The Turd Nerds

Can acne start in the gut?
In this episode of The Turd Nerds, we're joined once again by Dr. Megan Larravey for a fascinating case-based discussion exploring the connection between chronic acne, gut health, H. pylori, dysbiosis, and inflammation.
We walk through the case of a woman in her 30s who developed persistent cystic acne despite eating a clean diet, using clean skincare products, exercising regularly, sleeping well, and trying many conventional and natural treatment approaches. With no obvious hormonal pattern and no significant digestive symptoms, her case challenged many of our assumptions about what drives chronic acne.
What we found highlights the powerful relationship between the gut microbiome and skin health—and why some skin conditions may be rooted in underlying gastrointestinal dysfunction, even when the gut appears perfectly healthy.
✔ Why acne isn't always a hormone problem
✔ The surprising connection between H. pylori and chronic skin conditions
✔ How dysbiosis can contribute to persistent acne
✔ The role of biofilms in chronic inflammatory conditions
✔ Why some patients with gut dysfunction have no GI symptoms
✔ Pseudomonas, endotoxins, and systemic inflammation
✔ Leaky gut and its impact on skin health
✔ How we approach stubborn acne from a functional medicine perspective
✔ Stool testing, organic acid testing, and evaluating the gut-skin axis
✔ The role of probiotics, spore-based probiotics, and immunoglobulins
✔ Biofilm disruptors and antimicrobial herbs
✔ Why healing the gut often takes longer than people expect
✔ The importance of fiber, fermented foods, and rebuilding microbiome resilience
Acne is often viewed as a skin condition, but for some patients it may be a manifestation of deeper immune, inflammatory, and microbiome imbalances. This episode explores why chronic acne can persist despite doing "all the right things" and how addressing gut dysfunction may be an important piece of the puzzle.
Whether you're struggling with acne yourself or you're a clinician looking to better understand the gut-skin connection, this conversation offers a practical and thought-provoking look at how the microbiome influences skin health.

Music provided by Blue Dot.
👋 Connect with Dr. Meghan Larivee
⁠https://www.integrativedermatologysolutions.com/about⁠

👋 Connect with the Turds!
Rebecca Sand ND, LAc, MSOM

Why Acne Isn't Just a Skin Problem: The Gut-Skin Connection
What if your acne, eczema, rosacea, or chronic skin condition isn't actually starting in your skin?

In this episode of The Turd Nerds, we're joined by naturopathic physician and acupuncturist Megan Larivee for a deep dive into the fascinating world of the gut-skin axis.

We explore why the skin is much more than a protective barrier—it's actually the body's largest immune organ. From the skin microbiome and immune signaling to leaky gut, leaky skin, acne, eczema, rosacea, and psoriasis, we unpack the growing evidence connecting gastrointestinal health to chronic skin conditions.
We discuss how gut dysbiosis, inflammation, barrier dysfunction, hormones, diet, and environmental exposures may all contribute to skin symptoms—and why simply treating the skin often isn't enough.
✔ Why the skin is considered an immune organ
✔ The relationship between the skin microbiome and the gut microbiome
✔ Leaky gut and leaky skin: what they are and why they matter
✔ Acne, eczema, rosacea, psoriasis, and other chronic skin conditions
✔ How H. pylori and gut dysbiosis can influence skin health
✔ Why skin conditions often persist despite topical treatments
✔ The role of fiber and the microbiome in acne management
✔ Dairy, insulin signaling, and androgen-driven acne
✔ Candida, fungal overgrowth, and skin symptoms
✔ The impact of personal care products, soaps, and environmental chemicals on skin health
✔ Why skin barrier function is critical for long-term healing
✔ Clinical pearls for evaluating chronic skin conditions through a gut-health lens
The skin and gut are constantly communicating through immune, inflammatory, hormonal, and microbial pathways. When that communication breaks down, chronic skin conditions may develop—or become difficult to resolve.
If you've struggled with acne, eczema, rosacea, psoriasis, or unexplained skin symptoms, this episode offers a new perspective on where to look and what questions to ask.
Because sometimes the best way to heal the skin is to start with the gut.

