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Dr Andrea Robertson is an Osteopath, Naturopath, and Nutritionist. The information shared in this podcast is for educational purposes only and does not constitute medical advice. Always consult your healthcare provider before making changes to your health regimen.

Show Notes

Episode Transcript

Episode 7

 

Andrea: You've tried the creams, you've tried the prescriptions. You might have tried eliminating foods, changing your skincare routine, drinking more water, or spending a significant amount of money on something that promised to finally be the thing that worked. And yet, here you are, still managing it, still covering it, still waiting for your skin to just cooperate

Here's what you may not have been told yet. The skin is not where this problem starts. The skin is where it shows up. And once you understand what is actually driving it, the answer looks completely different. Welcome to Nourish, Heal, and Rise. I'm Dr. Andrea Robertson, osteopath, naturopath, and nutritionist.

Here, we nourish because food is medicine, and what you eat changes everything. We heal because the body has an extraordinary capacity to self-repair when we remove what's blocking [00:02:00] it. And we rise because feeling well isn't the destination, it's the foundation for living the life you truly desire. This is Nourish, Heal, and Rise

Before we begin, a quick and important note. Everything I share on this podcast is for educational purposes only. It's not personal medical advice, and it can't be, because in the context of this podcast, I don't know your health history, your medications, and what else is happening in your body. What I want this podcast to do is give you the knowledge to ask better questions, understand your body more deeply, and make more informed decisions in partnerships with the practitioners who do know you.

If something resonates and you wanna take action, please work with a qualified healthcare provider who knows your full picture

Andrea: Welcome back to Nourish, Heal, and Rise. This is episode seven, [00:03:00] and we are six episodes deep into our series on the eight most common signs of chronic inflammation in women's bodies. If you are new here, welcome. Hello. I would love you to go back and start from the beginning of this series because the episodes build on each other.

But this one stands completely on its own, just like the others. So wherever you are joining from, you are absolutely in the right place. In the last six episodes, we have covered inflammatory fatigue, weight loss resistance, brain fog, joint pain, and gut issues. And if you've been paying attention across the series, you will have noticed that the gut keeps coming up every single episode because it comes up in clinical practice every single day too.

Today, that gut connection becomes even more front and center than it has been in any episode so far, except probably the gut episode, because the sign we're covering today, skin conditions, has one of the most direct and well-documented connections to gut health of any symptom in this entire series. So [00:04:00] sign number six of chronic inflammation is the skin.

Eczema, psoriasis, rosacea, adult hormonal acne that no cream or antibiotic or contraceptive pill has actually resolved. The skin condition that has been treated for years, sometimes decades, from the outside without addressing what is driving it from the inside. Now, I want to be honest with you about something before we go any further.

This episode is one of the ones I feel most strongly about because in over 26 years of clinical practice,

Skin conditions are where I have seen some of the most dramatic clinical reversals I've ever witnessed. Women who have suffered with severe eczema or cystic acne for years, who have tried everything dermatology had available, and who cleared within weeks to months once we addressed the internal picture.

And I have seen women spend decades being told their skin condition is just genetic, just hormonal, just something they have to manage. And they gave up. And these women are gorgeous people whose skin didn't have to look that way at [00:05:00] all. So this one matters to me. Okay, let's get into it.

Here is what we are covering today. First, we're gonna look at what these four inflammatory skin conditions actually look like and why they matter beyond just the cosmetic. Then we're gonna go deep into the internal biology.

Five specific mechanisms that are driving skin inflammation from the inside out. And then the part I know you are here for, seven specific actionable steps you can start implementing this week. I want to start by acknowledging something that I do not think gets said enough in clinical settings.

Inflammatory skin conditions carry a burden that goes far beyond the physical. The skin is visible. Like, you can't leave it at home. You can't take a day off from it. Inflammatory skin conditions affect how women feel getting dressed in the morning, how they feel in social situations, how they feel in relationships and in their confidence in themselves.

They are a source of chronic self-consciousness in a way that most other inflammatory [00:06:00] symptoms simply are not. And medicine, conventional dermatology, absolutely there for a reason, but often it treats these women almost entirely as a cosmetic issue.

Something to manage, something to suppress topically, put some cream on it long term, rather than something to actually understand and resolve from the root cause. I want to reframe that entirely today because persistent treatment-resistant skin conditions are a clinical signal, a window into what's happening on the inside.

And when you learn to read what that window is showing you, you gain access to information that finally changes things

Let me take you through the four conditions I see most commonly and what each one is actually communicating. Let's start with eczema and its fancy name atopic dermatitis. Eczema presents as patches of dry, very itchy, inflamed skin, typically on the inner elbows, the backs of the knees, the wrists, hands, and face.

It has a characteristic pattern of flaring and then remitting, [00:07:00] worsening during periods of stress with certain foods, with environmental triggers, and often in direct response to the products applied to try and manage it. It's really common. So a peer-reviewed cohort study published in the Australasian Journal of Dermatology in two thousand twenty-three found that the lifetime prevalence of eczema in Australia from birth to age forty-four was reported at forty-two percent, with females more commonly affected, that was forty-eight percent, and males at thirty-six percent.

The near universal treatment is topical corticosteroids, so steroid creams. These can be appropriate absolutely for managing an acute severe flare, and I'm not dismissing that. But they work by suppressing the skin's immune response locally. They do not address the gut dysfunction, the immune dysregulation, and the compromised skin barrier function, three things that are all driving the eczema.

