What’s the relationship between gut health and acne?

There’s some evidence that gut microbes could play a role in acne. 

Acne is the most common skin condition in the Western world. It arises due to a combination of factors, including increased facial oil production, inflammation, and an imbalance of microbes on your skin. 

Research suggests that gut microbes and the substances they produce could influence each of these factors, contributing to breakouts.

As you'll discover in this article, you can promote good gut and skin health by eating to support a variety of microbes in your gut.

With the ZOE at-home test, you can find out which microbes live in your gut and which foods will help support the “good” bacteria there. Take our free quiz to find out how it works.

What's the link between gut health and acne?

A large and long-standing body of research has looked at connections between gut health and acne.

As far back as 1916, scientists suggested that people with acne have increased intestinal permeability.

This involves your gut letting compounds other than nutrients and water pass through into your bloodstream. Some refer to this as a leaky gut

More recently, several case-control studies have shown that people with acne have less bacterial diversity in their guts than other people.

They’ve also shown that those with acne are often lacking key “good” bacteria, such as strains of Lactobacilli and Bifidobacteria.

So, scientists know that there's a connection between the gut and the skin, and they’ve dubbed this connection “the gut-skin axis.” Experts still aren’t entirely sure how it works.

Research and theories

When it comes to the relationship between gut health and acne, most theories focus on the role of gut microbes. Here are some ideas about how these microbes might influence acne:

1. Increased intestinal permeability 

Remember how people with acne seem to have fewer “good” bacteria? An imbalance like this is known as dysbiosis

It’s a problem because these good bacteria produce substances called short-chain fatty acids (SCFAs), which help you maintain a healthy gut barrier.

Some scientists suggest that if there aren’t enough good bacteria and SCFAs, people with acne develop increased intestinal permeability.

More gut bacteria and their byproducts can then get into the bloodstream. 

From there, they could affect your skin health, influencing cell activity and causing inflammation that contributes to acne. 

2. Immune system activity

While it’s still unclear exactly how gut microbes might affect acne, some researchers think that your gut microbes’ influence on your immune system could play a part.

3. Cellular signaling pathways

Gut microbes also interact with something called the mTOR pathway, which acts like a signaling system in your cells. Changes to the community of microbes in your gut could change how this pathway functions.

The mTOR pathway plays a role in regulating your skin health. And researchers have observed that people with acne have noticeable changes in this pathway.

4. Nervous system function

Gut microbes produce neurotransmitters, which are chemical messengers. Your body uses neurotransmitters to send signals from your brain and other parts of your nervous system to other cells.

These messengers can affect the function of your skin. And this could factor into developing skin diseases, like acne. 

5. Skin microbiome composition

A microbiome is a community of microbes — like bacteria, viruses, and fungi — that live in a particular place. 

Like your gut, your skin is home to lots of microbes. Research suggests that the SCFAs produced by your gut bacteria may influence which bacteria grow on your skin. This could play a role in acne. 

As you can see from these theories, the gut-skin axis is a complex topic. There’s so much that we still don’t know about it.

Signs and symptoms of an unhealthy gut

Many of us experience occasional digestive symptoms. But if you have chronic symptoms, which may occur weekly or even daily, it can signal that you have an unhealthy gut

Some of these symptoms include:

  • gas

  • bloating

  • cramping 

  • abdominal discomfort

  • diarrhea

  • constipation

The effects of poor gut health can extend beyond the digestive system. It can lead to symptoms such as:

  • sleep issues

  • persistent fatigue

  • skin changes

  • food intolerances

  • sugar cravings

  • unexplained mood disorders

If you want to know more about the signs of an unhealthy gut, Dr. Will Bulsiewicz discusses these and other symptoms in a recent episode of the ZOE Science & Nutrition podcast.

Causes of poor gut health

Lots of factors can contribute to an imbalance in your gut bacteria and poor gut health. Some of these include:

  • Eating a low-quality, or “Western,” diet. A diet that's low in fiber and high in sugar and fat can influence the types of microbes living in your gut.

  • Taking antibiotics. These medicines kill bacteria, so they reduce bacterial diversity in your gut. However, antibiotics are often necessary, and they can be lifesaving. Always take them as your doctor prescribes.

  • Stress. Research suggests that prolonged stress can reduce the levels of Lactobacillus and Bifidobacteria in your gut, which are key “good” bacteria.

