The Surprising Link Between Gut Health and Clear Skin

Acne affects millions of people worldwide, yet conventional treatments often focus solely on topical solutions or medications without addressing underlying causes. The connection between what we eat and how our skin looks has been largely overlooked by mainstream dermatology, despite mounting evidence that gut health plays a crucial role in skin clarity.

Maria Marlowe, a certified integrative nutrition health coach and author, discovered this connection through her own four-and-a-half-year struggle with acne. After trying everything from drugstore treatments to dermatologist-prescribed medications—including nearly taking Accutane—she found that changing her diet cleared her skin in just three months. This revelation transformed not only her complexion but her entire career path, leading her to become an advocate for the gut-brain-skin connection.

Amy Cohen Epstein: I'm here today with Maria Marlowe to talk about our gut and acne, which has been a huge topic in my household. I have three boys, and I personally suffered from acne as a teenager. It dissipated in my twenties and thirties but came back, and I actually went on Accutane in my forties. For someone who's hardcore about health and wellness—I don't eat anything with chemicals—taking Accutane was shocking to most people and to myself. That's how frustrated I was with my skin.

Tell us who you are and how you got into this work. Why is this your passion?

Maria Marlowe: First, don't kick yourself for taking Accutane. I know how frustrating acne is because I had it for about four and a half years. It's not just physical—it's mental and emotional because it's your face, how you show up in the world. You have to do what you have to do.

I tried everything: drugstore products like Clean & Clear, infomercial Proactiv, dermatologist prescriptions including antibiotics, birth control, spironolactone, topical retinoids. None worked, or they'd work temporarily before the acne returned, sometimes worse. Finally, my dermatologist prescribed Accutane. Back then, it was harder to get—really reserved for when all other medications failed.

I remember filling the prescription and seeing stapled to the front of the bag the side effects list. One jumped out at me: severe depression that could lead to suicide. I thought, "What? For an acne medication?" I was already pretty depressed over my skin after struggling for years while doing everything I was told. I'm very Type A—if you tell me to take this medication or use this face wash to clear my skin, I'm doing it exactly as instructed.

When nothing worked, I internalized that something was wrong with me. Every doctor was telling me what to do, magazines had all this information, but none of it worked. I thought I had bad genes, bad luck, maybe bad karma. I decided not to take the Accutane because I was already depressed and didn't want to risk that side effect.

Amy Cohen Epstein: It really is your face, and it's so hard.

Maria Marlowe: I literally had a nervous breakdown in the bathroom mirror, crying hysterically because I couldn't understand why nothing was working when I was doing everything I was supposed to do.

Fast forward to college—I'm sitting down to lunch with a friend, complaining about my skin, and she says, "Your skin might actually be caused by what you're eating." I looked at her like she was crazy because I'd been to multiple dermatologists and not one ever asked what I was eating. But I was so desperate I said, "Just tell me what to do."

She introduced me to organic food and whole foods. My lunch that day was two slices of pizza, chocolate chip cookies, and a Coca-Cola—basically only processed foods. Long story short, my skin cleared up in about three months. I didn't believe it at first. I thought it was a miracle, not the food, so I went back to eating pizza, cookies, and Coca-Cola. Of course, I broke out right away.

It was mind-blowing to see in the mirror: when I ate certain foods, my skin was red, inflamed, and broken out. When I ate other foods, the redness went down, bumps disappeared, and my skin looked better. That changed my whole life trajectory. I decided to study nutrition and make it my mission to educate people about the connection between diet, gut health, and skin.

Amy Cohen Epstein: We've come so far. Doctors used to say, "Just wash your hands and don't put pizza grease on your face," not understanding that what you put in your stomach affects your skin.

Maria Marlowe: Exactly. What's mind-blowing is that even today, there's still a large population that thinks food only affects weight. I always tell people: if a tiny Advil pill can make your headache go away or kill a bacterial infection, what do you think the three to five pounds of food you eat daily is doing? It's going down the same digestive tract, so surely it's impacting your body.

Amy Cohen Epstein: Think about all the warning signs on that tiny Advil box versus a giant pizza. Food is powerful.

Maria Marlowe: I believe food is our medicine, and our lifestyle is our medicine too. Our thoughts, stress levels—all these things affect our health, definitely our gut, diet, and stress levels.

Amy Cohen Epstein: I tell my kids during puberty that there's only so much you can control. Your hormones are bouncing off the walls, you grew six inches—that's out of your control. But you can control what you put in your body and what you do with your body. You can control what you eat, drink, how you exercise, sleep, and treat yourself.

What does a good day look like? Take me through 7 AM to 8 PM in a perfect world with access to great choices.

Maria Marlowe: One helpful approach for teenagers is talking about upgrades. If you like salt and vinegar chips or Doritos, find the healthier version made with better oils and whole food ingredients. It may not be perfect, but avocado oil chips are an upgrade from corn oil chips while still giving you the crunch and flavor you want.

For a good day: How you sleep is really important for circadian rhythm balance. Wake up with the sun, get some sunlight—even just opening curtains and looking out the window. Sunlight in the morning helps with sleep, and good sleep means less stress on your body.

Start with a good breakfast to keep blood sugar stable. If you don't have much time, try a fruit and protein smoothie. I have a recipe called the Complexion Perfection Smoothie with blueberries, banana, and pumpkin seed protein powder, which I love for acne-prone skin. It's essentially ground pumpkin seeds, very high in magnesium and zinc.

Magnesium is needed for dealing with stress, which can trigger acne. It's also commonly deficient, especially with our stressful lifestyles. The smoothie provides about 50% of daily magnesium and zinc needs. Zinc is needed for wound healing and helps balance oil production.