And so often the condition continues requiring ongoing escalating treatment indefinitely because [00:08:00] the source has never been addressed. The root cause has never been treated. Then we have psoriasis. Psoriasis presents as raised, thickened, scaly patches or plaques, patches of skin where the cell turnover rate has gone into overdrive.

Think of normal skin cell turnover as a process that takes approximately twenty-eight days. Old cells start to shed gradually. New cells form and rise to the surface. In psoriasis, that entire process is compressed into approximately three to four days. The cells rise so fast they have no time to mature properly.

They accumulate on the surface as that characteristic thick, silvery kind of plaques. And here's the thing About psoriasis that changes how you understand it completely. It is now classified as a systemic inflammatory condition, not just a skin condition.

People with psoriasis have significantly elevated systemic inflammatory markers, C-reactive protein, interleukin 17, tumor necrosis factor. They have [00:09:00] substantially higher rates of psoriatic arthritis, cardiovascular disease, and metabolic syndrome. All of these conditions share the same inflammatory root.

The plaque on the skin is the visible tip of almost a systemic inflammatory iceberg. And now rosacea, a common one I see often in midlife women Rosacea presents as persistent facial redness, so flushing, visible blood vessels, and often inflammatory bumps across the cheeks, nose, foreheads, and chin.

Think of rosacea as the skin becoming hyperreactive, responding to things that should not be significant triggers, so temperature changes, a glass of wine, a hot shower, stress, sun, spicy food. The inflammatory flushing response is disproportionate, persistent, and frustrating for these women. There's a landmark study I want to tell you about published in Clinical Gastroenterology and Hepatology in 2008 by a researcher named Perotti and his colleagues.

They took one hundred and thirteen women and [00:10:00] men with rosacea and sixty matched healthy controls, and they tested everyone for SIBO using breath testing. What they found was really interesting. SIBO was present in forty-six percent of the rosacea patients compared to just five percent of the healthy controls.

And then they went further. They treated the SIBO-positive rosacea patients

with an antibiotic. And in the majority of these patients, the rosacea cleared, not improved, like it cleared, and that result held for at least nine months of follow-up. Then in 2016, Drake and colleagues published a three-year follow-up study in the Journal of the American Academy of Dermatology, tracking rosacea patients with confirmed SIBO over three years, and the finding was consistent.

When SIBO was present and treated, rosacea improved and clinical remission was maintained. When SIBO was not addressed, the skin did not improve. Now, I wanna be honest with you about the state of this research because that is always what I will do on this podcast. The research base here is not [00:11:00] enormous.

This is not 50 randomized control trials, which is the ideal, But what is there is specific, well-designed, and really clinically interesting, and it aligns completely with what I see in practice. Women with rosacea who have never had their gut investigated, who have been managing their skin for years without anyone ever asking what is happening in the gut.

Well, when we ask that question, and when we find and treat SIBO or some other gut problems, the skin responds in a way that no amount of cream or topical treatment ever managed. That to me is the skin-gut axis made visible And finally, adult hormonal acne. Not the acne of adolescence. The deep, cystic, painful acne that appears around the jawline, the skin, and the lower face in adult women.

The acne that has nothing to do with hygiene or skincare. The acne that worsens before the period, that comes back month after month, that has been treated with rounds of antibiotics often, and often the, the pill, the oral contraceptive pill. Neither of which have often resolved [00:12:00] it, because neither of these addressed what was actually driving it

Adult hormonal acne is driven by a specific combination of elevated androgens, the more masculinizing hormones like testosterone and DHEA, plus insulin resistance and gut dysbiosis. It is a hormonal and metabolic condition expressing itself through the sebaceous glands of the lower face, and it responds far better to addressing those drivers than to anything applied on the surface.

So what do these four conditions have in common? They are all driven by systemic inflammation. They all have a well-established connection to gut health, and they all usually respond when the internal environment is addressed. Okay, so let's go into the science and the five internal mechanisms driving inflammatory skin conditions

I wanna build this picture properly for you because understanding the mechanisms is what makes the treatment approach completely logical. Once you see what is happening inside, the steps we will [00:13:00] cover later will make immediate sense. They will then not feel like random health advice.

You'll see them as the obvious next move. Okay, we have mechanism one, the gut-skin axis

The gut-skin axis. Think of this as the biological communication highway that runs constantly between your gut and your skin, and it's one of the most important and most underutilized connections in medicine. The research has been accumulating for decades, and yet conventional dermatology continues to focus almost entirely on the skin surface.

So here is the foundational principle. Your gut lining and your skin are both epithelial tissues. So think of epithelial tissue as the body's barrier fabric, the specialized cells that form boundaries between the inside and the outside. The gut lining is an internal barrier separating the contents of the gut from the bloodstream, and the skin is the external barrier separating the body from the [00:14:00] environment.

Both are barrier organs separating our insides essentially from the outside, and both are in constant two-way conversations with the immune system. Both are maintained by many of the same nutrients, many of the same microbial signals, and many of the same inflammatory pathways.

What happens on one surface, inside usually, is reflected on the other, usually the outside.

When the gut microbiome is dysbiotic, so it's unbalanced and pro-inflammatory, and when the gut lining is compromised with leaky gut or intestinal permeability, bacterial fragments and inflammatory compounds cross from the gut into the bloodstream. The immune system responds. So inflammatory cytokines, think of these as the immune system's alarm signals.

