Skin Conditions

Why your skin reflects what is happening inside

The gut-skin axis is real, and it is measurable

Your gut and your skin are both barrier organs, and they are in constant communication. When the intestinal barrier becomes more permeable than it should be, bacterial products and food proteins cross into circulation, drive systemic inflammation, and that inflammation surfaces in the skin.

This is not a theory any more, it has been measured. A 2025 study in Scientific Reports compared adults with eczema against healthy controls and found that markers of intestinal permeability in the blood correlated directly with how severe their skin disease was. The leakier the gut, the worse the skin.

The most striking demonstration comes from rosacea. Researchers found that rosacea patients were roughly ten times more likely than controls to have bacterial overgrowth in the small intestine, and when they eradicated that overgrowth in a randomized trial, 78% of patients had their skin lesions clear completely. Almost all of those who cleared were still clear nine months later, and a three-year follow-up confirmed the finding held. A gut intervention cleared a skin disease.

Insulin tells your skin what to do

This is the mechanism almost nobody is told about, and for some conditions it is the whole story.

When you eat carbohydrate, insulin rises. Insulin raises IGF-1, a growth factor, and IGF-1 does two things directly relevant to skin: it increases oil production in the sebaceous glands, and it drives skin cells to proliferate faster. It also increases the biological activity of androgens, which push in the same direction.

So a high-carbohydrate diet is, quite literally, a signal to your skin to produce more oil and turn over cells faster. This has been tested. In a randomized, investigator-masked controlled trial, a high-protein, low-glycemic-load diet improved acne and the hormonal markers behind it compared with a conventional high-glycemic-load diet. A separate randomized controlled trial found that lowering glycemic load significantly reduced IGF-1 within two weeks.

That first trial is worth noting for one detail: the intervention was a high-protein, low-glycemic-load diet. That is a close description of what Revero puts patients on.

Inflammatory messengers drive the visible symptoms

Redness, swelling, itch, and plaque formation are all inflammatory processes, and TNF-alpha and IL-6 are central to them. They are what the newer biologic medications for psoriasis and eczema are designed to block. Randomized trial evidence shows low-carbohydrate diets significantly lower TNF-alpha and IL-6. Part of that comes from a metabolic shift: burning fat produces beta-hydroxybutyrate, a ketone body that directly inhibits the NLRP3 inflammasome, one of the master switches your immune system uses to generate inflammatory signals.

Which is exactly why generic skin diets fail

Here are two findings that, put side by side, explain the entire approach.

When researchers put psoriasis patients on a gluten-free diet for three months, the patients who carried antibodies to gliadin improved meaningfully, and 60% worsened again when gluten came back. The patients without those antibodies saw nothing at all.

And in a systematic review of dietary treatment in chronic urticaria covering more than 1,700 patients, a standardized elimination diet given to everybody produced complete resolution in under 5% of patients. Personalized exclusion diets, tailored to the individual’s own symptoms and test results, produced complete resolution in 74.6%.

Two different conditions, the same lesson. Averaged across a population, diet looks like it barely matters for skin. Done properly, targeted at the right person, it can be transformative. The difference between under 5% and nearly 75% is not the food. It is whether anyone bothered to work out which foods were yours.

That is the entire point of a structured elimination followed by careful reintroduction, and it is why we do not hand anyone a printed list of foods to avoid.

Psoriasis

What psoriasis is

Psoriasis is an immune-driven condition in which the immune system signals skin cells to reproduce far faster than they should. Cells that ought to take about a month to reach the surface arrive in a few days, piling up into the raised, scaly plaques that define it.

It is not cosmetic and it is not contagious. It is a systemic inflammatory disease that happens to be visible, which is why it travels with joint disease, cardiovascular risk, and metabolic conditions.