I also add collagen for skin and wound repair, plus a tablespoon of flaxseed for omega-3s and fiber. Regularity is super important for acne-prone skin, especially during hormonal fluctuation years, because the body excretes excess hormones through stool. If we're not regular, that contributes to hormonal havoc.

Aim for 20-30 grams of protein at breakfast to keep blood sugar stable and prevent sugar cravings throughout the day.

Amy Cohen Epstein: What about supplements?

Maria Marlowe: I'd take a probiotic. There's a lot of research on gut differences between people with acne versus clear skin. Studies show people with acne tend to lack good lactobacillus and bifidobacteria strains that provide anti-inflammatory benefits. They have more bacteria promoting inflammation, and acne is an inflammatory skin disorder.

People with acne also tend to lack bacterial diversity and are more likely to have increased intestinal permeability or leaky gut. A probiotic helps reseed the gut with good strains, supports leaky gut healing, and aids digestion and regularity. I actually formulated one called Glow Biome specifically for acne-prone skin.

I also recommend cod liver oil—a skin superfood with omega-3s and naturally occurring vitamins A and D. These are common deficiencies among people with acne. Omega-3s reduce inflammation, vitamin A helps with skin cell turnover, and vitamin D is helpful for leaky gut.

Amy Cohen Epstein: And for meals?

Maria Marlowe: Think of your plate as a pie chart. About 50% should be vegetables, ideally cooked since they're easier to digest when dealing with gut issues. Another quarter should be protein—I love wild salmon for its omega-3s. We need to balance omega-6 (in processed foods and vegetable oils) with omega-3s.

The final quarter could be whole grains, beans, or lentils, plus healthy fats like olive oil, avocado, nuts, or seeds. If you want something sweet, eat it after a well-balanced meal, not as a snack on an empty stomach, which can cause blood sugar imbalances.

Get some movement during the day—it's important for regularity, blood sugar balance, circulation, and lymphatic flow. If you're sweating through exercise, that helps you eliminate what needs to be eliminated.

Amy Cohen Epstein: Tell me about the gut-brain-skin connection.

Maria Marlowe: It's fascinating. In utero, the gut, brain, and skin form from the same tissue, then morph into different organs while maintaining connection—a two-way communication loop where what happens to one affects the others.

If you've ever blushed when embarrassed, that's your brain affecting your skin. Lost appetite when upset? That's your brain affecting your gut.

Even 100 years ago, dermatologists John H. Stokes and Donald M. Berry observed that patients with acne tended to be more stressed and anxious. They hypothesized that stressful thoughts could disrupt the gut, create inflammation, and show up as skin inflammation. Their hypothesis has been proven true—stressful thoughts do wipe out good gut bacteria, allowing pro-inflammatory bacteria to grow and contributing to leaky gut.

This creates inflammation in the bloodstream that can manifest as breakouts. It's quite fascinating but intuitive when you think about how connected our whole body is.

Amy Cohen Epstein: It really is intuitive. I have a friend with rosacea whose skin gets red whenever she's sick, stressed, or overtired.

Maria Marlowe: That's another example. Rosacea, like other chronic inflammatory skin disorders, typically has a gut origin. With rosacea, there's often a link to SIBO—small intestinal bacterial overgrowth. Different gut disruptions can manifest as different skin conditions.

We're often disconnected from cause and effect in modern society. We treat symptoms, not causes. I see this with younger girls covering skin issues with heavy makeup rather than addressing underlying causes like food, stress, sleep, or anxiety.

Amy Cohen Epstein: The covering up versus treating the root cause really concerns me.

Maria Marlowe: I think the biggest problem is lack of readily available knowledge about root causes. When we think of acne skincare, we think topical treatments or medications. Most people aren't thinking diet, blood sugar balance, gut microbiome, or probiotics because it's not widely discussed.

Our skin has two sides—outside and inside. Everything you eat nourishes your skin through your blood. Even with healthy diets, people can have nutrient deficiencies if they cut out food groups or don't absorb nutrients due to compromised gut health.

Sometimes fixing one nutrient deficiency can make a big change. It's about putting puzzle pieces together, which takes more work than just applying cream, but that's why we need to keep having these conversations.

Amy Cohen Epstein: It really comes down to knowing your body and what works for you.

Maria Marlowe: Absolutely. What I always say is acne is a blessing in disguise. I know it doesn't seem that way, but because it's on our face, it prompts us to dig deeper. Once you get to the root, it improves overall health—better gut health improves immune system and mood. It's a ripple effect.

It's all about baby steps. Keep your eyes on the prize—what's your goal? Clear skin? Make one change at a time. If you're drinking soda, switch to water for two weeks and see how you feel. Once comfortable, tackle the next thing. One change every two weeks becomes a habit, and over three months, you won't recognize yourself.

Amy Cohen Epstein: Baby steps definitely work. I remember giving up Diet Coke—went from multiple cans to one can to sipping throughout the day to completely giving it up. Now it tastes terrible to me.

Maria Marlowe: Exactly. Your taste buds recalibrate to real whole foods. Focus on what you add in before what you take out. When you're fueled by nutrients, fiber, protein, and healthy fats that actually fill you up, you're not a bottomless pit anymore. Over time, processed foods become too sweet, too this, too that—you don't actually like them anymore.

Amy Cohen Epstein: This conversation about the gut-brain-skin connection is wonderful and quite intuitive when you really think about it. Having troubled skin is really tough, and your approach is making a huge impact on people's lives. Thank you so much for this conversation.

Maria Marlowe: Thank you for having me and for helping spread this important message.

This interview has been edited for length and clarity.