Music provided by Blue Dot.
👋 Connect with Dr. Meghan Larivee
https://www.integrativedermatologysolutions.com/about

👋 Connect with the Turds!
Rebecca Sand ND, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.drrebeccasand.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@drrebeccasand⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Ilana Gurevich ND, FABNG, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.openwellnesspdx.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@openwellness_pdx⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠@ilana.gurevich⁠⁠⁠⁠⁠⁠⁠

Ami Kapadia, MD, ABFM, ABIHM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amikapadia.com/⁠⁠⁠⁠⁠⁠⁠

What can you actually do to support gallbladder health—before or after gallbladder removal?
In Part 3 of our Gallbladder Series, we move from theory into practice. After exploring the relationship between the gallbladder, microbiome, hormones, and bile acids in Parts 1 and 2, we discuss the clinical tools, supplements, dietary strategies, and testing considerations we use to support patients with gallbladder dysfunction, bile acid disorders, and post-cholecystectomy symptoms.
We explore why some patients continue to struggle with digestive symptoms long after gallbladder removal, how hormone fluctuations impact bile flow, and why supporting the microbiome may be one of the most overlooked pieces of gallbladder care.
Whether you're dealing with gallstones, bile acid diarrhea, digestive symptoms after surgery, or simply want to better understand how to support healthy bile flow, this episode is packed with practical takeaways.
✔ Conventional approaches to gallbladder disease and gallbladder removal
✔ Why removing the gallbladder doesn't always solve the entire problem
✔ The long-term microbiome consequences of cholecystectomy
✔ The connection between gallbladder function, metabolism, and insulin resistance
✔ Taurine and glycine for bile acid conjugation and bile production
✔ Bitter herbs and how they support bile flow and gallbladder function
✔ Dandelion, gentian, chicory, and other classic digestive bitters
✔ Phosphatidylcholine, lecithin, and cholesterol balance within bile
✔ Choline supplementation and gallbladder support
✔ Magnesium and gallbladder motility
✔ Ox bile, TUDCA, UDCA, and digestive enzyme support
✔ Psyllium fiber and bile acid regulation
✔ Butyrate and microbiome support after gallbladder removal
✔ The estrogen–microbiome–gallbladder connection
✔ DIM and calcium-d-glucarate for estrogen metabolism
✔ NAC, milk thistle, and liver support
✔ Hormone replacement therapy considerations in patients with gallbladder disease
✔ Functional testing options for patients with gallbladder concerns
✔ How these concepts have changed our clinical approach to patient care
✔ Gallbladder removal may be necessary, but it should also prompt a deeper look at why gallbladder dysfunction developed in the first place.
✔ Taurine, glycine, bitters, magnesium, and phosphatidylcholine can all play important roles in supporting bile production and flow.
✔ The microbiome is central to bile acid metabolism and should be considered in patients with ongoing digestive symptoms.
✔ DIM and calcium-d-glucarate may help support healthy estrogen metabolism and reduce gallbladder stress in susceptible individuals.
✔ Post-cholecystectomy patients may benefit from additional support for digestion, microbiome balance, fat-soluble vitamins, and bile acid regulation.
✔ Hormones, bile acids, the liver, and the microbiome are deeply interconnected systems that influence one another in meaningful ways.
Part 1: Gallbladder Physiology, Bile Acids & The Microbiome
Part 2: The Estrogen–Gallbladder Connection: Hormones, Menopause & Bile Acids
Part 3: Practical Strategies for Supporting Gallbladder Health Before and After Surgery

Music provided by Blue Dot.

