The Microbiome and Skin - with Dr. Whitney Bowe | The Empowering Neurologist EP. 70

Hello everyone, Dr. David Perlmutter here. Welcome again to The Empowering Neurologist. You know, we've been talking quite a bit about the role of bacteria in terms of our gut health and how that has manifestations throughout the body. For example, as we've written about the role of the gut microbiome, that means the bacteria, its genetic material, and what products they manufacture, how those things affect, for example, inflammation. How does that affect the brain? How does that have an impact on our immune systems, on things like allergy, etc.? Well, today we're going to explore the role of the gut bacteria and also importantly bacteria that live upon the skin. in terms of keeping your skin nice and healthy and looking really good. We're gonna be talking to Dr. Whitney Bowe, and this is her new book called The Beauty of Dirty Skin. It almost sounds paradoxical a bit, but you're gonna see that there's a lot of merit to the notion that the bacteria living upon the skin are in fact fundamental for its health. Let me tell you a little bit about Dr. Bowe. She is a New York-based dermatologist but really brings the notion of integrative medicine to the field of dermatology. She is one of the most sought-after dermatologists in America in terms of being in the media. You've probably seen her on shows like Good Morning America, The Rachael Ray Show, The Doctors, Dr. Oz. She has published extensively. She's done quite a bit of research. Her work has been cited in places like the Wall Street Journal, New York Times, Allure, and InStyle. She was trained at Yale University where she graduated summa cum laude with a Bachelor of Science in Molecular, Cellular, and Developmental Biology. After graduation, she was named a 21st Century Gamble Scholar and was given a full scholarship to attend the very prestigious University of Pennsylvania where she graduated at the top of her class. So we're very, very excited to spend some time with Dr. Whitney Bowe today. Let's jump right into our interview. Well, Dr. Bowe, you look like you have the Bowe Glow that you talked about in your book, so you must be doing everything right.

Thank you so much. Yes, that Bowe Glow, and it comes from the inside out, not just the outside in, right?

That was my first question. What does that mean?

So, having a healthy glow to the skin, that's something that so many of my patients come and they ask me about because a lot of people struggle with dull skin, uneven skin. They feel like their skin just doesn't reflect how they feel on the inside, or they'll struggle with chronic skin conditions, things like acne, rosacea, eczema, psoriasis, and they'll come and they feel like they're almost trapped in in skin that doesn't really reflect how they feel about themselves. And unfortunately, your skin very much impacts how the world interacts with you, right? So, not only does it affect your self-esteem and your confidence, but other people around you all of a sudden start acting a little bit differently towards you. Like either if you look old, they'll think that your ideas are old, right? So, if you're in a sales or marketing position or you're trying to move up in your job, that can really be a deterrent. But if you have a disease or a skin condition like vitiligo, psoriasis, oftentimes people think you're contagious. They think that they can catch it from you and then they don't even want to be near you. So having chronic skin issues can dramatically affect the quality of life of people. So when they come to me, they say, I want to get that healthy glow. I want to get healthy skin. And truly having a glow and having the quality of your skin improved, that really all comes down to Treating your body from the inside out. It comes down to the gut-brain-skin connection because that's really the core.

Right off the bat, I, you know, there's a chapter that deals with the gut-brain-skin relationship, and I thought that we were going to go from the gut to the skin, but you interspersed the brain. So tell us the role of the brain then in, in participating in this relationship.

Stress can be a good thing, right, if it's what we call acute stress. If you have a short burst of stress, say you have to meet a work deadline or you have to give a presentation in front of a big crowded room, stress can actually manifest in helpful ways. It can quicken your heartbeat, but it can also make you more alert. Aware and you can speak more articulately and you can— it heightens your senses, right? So it sort of helps you meet those deadlines. It helps you deliver. It helps you perform. So in the short term, stress can be good. But ongoing, chronic, low boil, ongoing stress where sort of we're living our typical Western lives, we're multitasking, we're on social media, we're not sleeping the way we should, we're not exercising the way we should, we're not taking care of our bodies the way we should, that chronic ongoing stress can really take a toll on the skin. So, our stress hormone cortisol has been known to absolutely just wreak havoc on the skin. It targets some of the proteins that are especially vulnerable to cortisol are collagen and elastic fibers. And those are the proteins in our skin that keep our skin firm and plump and youthful and healthy. So, if you're actually destroying those proteins because you're exposing them to chronic levels of these stress hormones, it can really take a toll on the skin. But we also know that the brain speaks to the skin and speaks to the gut, and that conversation goes back and forth in all different directions. So, if you take care of your gut and you take care of your brain, you can see dramatic changes in the health of your skin. But if you neglect your brain specifically, you were asking, in Yeah. In my job, it's more patients come to me and they'll say, Dr. Bowe, I feel like I aged 10 years in the span of a couple of months. And they're like, I don't think my prescription's working anymore, or, what cream do I need? Or, I think I need a laser. I think I need some filler under my eyes because it looks like I haven't slept forever. Can you fix that with a filler or with some Botox? And I say to them, wait a second. Let's take a step back. What's going on in your life right now? Have you had any sources of stress? And a lot of times patients are sort of like, why is my dermatologist asking me about stress?

