The gut microbiome: a root cause of female acne?

Acne is typically considered to be a teenage problem. But the patterns we’re now seeing in clinical practice tell us that women in their 30s, 40s, and 50s are also experiencing chronic and recurring acne too. The latest figures tell us that 65% of menstruating females will report monthly outbreaks of acne, which is often related to the timing of their cycle. A worsening of acne most commonly appears two weeks prior to menstruation, which points to a role of ovulation and hormonal influences. It appears acne is no longer just a teenage issue, but a shared experience for females of all ages. The question is, why now and what can we do about it?

How does acne form?

To understand why women might experience persistent low-grade acne, let’s first understand how a pimple forms. Every acne spot or pimple starts in a hair follicle and specifically, within a gland called a sebocyte. A sebocyte is responsible for producing sebum, which is a lipid (fat). Poor old sebum has been given a pretty bad rap over the years, but it’s important to know that it’s incredibly beneficial. Sebum helps our hair break through the surface of the skin, making sure it doesn’t get stuck along the way. It also helps moisturise the face and scalp. But just like everything, we want a “goldilocks” approach when it comes to sebum production - not too much or too little. Acne is a problem where there’s an overproduction of sebum. That’s step one in what we call the pathophysiology of acne. Along with too much sebum, there can also be too much skin cell production going on within that follicle. The hair follicle becomes trapped, and then we can get a buildup of a bacteria called Cutibacterium acnes (also known as Propionibacterium acnes). 

So what causes an overproduction of sebum?

All you need to do is search “hormonal acne” on Instagram or TikTok to find a number of acne "triggers". Dairy. Chocolate. Stress. Foaming cleanses. Cotton pillowcases. Hormones. While some of these triggers are legitimate, it’s important to understand the difference between a trigger and a root cause. A trigger is something that can exacerbate or make your conditions worse. If we take that trigger away, we can ask “is my condition healed? Is it gone?” If the answer is no, it’s a trigger, but not the root cause. This is what makes acne so complicated and frustrating for women, because there’s so many potential triggers for acne but not an obvious root cause. 

The link between the gut microbiome and acne

Enter the gut microbiome. Remember how I told you that 65% of menstruating females experience acne? If I think about it, always everyone I've known has had a pimple at some point in their life. It's a universal shared experience. 

Well, it turns out it’s not as universal as we think. In many indigenous cultures, the prevalence of certain conditions, such as acne, is virtually non-existent compared to Western societies. For instance, extensive studies conducted on the Aché tribe in Paraguay, a community of 115 individuals residing in the Amazon rainforest, revealed no instances of acne over a two-and-a-half-year observation period. Likewise, in Okinawa, Japan, before World War II, physicians with up to 40 years of practice in the region reported virtually non-existent cases of acne amongst the local population. Another study on the Kitavan community in Papua New Guinea, comprising around 1200 members, also concluded with a similar finding over a seven-week research period. Many indigenous societies don't even have a word for acne as it's such a foreign concept to them.

The role of prebiotic fibre in acne

It's important to understand that this absence of acne doesn't arise from any genetic advantages these communities possess. When individuals from these groups relocate to a Westernised country, they often start exhibiting symptoms of acne. This shift suggests that environmental and lifestyle factors, rather than genetic ones, play a pivotal role.

And you probably guessed it, but a significant distinction between Westernised and Indigenous populations lies in the gut microbiome. Indigenous populations tend to have more diverse gut microbiomes, largely influenced by their high-fibre diets, averaging 50 to 100 grams a day. In contrast, the average person in the UK consumes 15g (half of their recommended [minimum] daily intake). To fully reap the benefits of fibre, the research tells us we should be consuming upwards of 35g a day.

The adage "you are what you eat" holds particularly true here, as our dietary choices directly shape our microbiome. Beyond just fibre intake, indigenous diets are devoid of processed foods, chemicals, antibiotics, and common medications, all of which influence gut health. In my perspective, a key to understanding acne's prevalence in Western societies might very well lie in the differences in our gut microbiomes compared to those of indigenous communities.

Supporting skin health through the gut

Achieving 35g of fibre a day is hard work. Sometimes we need an extra helping hand. With myota's prebiotic fibre blends, each scoop provides 10g (or 1/3 of your daily fibre intake). Whether it's our original unflavoured blends or our flavoured myota blends, your gut microbiome will thank you.