How psoriasis affects your day

• Raised patches with silvery scale, most often on elbows, knees, scalp, and lower back
• Itching, burning, or soreness
• Skin that cracks and sometimes bleeds
• Scale in the hair that is visible on clothing
• Nail pitting, thickening, or lifting from the nail bed
• Dressing to cover rather than to suit the weather
• Flares after stress, illness, or for no discoverable reason
• Joint pain or stiffness, which can signal psoriatic arthritis

What is driving it

• Insulin and IGF-1 driving cell turnover. The core of psoriasis is skin cells proliferating too fast. IGF-1, which rises with insulin, is a direct driver of that proliferation. This is why the metabolic side of psoriasis is not a coincidental comorbidity but part of the mechanism.
• Metabolic health. Psoriasis is strongly associated with obesity, insulin resistance, and metabolic syndrome, and the relationship runs both ways. Improving metabolic health frequently improves the skin, which makes psoriasis one of the more addressable skin conditions there is.
• Inflammatory signalling. Specific inflammatory pathways sustain the accelerated turnover. These are the targets of modern biologic drugs, and they also respond to diet.
• Gluten sensitivity in a subset. A meaningful minority of people with psoriasis carry antibodies to gliadin, and those people respond to gluten removal dramatically. Finding out whether you are one of them is simple and worth doing.
• Alcohol and smoking. Both associated with more severe disease and poorer response to treatment.
• Stress and infection. Streptococcal infection in particular can trigger onset or a flare.

How Revero treats psoriasis

Psoriasis gives us two levers rather than one, and we pull both.

Lowering carbohydrate reduces insulin and therefore IGF-1, the growth factor driving your skin cells to turn over faster than they should. That addresses the mechanism directly rather than suppressing the result. It also reduces insulin resistance and excess weight, both genuine contributors to skin inflammation rather than unrelated coincidences. Separately, removing the foods provoking an immune response lowers the inflammatory signalling sustaining the plaques, and identifies whether you are one of the people for whom gluten is doing real damage.

Your provider follows hs-CRP, fasting insulin, and lipids at baseline and every three months, and that combination matters practically. In psoriasis the metabolic markers usually move before the skin does, so your labs give you evidence the plan is working during the weeks when your mirror has not caught up.

You track plaques, itching, and cracking daily, which builds a precise picture of what your skin responds to. Skin takes longer to show change than gut or joints do, which is why your coach’s job early on is keeping you with the plan while your labs move first, then running your reintroductions carefully so a single trigger does not get missed. As your skin and markers improve, your provider can begin reducing medication, gradually and with your consent.

Among Revero patients with psoriasis, symptom scores improved 9.3% within the first three months, which is a short window for skin.¹ In an independent Harvard Medical School affiliated study, 92% of participants with skin conditions reported their condition resolved or improved.³

Eczema

What eczema is

Eczema, or atopic dermatitis, is chronic inflammation of the skin with a defective skin barrier at its centre. The barrier that should hold moisture in and keep irritants out does neither well, so skin dries, cracks, and becomes inflamed, and irritants that would not bother anyone else get through and provoke a reaction.

The itch is the defining feature and the hardest part. Scratching damages the barrier further, which produces more inflammation and more itch. Most people with eczema are living inside that loop.

How eczema affects your day

• Intense itching, often worst at night
• Dry, scaly, cracked patches, commonly in elbow and knee creases, on hands, neck, and face
• Weeping or crusting during flares
• Skin that thickens and darkens where you have scratched over years
• Sleep broken by itching, and the exhaustion that follows
• Stinging from products, fabrics, sweat, or temperature changes
• Repeated skin infections in broken areas
• Constant management: creams, avoidance, planning around flares