I have been there, believe me.

They're like, huh? And then it just comes flooding out and the tears come gushing and it's, you know, I'm taking care of my mother. You know, she's, she's been really sick lately, but I'm also a mother and I've got kids and I'm trying to get them to school and then I'm trying to balance the job. And, and I've just— Dr. Bowe, I've been overwhelmed. And, and I said, okay, you know, I'm happy to do your filler under your eyes. I'm happy to do a laser, but Quite honestly, we're not gonna achieve the results you're looking for until we start helping you manage your stress. And I wish I could write a prescription, you know, have a stress-free week this week, but that's unrealistic. But what can I do is I can introduce, you know, techniques and tools that can help you manage your stress, that can help you to bring those stress hormones down, and that will end up reflecting in your skin.

You have, And really brought, I think, to the forefront the notion that as the gut depends on the health and diversity of the organisms that live within it, that our skin has its own microorganisms living upon it, 1 trillion you talk about.

Yes.

And that it is the health of and diversity of those species that ultimately creates the fertile ground, literally, for healthy skin. We all grew up at a time when, for teenage acne and cystic acne, the approaches were doing everything we possibly could to sterilize the skin. Exactly. Alcohol wipes in your locker in high school, I absolutely remember it. Yep. And even going so far as to use tetracycline and other antibiotics. We still see people whose teeth are gray from those experiences back years ago.

Yes.

So, you know, I would say though, still in mainstream knowledge base, and certainly in dermatology, that there's this notion that the bacteria are at fault. There are a couple of specific species that are the cause of acne. We got to do everything we can to sterilize the skin. And you are saying, by the nature of your title here, Dirty Skin, That mentality is not appropriate.

It's the beauty of dirty skin. You have to learn how to love, nurture, and protect and support your skin's good bugs if you want to have healthy skin. We were raised with the germ theory. We were raised to think that germs are bad, bacteria are bad. They cause infection. They cause acne. Americans are obsessed with getting that squeaky clean feeling. The number one skincare mistake that Americans make is that they're over-cleansing their skin. They are, in their attempt In their attempt to try to wipe out and sanitize their skin, they're relying on antibiotics, antibacterial soaps, hand sanitizers. They're reaching for instruments like buff puffs and loofahs and harsh washcloths that are quite literally rubbing and scrubbing away your healthy bugs. All of those things are dramatically contributing to the rapid rise of chronic skin conditions that we're seeing today.

We have to take a stop there. I want to stop right here because what you just said is really very, very profound. I mean, you are now challenging billion-dollar industry and the mentality, certainly pervasive in America, that we've got to do all these topical treatments to our skin and sterilize it to get rid of these nasty bugs. You stand in stark contrast to the pervasive mentality.