👋 Connect with the Turds!
Rebecca Sand ND, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.drrebeccasand.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@drrebeccasand⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Ilana Gurevich ND, FABNG, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.openwellnesspdx.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@openwellness_pdx⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠@ilana.gurevich⁠⁠⁠⁠⁠⁠

Ami Kapadia, MD, ABFM, ABIHM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amikapadia.com/⁠⁠⁠⁠⁠⁠⁠

Most people think gallbladder disease is all about gallstones. But what if the real story is hormones?
In Part 2 of our Gallbladder Series, we take a deep dive into the fascinating relationship between estrogen, progesterone, menopause, the microbiome, and gallbladder function. We explore why women are significantly more likely to develop gallbladder disease, why perimenopause may be a perfect storm for biliary dysfunction, and how both high and low estrogen states can increase gallbladder risk.
Along the way, we unpack the surprising idea that the gallbladder behaves like a hormone-responsive organ, discuss how oral contraceptives and hormone replacement therapy may influence gallbladder health, and explain why the microbiome may be one of the most overlooked pieces of the puzzle.
Whether you're navigating perimenopause, supporting patients with digestive issues, or simply curious about the intersection of hormones and gut health, this episode offers a fresh perspective on a commonly overlooked organ.
Why women develop gallbladder disease more often than men

The role of estrogen in bile production and gallbladder function

How both estrogen excess and estrogen deficiency can increase gallbladder risk

Why perimenopause creates a unique challenge for gallbladder health

The relationship between oral contraceptives, hormone therapy, and gallstones

How progesterone influences gallbladder motility

The estrogen–microbiome connection

Changes in the microbiome that occur during menopause

The role of Lactobacillus, Bifidobacterium, Akkermansia, and other key organisms

Why menopause may increase the risk of biliary dysfunction

How hormone fluctuations impact bile flow and gallbladder emptying

Why oral estrogen carries different risks than transdermal estrogen

Clinical considerations for hormone replacement therapy in patients with gallbladder concerns

The importance of antioxidant protection for the biliary system

How this information has changed the way we evaluate and treat patients

✔ The gallbladder is highly responsive to hormonal signaling, particularly estrogen.
✔ Both high and low estrogen states can negatively impact bile acid production and gallbladder function.
✔ Perimenopause may be one of the highest-risk times for gallbladder dysfunction due to fluctuating hormone levels.
✔ The microbiome and estrogen metabolism are deeply interconnected and may influence gallbladder health.
✔ Menopause doesn't just affect reproductive hormones—it also changes the microbiome, bile metabolism, and digestive physiology.
✔ The route of hormone therapy matters, especially for patients with a history of gallbladder disease.
Part 3 of our Gallbladder Series: Practical treatment strategies, supplements, and clinical tools for supporting gallbladder health before and after gallbladder removal.
In This Episode We Discuss:Key TakeawaysListen Next

Music provided by Blue Dot.

👋 Connect with the Turds!
Rebecca Sand ND, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.drrebeccasand.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@drrebeccasand⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Ilana Gurevich ND, FABNG, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.openwellnesspdx.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@openwellness_pdx⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠@ilana.gurevich⁠⁠⁠⁠⁠⁠

Ami Kapadia, MD, ABFM, ABIHM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amikapadia.com/⁠⁠⁠⁠⁠⁠⁠

Most people think gallbladder problems start and end with gallstones. The reality is much more complicated.
In this episode of The Turd Nerds, we discuss the hidden connections between the gallbladder, hormones, bile acids, estrogen metabolism, and the gut microbiome—and why these systems become especially important during perimenopause and menopause.

We cover:
✔ Why women develop more gallbladder disease than men
✔ The estrogen–gallbladder connection
✔ How the microbiome influences bile acid metabolism
✔ What changes after gallbladder removal
✔ Gallbladder dysfunction without stones
✔ DIM and calcium-d-glucarate for estrogen metabolism
✔ Taurine, glycine, bitters, phosphatidylcholine, magnesium, and bile support
✔ Bile acid malabsorption and chronic diarrhea
✔ How we approach gallbladder health in clinical practice

If you've ever been told your only option is to remove your gallbladder, this episode explores the physiology behind gallbladder dysfunction and the tools we use to support patients before and after surgery.

Music provided by Blue Dot.

👋 Connect with the Turds!
Rebecca Sand ND, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.drrebeccasand.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@drrebeccasand⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Ilana Gurevich ND, FABNG, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.openwellnesspdx.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@openwellness_pdx⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠@ilana.gurevich⁠⁠⁠⁠⁠⁠

Ami Kapadia, MD, ABFM, ABIHM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amikapadia.com/⁠⁠⁠⁠⁠⁠⁠