What is driving it

• Two broken barriers, not one. The skin barrier defect is well recognised. The gut barrier is the part usually left out. Measured markers of intestinal permeability correlate directly with how severe eczema is, which means the leaky barrier feeding your skin inflammation may not be the one you can see.
• Food sensitization. Sensitization to foods is significantly more common in adults with eczema than in people without it, and it tracks with disease severity. Which foods matter is individual, and it is a question worth answering properly.
• Gut microbiome imbalance. Altered gut bacterial populations disrupt the immune tolerance that keeps skin calm, and they respond to what you feed them.
• Metabolic inflammation. Reviews of eczema and obesity describe shared mechanisms including insulin resistance, leptin resistance, and elevated TNF-alpha and IL-6. In one study of adults, a weight loss intervention produced a significant fall in BMI and a measurable reduction in eczema severity alongside it.
• Sleep loss. Itch destroys sleep, and poor sleep raises inflammatory markers and lowers the itch threshold the next day. Another self-reinforcing loop, and another one that can be broken.
• Genetics. Mutations affecting skin barrier proteins are strongly associated with eczema. They set the starting difficulty. They do not set the outcome.

How Revero treats eczema

Most eczema treatment works from the outside in. Creams and topical steroids on the barrier you can see, which is worth doing, and does nothing about the barrier you cannot.

We work from the inside out. Removing the foods that increase intestinal permeability and provoke an immune response addresses the gut barrier whose leakiness has been shown to track with eczema severity, and it identifies which foods are yours rather than asking you to guess. Lowering carbohydrate reduces the insulin resistance and metabolic inflammation that reviews of eczema and obesity describe as shared mechanisms, and randomized trial evidence shows low-carbohydrate diets significantly lower TNF-alpha and IL-6, two of the cytokines involved. Where excess weight is part of your picture, losing it has been shown to reduce eczema severity directly.

Your provider runs a full panel at baseline including hs-CRP, fasting insulin, vitamin D, and a complete blood count, then repeats at three, six, and twelve months. You track rash, dryness, itching, and any weeping or crusting daily, which is how your coach learns which exposures line up with which flares.

Your coach also works on the itch and sleep loop, because it is usually the thing making everything else worse and it is rarely addressed directly. Patients frequently tell us sleeping through the night is the first real change they notice. As your skin improves, your provider can review your topical and systemic medications, gradually and with your consent.

In our survey of more than 11,000 people following a low-carb high-protein diet, 96% of those with skin conditions reported improvement.² In an independent Harvard Medical School affiliated study, 92% of participants with skin conditions reported their condition resolved or improved.³

Acne

What acne is

Acne develops when hair follicles become blocked with oil and dead skin cells, bacteria multiply in the blocked follicle, and the surrounding tissue inflames. That sequence is well understood. What is far less commonly explained is what is telling your skin to produce that much oil and turn cells over that fast in the first place.

The answer, for a great many people, is hormonal signalling that is directly downstream of what they eat.

Acne is also not a teenage problem that you grow out of. Adult acne, particularly in women, is common, persistent, and frequently dismissed.

How acne affects your day

• Blackheads and whiteheads across the face, chest, shoulders, or back
• Inflamed red bumps that are tender to touch
• Deeper, painful cysts and nodules that last for weeks
• Scarring and lasting dark marks
• Oily skin, often alongside dryness from treatments
• Flares that track with the menstrual cycle
• The daily cost of covering it, and of photographs, and of being looked at

What is driving it

• Insulin and IGF-1. The most important and most actionable driver. Insulin rises with dietary carbohydrate, insulin raises IGF-1, and IGF-1 directly increases oil production and drives follicle cells to proliferate. It also raises the biological activity of androgens. This is the pathway a low-glycemic-load diet interrupts, and it has been demonstrated in randomized trials.
• Dairy. Dairy raises IGF-1 independently of its glycemic effect, which is why it appears repeatedly in the acne literature and why it is one of the first things we look at.
• Inflammation. The redness, tenderness, and swelling are inflammatory, and inflammatory signalling determines whether a blocked follicle becomes a small blemish or a painful cyst that scars.
• Insulin resistance. Common in people with persistent acne, and strongly associated with polycystic ovary syndrome, which is a frequent underlying driver of adult acne in women and is very responsive to this approach.
• The gut-skin axis. Gut microbiome imbalance influences systemic inflammation and, through it, skin.
• Genetics and hormones. Both real, and both operating through the same oil-production and cell-turnover pathways that diet influences.

