Prevent Acne By Getting To Its Root Cause

Coming up on this episode of the Doctor's Pharmacy.

The best way to treat skin problems is from the inside out, whether it's eczema, acne, psoriasis, anything really on the skin often is coming from inside.

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Hi everybody, it's Dr. Mark Hyman, and welcome to the Doctor's Pharmacy, a place for conversations that matter. If you ever struggle with acne, you probably should listen up because this conversation is going to matter to you. And it's part of our special masterclass series where we dive deep into topics that you all care about, including inflammation, brain health, metabolic health, sleep, and much more. And I'm joined by my Guest co-host, my good friend, my business partner in crime, Drew Prudhomme, who's the host of the Drew Prudhomme podcast. And we are going to dive deep in the topic of acne, which is the source of so much suffering for so many people. And it's not that hard to fix. And it doesn't mean you have to slather on all kinds of potions, lotions and creams or take nasty pills.

Mark, this is a topic that a lot of people are passionate about and are curious about. I actually struggled with acne all throughout my high school. And for my freshman year, literally it's as if it was timed. My freshman year I came in, had terrible acne, cystic acne.

That's what made you such a compassionate person.

I know. And it continued right up until, and then literally when I got out of school and I was getting ready for my summer vacation right before college, I found out that dairy, which we're going to be talking about in a little bit, was a trigger for me and my gut health. There's many other things besides that that are connected to people's acne. So let's start off with the basics. What are some of the top things? Give us three things that are deeply connected to why acne is happening in the first place?

So again, your disease is your body's best attempt to deal with a bad sort of circumstances. So acne occurs when things are out of balance. And we know a lot about what happens with acne. And the problem with most traditional dermatology is you're attacking it from the outside in, but it's actually an inside out job to fix. And the things that are the biggest triggers for acne today are dairy. You mentioned dairy, which have over 60 different hormones naturally occurring, especially when they milk pregnant cows, there's even more. Two, sugar and the consequences of starch and sugar that drive what we call insulin resistance. And there's a whole downstream effect of that. and, and three, it's damage to our gut and the gut microbiome that has caused a leaky gut, which causes all kinds of food sensitivities. It can cause acne. Now, I know that, and I'm actually much better because I think I really fixed my gut a lot. But if I used to eat dairy, I would never eat dairy because I knew if I ate dairy, I would get pimples. And, you know, it's embarrassing to be like a 50 year old guy with pimples. So especially if I had to go on TV, you know, it was a big on my nose. So I would just know, I, it was like instant. I like had some dairy the next day, I'd get pimples. So it's really clear. And for women, you know, it's also a big issue because there's a whole phenomena called PCOS or polycystic ovarian syndrome, which is a condition that's not an ovarian problem. It's a nutritional problem induced by too much starch and sugar and insulin resistance that causes female bodies to make too much testosterone. So you've got all these things going on, and these are the sort of most common factors. There's also lots of nutritional deficiencies and.

Other things that are related to acne as well. So, somebody's listening and they're like, well, how is it that Mark Hyman could be, you know, when he was 50 years old and having like some dairy, some ice cream or whatever, and he gets a pimple, but then there's somebody else who can have dairy and maybe they even drink a glass of milk every single day. And they don't get pimples.

So, what's going on in the difference between those two people? I think one, we're all different. I mean, this is a fundamental principle of functional medicine is biochemical individuality, genetic individuality. I mean, the Human Genome Project and all the downstream unfolding of the genomics and the omics Revolution has taught us that, you know, two people are the same genetically. No, people are the same in their microbiome and their immune system and all the important ways that we're different. And so, you know, some people can tolerate things that other people can't. Some people have celiac disease, some people don't. A lot of it has to do with the gut. For me, it was a gut issue, and, and I, I had It's a long story I've told on a different podcast. I had mercury poisoning and that just destroys all the enzymes in your gut and I got a leaky gut and causes all kinds of problems. So I was really sensitive to everything and I would get rashes and sores everywhere, pimples.