I sure do. And, you know, actually, when it comes to dermatologists, We are some of the top prescribers of antibiotics because, you know, we treat chronic long-term conditions and antibiotics used to be the cornerstone of that therapy. So for acne, for rosacea, patients come to me and they've been on antibiotics for years, every day for years. And they say, you know, I'm here to refill my prescription. And sometimes they'll come and they'll have not only a prescription bottle of antibiotic pills, but they'll also have A lotion, an antibiotic lotion that's in a completely different class. So here they're using a topical clindamycin lotion and they're taking an oral tetracycline or doxycycline pill. And what is that doing? It's setting them up for antibiotic resistance. And then they're wondering why none of these products are actually working to clear their acne. When I was in high school, I remember getting ready for prom. I used an antibiotic wipe. It was like a little Pledge It. And it cleared my skin. It was awesome. It totally worked. But now what's happening is that we have these superbugs. We are developing multidrug-resistant bacteria and the CDC, the World Health Organization, the United Nations, they've all gathered and made these very scary declarations saying that we are at risk of entering a post-antibiotic era, meaning our children's generation are at risk of not being able to use antibiotics when they need them for life-threatening diseases. threatening infections. That to me as a mother is horribly scary and we are a huge part of that problem as dermatologists because here we are giving antibiotic after antibiotic after antibiotic and not only is it not working because the bugs on the skin are resistant, but we're actually causing resistance throughout the body. We're spreading that resistance in households. I've personally done studies showing that you can actually transfer bacterial resistance from one member of the household to another. If your teenage son is on an antibiotic, then that resistant bug that he's carrying on his skin is now being transmitted to the grandfather that happens to be living in the basement and his infant sibling who is maybe 4 or 6 months old. That is really quite scary. There's so many studies now showing that we can't wipe out the bad bugs. We can't focus on sanitizing and decimating all the bad bugs. Maybe it worked at one point in the distant past when antibiotics were still so powerful, but it's not working anymore. We need to focus on strengthening the host, on making our own bodies stronger. Probiotics are the new antibiotics. There are so many strains out there now. Yeah. Bacterial strains, healthy strains, good strains, good bugs that are capable of producing substances that can act as natural antibiotics and they can actually kill off what we once considered the bad bugs. I actually have a patent on one type of strain called Streptosalivarius that actually is in the mouth and the tongue of a small percentage of people walking around actually have this strain that's capable of killing P. acnes. P. acnes or Propionibacterium acnes is an acne-causing bacteria, or it's one of the bacteria that can be implicated in acne. So do we need to use a broad-spectrum antibiotic to wipe out not only the P. acnes but also every good bug living on your skin? And for those that it doesn't wipe out, maybe it causes pressure and actually makes those other bugs mutate and become drug-resistant so that then when we try to treat them in the future with another drug, that's just not going to work? Do we really need to do that or can we start looking towards the good bugs on our skin and seeing if we can harness their power and use them as our microbial warriors to actually protect us from infection and inflammation? There's a colleague of mine, Rich Gallo. He's out of UCSD in California. beautiful studies out of his lab showing that if you take a good, a healthy form of staph, Staph epidermidis, you can actually take that bacteria and use it to naturally, not using an antibiotic if you will, but using a substance that that good bug creates, you can use it to kill off Staph aureus. Now, Staph aureus, as you know, is a bad bug. It's a bad player out there. It can cause eczema flares, it can cause boils, it can cause life-threatening infections, especially if it's drug-resistant like MRSA, methicillin-resistant Staph aureus. So how amazing is it? Because now a lot of our antibiotics aren't working against Staph. Staph is one of the major causes of death worldwide because we can't treat it anymore because our antibiotics aren't working. But here's this guy in California who's able to find a good bug and Put that good bug in a cream and rub it on the skin. And then by rubbing it on the skin, it's preventing the bad bug, the bad staph, from taking hold and causing problems. And that's just one example of how we're in the field of skincare going to start using these good bugs to fight our battles for us. And, you know, just to take that one step further as far as complication goes, because I know you, you, you're like the most data-driven, evidence-based guy I know. I feel like you have every study at the tip of your tongue and I just so greatly admire that. I'm going to go to an even more complicated level with you. Acne, we used to think that P. acnes, so I mentioned before Propionibacterium acnes, was one of the major culprits when it came to acne. There's actually a recent study out of UCLA by Emma Barnard showing that not all P. acnes is created equal. So, you know, Propionibacterium is the genus, acnes is the species. So Propionibacterium acnes, that's what we thought a bacteria was for a very long time. We didn't realize that Propionibacterium acnes came in a number of different strains, meaning there's like subcategories of those P. acnes. And this study from Emma Barnard and her colleagues found that some P. acnes cause acne and some P. acnes protect you from getting acne. It's just absolutely mind-blowing that now that we have these advanced sequencing technologies and we're able to really take a very amazingly accurate glimpse into the ecosystem of the skin, we're realizing just how complicated this story gets and how it's not about just killing off the bad bugs. I mean, in the past, okay, I'm going to kill off P. acnes. I'm going to kill off P. acnes. Oh no, the antibiotics aren't working anymore. What do I do now? It's even more complicated than that because it's not just killing off the P. acnes. It's killing off the bad P. acnes, but what if you could put the good P. acnes in a bottle and you could start—

Beyond that, what we've learned, at least as it relates to the gut, and that is that many of our— what we used to think were bad bugs, bad bacteria, pathogenic bacteria, actually might well be playing an important positive role. time that the balance is disrupted by any sort of exogenous event, whether it's an antibiotic that was administered or other type of medication, that it's really the balance that is key here. Right. That when things are given an opportunity to grow out of their normal range, Clostridium, for example, that, you know, you're right, that's when we have clinical manifestations. I want to turn to the relationship, not just of the organisms within— on the skin, but But those within the gut, because a lot of the information in your book deals with diet and the gut bacteria as well. And I want to get into that by through the the lens of these commercials that we see so many times during as we watch the evening news about taking these monoclonal antibody medications for your plaque psoriasis. Take this today and You're right. You know, the skin being, you know, being shown to people, they're dancing, they're wearing short sleeves because people do judge others. And I think it's actually a, you know, a throwback to the time when people did recognize that changes in skin might be a manifestation of something perhaps contagious. But nonetheless, that the, you know, everybody's wanting to take these monoclonal antibody type of medications. And not listening to the second 30 seconds of the commercial where they talk about—

Oh, the side effects.