They're chemical messages that recruit inflammatory activity. Well, these start to circulate systemically through the whole body. Activated immune cells patrol the entire body. Antibody levels rise, [00:15:00] and all of that immune activity eventually expresses itself in the skin.

The specific conditions that develop, eczema, psoriasis, rosacea, acne, well, that depends on the individual's genetic predisposition and immune profile. But the driver is shared amongst all of those conditions, the internal inflammatory environment, and the gut is at the center of all of it

The research consistently confirms this. So studies examining the gut microbes of people with eczema, psoriasis, and rosacea show significant differences compared to healthy controls. Lower microbial diversity, higher proportions of pro-inflammatory bacterial species, lower proportions of the beneficial families, particularly the Lactobacillus and Bifidobacterium families of the gut microbiome.

Those ones are the healthy ones that produce the short-chain fatty acids that we want. They also support the gut lining integrity and regulate our immune system. The gut is different in people with these skin conditions, [00:16:00] and when that gut is supported, then the skin responds as well.

Then we have mechanism number two, the skin microbiome. Bet you've never heard of that one. Just as the gut has its own microbiome, its own ecosystem of bacteria and fungi and other microorganisms, so does the skin. The skin microbiome. Think of that as an invisible protective layer living on the surface of our skin, doing a job that you can't see, but your body absolutely depends on it.

A healthy skin microbiome is diverse, balanced, and resilient. It maintains the skin's pH at a slightly acidic level. So think of this as the pH that friendly microorganisms thrive in, and pathogenic ones cannot easily tolerate. It produces antimicrobial compounds that inhibit the growth of dangerous bacteria and fungi, and it communicates with the skin's own immune cells, calibrating their response, teaching them to react appropriately rather than [00:17:00] excessively to the environment.

In eczema specifically, the skin microbiome is typically disrupted in a very specific way. There is a dramatic reduction in diversity and an overgrowth of one particular species called Staphylococcus aureus. Think of Staph aureus as a disruptive colonizer. In healthy skin, it exists in low numbers, kept in check by the rest of the microbial community.

In eczema skin, it dominates, and it produces toxins that directly trigger an immune response in the skin. That immune response drives inflammation. It drives the itch. The scratching then damages the skin barrier further, and the barrier damage allows more Staph aureus to colonize. More immune response, more inflammation, more itch.

The itch-scratch cycle of eczema is a microbiome cycle as much as it is a sensory And here is where it connects back. The skin [00:18:00] microbiome is influenced by the gut microbiome. When gut microbiome diversity improves, skin microbiome diversity tends to follow. This is another mechanism through which healing the gut produces visible improvements in the skin.

The two ecosystems are talking to each other all the time. Okay, now mechanism three driving inflammatory skin conditions is an unhappy liver. Your liver is your primary detoxification organ, and its relationship to skin health is one of the most underappreciated connections in the whole clinical picture.

Think of your liver as your body's processing plant, a three-kilogram chemical factory running 24 hours a day, processing everything that needs to be rendered safe for excretion. Metabolites of hormones, which are essentially leftovers from used hormones, estrogen, testosterone, cortisol. These hormones have done their job and they now need to be cleared. It's metabolic waste products as well, and environmental toxins from foods, water, air, makeup, body products, inflammatory [00:19:00] compounds.

All of this stuff circulating in the bloodstream, it all has to pass through the liver for processing. When the liver is functioning well, processing efficiently, running its two-phase detoxification pathways without being overloaded, well, this whole process happens smoothly.

Compounds are processed and excreted through bile, stools, and urine. But when the liver is overburdened by excess alcohol, by a high-sugar diet that drives fatty liver changes, by a high toxic load from the environment, by a gut that is constantly sending inflammatory compounds across a leaky wall into the blood circulation, well, the liver's processing capacity becomes overwhelmed.

Compounds that should be cleared are not, and they start to recirculate back into the system, and you start to get a real toxic overload. And here is the piece that changes how you think about skin conditions. When the body cannot efficiently excrete waste and inflammatory compounds through its primary routes, through the liver and the kidneys, it reaches for its backup, which is the [00:20:00] skin.

Think of the skin as the body's emergency detoxification overflow valve. When the liver is overloaded, the skin starts doing the work the liver can't keep up with, and the result is skin inflammation. It's trying to detox your body, but instead we get rashes, acne, eczema, generalized congestion as the skin attempts to eliminate and excrete what the liver couldn't process and get rid of itself.

I see this often in clinical practice. Women who come in with generalized skin conditions, not necessarily even one specific diagnosis or condition, but often just a persistent, reactive, easily irritated skin. And I'm almost never interested in their skincare routine at that initial appointment.

I'm interested in their diet, their alcohol intake, their gut health, their liver load because the skin is telling me about those things. I don't want to know about the products they put on their face as a first instance. Okay. Then we have mechanism number four driving inflammatory skin conditions, the insulin and androgen connection

[00:21:00] This one is specifically for adult hormonal acne, and it is their mechanism I wish more women understood because understanding it completely dismantles the logic of long-term antibiotic treatment and the pill, the OCP, the oral contraceptive pill, as a solution. So elevated insulin, which is driven by a diet high in refined carbohydrates and sugar, and by the metabolic state of insulin resistance, well, that does something that conventional dermatology almost never talks about.

It directly stimulates the ovaries to increase androgen production. So androgens are male sex hormones, think testosterone and DHAs, that us females have too. And think of elevated insulin as a signal being sent to the ovarian cells saying, "Ramp up.

