Inside Out: The Gut-Skin Connection Explained with Molly Ohlback

We’ve all heard the phrase “healthy skin starts from within” - but what does that actually mean? In this expert Q&A, naturopath and skin therapist Molly Ohlback unpacks the powerful connection between gut health and common skin concerns like acne, rosacea and eczema. From internal triggers and inflammation to everyday rituals that support healing, Molly shares her holistic approach to building resilient, radiant skin from the inside out.

For those who don’t know you, can you tell us a little about your background and what led you to specialise in skin health?

I was drawn to natural medicine when I was in my teens. I had always struggled with my skin and, coming from a family of nurses, I was well-exposed to the healthcare industry. I knew I didn’t want to work in a hospital, but I loved the idea of helping people with their health in other ways, often curious about more natural, holistic approaches to healing, from the root cause. The next thing I knew, I was enrolled into a Bachelor of Health Science. In the last year of my Naturopathy degree, my acne was the worst it had ever been. This really solidified my desire to specialise in skin health, as I was forced to navigate the hardships of struggling with this extremely frustrating condition. The loss of confidence, the killed self esteem, the never-ending waiting for my skin to heal. After graduating, I got a job at a naturopathic skin clinic, training again, but this time as a therapist and everything there is to know about the skin barrier. This is when my skin truly started to heal properly and I realised how important the unification of both internal and external treatments are to achieve the healthiest skin.

You’re both a naturopath and skin therapist - How do those two worlds complement each other when treating skin concerns?

Skin conditions, whether it’s acne, eczema, rosacea or psoriasis, etc. are rarely skin-deep. Topical treatments can only go so far for skin, offering relief from inflammation, redness or breakouts. However, most skin conditions will have some sort of internal root driver, perpetually sustaining new breakouts, flares or reactions. If the root cause has not been addressed and triggers have not been removed, the issue will not go away.

Conversely, if the skin’s barrier is constantly compromised from repeated flares or harsh, stripping products, its ability to heal long term will be significantly reduced. Subsequently, you can find yourself with an impaired skin barrier, leading to chronic skin sensitivity, excessive dryness that doesn’t seem to improve, and poor skin healing resilience.

We hear a lot about the “gut–skin connection” lately, but what does that actually mean?

The gut-skin connection is a complex and multifaceted axis, which also involves the immune and nervous systems, as well as blood circulation. 

It’s estimated about about 70-80% of the immune system resides within the gut, and the trillions of microbes living within your gut microbiome are constantly signalling to the immune cells living within your skin. So, if there are gut imbalances or bacterial overgrowths, food sensitivities, nutrient deficiencies, etc., this can create inflammation, which can then travel to and manifest through the skin.

How closely linked are gut health and common skin concerns like acne, rosacea, or eczema?

Extremely closely, you can’t target the root driving factors of these conditions without looking deeper, as almost all of them are driven by underlying inflammation. That’s why inflammation on the skin is your body’s way of telling you something is not working. The skin is the body’s largest organ, and as a major detoxification organ, we find it often takes over the burden of other organs like the liver and gut because they’re overwhelmed. This might look like gut dysbiosis, immune overactivation and sensitivity, hormonal imbalances or nervous system dysregulation.

What are some signs a skin issue may actually be rooted internally, rather than something topical?

Topically-driven skin issues often respond and resolve long-term quickly and effectively to treatment, i.e a fungal nail infection or a staph infection. Internal skin issues typically present with other concurrent symptoms including digestive issues, metabolic or hormonal imbalances, immune dysregulation or allergies, and/or mental health problems. This is why naturopaths look at each person as a whole, because we need to understand what’s going on inside the body from every angle, instead of treating just the skin.

What are some of the biggest gut or lifestyle triggers you commonly see impacting skin health?

Diet is huge for triggering skin issues. You truly are what you eat, and you would be shocked to see the results you could experience purely just from removing known trigger foods. Doing comprehensive testing can help take out a lot of this guesswork, as everyone is different, but the main offenders I see are gluten, dairy, processed sugar, and alcohol. There can of course be others, but I’d like to stress the fact that it’s almost always not the food that’s the problem- it’s your ability to digest it. If your body isn’t digesting something properly, it will subsequently generate inflammation.

Stress is by far the most common lifestyle trigger I find in clients with skin issues. It’s the hardest trigger too, because it’s often the one we have the least control over. So troubleshooting ways to overcome or manage someone’s source of stress is vital to helping repair the skin.

Skincare is also a huge trigger I see these days, as there is so much conflicting information and oversaturation online on what is best to use for what. Most cheap pharmacy brands are full of harmful ingredients and chemicals that just ruin the skin’s barrier and deprive it of real nutrients to help restore it. 

If someone is struggling with problematic skin, where should they start before overhauling everything?

I’d definitely recommend seeking a holistic healthcare practitioner to properly identify and map the best treatment for them specifically, but aside from that, I would start with the diet- and not cutting out foods, but simply including more therapeutic foods for optimising skin health. Anti-inflammatory foods rich in omega-3s (small fatty fish, olive oil, avocado, spinach, flax & hemp seeds, chia seeds, walnuts, macadamias, kidney beans), and antioxidants (dark berries, grapes, apples, sweet potato, kiwifruit, pumpkin, dark leafy greens, carrots, beetroot, 80%+ dark chocolate). You can never go wrong with starting on the foundationals for skin health: Diet, sleep, movement, connection & sun.

Are there any foods, nutrients or simple rituals you commonly recommend for supporting skin from within?

I always recommend the previously mentioned food groups, like omega 3s and antioxidant-rich foods to help calm, nourish and heal the skin, but additionally zinc, vitamin C and magnesium are also really important in skin healing, as these are cofactors for many of the skin’s healing mechanisms. Magnesium is also great for supporting the nervous system, which is also often stressed and overworked when someone’s dealing with inflamed skin.

Other simple rituals I like include helping regulate digestion through bitters, like apple cider vinegar before meals or a handful of bitter greens with dinner, and getting sunlight in the eyes within the first hour of waking to support hormones, nervous system regulation and inflammation.

What’s the biggest misconception you wish people would stop believing when it comes to skin health?

That their skin will heal in a couple of weeks.

Skin is an incredibly slow moving organ, and skin cell turnover (the process of your skin cells shedding off while new ones come to the surface) takes roughly 30 days. This is a conversation I have a lot, especially if someone has had skin issues for years and there’s multiple layers of healing that needs to happen. It's a process, and healing from the root cause is not a quick fix. It can take anywhere between 3-12 months to see real results, depending of course on the condition and the complexity.

If readers take away one thing about the skin–gut connection, what would you want it to be?

Your skin is really just a reflection on what’s happening in the gut, even if you may not think you have gut issues. If you feel like you’ve tried everything for your skin and nothing is working, but you haven’t explored your gut health properly, you haven’t explored the full picture yet.

To follow more of Molly’s work or connect with her directly, you can find her on Instagram at @awaken.naturoapathy