This drug shouldn't be taken by anybody who has a vowel in their name or who knows what.

Tuberculosis.

Talking about all the potential serious risks, including death, that this drug might be associated with. But nobody thinks about that because they're looking now at the woman dancing at her, you know, her son's wedding or whatever it is, and everybody's happy. So the approach is to either use topical steroids in this case or other medications or suppress the immune system with monoclonal antibody type drugs or oral steroids as opposed to what you are advocating, and that is first paying attention to reestablishing gut health through the very foods that we eat.

I love that you brought that up because, you know, it's just the beauty of marketing, right? You see that commercial and you're like, ooh, it seems It's a shortcut. And, you know, for some people it is a shortcut, and for some people they honestly don't sort of know that there are other options out there. As a doctor, you know, the most important thing is do no harm, right? We took that Hippocratic oath, and I feel like every time I administer a prescription, there's always a risk-benefit ratio, and I always have to go through the side effects with a patient. A lot of these drugs, and you touched on biologics, that category of drugs that actually have not just side effects, but really consequential side effects. I mean, really, if you listen and you read the fine print on those commercials, it's pretty scary. I mean, to say to somebody, you could potentially develop lymphoma. If you take this drug. If they actually stopped and paused and digested that information, I think that that would maybe have a lot of people stop and think, but—

Progressive multifocal leukoencephalopathy. That wouldn't be fun either.

Yeah, no, but in this day and age, I think that doctors don't have a lot of time in the office the way that the healthcare system is, the reimbursement rates. Doctors are forced to see more and more patients in a shorter and shorter period of time. I think writing a prescription might be a little bit easier than sitting down and saying, what did you eat for breakfast? What did you eat for lunch? Of course, layer on top of that what we discussed before, that nutrition is not necessarily part of the curriculum right now in traditional medical schools.

That's an incredible— I love that some marketing person was able to attach the term biologicals to these drugs. What is biological? Right. Doesn't it sound empowering and healthy? It makes it natural. What is biological about these drugs?

It's an excellent point. It's almost like an oxymoron. I do have to say, I am not against all prescriptions. I certainly, as a last resort, if I've tried my first line, my second line, my third line, If other things aren't working and someone's suffering, I will give them a prescription. An example of that is if somebody's dealing with scarring acne and I'm working with them in a number of different ways and they need Accutane, I will prescribe it, but it's very much as a last resort. I'm not saying that these drugs don't have a place. I'm saying that we're using them too quickly. It's like a knee-jerk reaction.

Absolutely.

Americans are all about shortcuts. We're all about the quick fix. I feel like it takes a lot more effort to look at your diet and to make lifestyle changes. It's hard. It's hard to make lifestyle changes.

It's hard to wake up. What we're trained to do in America is to outsource responsibility. I'm just going to let my doctor figure it out, and he or she is going to write a script or do a procedure, and I have no real role to play. The empowerment that resides in your book is the science that underlies the notion that we have a powerful role to play, in this case, in our skin health. Let me get to another interesting topic, and that is you are indicating that we need to consider beyond sunscreens in terms of skin cancer. Yeah. You called attention to the incredible rates of melanoma, for example, new cases. And that, you know, many people think, well, they put on the sunscreen and that's really the best that they can do, but you're offering up more.

I am. So skin cancer is on the rise. The rates of basal cell carcinoma, squamous cell carcinoma, melanoma, which is the deadliest of the cancers, they keep increasing. One person dies of melanoma every single hour, and it is really frightening. And we're using sunscreen, right? But sunscreen is simply not enough. And now we finally have evidence and data showing that if you take a supplement or eat certain foods, you can actually boost the effects of your sunscreen. So I'm not saying don't use sunscreen. I'm a very strong advocate of using sunscreen. But if you can make your sunscreen work even more effectively by supplementing that, with a pill or a cream or a dietary change, then that can make a world of difference for these patients who I see in my office who are getting— they're getting surgery after surgery after surgery because they just keep being diagnosed with different, different types of cancers. And, you know, what's so interesting is that now, just in the last couple of years, scientists are realizing that it's not just ultraviolet rays that are at play here. You know, when it comes— we always knew that the sun is the number one cause of skin cancer. But it also causes premature aging. And it's not just ultraviolet light. So the sun also gives off infrared rays. And that's if you feel— if you're out in the sun and your skin feels warm, you feel that heat, that's infrared. And just being able to see any— anytime you're in a room where there's light, it means that there's visible light. And visible light now has been shown to cause hyperpigmentation, premature aging, free radical damage, and potentially be contributing to skin cancer as well. Our traditional sunscreens can protect against ultraviolet light. They don't protect against infrared. They don't protect against visible.

