The Root Causes of Acne and Rosacea Revealed

Coming up on this episode of the Doctor's Pharmacy, even if you are not celiac and even if you don't think you have any symptoms or don't notice any symptoms when you eat gluten, Dr. Alessio Fasano, who's the world's expert at Harvard on gluten, he said everybody who eats gluten creates some level of leaky gut. Hey everyone, it's Dr. Mark here. I'm always talking about the health benefits of wild caught salmon, and it's one of the easiest ways to up your intake of protein and healthy omega-3 fats. And eating it twice a week can cut your risk of a heart attack, stroke, high blood pressure and high triglycerides, but it has to be top quality salmon. And sadly, most salmon you find online or in grocery stores, salmon is double frozen, meaning it's frozen whole, thought out for processing, then refrozen before it's sold to you. This process often results in lower quality fish when it comes to taste and texture. And that's why I love butcher box. Not only do they make it really easy to get healthy meats and like 100 grass-fed beef and organic free-range chicken, but they also partner with responsible Fisheries to Source some of the best wild caught, sustainably harvested Alaskan salmon on the planet. Butcher box is giving new members two pounds of wild caught salmon free, plus $30 off. Visit butcherbox.com/ pharmacy and use the code FARMACY30. That's F-A-R-M-A-C-Y 3-0 at the checkout. Before we jump into today's episode, I'd like to note that while I wish I could help everyone via my personal practice, there's simply not enough time for me to do this at this scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out function Health for real-time lab insights. If you're in need of deepening your knowledge around your health Journey, check out my membership Community, hymen hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website supplement store for a summary of my favorite and tested products. Hi, I'm Dr. Mark Hyman, a practicing physician and proponent of systems medicine, a framework to help you understand the why or the root cause of your symptoms. Welcome to the doctor's Pharmacy. Every week I bring on interesting guests to discuss the latest in the field of functional medicine and do a deep dive on how these topics pertain to your health. In today's episode, I have some interesting discussions with other experts in the field. So let's just jump right in. From traditional medicine, there really isn't an approach to helping heal the skin from the inside out.

No, not at all.

And whether you have acne or eczema or psoriasis or rosacea or any one of the myriad skin conditions that we get, most of them have their root cause inside, not on the topical level.

Exactly.

And often it's the gut.

Yeah, absolutely.

So you mentioned a little bit earlier leaky gut. So take us through from a functional medicine perspective are thinking about the root causes. What are the things that you think about when someone comes to your office and their face is all red and they got all this acne on there and they've got these telangiectasia, these little red lines everywhere and you can see the blood vessels dilated. and they're kind of looking like Santa Claus.

Yeah, exactly. And they also get photosensitivity too, which is the other thing. And the interesting thing is, they can't.

Go in the sun without getting it worse.

And that also ties in with these antimicrobial peptides because it's thought, it's theorized that the Celts, the ones who live in the higher northern latitudes, they don't get as much sun as we do. So it's thought that from an evolutionary standpoint that they benefit by having this. They have a more robust immune system when there's not enough sunshine. and sunshine will actually activate this innate immune system. And that's why sun exposure oftentimes makes it worse, 'cause they produce more of these antimicrobial peptides, and then those antimicrobial peptides have to get processed, and in the process of breaking them apart, the immune system then starts responding to it. So that's why there's sort of a.

Photosensitivity aspect to it. And what are the other sort of.

Things you think about when someone comes to your office with rosacea? Well, one of the things I oftentimes look at is their vitamin D levels. Vitamin D is part of the immune system, and it's tied in with intimately with the antimicrobial peptides system in the body. So oftentimes patients who have this have low vitamin D levels. We'll look at the microbiome testing to see if there's any evidence of dysbiosis, bacterial overgrowth testing, the SIBO testing, checking for hydrogen and methane. I mean, probably the majority of patients who I see of rosacea have problems with bacterial overgrowth. Other thing is low stomach acid. which also promotes and contributes to bacterial overgrowth. So checking for the patients, sometimes these patients are also on PPIs. Acid blocking medications. Absolutely. Because we have acid in our stomach to help us to digest food, it's also there to decrease the amount of bacteria higher up in the colon. So it's good to have stomach acid.

