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The amazing world of the skin-gut axis

including the role of the microbiome

Marcelline Goyen • Boek • paperback

  • Samenvatting
    This scientifically backed up text on the skin-gut axis is a must-read for healthcare professionals. It takes you on a microscopic journey through the skin and gut, also exploring the role of our remarkable microbiome and its role in health and disease. The book includes practical tips, advice, and examples underpinning the importance of the skin-gut axis.

    Marcelline Goyen is a well-known skin therapist BHs, and authority on the gut-skin axis in the Netherlands and Belgium. She was the first to integrate this perspective into her skin therapy practice and wrote the scientific bestseller "The Skin-Gut Axis" in 2019. Her second book (2023) is also widely used as a textbook and teaching material due to its unique and holistic approach.

    Recommendations:
    “A must-read for every skin care worker!”
    “Highly recommended, written with humor and also easy to read!”
    “Thanks to this book I learned many special new insights and tips”
    “Now I fi nally understand what my skin and my poop are telling me!

    The first science based book about the skin-gut axis for health and skin care professionals, and the role of our microbiome, lifestyle and diet in health and disease.
  • Productinformatie
    Binding : Paperback
    Distributievorm : Boek (print, druk)
    Formaat : 170mm x 240mm
    Aantal pagina's : 340
    Uitgeverij : Opus Nova
    ISBN : 9789465111346
    Datum publicatie : 09-2024
  • Inhoudsopgave
    Table of Contents

    Foreword 8
    Introduction 9

    1 Practical demonstrations of the ‘skin-gut axis' 12
    Case study: Chronic atopic eczema 13
    Case study: Acne 15
    Case study: Seborrheic eczema 16
    Case study: Painful cysts in breasts 18
    Case study: Swollen fingers due to roundworms in the intestine 19
    Case study: Irritable bowel syndrome and gluten intolerance 19
    The power of your thoughts and the 'brain-gut axis’ 21

    2 The skin 24
    Functions of our skin 25
    The skin as ‘observer’ 27
    The layers of the skin and what happens within them 28
    Fascinating facts about skin flakes 34
    Various influences on the skin 34

    3 Tight junctions: the connections between cells 36
    Tight junctions in the intestines, zonulin and gluten 37
    Tight junctions and the role of our microbiome 38
    Tight junctions in the skin and disruptive triggers 39
    Tight junctions and pharmaceuticals on the skin 41

    4 Skin parameters 42
    Transepidermal water loss (TEWL) 42
    Natural Moisturising Factor (NMF) 43
    The hydration state in the horny layer (Stratum corneum) 44
    Vitamin D in the skin 46
    Calcium and calmodulin in the skin 47
    Body temperature as a skin parameter 48
    Sweat 49
    Sebum and sebogenesis or the origin of sebum 51
    Summary on sebum 61

    5 The skin’s acidity or skin pH 63
    The terms ‘acidity’ and ‘pH-value’ explained 64
    When is something of acidic? 66
    The acidity in and on our body 66
    The bodily function of acidity 69
    Help, I’ve gone sour… am I a sourpuss now? 70
    The acid mantle of the skin 72
    The acidity of the skin 72
    Summary of the skin’s acidity 89

    6 The development of skin before birth 90
    ‘Normal’ delivery versus ‘C. section’ 90
    Vernix caseosa: that greasy protective layer at birth 90
    Skin development in premature babies 92
    Snot, poop and urine on baby’s skin 92

    7 The human microbiome 93
    Concepts regarding the microbiome 93
    Skin microbiota & gut microbiota versus ‘skin flora’ & ‘gut flora’ 94
    Kinds of microbiome 95
    So what exactly is our microbiome? 96
    Classification of microbes: domain, phylum, class, etcetera 96
    Scientific writing guidelines for describing microbes 97
    Why is our microbiome so important? 97
    The human microbiome: ‘from mouth to anus’ 97
    The origin of our microbiome 98
    Birth: vaginal delivery versus Caesarean section 98
    Variations in composition of human microbiomes 100
    Microbes we pick up from our environment 101
    Microbiome in couples 102
    Dog and owner as lookalikes, more than you think 103
    Zoonosis: transfer of microbes from animal to human 103
    The microbiome and the ‘restaurant hypothesis’ 104
    Resident, transient and opportunistic microbes 109
    Hazards for our microbiome 113
    Prebiotics and probiotics for our microbiome 115

    8 The skin microbiome 121
    The functions of our skin microbiome 121
    Composition of the skin microbiome 122
    Skin microbes and their favorite environment 127
    The resident skin microbiota 130
    The resident skin bacteria 130
    The transient, temporary, or passing microbes 137
    Vectors 141
    Parasites on the skin 142
    Viruses 151
    Fungi and yeasts 152
    Cases on disturbed skin microbiome 159
    Microbiome dysbiosis in skin disease 161
    Hygiene and skin microbes: sensible or rather not? 165
    How to maintain the stability of your healthy skin microbiome? 166