I know that our viewers right now are wanting to take you back, and I'll do it for you, to what supplements, what should the diet be like, but what specific vitamins and supplements then are gonna be skin protective?

So right now there's 2 to really focus on. So one is going to be oral probiotics, and certain probiotic strains have been shown to have a UV protective effect for the skin. They actually help to mitigate or lessen the damage from the sun on the skin. And primarily you want to look for strains like Lactobacillus and Bifidobacterium. And I go into the specific ones in the book that have this data behind them. But as we discussed before, variety is key. So not just relying on a supplement, but also trying to get probiotics in your diet and prebiotics as well. So having, you know, whether it's sipping on some kombucha or having fermented vegetables, Something like having sauerkraut or having kimchi or having yogurt with live active cultures or drinking—

Where have I heard this before?

Who

knew?

I'm preaching to the choir here, but it's just for everything that you've been speaking to, add one more thing to that list in that it's actually going to protect against skin cancer, which is profound. But that's one category. The other category is antioxidants. So we now know that free radicals are one of the biggest causes of premature aging and skin cancer in the skin. So free radicals are like little missiles. They target all the different components and attack the different parts of our skin, and they trigger inflammation and they trigger breakdown. They can target DNA and cause mutations leading to skin cancer. They can target your cell membranes. They can target your collagen, making your skin sag and lose its elasticity. So they lead to both skin cancer as well as signs of aging in the skin. So if you can counter that with antioxidants, then you're 10 steps ahead. But antioxidants, we've known for a while, we use them as topical serums. So, we use them— there's a serum that I recommend underneath your sunscreen, combined, or now there's new companies coming out with combinations of antioxidants plus sunscreens that you apply topically. But as you and I know, that's only one part of the puzzle. It's only one piece of the puzzle, right? You also want to get your antioxidants through diet or through supplementation. So, through diet, anything deeply colored fruits and vegetables, emphasis on vegetables, and then also having things like green tea and dark chocolate, those are rich sources of antioxidants. But there's also pills out there. Heliocare that's got a Polypodium leucotomos extract. It's a fern plant extract from Central and South America that has beautiful studies showing that it can neutralize free radicals in the skin, protect the skin from the inside out. So when you're getting ready to go to the beach, put on your sunscreen, put on a hat. I'm not saying don't do those things, but also consider taking an antioxidant supplement, a probiotic supplement, or starting your day with a bottle of kombucha.

A couple of comments. First, as a question, do you wear and recommend sunscreen? I mean, you say going to the beach, but just for your day-to-day, going to the office and in the car, etc.?

I do. I wear sunscreen every single day, rain or shine. The vast majority of UVA rays, which are also very much implicated in skin cancer and premature aging, can penetrate through window glass when you're driving to your office. They penetrate through the clouds. They penetrate through your office window if you happen to be lucky enough to have an an office that's near a window. So for all those reasons, we know it's cumulative. And a lot of my patients are not just interested in skin cancer, they're also interested in keeping their skin looking youthful and healthy. And they want to have that beautiful, healthy glow to the skin. So for all those reasons, I do recommend using sunscreens all year long. But sunscreens have their limitations. As I said before, you're inside your office and you've got fluorescent bulbs coming down at you, or you're in front of a laptop computer or a television, and those are all emitting blue wavelengths and they're emitting visible light. And now we know that that can cause hyperpigmentation, brown spots. It can make melasma worse. It can make dark spots after acne. If you're left with those dark marks that stay forever, maybe the zit or the pimple goes away after a week, but then you're left with that mark for a month.

The zit is a very technical term. I love that.

Absolutely, yes. So it will leave those dark marks. So we know that blue light can really make all those issues that are hyperpigmentation or skin darkening, they can make them that much worse, aging, dry skin, dull skin, even pollution. We're learning all these things that we used to think it was just UV, just protect your skin from the sun, but it's actually so much more than that now. We have to take an inside-out approach. We have to start thinking, what are the things in our diet that are going to be able to protect us all day long from the sun? Because what if you forget to reapply your sunscreen, or what if another wavelength, like a visible light wavelength or an infrared wavelength, penetrates through that sunscreen that wasn't designed to protect you against that, then what? You're still getting that free radical damage and you're still putting your skin at risk.

I have a question about parabens in sunscreen in a minute, but I just want to say a couple days ago I went to, in New York where you are, MindBodyGreen, and was interviewed by the founder of MindBodyGreen, Jason Wachob. And he, at the end of our interview, he said, if you could go back to being 20 years old, What would you do differently? And the 2 things that came to mind, I told him I would floss my teeth more frequently.

Yes.