How Revero treats acne

Acne is the condition on this page where the mechanism is clearest and the evidence most direct, because the pathway from what you eat to what happens in a follicle has actually been mapped.

In a randomized, investigator-masked controlled trial, a high-protein, low-glycemic-load diet improved acne and the hormonal markers driving it compared with a conventional high-glycemic-load diet, with dermatologists assessing the skin blind to which group patients were in. A separate randomized controlled trial found that lowering glycemic index and load significantly reduced IGF-1 in adults with moderate to severe acne within two weeks.

A high-protein, low-carbohydrate diet is precisely what your Revero plan is. Lowering carbohydrate lowers insulin, which lowers IGF-1, which reduces the signal telling your skin to produce oil and proliferate. Removing dairy addresses a second, independent route to raised IGF-1. And removing the foods that provoke an immune response reduces the inflammatory component that turns a blocked pore into a cyst that scars.

Your provider runs fasting insulin, hs-CRP, and a full metabolic panel at baseline, which is worth doing properly, because insulin resistance and polycystic ovary syndrome are common in persistent adult acne and are frequently never investigated. If that is part of your picture, treating it treats your skin.

You track lesions daily, distinguishing small blemishes from the deeper inflamed ones, so improvement is visible in the data before it is obvious in the mirror. Your coach handles the practical side of eating this way and holds you through the early weeks, since skin lags behind the internal changes. As your skin clears, your provider can review any long-term acne medication you are taking.

In our survey of more than 11,000 people following a low-carb high-protein diet, 96% of those with skin conditions reported improvement.² In an independent Harvard Medical School affiliated study, 92% of participants with skin conditions reported their condition resolved or improved.³

Chronic Urticaria

What chronic urticaria is

Chronic urticaria means hives that keep coming back for more than six weeks. Raised, itching welts appear, last hours, fade, and appear somewhere else. Some people also get deeper swelling of the lips, eyelids, hands, or feet.

It is usually labelled chronic spontaneous urticaria, and the word spontaneous is doing a lot of concealing. It means no cause was identified. It does not mean there is no cause.

The underlying event is mast cells in the skin releasing histamine and other mediators when they should not. What sets them off is the question worth answering, and for a substantial share of patients the answer is in what they are eating.

How chronic urticaria affects your day

• Raised, itching welts that appear and move around the body
• Deeper swelling of lips, eyelids, hands, or feet
• Intense itching, frequently worse at night
• A burning or stinging quality rather than only itch
• Sleep broken by flares
• Antihistamines that help partially, or stop helping
• The particular exhaustion of never knowing what set it off
• Anxiety about swelling, which is entirely reasonable

What is driving it

• Histamine in food, and foods that release it. Aged, fermented, and cured foods carry substantial histamine, and others prompt your own mast cells to release it. If your capacity to clear histamine is limited, dietary histamine adds directly to the load your body is already carrying.
• Pseudoallergens. Food additives, preservatives, colourings, and certain naturally occurring compounds in fruits, vegetables, and spices can trigger reactions that look exactly like allergy without involving the allergic antibody pathway. Standard allergy testing does not detect them, which is a large part of why so many people are told nothing was found.
• Gut permeability. Pseudoallergic reactions in chronic urticaria have been shown to be associated with altered gut permeability, which connects this condition to the same barrier mechanism running through the rest of this page.
• Systemic inflammation. Inflammatory signalling lowers the threshold at which mast cells fire.
• Stress, heat, pressure, and alcohol. Common aggravators, and alcohol carries both histamine and a direct mast cell effect.