Produce more testosterone." And there is also good evidence that the adrenal glands respond similarly, producing more DHEA. The body, in a state of chronically elevated insulin, is running hotter with these androgen hormones, and that androgen heat [00:22:00] then shows up on the skin. Those androgens, particularly dihydrotestosterone or DHT, which is the most potent androgen at the level of the skin, they directly stimulate the sebaceous glands.

Think of the sebaceous glands as the skin's oil production factories, one in every little pore. When androgen stimulation is high, those glands go into more overproduction mode. They produce more excess sebum, the oily substance that in appropriate amounts keeps the skin supple. But in excess, it blocks pores, creates the environment in which acne bacteria proliferate, and drives that deep, painful cystic kind of inflammation of adult hormonal acne At the same time, elevated insulin directly promotes the growth of a bacteria closely associated with inflammatory acne, and increases the production of pro-inflammatory compounds within the skin itself.

So the insulin is driving the androgen, it's driving the sebum, like the oil on the skin. It's [00:23:00] driving the bacteria. It's driving the inflammation. It's a cascade, and antibiotics address just one part of that cascade, the bacteria, while leaving the insulin and androgen drivers completely untouched.

Which is why the acne comes back often just days after antibiotics are stopped. And the oral contraceptive pill works by suppressing ovarian androgen production, which does reduce the acne. But that one doesn't address the insulin resistance driving the androgen, and the OCP, the oral contraceptive pill, also disrupts the gut microbiome significantly, which, as we have discovered, is itself a driver of skin inflammation.

So it manages the symptoms through hormonal suppression while potentially worsening

the underlying gut drivers. The acne frequently returns when the pill is stopped, sometimes worse than before

Now, I want to mention dairy here because the connection to hormonal acne is pretty specific and well-documented. Conventional [00:24:00] cow's milk products contain several compounds that drive the hormonal acne cascade. Insulin-like growth factor 1, IGF-1, which directly stimulates sebaceous gland activity in the same way androgens do.

Think of IGF-1 as knocking on the sebaceous gland's door and turning up the volume on oil production. Conventional dairy also contains the A1 casein protein. It's a protein found in most commercial cow's milk that drives gut inflammation and increases intestinal permeability. And conventional dairy from hormonally managed cows

also contains exogenous hormones that can add to that whole hormonal load. Exogenous means hormones made outside of our bodies. For women with significant adult hormonal acne, I almost always recommend a minimum of a six-week elimination of conventional dairy as one of the first interventions. We often see positive changes in skin well before the six weeks is up.

Okay, now it's time for mechanism five driving inflammatory skin [00:25:00] conditions, the stress-skin connection

This one tends to surprise people because most of us understand that stress worsens skin conditions. But what we do not understand usually is why. And when you understand the mechanism, you realize that stress management is not a soft wellness add-on for skin health,

it's a key clinical intervention. So here's the important piece. The skin has its own stress response system. Isn't that amazing? Think of this as like a little miniaturized version of the body's HPA axis. That is the hypothalamic pituitary adrenal axis, the main stress response system of the body. So the skin's little mini version of this is operating locally at the level of the skin itself.

The skin produces its own cortisol, its own stress signaling molecules, and when systemic stress is elevated, when circulating cortisol is chronically high, the skin's own stress response system is simultaneously activated

So what does chronically elevated [00:26:00] cortisol do in the skin? Well, there's several things, and all of them relevant to the conditions we've been discussing. It increases sebum, the oil production, which directly contributes to the oily blocked pore environment of acne.

It impairs the skin barrier, that outermost layer of the skin. Think of this as the skin's weatherproofing layer. The specialized surface cells packed with lipids that retain moisture inside and keep irritants out. Well, this becomes less effective when cortisol is chronically high.

The lipid composition of the barrier changes. Moisture escapes more easily. Irritants penetrate more readily, and the result is the dry, reactive, easily triggered skin of eczema. Worsening even when nothing in the diet or the environment has obviously changed

Stress also activates something called mast cells. So mast cells are immune cells distributed throughout the body, but even really densely distributed in the skin. Think of them as like the loaded guns packed with histamine and other [00:27:00] inflammatory compounds. Under chronic stress, mast cells are primed and reactive.

Any trigger, food, environment, emotional, it fires them off, and histamine floods the tissue, and we see itching, redness, inflammation. This is the mechanism behind the specific worsening of eczema and hives that women often report during periods of high stress

This reminds me of a patient of mine, one of the ladies who did my 12-week program back in, I think, 2022. Let's call her Sarah for privacy reasons. So Sarah was in her late 40s when we first met. She had had a history of eczema that had generally been under control for most of her adult life, but a few months before we met, it ramped up.

It had spread, intensified, and stopped responding to the things Sarah used to do that usually kept it in check. When I mapped out the timeline with her, it was quite obvious what was going on. She had had a new manager at work who sounded [00:28:00] like, by any measure, a very difficult human being, and I remember Sarah describing her, and she sounded like unpredictable, super critical of Sarah, and created this work environment that kept Sarah's nervous system in a constant state of low-level threat, like in that fight and flight nervous system every day, five days a week for months.

So Sarah's diet hadn't changed, her triggers hadn't changed, but her baseline mast cell reactivity had been raised so significantly by that sustained stress load that her normal buffer, that normal skin protective buffer, was completely gone. Things she had always tolerated were now firing her off constantly.