Which I didn't, and I wish I would have. And I would have been far more careful. I mean, I live in South Florida, far more careful about sun exposure. I mean, I worked construction building houses in the Florida Keys, and, you know, here I am at my age wishing I had— we didn't know in those days, so we were In those days, it was baby oil with iodine and album covers, which many of our viewers might not know what that is, but in the old days when we had vinyl records, the album cover, you could open it up and cover it with aluminum foil just to reflect even more damaging sun's rays onto your face. It's remarkable how we survived. Tanning was a pastime.

I can't even tell you how many times I went to a tanning salon. Oh,

wow.

I mean, I thought I was giving myself a base tan. I thought I needed a base tan to protect myself from the sun. So I thought, well, I'll go to the tanning salon and I'll get the base tan and then I'll go to Aruba and that way I'll be— I mean, and now it's just mind-blowing how just going to a tanning salon a few times in your life can dramatically increase your risk of getting skin cancer.

Yeah, I mean, I think the idea of a base tan would only be worthwhile if you were going to go on Naked and Afraid. Because you're not allowed to bring sunscreen. That's what gets these people.

It's such a myth, yes.

Do you pay much attention to the presence of parabens in topicals?

You know, it's not just parabens. I think that there's more and more concern surrounding a lot of different ingredients when it comes to sunscreen. You know, there's issues surrounding parabens, sulfates, phthalates, oxybenzone, nanotechnology, There's actually sunscreen by itself is a whole topic, and I actually have several videos that cover this on my website, but it is a little bit scary. It's a little bit daunting, not just what it can do potentially to us and our health, but also to our environment. Yes. Something like oxybenzone can really destroy the coral reefs, and that's also something to keep in mind. Right now, I think that we're still learning the nuances. I think right now, based on the literature, and all of this is changing, and as you know, your recommendations change with the science, right? So based on what I know right now, nanotechnology appears to be safe. Nanotechnology is making— so when you think about physical blockers, so physical blockers are things like zinc and titanium. So people think, oh, physical, it's safe, right? Because it's not chemical. And we're worried about the chemicals. We're worried about them affecting the hormones. We're worried about them causing cancer. But physical blockers, it's natural, so that's going to be safe. But when you put on zinc or titanium on your skin, you look like a You get that white look to your skin. So what did skincare companies do? They actually took those molecules and they made them tiny. They made them into nanomolecules and nanotechnology. So now you've got these tiny little pieces of zinc and titanium that you're spreading all over your skin. And the fear was, wait, are they so tiny that they're getting into your bloodstream and they're causing problems? So there were a lot of studies surrounding that. And as of now, it looks like these sunscreens check out. It looks like they're not— even those nanoparticles, Chemicals are not capable of penetrating deep enough, and if they do, it's in such a small concentration that it doesn't seem to pose any kind of problem.

I think that for myself, and I think it makes good sense, that going for physical barrier is the way. I spend a fair amount of time fishing in places like the Bahamas, etc., and I am covered from head to toe. I wear a buff that goes over my neck. Over my head, just glasses here, covers my nose and mouth, and I wear gloves, long pants, shoes, socks, the whole bit. It's no longer an aberrancy. We see even the guides are covered up now, so it's not like we're making a fashion statement.

There's new lines, yes, and there's actually new clothing lines. What you look for is UPF. With sunscreen, it's SPF, sun protective factor. With fabric, it's called UPF. Now there's actually tons of lines out there that you can Google and find. And clothing that is quite fashionable, I wear it every summer, it's all over my Instagram channel, but I like to lessen the amount of sunscreen that I'm using on my skin because I think it is like an evolving science. Yeah. I'll rotate between a chemical blocker and a physical blocker because the chemical plus physical have been shown to perform better. When you look at Consumer Reports and you look at these third-party testers, there's something about that combination of the chemical and the physical that actually provides more effective Protection than physical alone. But you know there is that question: Is one day is there going to be a study coming out that actually does convince me that the chemical sunscreens are dangerous? And we do know that as of now some of them are dangerous for our environment. So I rotate between the chemical and the physical, but I also try to wear UPF clothing, meaning I'll wear a rash guard, I'll wear a top that's from my neck all the way down to my wrists, I'll wear a broad spectrum hat, I'll wear. Sunglasses that cover from both UVA and UVB, and then I'll put sunscreen on the exposed areas. I feel like I'm trying to lessen the amount of sunscreen I am exposing my body to, but it doesn't mean I'm going to go without sunscreen and just bake in the sun because, oh, sunscreen is dangerous. We know sunscreen protects you from skin cancer. We know that UV light causes skin cancer. It's completely avoidable. We know melanoma kills. Right. You can't just say, oh, I'm not going to wear sunscreen. You have to wear your sunscreen. Right now, the studies are not convincing enough to show that they really do jeopardize our health, but for all those reasons we just discussed and my healthy skepticism, I like to minimize and diversify my risk. I'd like to use a little bit of sunscreen, switch it between the physical and the chemical, and also use all these other sun protective behaviors. Mm-hmm. Clothing and habits. Stay out of the sun between 11:00 AM and 2:00 PM. If I go— I just got back from vacation with my family. We like to go to Caribbean vacations and my daughter and my family, we are never in the sun between the hours of 12:00 and 2:00. When that sun is at its peak in the Caribbean, it doesn't matter what you're wearing. Even if you're wearing a hat, it's reflecting off the sand. It's reflecting off the ocean. Even if you're wearing your sunscreen, it's just not going to be enough.