Once I fixed that, I was good. I don't remember the last time I had a pimple. Yeah, that's huge. So we talked a little bit about some foods that can trigger it, like dairy. And again, dairy is not dairy is not dairy because we just did a whole episode about some of the benefits of like goat's milk, for instance. Yeah, goat's milk. And how some people better tolerate that. But we're really talking about when we're talking about acne, we're talking about cow's.

Milk, and in particular cow's milk here in the United States. Well, I have a confession, actually. I'm friends with Rylan Englehart who started his family, the Gratitude Cafe, and also then realized that regenerative agriculture was so important and started Kiss the Ground. which is a nonprofit to raise awareness about soil health. It was a movie called Kiss the Ground. I encourage everybody to watch it on Netflix. I was in it. And he sent me an email a few months ago. He said, Mark, there's this amazing guy who started a regenerative farm using A2 cows. So A2 cows, a different form of casein, which isn't as inflammatory, which is really what was naturally in cows before it was all bred out. And it's what sheep and goat have, is a form of casein, which is the protein in milk. and then he says, it's all regenerative, and it's A2 casein. I'm like, you just said the two things that are my kryptonite. So I'll try it. Okay. Send me the ice cream. He sent me, like, five flavors of ice cream. I tried it. I ate it. I didn't get a pimple. It was interesting. And I think it's because. I think it was. It was the A2 casein. Or maybe it's because I fixed my gut. But it's. It was.

I was, like, really surprised, because normally I would get a pimple. Right, and it's good that you have that awareness, but for a lot of people who don't, they don't realize that dairy could be a key component. It's huge. But like dairy, what are some other foods? Let's talk about foods first before we go into everything else. What are some other foods that can contribute or agitate the underlining root issues.

That can make acne more likely to happen? So acne is a state of inflammation, right? Inflammation is anything that's red hot, swollen and tender, right? Which is a pimple. inflammation can be triggered by many, many things, including infections, including our diet. And the primary problem with our Western processed diet is it's highly inflammatory. So just, just the high amounts of refined carbohydrates, the high amounts of sugar, the high amounts of refined oils and processed oils, the lack of protective nutrients, the phytochemicals in food, the anti-inflammatory polyphenols and flavonols and terpenes, all things that we need to be eating that are regulating inflammation. We don't eat because we basically processed junk food. 60% of our diet is processed junk food. And that's, you know, the average for Americans. And that includes everybody, not just, you know, people who are overweight or unhealthy, but literally everybody. When you think about it, that's six out of 10 Americans. I mean, sorry, 60% of the average American. So, people, maybe it's 90 or a hundred percent, right? So getting on an anti-inflammatory diet and getting off the inflammatory foods is critical as a first step. in regulating inflammation and oxidative stress in your body. And that alone may just help. And then, you know, getting off the dairy and getting off sugar also are the next two things you have to think about because those two, without a doubt, have been proven in the scientific literature to be drivers of acne. That doesn't mean everybody who eats dairy is gonna get acne or anybody who eats sugar is gonna get acne. But it's, if, if you are prone.

To acne, it's definitely the first thing to think about. so sugar, why is sugar on that list? And what are the mechanisms of how sugar would end up creating more inflammation, which then ultimately in this instance could lead to acne?