Yeah, because if you don't have stomach acid, then the pH of your small intestine changes, becomes more alkaline, and then bugs grow in there that wouldn't necessarily grow. Yeah. And that's when you get this overgrowth of bad bugs in there. And it can be what we call SIBO, which is small intestinal bacterial overgrowth, where bad bugs migrate up from the lower intestine into the small intestine. Then when you eat food, you get bloating, distension. It causes leaky gut. You end up causing damage to the lining of the gut and food particles and bacterial toxins leak in and create inflammation throughout the body and on the skin. So, you know, leaky gut can cause hundreds of different manifestations, one of which is rosacea. And unless you think about that and know how to treat it, you may not be able to be successful with it. There's also another condition that I've seen, Todd, in a lot of my patients called SIFO. SIFO.

Small intestinal fungal.

Small intestinal fungal overgrowth. And a lot of people talk about it as Candida, but there's many, many species of yeast and fungus. And so what I found often is that treating the gut through addressing the bacterial overgrowth, the yeast overgrowth, healing leaky gut, dealing with the food sensitivities makes a profound impact. And a lot of times it is food sensitivities that can trigger. I mean, for example, gluten we've talked about on the show, that is one of the biggest drivers of leaky gut. And even if you are not celiac, and even if you don't think you have any symptoms or don't notice any symptoms when you eat gluten, Dr. Alessio Fasano, who's the world's expert at Harvard on gluten, he said, everybody who eats gluten creates some level of leaky gut. Now, most people kind of handle it.

Right. Transient leaky gut.

Exactly. So I don't know. Like, it's probably not a good idea to eat that much gluten because of the potential to create leaky gut and how that is linked to so many chronic diseases, including weight gain, diabetes, cancer, heart disease, Alzheimer's, autoimmune diseases, allergies, act. I mean, you just name it. Depression, all this stuff. is connected by leaky gut. So I really, I think, you know, getting a very different thinking about this is key. And you did, you talked about the stomach acid, you talked about the acid blockers, you talked about maybe other things that, you know, are relevant in the gut and fix certain infections like H. Pylori, which is a common bacteria that causes ulcers, also has been linked to H. Pylori and food sensitivity. So how do we approach these patients when they come in? What are the kinds of things that we would do from a diagnostic point.

Of view that you wouldn't get when you went to the dermatologist? Well, from a diagnostic standpoint, again, I would do testing for, you know, leaky gut, I would do intestinal permeability testing, checking for antibodies to zonulin with the Cyrex testing that we do, Cyrex array number three.

So that's basically, there's a test that we do at the center for, at the Ultra Wellness Center here in Lenox, Massachusetts, where we're recording live, is Cyrex testing. It's a lab that looks at antibodies that you produce against these proteins that are in your gut that come from gluten or even from bacteria. And so if you're creating a lot of antibodies to these proteins, it's clear that they're getting across the lining of your gut, leaking into your bloodstream and causing an immune response, which is not only local but systemic.

Right, and there are other ways you can actually measure zonulin in the blood and you can measure it also in the stool. And that's only like a snapshot in time. So you can develop leaky gut for, you know, a couple hours or a day or so, but if it stops, then you're all fine. The antibodies against zonulin is the one that tells you there's this chronic leaky gut, which is really more valuable. Because if I gave you a shot of tequila, then, you know, an hour.

Later, measure your zonulin, it's going to go up.

Okay, where's the tequila? Sounds good. Right.

So.

So that's why I think that the. The testing for the antibodies against zonulin.

Is even more valuable in these patients with chronic conditions. And one other kinds of test, besides the. The. The zonulin and the lipopolysaccharide test that we do to look at the antibodies.