How Revero treats chronic urticaria

This is the condition with the single most persuasive evidence for doing elimination properly rather than generically, and the numbers are worth sitting with.

A systematic review covering more than 1,700 patients compared approaches. A standardized elimination diet given to every patient produced complete resolution in under 5%. Personalized exclusion diets, built around the individual patient’s own symptoms and results, produced complete resolution in 74.6%. A prospective trial in patients whose urticaria had not responded adequately to standard care found that around one in three benefited from removing pseudoallergens, and concluded that the diet is a safe and effective way to identify who those patients are.

That gap between 5% and 75% is the whole argument. A generic hives diet is close to useless. A structured, personalized elimination that identifies your particular triggers is one of the most effective things available for this condition, and running it properly is exactly what your care team does. We remove the likely triggers, including the additives and preservatives that standard allergy testing cannot detect, let your mast cells settle, then reintroduce systematically while you track daily.

Your provider runs a full baseline panel including hs-CRP, thyroid function, and a complete blood count, because thyroid autoimmunity is a recognised and treatable contributor to chronic urticaria and is worth identifying at the outset. You log hives, itching, and any swelling daily, which is what makes it possible to connect a reaction to something you ate up to a day earlier.

Your coach works through the reintroduction phase with you, and in this condition that is the part that produces the answer. As your flares settle, your provider can review your antihistamine use with you, gradually and with your consent.

In our survey of more than 11,000 people following a low-carb high-protein diet, 96% of those with skin conditions reported improvement.² In an independent Harvard Medical School affiliated study, 92% of participants with skin conditions reported their condition resolved or improved.³

Rosacea

What rosacea is

Rosacea is chronic inflammation of facial skin, producing persistent redness across the cheeks, nose, chin, and forehead, visible blood vessels, and in many people bumps and pustules that get mistaken for acne. It typically appears in adulthood and follows a pattern of flushing that becomes permanent redness over time.

Conventional treatment is often disappointing, and the reason usually given is that rosacea relapses. There is a more interesting explanation, and it points somewhere most patients are never asked about.

How rosacea affects your day

• Persistent facial redness, most often across the cheeks and nose
• Flushing triggered by heat, alcohol, spicy food, exercise, or stress
• Visible small blood vessels
• Bumps and pustules resembling acne
• Burning, stinging, or skin that reacts to almost every product
• Gritty, irritated eyes and inflamed lids
• Thickening of the skin on the nose over years
• Being asked whether you are embarrassed, hot, or drinking

What is driving it

• Bacterial overgrowth in the small intestine. This is the most important thing on this page for anyone with rosacea. Patients with rosacea are roughly ten times more likely than controls to have bacterial overgrowth in the small intestine, and clearing it clears the skin in the large majority of cases. If your rosacea keeps relapsing, this is the question nobody has asked you.
• Gut-driven systemic inflammation. Rosacea is associated with a range of digestive conditions, including inflammatory bowel disease, coeliac disease, irritable bowel syndrome, and reflux. That clustering is not coincidence, it is the gut-skin axis.
• Fermentation and dietary triggers. Fermentable carbohydrate feeds bacterial overgrowth, and histamine-rich and vasoactive foods provoke flushing directly.
• Metabolic health. Rosacea is associated with metabolic syndrome, and the inflammatory signalling from excess weight contributes to facial inflammation like it does elsewhere.
• Vascular reactivity. The blood vessels in rosacea-affected skin dilate too readily, which is what turns a normal response to heat or alcohol into a flare.
• Alcohol. A reliable trigger, and it carries histamine as well as dilating vessels.

How Revero treats rosacea

Rosacea has the most remarkable piece of evidence on this page, and it comes from gastroenterology rather than dermatology.

Researchers found bacterial overgrowth of the small intestine in a large proportion of rosacea patients, at roughly ten times the rate in healthy controls. They then eradicated it in a randomized trial. 78% of treated patients had their skin lesions clear completely and a further 18% improved substantially. 96% of those who cleared remained clear for at least nine months, and a three-year follow-up confirmed the result held. A gut treatment cleared a facial skin disease, and it held.