Well, sugar works through a lot of different mechanisms, but, you know, if you want to get inflamed, eat sugar. Essentially, when you, when you eat a lot of sugar, it raises insulin levels. It causes fatty liver, which creates more inflammation, C-reactive protein. it actually creates more cytokines in the body. When you have lots of sugar and starch, it increases the production of certain fat cells in your belly fat called adipocytes, which produce, which just means fat cells, a fancy word for fat cell, but it produce, and everybody's heard of the cytokine storm with COVID it produces what we call adipocytokines. So your fat cells are not just sitting in there keeping storage, calories for later or holding up your pants, they're metabolically extremely active. And one of the things that happens when you eat a lot of sugar is you get increase in these inflammatory cytokines produced by your fat cells. So if you have looked down, you have belly fat, that's a sign you probably have cells in there that are driving inflammation in that whole cascade. And again, anything in this, anything cause inflammation will cause potentially inflammation of the skin. Also, the gut microbiome plays a huge role. And when you eat sugar and starch, you're feeding all the toxic bad bugs that produce endotoxins. And you're basically not having the healthy anti-inflammatory bugs in your gut. And so you get this whole, we call metabolic endotoxemia, where you get real damage to your metabolism, causing some resistance through even the bacteria. So we mentioned inflammation. by eating sugar and some of the adipocytes. But for example, if you eat crap and your microbiome is a mess, you're gonna be absorbing these bacterial byproducts called lipopolysaccharides, which essentially your immune system sees and goes, whoa, that's not good. It's a bacterial endotoxin. So then it creates more cytokines like TNF alpha. And what that does is that that blocks this insulin receptors. So inflammation even if it's not from eating sugar, will cause insulin resistance. Because if you have bad bugs in your gut and you have all these downstream effects, you're gonna be causing inflammation, which then causes insulin resistance. So insulin resistance cause inflammation, but inflammation causes insulin resistance. It's a vicious cycle. And so you really wanna look at.

Your diet very carefully and try to eliminate the starch and sugar. In addition to the starch and sugar, which is like huge, what are some other things that people can be looking at to first even understand that they have an imbalanced gut microbiome, which could be contributing to this? Like, what are questions that they're gonna be asking themselves to see, is my gut working the way that I want.

It to be working? Well, you know, Drew, I think, I think it's important we all understand we live in a gut-busting culture and world. One third of babies are born by C-section. Many babies are not breastfed. Many babies are given antibiotics in the first year of life. Many babies are fed formula. which, I mean, 25% of the calories in breast milk is non-digestible by the baby. It's food for the bacteria. But if you have formula, it doesn't have that in it. And the microbiome is very, very different. You start off very young as a culture where we're messing up our guts from the start. And then there's the antibiotics that you get as kids, and then there's the processed food, and then there's. use of medication, which is gut busting that we happen as we get older like Advil and aspirin and all the acid blocking drugs and all antibiotics obviously, these are all gut busting drugs. Even oral contraception is a gut busting drug. So all these things tend to drive more inflammation, more gut dysfunction, more dysbiosis. And what happens is, you can make it active when you're younger, but you can get autoimmune disease later. So it's this steady progression of leaky gut, inflammation, and all the downstream consequences.

So there's a big question that a lot of women have in particular, which is why do they break out right before their period?

Sure. Well, not every woman does, but there's, you know, hormonal systems are networked, right? So we call the chicken wire in medical school. If you look at a, like the, like a a chart of hormone metabolism, your basic hormones are made from cholesterol, but then that gets converted into intermediates and ultimately into estrogen and testosterone and progesterone and DHEA. So you've got all these hormones that are all interconnected, all swapping back and forth. So for example, estrogen can be made into testosterone or testosterone can be made into estrogen.

Right?

So in, in, you know, and so for example, Men who are overweight increase aromatase in their cells and they actually cause the testosterone to be turned into estrogen. So the men that get man boobs and they get hair loss on their body and they get, you know, very soft skin and they get very estrogenized. Women, the other things, other problem happens. They actually produce more testosterone in response to insulin resistance and the sugar and the starch. So if you want to increase starch and sugar in your diet as a woman, it's going to drive more of the estrogen into testosterone, which causes problems. And there's various forms of testosterone that can be high, especially if women are insulin resistant with something called PCOS. They get high DHT or dihydroepiandrosterone. They get high androstenedione, they get high total free testosterone, and they get high DHEA sulfate. You can measure these in their blood tests. And so I can tell very quickly what's going on. For example, I had a A friend who struggled with acne and she's like 36 years old and she's a beautiful woman, but she's struggling. And we sort of drilled down into it and she had high levels of these androgens that were coming from sort of this disorder. And so we cleaned up her diet and we started putting on herbs and we sort of shift everything and her acne went away.

