have to contend with significant levels of air pollution, mould and the work hard, play hard mentality.

The body has the ability to naturally empty the bucket, through detoxification pathways in the liver. But, when the rate of filling the toxic bucket exceeds the body’s capacity to empty it, the bucket begins to overflow.

In this case, the excess usually overflows into the organs which help excrete toxins: the liver, kidney, lungs, gut and skin.

When your toxic bucket is constantly near capacity, one tiny thing, like the wrong food, can trigger a reaction like a breakout of spots.

If your spots are related to liver function, you may also have noticed you feel very tired, or have lost your appetite.

Sarah and I identified and removed trigger foods from her diet, like dairy and alcohol. We also decreased the amount of high glycaemic foods (like white bread and white rice) and sugar, while increasing the amount of greens she ate, and incorporating seeds into her diet to support each phase of her menstrual cycle.

We also looked at her skincare routine, choosing a natural cleanser and toner that was right for her skin, and we were careful to avoid potentially aggravating products since she was reactive to certain sunscreens.

Lots of skincare products (especially sunscreen) contain ingredients which clog pores. There are online tools which can help you identify if your current products contain ingredients which could be disrupting your skin.

While sunscreen is important, choosing a mineral-based sunscreen that contains zinc can help promote skin health, as zinc can help treat spots.

Sarah felt the benefits of these changes after only a month. Her digestive symptoms had improved and her skin health had improved. While there were still some occasional slip-ups in her diet (Sarah is only human) her skin and digestive system were more resilient and symptoms were less severe than before.

Sarah GI-test results

Sarah’s GI-Map results showed that she had an overgrowth of Streptococcus, one of the bacterium on the skin which causes spots. She had low levels of beneficial bacteria.

She also had excess levels of anti-gliadin IgA, an antibody which reacts to a protein in gluten, showing that she had a gluten sensitivity. Eating foods which you’re intolerant to can lead to leaky gut – which is why it came as no surprise that Sarah’s markers for leaky gut were high.

We removed gluten from her diet, tweaked her treatment plan to promote a healthy balance of bacteria in her digestive tract and re-heal her gut lining which in turn would support her skin microbiome. 

Sarah’s hormonal and emotional health

On her next visit, Sarah’s forehead and jaw were clear of pimples. She still had a few blemishes on her cheeks, but she was also under a lot of family stress, which was triggering negative self-talk during this period.

Studies have found that stress stimulates sebum production, a contributing factor for spots. A systematic review demonstrated there was a significant association between stress and breakouts.

During this visit, we did some emotional work to release her from the false narratives that she was not enough. We adjusted her treatment to support her mood as well as digestive and skin health.

Her DUTCH hormone test demonstrated that she had low oestrogen and progesterone, which can cause pimples. In addition, she had low testosterone, a common cause of dry skin, resulting in combined skin problems. Her melatonin, B12 and dopamine metabolites were low too, all of which negatively affect mood.

We adjusted her treatment plan to help rebalance her hormones and replenish her low B12 levels for better mood support.

Hope on the horizon

After 3 months of treatment, Sarah reported her spots were under control, her skin less sensitive, her mood brighter, and her digestion significantly improved. She experienced the occasional pimple, usually after eating out, but she felt much more in control of the triggers in her diet.

Sarah’s spots were not a solitary symptom, they were connected to her liver health, diet and her emotional health. Each person with spots has a unique presentation, and what worked for Sarah won’t work for everyone. It’s important to get personalised advice from a naturopathic doctor to uncover the root cause of your health concern. If you’re struggling with spots, I can help.

References
L A Alzahrani et al, Impact of stress on the prevalence of acne among medical students in the Middle East: a systematic review, 2025.