  • Genetics. One gene called NOD2 plays a role in your immune response, and it helps prevent “bad” microbes from settling in your gut. Some people have variants of NOD2 that don't work, so they have an increased risk of developing dysbiosis. 

You can learn about other factors that contribute to poor gut health in our article on dysbiosis

Tips for a healthy gut

Luckily, there’s lots you can do to support your gut health. Here are some key strategies:

  • Aim for 30 different plant foods a week: Eating a wide variety of foods encourages bacterial diversity, which is good for a healthy gut. Fruits, vegetables, spices, herbs, legumes, nuts, and seeds all count toward your total.

  • Eat the rainbow: Polyphenols are compounds in colorful plants, and they feed your “good” gut bacteria. So, try to eat as many different colored plant foods as you can.

  • Include legumes: Foods like chickpeas and lentils contain special prebiotic fiber, which acts as fuel for your “good” bacteria.

  • Eat fermented foods: These contain live bacteria, which may also increase the diversity of your gut microbiome.

  • Avoid ultra-processed foods: ZOE's research shows that people who eat more highly processed foods have more “bad” bugs in their guts. 

  • Minimize eating late in the day: ZOE Co-Founder Prof. Tim Spector recommends giving your gut bugs a break. Having this rest from eating is particularly important overnight.

  • Optimize your lifestyle: Getting good sleep, exercising, reducing stress, and stopping smoking all promote good gut health.

  • Get personalized nutrition advice: Each of us has a unique gut microbiome. So, the best foods for a healthy gut vary from person to person. Having a diet that’s personalized can help you maintain a solid balance of “good” and “bad” gut bugs.

At ZOE, our at-home test assesses your blood sugar and blood fat responses to food. It also checks which bugs live in your gut.

With this information, our personalized nutrition program can show you the best foods for you and your long-term health goals. Find out how it works and take our free quiz.

How to clear up acne

A lot of what’s good for your gut health is likely good for your skin, too. So, many of the strategies we list above could help with acne.

With that said, the severity of acne varies. For severe cases, which can cause scarring, it’s important to seek treatment from a doctor early.

For mild acne, tweaking parts of your diet and daily routine may ease the symptoms. Here are some steps that might help:

  • Follow a low-glycemic index diet: This means limiting foods that cause your blood sugar to rise rapidly. Research suggests that this type of diet, also called a low-GI diet, can lead to fewer breakouts, compared with a high-GI diet.

  • Enjoy the outdoors: Exposing your skin to natural outdoor environments might be good for your skin microbiome. But it’s important to use sun protection. Look for products that are “noncomedogenic,” which means that they won’t clog your pores.

  • Get a good night’s sleep: Research suggests that there could be a link between your sleep quality and how severe your acne is.

  • Reduce stress when possible: The release of stress hormones can affect the production of oil in your skin’s sebaceous glands. 

  • Moisturize: This strengthens your skin’s ability to work as a barrier. Again, look for noncomedogenic products to prevent clogged pores.

To learn more about acne, skin aging, and your skin and gut microbiomes, check out a recent ZOE Science & Nutrition podcast, which features Dr. Justine Kluk.

Will it help if I stop eating dairy?

Some observational research has linked dairy consumption to acne. The association is strongest for milk — things are less clear when it comes to yogurt and cheese.

You could try eliminating dairy for a month or so to see if it helps your skin.

But many dairy foods can be a healthy part of your diet, so don't cut them out if you don’t need to.

Frequently asked questions

Here, we answer some common questions about gut health and acne.

Is skin disease related to gut health? 

They can be related, but they’re not always. Research has linked gut dysbiosis to acne, rosacea, eczema, psoriasis, and other skin conditions. Still, figuring out the connection will take more research.

Does Accutane kill gut bacteria?

There haven’t been studies about this in humans, but one study in mice showed that isotretinoin (another name for Accutane) had no significant effect on gut microbes. 

Is hormonal acne related to gut health?

Possibly. Gut bacteria may play a role in regulating sex hormones. If this is true, gut bacteria could influence hormonal acne. Exploring this will require more research.


Gut microbes could play a significant role in acne via the gut-skin axis.

A few studies show that people with acne have an imbalance in the “good” and “bad” bacteria in their guts, typically with reduced microbial diversity.

Overall, though, scientists still aren’t sure how these issues are connected.

You can support your microbial diversity and promote good gut health by eating a wide variety of plants and cutting down on ultra-processed foods.

And many of the strategies for supporting your gut health — like eating well, getting quality sleep, and limiting stress — can have a positive effect on your skin health, too.


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