Yeah, I would just say a personal testimony is that my wife, before she was with my wife and we first met and we were dating, she would share that Right before her period came, she'd break out. And it was very emotional for her because she felt like she always had great skin growing up. And then later on in life, things weren't the same way and she would feel so self-conscious and like, why am I breaking out? Why is this happening? What's going on? And then as we started to learn more about blood sugar, which I knew a lot about it, but I wasn't using a continuous glucose monitor. And when Levels and Casey and everything approached us and we were trying it out, I had her try it. And just by simply focusing on a diet that is in a good metabolic score that she had. She had a significant difference. She added more fat. She wasn't overweight.

She wasn't overweight. She was classically pre-diabetic, but it still.

Made a difference, right? Exactly, it made a huge difference. And she had great skin when she was in her puberty years. And a lot of people who struggle with acne later on in adult life, maybe they also had acne when they were younger, but there are many people, and especially women in my sort of anecdotal just looking around and asking around, who for the first time start to get adult acne, and now they're very curious. And I think there was a lot more awareness around food sensitivities and like, is dairy an issue, is this an issue, is that? But there was less awareness about the blood sugar component. Yeah, yeah, for sure. And there's a lot of people that are drinking oat milk lattes and other stuff and having a lot of sugar bombs, even if they think that they eat really clean. Yeah, yeah. And that has a significant impact on.

Especially breaking out right before they get their period. 100%, I think that's, I mean, for me, Day one, I mean, the connection between insulin resistance and acne, I've known for 30 years, you know? But it's not really permeated popular culture. It's surprising how most people don't really get it. And it's the easiest thing you can do. Just quit dairy and, you know, if you want to try sheep but goat, okay, but give yourself at least three or four weeks to clear out your system and then get off of all the starch and sugar for a little while and see what happens for a couple of your woman for at least two or three cycles and see what happens. your body will tell you. I mean, it's the smartest doctor in the room. You don't have to worry.

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Well, speaking about sometimes not always the smartest doctor in their room, often women will go to their doctor and say that I'm struggling with acne and they'll meet with them and a lot of women are given birth control to address their issues with acne. Why is that the case and what are your thoughts about this?

Then I kind of laugh because pretty much any menstrual disorder or any hormonal disorder, the knee-jerk response of most doctors is give you a pill, shut everything off, block it. So what happens is you shut off your own hormone production when you take a pill, an external form of hormones. So your natural cycles are all interrupted. and yes, it can help, but it's not the solution because often when you stop, then it'll come back with vengeance. And so you don't want to do that if you don't have to. Plus, the pill causes more yeast overgrowth, more leaky gut, B6 deficiency. It's not that it's terrible to take the pill. And I don't. If women are taking the pill, it's okay. But you got to be aware. You want to make sure your gut's healthy, make sure you're taking probiotics against yeast, make sure you're, you know. actually making sure you're taking care of your gut and taking the right vitamins and so forth. So it's really, it's important. So the hormonal changes that happen with the pill are just to shut everything off. But there's a lot of ways to create hormone balance without having to take the pill. And I've worked with women for decades. In fact, at Canyon Ranch, it was sort of like a training ground for me because pretty much all my patients are between like 40 and 60 and were women. all going through menopause. And I don't have younger women, too, to have severe PMS and heavy bleeding and cramps and fibroids. And it's just like, it's such a plague on women, all these hormonal challenges. But they're not, they're not inevitable. I mean, it's not like, it's not like there's a design flaw in humans, especially in women, where 75 have PMS. Like, that's just insane to think that that's normal. But it's sort of normalized in our culture. It's like, oh, I I had a friend who was a very healthy young woman, very awesome, who thought she was great, but she had debilitating menstrual cramps, debilitating PMS. And I just saw her a couple of weeks ago, she's like, you changed my life. You just made a few little changes in my diet and a few little supplements and I'm good. I don't even know my period's coming. I don't have any PMS, I don't have any cramps. So the body has the ability to heal and repair given the right conditions. And that's really what's so powerful about functional medicine. But it's hard because people don't know what to do. And really it's honestly not that hard. It's like that joke from the doctor who gives his patient a bill for an appendectomy and it's $1,000 and the patient goes, God, that's a lot of money for such a simple operation. Is that too much? He's like, well, let me think about it. I think you're right. I'll send you a new bill. Send me a bill. Take out your appendix $1. knowing that's what needs to be taken out, $999. So it's knowing where to push or what to do is the key.