    9 The immune system 168
    The innate and acquired immune system 169
    The lymphatic system 169
    The lymphatic system of our mucosal surfaces and skin 173
    The mucosal immune system (MIS) 174

    10 the immune system of the skin 183
    Keratinocytes (epidermal cells) 184
    Antimicrobial peptides in the skin 184
    Antimicrobial peptides in the sebaceous glands 185
    Complement, another mechanism to attack bacteria and viruses 185
    Antigens 186
    Antigen Presenting Cells (APCs) 187
    Mast cells (MCs) 190
    Signal molecules 193
    Fibroblasts 198
    T helper cells (Th) 199
    Receptors 200
    Sports and our immune system 202

    11 The immune system and our microbes 203
    The interaction between the immune system and our microbes 204
    Communication amongst microbes 205
    Biofilm 208
    Factors unfavourable for our skin microbiome 209
    Immune system educated by microbes in asthma and allergies 210

    12 Skin- and intestinal microbes in health and disease 211
    ‘To be … or not to be’ that’s the question for a pathogen 211
    How does skin fall ill from within? 213
    From first line of defense to second line of defense 213

    13 The gut microbiome 217
    Fungi and yeasts in the intestines 219
    Parasites in the intestines 220
    Intestinal parasites and the consequences for the skin 224
    Microbiota and urtica (nettle rash, hives) 229

    14 The intestinal immune system 231
    First line of intestinal defense 233
    Second line of intestinal defense 234
    Lamina propria 235
    Antibiotics versus antimicrobial peptides (AMPs) 235
    Secretory immunoglobulin A (sIgA) 236
    Interaction between immune system and gut microbes 239
    Short-chain fatty acids (SCFAs) for mucosal health 239
    Zonulin and tight junctions (TJs) in the intestines 240
    Gluten-free diet: sensible or bogus? 242
    ‘Leaky gut’ 244
    How to recognise a leaky gut? 245
    Virulence factors in our intestines 249
    Intestinal diseases relating to skin ailments 251

    15 Immune responses in food allergy 261
    Biogenic amines, histamine and histamine releasing substances 264
    Hives, urticaria and strawberries 267
    Food allergy and the ‘restaurant hypothesis’ 268
    Food allergy and the skin microbiome 271
    Food allergy and the intestinal microbiome 272
    Food allergy, IgE and gut bacteria 273
    Food allergy and the role of a healthy diet and vitamins 273
    Food allergy, food hypersensitivity and vitamin D 274
    Food allergy and short-chain fatty acids (SCFAs) 275
    Cutibacteria and short-chain fatty acids (SCFA’s) 277
    How SCFAs affect the skin health 278

    16 Talking about poop, how fun and meaningful is that? 279
    What story does poop tell about its producer? 280
    The 'poop scale', also known as the Bristol stool chart 282
    Concluding poop remarks 288

    17 Stressors in the immune system 289
    Stress and ‘freeze, flight or fight’ 290
    Free radicals 292
    ROS and oxidative stress 294
    NO and Nitrostress in the skin barrier 298
    UV radiation 300

    18 Antioxidative defense 307
    Free radicals versus free radical scavengers 307
    Antioxidant vitamins 308
    Endogenous antioxidants 308
    Flavonoids 318
    Carotenoids 319
    Minerals and trace elements 319
    Omega-3 and krill oil 324
    Sun protection through diet and food supplements 325

    19 Generic ‘skin-gut’ recommendations 328

    20 Challenges in skin diseases 335

    Acknowledgements 337

    Bibliography 338
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Foreword

There’s quite a lot of attention these days for the concept of ‘axes’. The gut-brain axis, the hypothalamus-adrenal axis, the placenta-brain axis and so on. So it is not that surprising to discuss the skin-gut axis, as these are the two ’sheets’ with which the individual interacts with its environment. It is also in line with evolutionary expectation, as the skin and the intestines (’the inverted outside’) have had to cope with the same challenges and threats from the environment. Experienced and reflective skin therapist Marcelline Goyen takes you on an engaging journey through these organs and the connections they have with the microbiome and the immune system. Permeated with examples from her many years of practice, she addresses the anatomy and physiology of both the skin and the gut and all topics that intertwine the function of these organs but also in their reciprocal relation with the microbiome, the immune system and, therefore, one’s general well being and health. The text is worth reading for all with an interest in health care in general and skin care in particular. It is thought-provoking, immersive and inspires the reader to contemplate about the intricacies brought about by these seemingly unrelated organs and their role in the health of the entire organism.

Ron Legerstee
MSc Wound Healing & Tissue Repair - Cardiff University


Introduction

"A healthy skin comes from both outside and inside!"