One thing I learned is that even though when I snorkel I wear a rash guard, so that is a very thin material that covers your arms and legs, and then you have your fins on, of course. But as I get older and I get a little thin up top in terms of my hair, I noticed that my scalp was exposed. So now I wear the buff and it goes all the way over, and then I put my mask on over that. So if you were to, I think, look at me from above, you would see everything is covered. And

Yeah, one of the top areas of skin cancer in men is their scalp and the top of the ears, so you're smart to do that.

Important though that people understand that one of the functions of skin is to help in the manufacture of vitamin D, and when we are blocking all of the various types of light, that we have to be consider— we have to consider rather the fact that we need to know where we are on our vitamin D production or at least vitamin D levels.

Absolutely, and I supplement with vitamin D every single day. I tell most of my patients, you want to take 1,000 international units of vitamin D, if not more. Talk to your doctor and get your levels tested if you're curious about your exact dose or if you have specific risk factors such as osteoporosis or any other symptoms that you might be experiencing that could suggest, or maybe you have fat malabsorption or another reason why you're not getting a lot of vitamin D. I tell my patients, you don't want to get your vitamin D from the sun, you want to get it from either fortified unsweetened almond milk or from a supplement. Vitamin D is actually also— I think you were one of the first people who talked about this, is that you kind of need a little cholesterol to make vitamin D. I grew up with the fat-free craze. I remember that anything that said fat-free, I think I'd wake up and I'd have a Pop-Tart and then I'd have Twizzlers and like, hey, I was eating fat-free, so I was eating healthy. Fat-free is something that it's still hard. Now, even with all this new science that's emerging showing that we can start embracing some of these healthy fats much more liberally in our diets, and it's really the carbs and the refined sugars that are causing the problems, I still have so many patients who just can't seem to get over that hurdle. When I explain to them that you can't even make vitamin D unless you have enough cholesterol in your diet, why don't you throw an egg yolk into your omelet this morning? They look at me like I'm crazy.

No, egg whites only. Absolutely. God forbid you eat a skillet. Egg white omelets.

I grew up where the menu said egg white. It was just part of the culture.

Oh, yeah. It's ubiquitous.

Yes, it depends on the egg, and yes, you want a pasture-raised, cage-free, flax-fed chicken. You want a certain type of egg. I talk all about in the book the omega-3 and omega-6 ratio and what it does for the skin. You're looking for a healthy type of egg, but by all means, for most Americans, if you can make the simple switch of changing your diet, if you can change having a baked bagel for breakfast to having an omelet for breakfast, you'll be 10 ahead when it comes to your skin.

That's fascinating.

Just making that one change, because for some reason in America, we eat dessert for breakfast. We're so busy having a carb-loaded breakfast, and then we're wondering why we're crashing and we're tired and we can't focus and our skin is breaking out and we're having all of these premature signs of aging on our skin. Yet just changing what you do in the morning Having your first meal be something that has healthy fats, proteins, antioxidants, ideally some probiotics, and staying away from those refined sugars, that changes—

That brings us to a very interesting point, and that is— I think I've been a bit vocal about sugar over the years. Good for you. Yet, you have a really compelling sugar scrub for the face that I haven't done yet, but it sounded really neat. It's really interesting. How could sugar, which is so vilified, be good for the skin?

Sugar is not okay when you eat it or when you drink it, no matter what form it's in. I don't even care if it says agave nectar and comes in beet sugar and has all these interesting, ooh, this is like a healthy sugar. Sugar is sugar.

Healthy sugar is— I think that's a contrast in terms.