So Mark, what about what vitamins and nutrients are essential for helping the body? And by helping the body, you create a state where acne doesn't end up happening.

Yeah, I mean, there's really important nutrients for skin health that are essential for everybody, but particularly more important in terms of acne. Vitamin A, you've probably heard of retinol. which is a drug that's used to treat acne, but where does it come from? From vitamin A. You can take straight up vitamin A, not beta carotene, not carotenoids that are plant-based, not carrots, but actual vitamin A, which usually comes from animals like liver. Two would be zinc, which is really important for skin health and immunity. And also, vitamin C is very helpful, but also, so because it's important in skin health and collagen, but fish oil is really important. So Omega-3 fats are really critical. And there's a particular also essential fatty acid that's not Omega-3, it's an Omega-6 fat. It's called GLA or gamma linolenic acid, which is also found in evening primrose oil and borage oil. So I often recommend evening primrose oil, fish oil, zinc, vitamin A, and that can be really, really helpful. So I think it's, you know, you don't necessarily take all of them, but all that can really help your overall nutritional status and help your skin health.

It's fantastic.

Also, there's some supplements that can help if people have hormonal acne, particularly women with PCOS. There's a compound from Saw Palmetto, which is an herb used actually for prostate health, and often it has prostate-related names on the label when you buy it. My women, why? I'm like, why are you giving me something called Ultra Prostagen? I don't have a prostate. I'm like, well, it's the mechanism of action we're working on here. Some guy named it, but it's not the actual reason why it works. And if you have the high levels of androgens or testosterone, if you're a woman with PCOS, it literally can block the conversion of testosterone to dihydrotestosterone, which is the thing that tends to cause more problems with acne. And it also is great for fertility, it's great for facial hair, hair loss in the head, a lot of the things that women use this for. are related to this PCOS phenomena. One of the drugs we use called spironolactone is a diuretic that can really help acne because it blocks the testosterone, but also it actually blocks the conversion of dihydro to testosterone to dihydrotestosterone. So, to lower the more inflammatory androgenic testosterone. So, there's a lot of ways to hack this, but you can try the herbs and supplements to diet. If that doesn't work, there's other things to do.

Beautiful. So let's go into some community questions. So we talked about most classifications and groups of people, but for individuals that are in that sort of prime puberty age group, this is a question from the Dr. Hyman Plus group. There's somebody that says that, what are your suggestions to help a 12 year old girl that has and is suffering with acne? She's in middle school, very shy and is struggling to make friends. She has a very limited diet and she's a picky eater. Please help! Exclamation mark, exclamation mark.

I feel bad, you know, being a kid hard enough. Being a young woman today, size is hard enough. Being 12 years old is hard enough. And having acne on top of that, it's rough. I mean, I can relate. I, I basically when I was 13, I got glasses and braces, and that was like the end for me. Till I hit 20 years old, I was like, it was bad. But, you know, I would just tell her the same things we've been covering on the podcast, you know, clean up your gut, do an elimination diet, take the right supplements. get off of sugar and dairy and see what happens. And often that is enough to clear things up for most people. And it might not be that she.

Needs to do a full elimination diet, but like you said, sugar and dairy.