How would it be if your skin could function completely on its own? That is, if your skin could operate and survive independently and without help from the rest of the body? Does that sound logical? No, right? In my view, it certainly doesn't, because the skin needs nutrients to nourish itself and the microorganisms present on it. It also needs a system to deliver nutrients and remove waste products. This happens via small blood vessels that connect to larger blood vessels, which then lead to the intestines where nutrients, released from the digestion of food and drinks, can be absorbed and transported to all cells.

Additionally, the skin requires a nervous system and brain to perceive and respond to signals such as touch, pain, pressure, heat, or cold. This allows you to quickly pull your hand away if you touch a hot pan; otherwise, your skin would burn. The signals that help you with this, such as the perception of temperature and experiencing pain, occur in the skin but cannot be ‘translated’ within the skin itself. You need nerves, nerve conduction, and a connection to your brain to act quickly and appropriately and, ideally, also to make you comprehend what is happening.

And we often forget the role of our immune system, or our defense system, supported by all the microbes living on our skin and in our body.

In short, the skin does not stand alone and, as the largest visible organ of our body, is an essential part of the body, composed of countless cells that belong to various tissues, blood vessels, nerves, organs, bones, and the brain. All these cells, structures, and organs cannot live independently without the help or cooperation of other organs and tissues, such as for the delivery of nutrients and information. Furthermore, we, as humans, don't stand a chance of survival without a well-functioning immune system that ensures our defense works when needed. This includes instances like a cold or flu, a nasty intestinal parasite, a food infection, a severe bone fracture, or a cut in the skin, and all other moments when the body is out of balance. Your brain also plays a significant role in this, both consciously and unconsciously.

Fortunately, we don't have to think about how our blood vessels should react or when a particular enzyme needs to be released to help digest food or to mature skin cells. Most processes in our body happen without our awareness, and that’s a good thing. Even when we think consciously and take action, we are supported by our subconscious processes such as breathing, the flow of blood and lymph in blood vessels and lymph vessels, the beating of our heart, hormone regulation, and our immune system.

Almost 100 years ago, dermatologists Stokes and Pillsbury were far ahead of their time when they proposed a ‘Gut-Brain-Skin’ theory in 1930. They wrote about the relationship between gut problems (gut), emotional issues (brain), and the skin condition acne vulgaris (skin). It is remarkable that this theory has only been taken seriously in recent decades and has been brought back to the attention of the research community. Their theory is now being underpinned with evidence and explained from various perspectives, such as the immune system and our microbiome. It has been found that digestive problems, such as in the stomach and intestines, and emotional imbalances like depression are more common in people with acne vulgaris than in healthy individuals.

Even more astonishing is that, in 2024, many people still think that the skin has no (clear) relationship with the gut. Unfortunately, even many doctors, including dermatologists, seem to view the connection between the skin, the gut, and our lifestyle as ‘not relevant to the skin itself’. The fact that this relationship is indeed present in many remarkable ways was extensively described in my first book, thanks in part to the researchers who have been exploring these themes in recent years.

The key role in this is played by our microbiome, which has only garnered increasing attention in recent decades. As a 'host', we humans, together with our microbiome, form a holobiont (from the Greek: “holos = whole). This indicates that on all conceivable 'axes' interrelations take place that we are only just learning to understand, so we’re just scratching the surface in this book. The microbiome encompasses all the living and dead microorganisms and their produced substances that live in and on our bodies, contributing to our healthy balance and sometimes to imbalance or disease. Although this microbiome is not human, it is often referred to as our ‘external organ’, with which we come into contact even before birth in the womb and via the umbilical cord, especially during and after birth. Without this organ, we cannot live, let alone survive. After birth, exposure to microbes increases significantly, causing our microbiome to grow like a tsunami in numbers and species until it eventually becomes a mature and stable community.

The microbial ‘little beings’ living in our microbiome, which are part of our healthy ‘external organ’, help us communicate between different organs and tissues, allowing signals to be sent and responses to be triggered even from a distance. Together with our immune system, they contribute to our health. In unfavourable circumstances, they also contribute to disease through the presence of pathogenic bacteria, fungi, viruses, and parasites. But don’t be alarmed. We constantly encounter a vast number of different microorganisms without even noticing, and we usually don’t get sick from them. Our body is fortunately smart and complex in its defense mechanisms, able to maintain or restore a healthy balance in most cases, even after a disruption like an invasion by harmful bacteria or parasites.

In this book, I will describe and explain several of these processes step by step, so you can better understand that the skin does not stand alone and is even dependent on you and your behaviour. If you have a skin condition like eczema, acne, psoriasis or rosacea, I hope you will also consider your digestion and intestines in relation to your diet and lifestyle, including factors like stress, burnout, etc. The expression ‘not feeling comfortable in your own skin’ is influenced not only by what you do and what happens inside you but also by what you think and feel.

I wish you a wonderful journey into the fascinating and complex world of the skin-gut axis.

Marcelline Goyen
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