Beauty from the Inside Out: Exploring the Gut-Skin Connection with Dr. Tanisha Shekdar

Introduction

Meet Dr. Tanisha Shekdar,  a licensed Naturopathic Doctor specializing in stress, weight management, pre-diabetes, and metabolic concerns. Dr. Shekdar is passionate about empowering her patients to take control of their health by focusing on the foundational pillars of health and incorporating evidence-based approaches related to diet and lifestyle counselling, natural health products, herbal medicine and acupuncture. Today we will be interviewing her on the Gut-Skin connection to get a better idea of how we can optimize our eating for radiant skin. 

 

To start off, could you explain how our gut health influences the health and appearance of our skin?

Just like how we have a gut-brain axis, the “gut-skin” axis refers to the bi-directional relationship between our digestive system and our skin. This means our gut health can profoundly impact and influence the health of our skin. Research has shown time and time again that damage to our gut lining from things like excessive alcohol consumption, stress, eating foods high in refined sugars and saturated fats, certain medications, and antibiotic usage can hugely  impact our gut microbiome and reduce the presence of helpful and beneficial bacteria like lactobacillus and bifidobacterium. When beneficial bacteria like these start reducing in amounts, this creates the perfect environment for harmful and pathogenic bacteria to thrive which leads to inflammation in the body and ultimately inflammation at the level of the skin. Additionally, the skin also acts as the first line of defence between our outside environment and inside our bodies - if there is any sort of skin-barrier dysfunction from things like sun damage, harsh skin-care product usage, chemical use, air pollution, this can also create the perfect environment for bacterial overgrowth and infections happening. 

To add, our gut lining allows for the proper absorption of essential nutrients and minerals which are crucial for the health of our skin - things like essential fatty acids, vitamin A, vitamin E, zinc, and vitamin D help maintain the lining of our hair, skin, and nails. So therefore, poor gut health as a result of poor diet and lifestyle habits can impact the elasticity, hydration, and overall look of our skin.

 

What are some common skin conditions that might signal underlying gut issues?

We all know the term “you are what you eat” - underlying gut health issues can therefore manifest in our bodies as certain skin conditions! You might be aware of the common skin conditions related to a dysfunctional gut such as acne, hives, and eczema. However, things like rosacea, angular cheilitis, dandruff, keratosis pilaris (chicken skin), and hyperpigmentation especially in certain areas of the body such as the neck, cheekbones, armpits, and under the breasts can also signal that there may be issues with the digestive system. I love using comprehensive lab testing for skin-related conditions because most often, there are a combination of organ systems that may be dysregulated. For example, acne can be due to an overgrowth of harmful bacteria in the gut, but can also be due to poor liver function and high levels of circulating insulin in the blood! Psoriasis and psoriasis-related flare ups on the other hand can also be due to gut dysbiosis but can get worse with a poorly functioning immune system so supporting both is helpful.

 

When it comes to our hormones, what role do they play in how our skin looks and feels?

When I have patients coming in struggling with skin-related concerns, I’m always making sure to run lab work to help get a better idea of which organ system(s) need a little more love and support. When talking about skin-related concerns and skin health, there are several hormones that first come to mind:

Insulin and blood sugar - persistently high levels of insulin circulating in the body have an impact on the amount of local androgens (i.e testosterone) at the level of the skin. This increases the amount of oil production, inflammation, oxidation, and therefore the composition of your skin barrier. This cascade of events increases the risk of acne production! Additionally, high levels of circulating insulin in general has been shown to be associated with acne. Acanthosis nigricans is the term describing hyperpigmentation and darkening of the skin especially around the neck folds, cheek bones, armpits and areas under the breasts. This darkening and thickening of the skin is a common telltale sign of insulin resistance and blood sugar imbalance. 

Female hormones - Estrogen production and detoxification is crucial for the health of your skin. If estrogen levels start dropping, this can impact the elasticity and hydration of the skin by decreasing the amount of collagen production which in turn accelerates ageing. During perimenopause and menopause, this decrease in estrogen leads to thinner and drier skin lacking elasticity

Thyroid health - your thyroid plays a fundamental role in your metabolic health but also helps maintain the lustre and shine of your skin and hair! The thyroid is especially sensitive to stress so chronic and long-term stress can overburden the thyroid and affect energy levels, mood, weight, menstrual cycles and result in dry skin and brittle hair and nails. 

 

Many people talk about stress impacting their skin. Could you explain how stress shows up in our skin and how we can tell if it’s stress-related?