I mean, sugar and dairy, but if that doesn't work, what happens to you is that, and I listed this at the beginning, one of the key reasons besides sugar and dairy is leaky gut. And leaky gut leads to food sensitivities, not true allergies, but food sensitivity. So it might be some random thing like soy or corn or who the heck knows. So someone is doing a more, if you're not successful with the sugar and dairy, to do a more extensive elimination.

For 21 days, like the 10-day detox diet, for example.

Right.

But to start off, maybe sugar and dairy, because those are going to be the biggest ones, getting, especially the kids off of these liquid calories that are there if they're drinking sodas, chocolate milks, other stuff. And it's tough. It's tough. But vanity is a great motivator. And if you can help, you know, young children understand that, like, Literally, let's try this out for like a month or two and you could have a significant improvement in your health. People are willing to do a lot of different things. Okay, great. Next question from our audience. We have, My daughter has reoccurring acne on one side of her face. She is right-handed and it's the right side of her face. I'm assuming that's because she's touching her face on that side more often. She sleeps on the left side of her face at night, water helpful tips, yada, yada, yada. Mark, do you think this idea of touching our face is a little bit overblown in this world? And what are your thoughts on this component?

Well, you know, you know when your dog gets a surgery, they have those cones.

They put cones, right?

Yeah. Give her one of those cones. That might help. But no, just kidding aside, you know, I don't think that's a huge issue. If, yes, you want to practice hygiene, you want to clean your face, you want to get the oils off, you want to, you want, and you want to, I mean, you want to work on your, inside out first, but you also have to work on the outside in. So I'm not opposed to people, you know, working on their skin through various cleansers and even low, low dose benzoyl peroxide can be fine to just help kind of reduce the inflammation. It's very drying, so you want to be careful that Retin-A can be often helpful if people get stuck. But I, I think the key is to actually clean up things from the inside out and not, not be worried about what you're, you know, if you never wash your face, you stick your hand, dirty hands on your face all the time, you have clogged pores.

Yeah, that's a thing.

But. I think that's probably not it for most people.

Yeah, and there's so many like different superstitions and tales and other stuff. When I first met my now wife, you know, sorry, I'm telling all your stories here, Jasmine. When she was just my girlfriend, you know, she would be very sensitive about if I went to go like touch her face, like if you're grabbing her, like give her a kiss or whatever, she just doesn't want me to touch her face.

Yeah.

And I'm thinking like anytime my face touches yours, there's also like oils on my face and they're touching your face, we think, And again, it's so tough because when you're suffering with acne and you don't know what it's coming from, you get panic, right? You get panic and you're like, Don't touch my face.

Don't do this. Don't do that.

Again, it came from my face. She's like, Don't touch my face. Oh my gosh. And it's like, okay, I don't know if that's exactly it, but then when she cleaned up her diet and she got better rest and just taking the sugar out of her diet and having her on a CGM and having that balanced blood sugar, and then that acne that would typically come right before her period, just stopped happening. And she's like, okay, maybe you could touch my face now. It's like a little, you know, now that things are a little bit more under control. All right, let's go to the next question. What is the difference between face acne, chest acne, back neck, back acne, and is there the same solution that Dr.

Hyman is suggesting for all those? There are different kinds of acne, right? So if you're, if you're, if you're have high cortisol and stress, that can cause acne because steroids cause acne. So, Fortisone, prednisone, that kind of stuff, that alone can do it. If you're chronically stressed, have high cortisol, that may be a factor. If you are someone who's taking anabolic steroids or you have high testosterone, that can cause back acne, chest acne. So you see a lot of bodybuilders who are jacked up on testosterone, have like terrible acne over the chest and back. Also, sometimes it's weird stuff, Drew. I had a patient, there's different kinds of acne, cystic acne, because often you get the big cystic stuff, which is nasty and painful and big deep cysts. That's kind of a different kind of acne. And I had this one patient years ago who had parasites and we cleared up her parasites and the cystic acne went away. I was like, wow, this is amazing. So I've seen all kinds of stuff. You know, gut for sure is a big factor. And I think that's the place to start, but also think about hormonal imbalances like excess testosterone, or other factors that are driving excess testosterone, whether it's stress or stress hormones like cortisol and all those things can be really problematic when it comes to acne. So getting your stress level under control, getting your sugar, all the stuff we just talked about how to manage testosterone, but then there's hacks that people get stuck. Yeah.