So we addressed the gut and refined the diet a little bit more, but we treated the stress as the primary clinical driver. Within three months, the intensity had reduced significantly because the nervous system load had shifted. So Sarah's eczema wasn't the main issue, her stress load was, and her skin knew the difference.

The skin's honest. It shows you what's happening [00:29:00] inside, and what was happening inside for Sarah was very clearly showing up on the outside on her skin.

Okay, the last mechanism driving inflammatory skin conditions is nutritional deficiencies. This last one is brief, but very important. The skin is, metabolically speaking, the last organ in the queue to get nutrients in our body. When the body is rationing out its nutrients, which happens in any state of gut dysfunction, chronic inflammation or nutritional depletion, it prioritizes the vital organs first, so the heart, the brain, the liver, the kidneys, and the skin kind of gets what's left over.

In women with gut dysfunction who are absorbing nutrients poorly, which is many of the women I see, what is left over is often very little, and several specific deficiencies show up directly in the skin. Zinc is essential for skin cell production, wound healing, and the regulation of sebaceous gland activity.

That's the ones that create oil. Low zinc is directly associated with acne, eczema, and [00:30:00] impaired skin healing. Think of zinc as the quality controller of skin cell production. Without adequate zinc, the immune response in the skin is poorly regulated. Skin cells are not formed properly, and healing is slow

Then we have omega-3 fatty acids. EPA and DHA are structural components of the skin cell membranes. Think of them as the premium building material for cell walls throughout the skin. When omega-3 levels are adequate, cell membranes are fluid, resilient, and anti-inflammatory. When omega-3s are insufficient, which is very common in women eating a standard Western diet, cell membranes become rigid, pro-inflammatory.

The skin is less supple, less hydrated, and more reactive. Now, vitamin D. This functions as both a vitamin and a hormone, and I really think it should be called hormone D, not vitamin D. But vitamin D directly regulates immune function in the skin and in the rest of the body, but in the skin.

Low vitamin D is associated with increased severity [00:31:00] of both eczema and psoriasis, and supplementation has shown benefits in multiple clinical trials for both conditions. In Australia, we kind of assume that we have adequate vitamin D because we've got lots of beautiful sunlight. However, we're   frequently wrong. I check vitamin D levels on almost every new patient that I see, And low results often surprise my patients. They don't surprise me, though.

Okay, now vitamin A. This is essential for skin cell differentiation and the structural integrity of the skin barrier. Think of vitamin A as the architect of healthy skin cell structure. It determines how skin cells are formed and how well they function as a barrier.

Deficiency produces rough, bumpy skin, impaired barrier function, and increased susceptibility to infection. And silica. This is a trace mineral found in cucumber, celery, oats, and some mineral waters, and this is essential for collagen organization and skin firmness. Think of silica as the tensioning system in the skin's structural scaffolding.

Without it, the collagen [00:32:00] fibers lose their organized arrangement, and the skin kind of loses its resistance.

Andrea: Okay. But now, what do we do with all of this?

I have seven specific actionable steps that you can start today. I'm gonna give you these steps in the order I would work through them in clinic, [00:33:00] because the order matters. This is not a list of things to try randomly. It is a logical sequence that addresses the internal drivers in the right order.  

Step one, heal the gut. This is always first. If there is one message from this entire episode that I want you to take with you, it is this. The skin is downstream of the gut. You can do everything else on this list, and if the gut is not addressed, the results will be incomplete and frustratingly temporary.

So the gut first, always. Remove the gut disruptors, refined sugar, alcohol, industrial seed oils. Think of these as the cheap, highly processed vegetable and seed oils that are in almost every packaged food. So canola oil, sunflower oil, soybean oil, oxidized and inflammatory by nature. And of course, remove all ultra-processed foods and conventional dairy if hormonal acne is significant

Add plant food diversity. This is the [00:34:00] single most important thing you can do for your gut microbiome. Increase the number of different plant foods you eat across a week. Research from the American Gut Project, one of the largest microbiome studies ever conducted, found that people who eat 30 or more different plant foods per week have significantly more diverse gut microbiomes than anyone who eats 10 or fewer.

Diversity in is diversity out. Different plant foods feed different microbial species. No single plant food does the whole job. Then support the gut lining. L-glutamine is the amino acid that is the primary fuel source for the cells lining the gut, and you can supplement with glutamine at five grams per day to support gut lining repair.

Zinc is also essential for gut lining repair, as it is for skin integrity, and vitamin A supports the differentiation of the epithelial cells that form both the gut lining and the skin surface. [00:35:00] So the overlap here is not coincidental. Both are epithelial barrier tissues, the skin and the gut, maintained by the same nutrients.

And consider, is something else going on in the gut? If you have rosacea that is not responding to dietary interventions or eczema that flares seemingly without obvious food triggers, check what else may be going on. SIBO, small intestinal bacterial overgrowth, is worth investigating with a qualified practitioner.

The rosacea-SIBO connection specifically is well-documented enough that I consider it almost a clinical default assumption until proven otherwise

  And then step two, eliminate the primary skin inflammatory dietary triggers. Beyond the general gut disruptors of gluten, cow's dairy, sugar, alcohol, and ultra-processed foods, there are other specific foods with particular direct connections to specific skin conditions

For hormonal acne, the [00:36:00] categories to remove first for a minimum of six weeks are refined sugar, refined carbohydrates, and conventional dairy. These dietary changes implemented together and maintained consistently produce the most dramatic results in adult hormonal acne of anything I've seen in clinical practice.