Cortisol is the main hormone culprit here! Stress is inevitable - we are constantly bombarded with stressor after stressor whether it’s jumping from meeting to meeting, sitting in traffic, eating on the go and even exercising (yes exercise is good for you and is a positive stressor but is still a stressor nonetheless!). When we face these stressors, our body releases adrenaline in response which is immediate - 30-40 minutes later, cortisol gets released by the adrenal glands. If we are CONSTANTLY experiencing stress and don’t have any way to manage it, high circulating levels of cortisol in the body can increase oil production, similar to how insulin does, which then worsens and increases acne production. 

 

What happens to our skin & hair when we ignore stress or fail to manage it well over time?

Chronic stress and chronic cortisol production also impacts the immune system - with a weakened immune system, we also don’t have the ability to support proper healing of the skin. This is where we might see eczema constantly cracking, bleeding, and never properly healing. I am always discussing with my patients the importance of completing your stress cycle in order to allow your body to shift from fight-or-flight back into rest-and-digest. We all have a threshold of tolerance. Acute stressors bring us close to the top end of that threshold but we need to have tools in our toolkit to support our body and bring it away from the top limit and back to baseline so that with the next stressor we experience we aren’t tipping out of that threshold. Tools like meditation, deep belly breathing, walking in nature, cold exposure, and activities that activate your vagus nerve are all ways you can complete your stress cycle and bring your body back to baseline and AWAY from the upper limit of your stress threshold.

What are some common toxic ingredients in cosmetics that you think people overlook, and how do these impact our skin and overall health?

Endocrine disruptors are chemicals that directly impact the hormone-receptor pathways in our bodies which then cause those receptors to not work as well. Some of these ingredients can also look and mimic the way our hormones work - these are called xenoestrogens. Xenoestrogens have the ability to actually bind to receptors in the body which can then potentially disrupt hormonal balance by causing the body to over respond or respond at the wrong time. Endocrine disruptors have been linked to hair loss, sperm and egg quality, fertility in general. Endocrine disruptors that we should be aware of when reading ingredients of products include fragrance/parfums, parabens, phthalates, BPA, PCBs, SLS (sodium lauryl sulfate), triclosan, and dioxins to name a few. 

 

Besides cosmetics, are there other everyday products that could be harming our skin without us realising it?

• Hand soaps and detergents can have harsh chemicals that can strip the skin’s natural oils which can lead to dryness and irritation. In 2020 when there was a frenzy of hand washing and sanitizing, the increase in hand eczema (dermatitis) was quite common!

• Cleaning agents especially if we are not using gloves to clean parts of our homes like the oven/stove, sink, and bathroom. The use of constant and prolonged chemical use such as ammonia, bleach and disinfectants can lead to chemical burns of the hands and arms. 

• Deodorants contain various fragrances/parfums and aluminum that can also cause burning, irritation, and sensitivity of the area.

• Body scrubs that contain harsh plastics, microbeads, and parfums/fragrances that negatively impact the skin’s protective layers making you more prone to dryness and irritation. Instead of those you can try non-toxic options like these hydrating options here at Sugar Plum Scrubs

 

Once we become aware of these toxins, what steps can we take to reduce or eliminate them from our routine and how do you suggest we be more intentional about the products we use without feeling more stressed? 

Doing a complete overhaul of your product use, foods, and maybe even clothing can be very overwhelming! What I usually suggest for my patients is picking 1-3 things that you use every single day and look into swapping that first. This might be your body lotion, deodorant and body wash. Once you get the hang of these larger and more impactful changes, then you can look into making the smaller switches. 

If someone wants to start nurturing their gut, balance their hormones, and improve their skin, what are some simple lifestyle or dietary changes you’d recommend to start?

The first thing I recommend everyone do is look into comprehensive lab testing to understand what YOUR body’s needs and loops of dysfunction might be. Skin changes are your body’s way of telling you there might be something going on at a deeper level in a language that you can understand - you need to play detective and take a deeper dive into what this might be. For someone who has acne, for example, their root cause of this issue might predominantly be diet-related and supporting their gut health. For another person it might have to do with regulating their hormones a little more! Getting a comprehensive understanding of your lab work helps paint a beautiful picture for someone like myself and other primary care providers to create a tailored plan to fit you and your body’s needs. Generally what I do with patients who need skin care support is use a combination of herbs and nutrition/lifestyle changes specific to their needs. For patients who need a little extra support whether it be for severe acne flare ups and scar formation I tie in facial acupuncture as an adjunct therapy alongside their treatment plan.

In general, the four biggest things you can start doing today to support your skin and overall health is by focusing your dietary choices, increasing hydration, and supporting your stress and nervous system health. 

If you are looking for support or are confused with information overload from social media and advice from friends and family, I would be honored to work alongside you on your health journey! You can email me directly at tshekdar.health@gmail.com or shoot me a DM  @santaihealth on instagram