One other anecdote that I'll toss in is that even though I can have a little bit of goat cheese, if I have a lot of goat cheese, I'll end up breaking out. Another thing that I found out, you were talking about endotoxemia a few years ago. I connected with a microbiologist, Kiran Krishnan from Microbiome Labs, and he was telling me I was having this, after only really suffering with acne in high school, I had this resurgence of my face would break out and I have this redness in my face and I could not figure out what it was. And he was saying that a lot of people don't realize that certain types of high quantity of saturated fats can trigger this endotoxemia reaction. In my case, I was at the time cooking with a lot of coconut oil and I'd add coconut oil to a lot of stuff that I had. And I immediately took coconut oil on my diet. And that inflammation for me, I'm not saying this is for everybody, that inflammation went completely away. Now, that doesn't happen with MCT oil, doesn't happen with other things, but if I have a concentration of butter, people used to do Bulletproof Coffee and other things like that, same type of reaction. So if there's somebody that's out there that can relate and is experiencing this, you may want to look at what Mark was talking about earlier with this endotoxemia and concentrated amounts of certain things. In my case, it was saturated fat. in a very specific amount that was.

Happening, you know, on a regular basis. Yeah, saturated fat isn't for everybody, but it's not bad for most people, but it can be bad for some people. Like anything, right? Totally, like anything. And so I think you have to find out what is your, what is your perfect Goldilocks diet that works for you and it's different for everybody. So, yes, if you take a lot of saturated fats, it can be inflammatory potentially. And especially, and I would just caution, and I wrote a whole book about this called Eat Fat, Get Thin. Saturated fats in a very low starch and sugar diet, a low glycemic diet, usually aren't a problem, but they're deadly and highly inflammatory when you eat them along with starch and sugar, right? So think ice cream, think bagels and butter, right? Think cookies, right? Butter, cookies and flour, sugar. That's where the problem is. So when you eat saturated fat alone without starch and sugar, it's usually not as big of a problem.

For sure. And then some people will just have issues with coconut in general. So that's another reason why it might be willing to try elimination diet if you're having a lot of coconut oil that's there. This is the next question from someone on social media. I have a child that is nine years old who has developed a significant form of acne. What should I be thinking about for a child this young when it comes to recovery? Creams and soaps don't help.

Well, clearly it's not hormonal in the sense of being because of increasing, you know, fluctuations in.

Or also is it? Because if it's, you know, there's these days, like kids are getting, right?

I mean, that's the other thing. Like, as a nine-year-old girl, as a nine-year-old boy, it's a little bit different. But part of the problem is we're seeing a lot of premature puberty.

Right.

And the reason we're seeing it is because of our diet, number one, sugar, for sure, because it increases estrogen. Right? So estrogen will, high estrogen will start to trigger puberty. Second is, is what we call xenoestrogens or foreign estrogens, which are basically toxins that are in our environment. And there's thousands of them that are estrogen mimics. And, and we're seeing a lot of hormonal dysregulation because of these environmental toxins. So I would look for that. But I think ultimately with somebody who's nine years old, it most likely is going to be an inflammatory diet and a gut issue and food sensitivity. So I would start with sugar and dairy, fixing the gut and taking the supplements that I recommend it and that usually will take care of it. The creams and lotions and soaps don't help. It's like trying to like the gasoline's on your fire and one hand you're pouring water on the other, it doesn't make sense. You've got to get to the root cause. And so all the lotions, potions, creams and gels, ultimately are not going to fix acne. They might treat it by keeping the inflammation down or helping to heal the sores, but it's definitely not going to cure your acne. Once you stop using it, it'll come back. So, you want stuff that's going to actually cure it.