The insulin androgen cascade we covered earlier responds within weeks to removing these drivers, and by six weeks many women are seeing significant changes in their skin, not just a mild improvement. Change they have not seen with years of other treatments. For eczema, food triggers are highly individual.

The most common ones are gluten, conventional dairy, eggs, soy, and certain nuts. But eczema food triggers cannot be identified from a list. They really need to be identified through a proper elimination and reintroduction process. In my practice and in my 12-week Whole Health Solution program, I use what I call my always, sometimes, special occasion and never food framework.

Foods that form the daily [00:37:00] foundation versus foods that are occasional foods, versus foods that are genuine rare treats, versus foods that are completely off the table given what we know about how they affect you specifically. For eczema, the identification of your personal never foods is some of the most important work you can do.

For rosacea, the high histamine foods are the most common consistently reported dietary triggers. Alcohol, especially the red wine and beer, aged and fermented cheeses, tomatoes, very sadly chocolate,

spicy foods and coffee. If rosacea is your primary concern, a low histamine dietary approach alongside addressing any underlying gut issues like SIBO is a really good clinically effective starting point. For psoriasis, gluten has a particularly significant and specific association So there's a subset of people with psoriasis who carry elevated anti-gliadin antibodies, indicating an immune response to gliadin, the protein in gluten, that [00:38:00] cross-reacts with skin tissue.

Think of this as a case of almost like mistaken identity. The immune system raises an alarm against gluten, and in the process also attacks the skin. A strict gluten elimination trial of a minimum of three months, long enough to clear the immune response and allow the gut to heal, well, that's one of the most important dietary experiments for someone with psoriasis.

Alcohol is also a major psoriasis trigger. It directly increases intestinal permeability, leaky gut, driving systemic inflammation and impairing that liver clearance of the inflammatory compounds driving the psoriatic plaques that we see on the skin.

Now, step three on what can do for inflammatory skin conditions. Support the liver. Cruciferous Vegetables every day, non-negotiable. Broccoli, cauliflower, Brussels sprouts, kale, bok choy, cabbage, at least one serve. These vegetables contain some amazing compounds, particularly [00:39:00] indole-3-carbinol and sulforaphane, that directly support both phases of the liver's detoxification process.

Think of liver detoxification as a two-phase system. Phase one breaks down the toxins, so it transforms them from fat-soluble into a kind of intermediate form, and then phase two packages them so they are water-soluble, so they can be safely excreted from the body.

Cruciferous vegetables. I always say criniferous for some reason, but cruciferous vegetables support both phases. They are the most potent natural liver support food available. And drink adequate water, two liters per day at minimum, filtered where possible, to support the kidney excretion of what the liver has processed.

If you are not drinking enough water, you are asking the liver to process things without giving it the means to actually clear them. And reduce alcohol or cut it out completely. This is a non-negotiable part of the skin conversation. Alcohol is directly toxic to liver cells. It's a [00:40:00] hepatotoxin, and it directly increases intestinal permeability.

I know I've said this a million times, but I want it to get in there. Like, it causes leaky gut, feeding the gut-skin axis driver that we've covered. For women with significant skin conditions who are drinking regularly, reducing alcohol or cutting it out altogether is one of the highest impact interventions available.

And then a supplement I love, milk thistle, St. Mary's thistle, silymarin. Think of St. Mary's thistle as a protective shield for liver cells. It reduces oxidative stress in the liver, supports liver cell regeneration, and improves the liver's processing capacity

And then add bitter foods, dandelion greens, rocket, radicchio, artichoke. These directly stimulate bile production. Think of bile as like the liver's garbage truck, the vehicle it uses to carry processed wastes from the liver to the gut for excretion. When bile flow is adequate, the liver can clean efficiently.

When bile is sluggish, which [00:41:00] happens on a low-fat diet, by the way, because fat is the stimulus for bile secretion, well, processed compounds back up and recirculate. So eat your healthy fats too, my friends. Okay, step four, nourish the skin from the inside out.

Let's look at omega-3 fatty acids first, EPA and DHA. Have oily fish three to four times per week, salmon, sardines, mackerel, anchovies. Unfortunately, farmed salmon in particular has a much lower omega-3 content than wild-caught, so see if you can find wild-caught salmon.

I get mine online from Butcher Crowd here in Australia. And add a quality concentrated fish oil supplement providing at least two grams of combined EPA and DHA per day. The anti-inflammatory prostaglandins produced from EPA and DHA directly reduce the inflammatory compounds driving eczema, psoriasis, and acne.

And DHA supports the fluidity of skin cell membranes, the structural quality of the cell walls throughout the [00:42:00] skin. Now, zinc, which we can get from food and supplementation where needed. Though oysters are the most zinc-rich food available by a significant margin, a single serving provides more than the recommended daily intake.

So for non-oyster eaters like me, pumpkin seeds, quality red meat, and cashews are reasonable sources as well. But for women with active skin conditions, food alone is often not enough. So zinc bisglycinate or zinc citrate supplements at 15 to 20 milligrams per day

are well-tolerated and highly bioavailable forms. Make sure you do take zinc though with food, because otherwise it can cause some nausea on an empty stomach. Okay, now vitamin A from liver, eggs, and orange and yellow vegetables rich in beta carotene. If you're supplementing though, go for a food-based vitamin A if you can.