Right, exactly. So eating sugar, bad for the skin. Applying sugar temporarily as a gentle exfoliating scrub on your elbows, on your heels, on your knees is totally fine. The actual application of the sugar molecule to the skin doesn't seem to have any of those implications that eating or drinking sugar might have. So one of my favorite DIY scrubs is to just mix a little brown sugar with a little almond oil or olive oil. Or coconut oil, whatever you happen to have in your kitchen, and you can just use that to rub into your rough areas and just for a minute or 2, and then you wash it away with water. But you don't want to do that too often. Exfoliating is really something you only want to do once or twice a week because if you over-exfoliate, if you over-scrub, then you can actually start to hurt that delicate balance of bacteria on the skin. Okay. Yeah. I always tell my patients when we're starting the 3-week plan and the beauty of dirty skin, about week 3, we're going to focus on the skin. In week 3, I want you to take a basket and I want you to take a buff puff, loofah, washcloth, face brush, antibacterial soaps, hand sanitizers, any soap, even a bar that leaves your skin feeling tight and dry or squeaky clean. It's all going to go in that and you're going to toss it because you You can't over-scrub. You don't want to use sandpaper on your skin because it's damaging the skin barrier and that paves the road for chronic skin conditions. The skincare industry loves exfoliating. They love selling scrubs and telling us to use them twice a day, every day, and we're basically rubbing our skin raw and then we're sabotaging that delicate balance of bacteria. People are surprised when their skin is stinging and blotchy and irritable and inflamed and they're having chronic inflammation in the skin and all the sequelae of chronic Yeah. Inflammation in the skin. I love getting busy in the kitchen and finding cheaper versions of fun things that you don't have to spend a fortune on by going to the store, but at the same time, whenever you're doing a scrub in particular, it's something that's sort of a luxury. It's like once a week, twice a week. Don't go crazy. A sugar scrub is way too harsh to use on your face, your neck, or your chest. That's really for those thick skin areas. So if you've got, you know, cracked heels and you want to, you know, wear your sandals for the summer, you can go ahead and use a sugar scrub there.

You know, I find so fascinating, we've interviewed so many people on this program dealing with things like eye health, mood issues, weight loss, gastrointestinal disorders, etc. In my case, dealing with brain health and resistance to disease. It's incredible how pretty much we're all saying the same thing.

It's incredible, yet isn't it discouraging that so much of the medical community still isn't listening? When it comes to sugars and refined carbohydrates, that is probably the number one saboteur when it comes to skin. We have beautiful evidence-based. We have large-scale randomized clinical trials, which are hard to find when it comes to diet, right? Those are hard to find.

Sure.

We have studies from Australia, from Korea, showing that if you take teenage boys who have cystic, severe acne and you put them on a low glycemic index diet, meaning you cut out those refined carbs, the chips, the cornflakes, The white rice, the white bread, the pasta, and then you replace them with foods that are lower in glycemic index, things like quinoa, oatmeal, multigrain bread on occasion. I'm not a huge fan, but mostly vegetables, sweet potato or different types of vegetables. That's my favorite source of carbs. Those boys, without going on a medication, without going on an antibiotic, without going on Accutane, Their mood will improve.

They'll be able to pay attention better in school, and they'll be less likely to develop type 2 diabetes.

Yes.

Those are the side effects. You know, you mentioned earlier looking at the risk-benefit and above all do no harm, and I'm still taken by the notion of lowering cholesterol and the cholesterol-lowering drugs obviously targeting those people who feel that they're at risk. risk for coronary artery disease or heart attack. Right. And recognizing that those drugs, published in the Journal of the American Medical Association, in both men and women, are associated with about a 40% increased risk of type 2 diabetes, which is a risk factor for coronary artery disease. So, you know, oh, maybe I should take a drug for my diabetes as well. Well, if you do that, then you're playing right into the hands of those individuals who are manipulating you in order to— for profitability, dare I say.

Right, right.

But anyhow, let me thank you for not just appearing on the program today, but for all the work that you're doing, for your public outreach. You know, we're seeing you all over on television, really getting the message out, and your really wonderful book. I know, you know, I see the amount of work that went into it, and I really just want to commend you for

You are an inspiration to me, so I am grateful that people like you paved the road and allowed me to have the confidence to get in front of an audience of a couple of million on national television and say that what we're eating impacts our skin and you better start thinking about it. So I thank you.

My pleasure. Well, I hope to see you soon. I'll try to look you up the next time I'm up in New York and again— I'd love that.

That would be wonderful. Take care.

Okay, bye. Well, that was really interesting information, wasn't it? We learned that, you know, this notion of the microbiome, the collection of organisms within the gut but also on the skin, are playing a very important role in terms of the health of the skin, the skin's appearance, and how maybe off-track it might be to think that a topical cream, topical antibiotic, oral antibiotics, etc., might be the answer for healthy skin. We also, as you'll recall, explored the really interesting connection between the gut, the brain, and the skin, and I think, you know, that really tends to strengthen our view of the body functioning as a really holistic unit where every part of the body is in direct communication with the rest of the body, and each part is important in terms of its function because dysfunction or problems in one area of the body can clearly impact another. So again, here is the book, The Beauty of Dirty Skin by Dr. Whitney Bowe, a very, very exceptional book. I wrote the little thing on the top. Let me read it to you. A groundbreaking plan to create beauty and radiance from the inside out. And today I think we learned why that is certainly true. Thanks for joining us here on The Empowering Neurologist. I'm Dr. David Perlmutter. See you soon. Bye for now. Bye.