In the world of Chinese medicine and other sort of ancient teachings, they'll often say that acne on certain parts of the face might correspond to an organ in the body. Do you give any truth to that? and has it been something that you've ever, you know, dug into yourself?

Well, traditional Chinese medicine is very fascinating. And I don't know if everybody listening knows, but I majored in Asian Studies in college. I majored in Chinese, spoke fluent Chinese, forgot a lot of it. But I guess I'll make my way on a Chinese restaurant, okay? Because that's what counts. And I studied a lot about traditional Chinese medicine, and it's fascinating because everything is connected and everything is connected along meridian lines. and, you know, so how can you, like, stick a needle in your foot and your neck pain goes away, right? It's like that, that, that funny cartoon I used to show, which was this, you know, woolly mammoth and these little hunter gathers throwing Spears at them. And, and, and a spear hits the bully mammoth in the butt. And he's like, wow, man. Hey, Joe, my neck pain's gone. What happened? You know, and I think, you know, there, there's such an interconnected web of biology, physiology, electromatic signals. so, yeah, I mean, there's, there's probably something to it. There's circadian rhythms in our body. And I, you know, I don't think we completely understand it all from a western point of view, but it's, it's definitely a very powerful, cohesive system of thinking. And, you know, I, I thought to explore it. So traditional Chinese medicine may also be very helpful.

So, Mark, I think it would be great to do a little bit of a recap on some of the top key points of, you know, a summary of what we were talking about today. You know, what are the top reasons.

That we get acne and what are the top things that we can do to address it? Yeah, for sure. I mean, the top reasons acne are one, sugar and starch in the diet, flour and sugar, which is 60% of our diet or more. Two, it's dairy and usually modern dairy, not cheaper goat so much, but traditional dairy, big factor driving hormones and acne. A third would be leaky gut and food sensitivities in general, which need to be sorted out on an individual basis, but elimination diet can often be really helpful. And then you can add things back and see what's triggering it. And the 10-day detox is great, but I would do it for three weeks. and it's my book I wrote years ago, but it's still pretty much what I use for clinical care because it's so effective. And then, you know, getting rid of sugar and dairy and healing your gut, great probiotics, all that stuff. There's some really important nutrients that people need. Zinc, vitamin A, evening primrose oil, fish oil, all very, very helpful in terms of regulating immune function, skin health, and then For people who are really stuck, there may be additional strategies around blockers of estrogen to testosterone or inhibitors of testosterone to the bad form of testosterone that can happen in women. So there can be medications or herbs like saw palmetto. So there's a lot of different things we get to use in medicine, but I think that this is usually a very soluble problem. I don't think I've ever had a patient who I couldn't fix their acne, which sounds crazy, but when you understand the joke about the doctor with the thing on the appendix, it's like if you know what to do, it's easy, right? Yeah.

And especially with the most underrated area being just like, again, as you mentioned, look at some of the food sensitivities, dairy in particular, and then focus on starch and sugar, right? Like that already.

Yeah.

It's gonna be so underrated by people.

You know, a colleague of mine, Dr. Val Treloar is a dermatologist and she wrote a book years ago called the Clear Skin Diet, which talks about a functional medicine approach to acne and skin health. And, she's a dermatologist. So, thank God some dermatologists are getting into functional medicine because it's the best way to treat skin problems is from the inside out, whether it's eczema, acne, psoriasis, anything really on the skin often is coming from inside. So that's why I say Beauty starts from the inside out.

Great, Mark. Well, those are all the questions that.

We have for today. Thank you. It's great to be with you again, Drew, on the master class and Dr. Sormaz podcast. For those of you listening, if you have had acne, you should read this out. Listen to this podcast carefully. If you, if you have a friend who needs it, share with them on social media. Tell us how you've handled your symptoms and your acne. What have you done? What's worked? What hasn't worked? We'd love to know. Helps us learn. and subscribe wherever you get your podcasts. And we'll see you next week on the Doctor's Pharmacy. Hey everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter.

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