Now, vitamin D. Test your level before supplementing, and target the functional medicine range of around 100 nanomoles per liter. In my practice, [00:43:00] I almost never see women sitting in that optimal range without supplementation, even in Australia, even in summer. The deficiency rates are actually extraordinary.

There's a lot of deficiency of vitamin D in our country. And given vitamin D's direct role in skin immune regulation and its established connection to eczema and psoriasis severity, this is a supplement non-negotiable for women with active skin conditions

Now, I know you are sitting there listening to this about to say, " what about collagen, Andrea?" So yes, collagen. Have collagen, 10 to 15 grams per day in powder form, which you can add to smoothies, soups, or warm drinks.

Research, including a well-conducted systematic review and meta-analysis published in 2023, shows that consistent collagen peptide supplementation at this dose significantly improves skin elasticity, hydration, and barrier function over 12 weeks. How good's that? This is one of the areas where evidence has actually caught up with the clinical experience, and it is particularly relevant for women in [00:44:00] perimenopause and beyond, where declining estrogen, sadly, directly accelerates collagen loss.

Okay. Now we go on to step five of what we can do to support inflammatory skin conditions. Clean up what goes on your skin. This one surprises people because the products designed to treat inflammatory skin conditions are sometimes contributing to the drivers of these conditions themselves. The skin absorbs a significant portion of what is applied onto it.

Estimates vary, but a significant amount of what goes on the skin crosses into the bloodstream. Think of the skin not just as a surface, but as a route of entry, like a second digestive system almost for the topical environment. And conventional body products, makeup, hair products, those personal care products, the ones you find in most chemists and supermarkets, they frequently contain parabens, synthetic fragrances, phthalates, and other endocrine-disrupting compounds that add to the toxic and inflammatory load the [00:45:00] body is already managing.

They're almost adding fuel to the fire that they are supposed to be putting out. So some practical steps for you. Switch to fragrance-free, paraben-free, phthalate-free personal care products across the board. Not just your skincare, but your shampoo, conditioner, body wash, deodorant, laundry powder. A practical guide is to look for products that are organic or the list of ingredients contains no chemical-sounding names that you can't identify. So I personally do all my shopping for these type of products at The Natural Supply Co. A great website here in Australia created by two women in Geelong, which is a city near me here in Melbourne.

Now, step six of what we can do to support inflammatory skin conditions is manage stress. Given the skin's own internal stress response, its own cortisol production, its own mast cell activation, its own barrier-impairing response to elevated systemic cortisol, stress management is a perfect clinical intervention for skin health.

Not just [00:46:00] a nice-to-have, not a soft suggestion, but a really direct evidence-based intervention. So mindfulness-based stress reduction actually has clinical evidence for psoriasis, not just for general wellness, but for actual psoriasis specifically, believe it or not. Studies show that people with psoriasis who practice mindfulness-based stress reduction clear their psoriasis plaques significantly faster during phototherapy treatment than those receiving the phototherapy alone. The nervous system response is directly affecting the skin's inflammatory pathways, and calming that response produces really good skin improvements. That is as solid as the evidence gets.

So the practical tools we have applied across this series all apply here, too, in terms of the nervous system. Breathwork. Think deep diaphragmatic breathing for five minutes at any time you're feeling stressed, that activates the vagus nerve and it shifts the nervous system from the fight and flight sympathetics to the rest, relax, digest parasympathetics. And then protect your morning cortisol [00:47:00] pattern, keeping the first 90 minutes of the day screen-free and emotionally quiet, allowing the natural cortisol awakening response to do its job before the demands of the day pile on And build real recovery into the day.

Not just exercise recovery, but psychological recovery too. Time when nothing is required of you. And one that I think is specifically relevant for skin conditions, have some time near water, whether it's an ocean, a lake, a river, even a bath. There is consistent evidence that proximity to blue space has beautiful nervous system calming effects.

And for women whose skin flares in response to stress, intentional repeated nervous system downregulation is one of the most direct interventions available.

Okay, step seven of what we can do to support inflammatory skin conditions: consider a targeted supplementation for your specific condition. Beyond the foundational skin nutrition, omega-3s, zinc, vitamin A, vitamin D, there are specific [00:48:00] supplements with strong evidence for specific conditions, so I'm gonna keep this really targeted.

For eczema, evening primrose oil, which is rich in gamma-linolenic acid, GLA, a specific omega-6 fatty acid that has anti-inflammatory than pro-inflam- rather than pro-inflammatory effects, and directly supports skin barrier lipid structure.

One to three grams per day. Also Lactobacillus rhamnosus GG, a specific probiotic strain that has been tested in multiple clinical trials for eczema prevention and management, including both children and adults.

This is one case where a specific probiotic strain, not just food-based probiotics, has genuine robust clinical evidence behind it. For psoriasis, fish oil at therapeutic doses of three to four grams of combined EPA and DHA has shown reduction in psoriasis severity in clinical trials. And berberine, a plant alkaloid with broad anti-inflammatory and gut modulating effects, has emerging evidence for psoriasis [00:49:00] also through its impact on gut dysbiosis, intestinal permeability, the leaky gut, and the inflammatory pathway driving psoriatic plaque formation on the skin.

For rosacea, a DAO enzyme, D-A-O enzyme, supplement taken before meals supports histamine clearance. DAO is the enzyme responsible for breaking down ingested histamine in the gut,

And low DAO activity is common in women with rosacea and histamine sensitivity. And again, investigating and addressing SIBO specifically with the guidance of a functional medicine practitioner like myself or my team or one you already know is one of the most impactful clinical interventions available for rosacea that is not fully responding to dietary modification alone.

