Almost every woman with melasma I have worked with also had gut issues. These ranged from chronic constipation to leaky gut syndrome, virtually no existing probiotics, or simply daily bloating. Daily bloating can become the norm, which is why many women don’t even know they have a problem—until they undergo testing.

The skin and gut share a connection through the nervous and immune systems, and the microbiome. When the digestive system is inflamed and the gut microbiome is out of balance it shows on the skin.

Here is why gut issues are linked to melasma:

1. Poor detoxification

One of the most notorious root-causes of melasma are hormone imbalances. Doctors rarely recognize toxicities in the body as the root-cause of hormone imbalances, despite the countless scientific papers that prove a clear link.

The bowels are one of your detox pathways. If your detox pathways are impaired, environmental toxins from your food, water, and cosmetics that have entered your blood stream cannot be eliminated properly. Environmental toxins are linked to hormone imbalance, oxidative stress and inflammation—three symptoms of toxicity common in people battling melasma.

2. Estrogen imbalance

Estrogen imbalance is the 2nd most prominent cause of melasma. Estrogen metabolism is partially done in the gut. After the liver breaks down estrogen, the metabolites are carried to the gut, where they are further digested by particular gut bacteria. From there, estrogen is either eliminated with the stool or reabsorbed and recirculated through the body. Those particular gut bacteria are called the estrobolome, which excrete a specific enzyme (beta-glucuronidase) that converts estrogen into its active form for reabsorption. When there is an imbalance in the gut microbiome, and the estrobolome takes over, too much active estrogen is reabsorbed, which leads to estrogen dominance.

If constipation is something you are battling, then this also compromises your hormone clearance.

3. Inflammation

The skin and the immune system work in union and if one of the is out of balance, the other one comes in and sends strong signals. In the case of melasma, when chronic gut cause system inflammation, the skin mobilizes its protection mechanisms and does what it needs to do to protect the skin from further damage. Unfortunately, this signal creates dark spots and is misunderstood in the beauty industry and dermatology. Instead of calming inflammation, women are handed products and recommended treatments that. Create even more inflammation. Mast cell activation, increased lymphocyte count, , SFC, COX-2, interleukins are inflammatory markers detected in patients with melasma and are all common in people with gut issues. Histamine levels are increased when mast cells are activated. Histamine isn’t just a typical indicator of allergies and gut inflammation, it also drives normal melanocytes into hyperactivity. And there are more immune markers, which I discuss in The Truth About Melasma along with other root causes, contributing factors and solutions.

4. Impaired nutrient uptake

When the gut is inflamed, is leaky or certain probiotics are missing, the nutrient uptake is compromised too. Nutrient deficiencies are a major root-cause of skin issues. Vitamin B12 and zinc are nutrients particularly linked to hyperpigmentation and hormone imbalance. Low zinc levels for example drive high copper levels. Increased copper increases estrogen but is also linked to skin hyperpigmentation as it increases the enzyme tyrosinase—a typical symptom in melasma. (Zinc deficiency is also common in women who were taking the contraceptive pill in the past.)

The Factors

Here are some of the reasons why your digestive system might be inflamed.

Food

The foods and drinks we ingest have the biggest impact on our digestive health as they all land in the gut. I don’t want to preach a specific diet. I have been on many different diets and what works best for me might not work for you.

Some people do well with gluten, some do not. The same is true for dairy, eggs, nuts and grains.

Gluten is one of the main triggers of gut issues. If you live in the US and have wondered why you have no problems eating bread and pastries in Europe. This is because the US prefers hard wheat varieties, which contain naturally more gluten than soft wheat varieties that are used in Europe. On top of that, most Europeans traditionally ferment their dough before it becomes are ready-to eat product. Sourdough is available in the US but instead of being a staple, it is an expensive option in the gourmet section (at least that is what I experienced when I lived in Cali).

So called bread wheat that is grown in Italy and small farms has significantly less gluten than the wheat that is grown on a large scale.

Another common trigger food is dairy.

Please let me share my personal story. While I had skin and gut issues, I always thought dairy is my trigger. Whenever I had milk or yoghurt, I had flare ups. And when I became vegan my skin cleared. It seemed like case closed. But not so fast. After a long animal product-free phase, I reintroduced dairy and to my surprise, no flare-ups. What changed?

Before my vegan journey, I wasn’t aware of the quality differences of dairy and being a student, I went for the cheapest products. When I reintroduced dairy ten years later, I had access to raw, grass-feed milk from cows who weren’t treated with antibiotics or hormones. This and other experiences gave me the light bulb moment I needed to understand that it isn’t the basic foods itself that cause issues but the modifications that come along with modern farming practices.

Other reasons for chronic gut issues can be infections, food poisoning, antibiotics, painkillers (aspirin and ibuprofen), “undigested” emotional trauma, high stress, and anxiety.

There is a lot more we can talk about this topic. But I want to provide you with solutions, because getting better is what matters most.

Click here and access the full article on Substack for the price of a coffee. In the solutions part, I will walk you through the same steps I guide all my clients through.