That tells you where to look. Our nutrition therapy reduces the fermentable carbohydrate that feeds bacterial overgrowth in the small intestine, which removes the fuel supply rather than only knocking the population back. It removes the histamine-rich and vasoactive foods that drive flushing. It lowers the metabolic inflammation contributing to facial redness. And your coach works with you on meal spacing, which supports your gut’s natural clearing mechanism between meals and is one of the practical reasons overgrowth returns in people who address it once and change nothing else.

Your provider reviews your full digestive history at intake, which is the step most rosacea patients have never had, and runs a baseline panel including hs-CRP and metabolic markers. If bacterial overgrowth or another digestive condition looks likely, that becomes part of your treatment plan rather than a separate problem for a different clinic. You track facial redness, flushing, and bumps daily alongside your digestive symptoms, so the connection becomes visible in your own data.

In our survey of more than 11,000 people following a low-carb high-protein diet, 96% of those with skin conditions and 95% of those with gastrointestinal conditions reported improvement.² In an independent Harvard Medical School affiliated study, 92% of participants with skin conditions reported their condition resolved or improved.³

How your plan actually works

The first phase finds your triggers

We start by removing the most common triggers together and lowering carbohydrate. Not because you will avoid all of it forever, but because while you are eating all of it there is no way to tell which parts are driving your skin.

No blood test answers this reliably. Food sensitivity panels are heavily marketed and are not dependable, and standard allergy testing misses the additives and preservatives that matter most in conditions like urticaria. Structured elimination followed by careful reintroduction is the most accurate method available. It is also, judging by the research on this page, dramatically more effective than any standardized diet.

Then you get your foods back

Once your skin and your markers have improved, your care team adds foods back one at a time while you keep tracking daily. No reaction, and it stays. A flare, and you have learned something specific and permanent about your own body.

Skin has a lag, so reintroduction here is slower and more deliberate than in gut conditions, and your coach paces it so a single trigger does not get lost in the noise. Most people finish eating considerably more variety than they expected, knowing exactly what sets their skin off.

Expect your labs to move before your mirror does

This is worth saying plainly, because it is where people give up. Skin turns over slowly, and inflammatory and metabolic markers respond faster than plaques, hives, or lesions do. Your three-month labs will very often show clear improvement while your skin is still catching up.

That is why we measure both. Seeing your markers move is what makes it possible to keep going through the weeks where the mirror has not changed yet, and it is a large part of what your coach is there for.

Medications

You do not stop anything to start with us. You begin your nutrition therapy while continuing everything you currently take, whether that is a topical treatment, an antihistamine, or a systemic medication, and nothing changes unless your provider recommends it and you agree.

As your skin and inflammatory markers improve, reducing medication becomes a real possibility. Revero uses a structured, stepwise process run by your provider, monitored with lab work and daily tracking. Some of these medications need careful tapering, and having a provider watching your labs and your skin is exactly what makes reducing them safe. Many of our patients get there.

Results

Across all conditions, Revero patients saw hs-CRP, a standard marker of systemic inflammation, improve 25% in three months. Among patients with psoriasis, symptom scores improved 9.3% over the same period, which is early for skin.¹

Patients who entered the program with the lowest quality-of-life scores saw substantial gains across nearly every domain measured, including emotional wellbeing, social functioning, and energy. That matters particularly in skin conditions, where the burden is as much social as it is physical.¹

In our survey of more than 11,000 people following a low-carb high-protein diet, 96% of those with skin conditions reported improvement, and 79% of those taking medications reported reducing or eliminating them.² In an independent Harvard Medical School affiliated study, 92% of participants with skin conditions reported their condition resolved or improved, and 95% reported their overall health improved.³