For hormonal acne, spearmint tea at two cups per day has growing evidence for reducing androgen levels in women with elevated androgens there are now small but methodologically reasonable clinical trials to support this. And DIM, [00:50:00] diindolylmethane, found naturally in cruciferous vegetables and also available in concentrated supplement form.

While DIM supports estrogen metabolism and reduces the androgenic effects driving hormonal acne. And myo-inositol, a naturally occurring compound that improves insulin sensitivity, has specific evidence for reducing hormonal acne in women with insulin resistance and polycystic ovarian syndrome. Just a little side note, PCOS has been officially renamed to polyendocrine metabolic ovarian syndrome, PMOS, just in May of this year, 2026.

And PCOS or PMOS now is one of the most androgenic driven hormonal patterns I see clinically. So let me bring those seven steps together quickly as a recap. Step one, heal the gut first, always. Remove the disruptors, add plant diversity, and support the gut lining. Step two, eliminate the primary skin inflammatory dietary triggers for your specific condition.

Step three, [00:51:00] support the liver through cruciferous vegetables, adequate water, reduced alcohol, milk thistle, and bitter foods. Step four, nourish the skin from the inside, omega-3s, zinc, vitamin A, vitamin D, and collagen peptides. Step five, clean up what goes on your skin. Keep it fragrance-free

and organic. Step six, manage stress as a direct clinical intervention for the skin, not as an optional extra add-on. And step seven, add targeted supplementation for your specific condition based on the evidence

I wanna finish this episode by painting you the picture of what healing looks like, because I think it's worth describing clearly, not as a promise, but because healing timelines vary significantly, and I will not pretend otherwise. But healing is a real documented clinically common outcome when the work is done. So I can think of a patient, I'm gonna call her Anne for privacy reasons, who came to me in her early 40s, I think, after about 12 years of [00:52:00] eczema that had been worsening progressively. She'd been through multiple courses of topical corticosteroids on her skin.

She'd tried various elimination diets with inconsistent results, and had largely accepted that this was just normal, just something that she was gonna manage. She was an intelligent, health-conscious woman, and she was already doing many things right, but the gut piece had never been addressed in a systematic way.

So we ran comprehensive gut testing, and we confirmed significant dysbiosis and a candida overgrowth that had not been previously identified. So with her, I implemented a six-month gut healing protocol. We addressed the specific food triggers through elimination and reintroduction, and we created, and we corrected several nutritional deficiencies, including zinc and vitamin D, and we changed her makeup and her body products over to organic.

At three months, her eczema had reduced by about 60%. At six months, it had reduced by roughly 90%. She still had mild reactivity [00:53:00] to certain foods and needed to manage her stress load carefully. But the condition that had been, like, defining her skin for 12 years was for all practical reasons gone.

She described it, and I remember her exact words, as finally feeling comfortable in her own skin. Like it was so beautiful. Not in a metaphorical way, but like quite literally, she was comfortable in her own skin for the first time in like 12 years. This is not an unusual outcome.

When the internal picture is addressed systematically and completely, it's a common one, and it is one that becomes available when you stop treating the skin as the source and start treating it as the signal. Your skin is talking. It's talking to you.

It's been talking to you for years, and the conversation it is having is not about the products you are using or the cream you've not tried yet. It's about the gut, the liver, the hormones, the inflammatory load, the nutrient status, your stress. It is about the internal environment. And when you address that environment, when you give the body what it needs and remove what is disrupting [00:54:00] it, the skin responds, often faster than you expect

So start with step one this week, just step one. Remove the gut disruptors, the refined sugar, the alcohol, the ultra-processed foods, and begin adding plant food diversity. 30 different plant foods across the week. Try it, and pay attention to what your skin starts to tell you as the internal environment begins to shift.

I would genuinely love to hear from you. Tell me on Instagram at nourishhealrisepodcast what you are doing, what you are noticing, what is changing, because this community of women making these changes and sharing what they are experiencing is one of the things I really value most about doing this work.

Next week in episode eight, we go on to sign number seven of chronic inflammation, and that is mood changes. The anxiety that feels disproportionate, the low mood that does not fit your circumstance, the irritability that arrives without an obvious cause, the emotional rawness that makes you feel like you're not yourself, and [00:55:00] the really interesting connection between systemic inflammation and mental health that is one of the most important and most rapidly evolving areas of research in medicine right now.

Neuroinflammation, the gut-brain axis, the role of inflammatory cytokines in anxiety and depression. This is an episode that a lot of women have been waiting for, so make sure you are subscribed so you do not miss it. So please hit subscribe or follow the show on whatever platform you are listening on right now, because you do not want to miss a single episode.

And if someone in your life needs to hear this, please share it with them too, because the more women who have access to this kind of information, the better. Just a little note, all of my free resources, my three-week inflammation detox and my 12-week whole health solution program can be found at andrearobertson.health.

Everything you need is right there waiting for you. If you've loved today's episode, please take 30 seconds to leave a review on Apple Podcasts, Spotify, or wherever you listen to your podcasts. It helps more women find the show so they can [00:56:00] nourish, heal, and rise too. Until next week, nourish your body, keep healing, and never stop rising.

I'm Dr. Andrea Robertson, and this has been Nourish, Heal, and Rise.