Against these proteins in the gut that come from a leaky. We'll do the small intestinal bacterial overgrowth where we measure the production of fermentation products. So hydrogen and methane are gases that are normally produced in the body. When people have small intestinal bacterial overgrowth, those will be produced at higher levels. So we can check that and over time, or I think the test that we do is a three hour test. So you measure baseline hydrogen methane, check it at intervals of about every half hour, and you do that over a three hour time period. And that can tell you definitively, do you or do you not have bacterial overgrowth and how bad is it?

And it's a predominantly hydrogen.

Or is it methylation?

So essentially what you're saying is that when we eat foods, humans don't produce gas. It's the bacteria that are fermenting the foods we eat that produce the gas. So if you go bloated or distended or you're passing gas, it's not you. You can blame it on the bugs. But the problem is that we don't know how to regulate the bugs and get a healthier ecosystem. And that is what most physicians never were trained to do. And it's the foundation of functional medicine. It's the foundation of our practice here at the UltraWellness Center where we really dig into these issues and we look at bacterial overgrowth. We look at fungal overgrowth. We look at a leaky gut. We look at food sensitivities. We'll do other testing. We'll look at whether you're reacting to gluten or dairy or eggs or other foods.

And, and it's really helpful in, in drilling down on what's really going on with people. Absolutely.

Yeah.

And that, you know, we're talking basically producing gases. That's basically a fermentation process. And normally fermentation happens lower in the colon. That's in the, in the colonic area. The ant, when it was more of an, what's an anaerobic environment or a lack of oxygen.

That's normal for that to be happening.

But when that process is taking place, higher up in a different neighborhood, it's not a good thing.

Yeah, and I mean, you want your upper intestine to be sterile and... Or mostly sterile. Mostly sterile, and when all that bacteria migrates up there, it's just a bad situation. And when we take acid blockers, when we are low in magnesium, which half of us are, when we're under stress and our gut motility is slow, when we've taken lots of antibiotics and it screws up our whole system in there, all these are reasons why we get these bacterial overgrowth issues and they're super common and they're easy, relatively easy to treat with functional medicine. Now, the other thing we do is look at stool testing, right? So we look at not just the proteins from leaky gut or we look at the food sensitivities or bacterial overgrowth, gas production, but we actually look at the poop. So what are we looking for in.

The poop that helps us figure out what's going on? Well, there's a lot of things, you.

Know, there's gold in there.

It really is. It's- Gold in them there hills. Gold in them there hills. Yeah, so a lot of information can be determined by doing microbial analysis. So you can look at the overall balance of bacteria. So there are, you know, everybody's got hundreds of different kinds of bacteria in the GI tract. And we can measure those using DNA PCR analysis and we can do quantitative. We can measure how many there are of each different species. Look at ones that are normally found, look at ones that are found in the gut, but normally they want to be at low levels. look at bacteria that are associated with autoimmunity. So things like Citrobacter, Klebsiella, Salmonella, et cetera. We can look at now analyze for yeast overgrowth, various forms of yeast, and then also microbial markers of inflammation, things like calprotectin, looking for fat. So you can get- Enzyme function. Exact enzyme function, butyrate, checking for butyrate.

Short-Chain fatty acids, indicators of healthy ecosystem. So, you know, what you're saying is that, you know, traditional sort of microbiome testing, they just look at the, the genetic material of the, the microbiome, and they can't really test everything, although they can do some really extraordinary tests now. But there are, there are kits out there where you can look at your microbiome, but it, it's far more than just what bugs you have in there. It's what they're doing. And so we look at the, the result, the function on the ecosystem. We look, like you said, at the enzyme function. Are you absorbing your food? Is there inflammation? Are you having good bugs in there that are producing the super fuel for the gut, these short chain fatty acids that are so important. Oh, huge. You have the right balance of gut, are you missing some key bugs? You have overgrowth of bad bugs, you have yeast, you have parasites.

And it's such a much more comprehensive stool test that we do here at the Ultra Wellness Center. We were talking earlier about Delta sleep and the interesting thing is that when you have good bugs in the digestive tract and you're eating in a fiber.

In your diet and you're producing higher levels of butyrate, that has an effect on the brain and also improves sleep. That's amazing.

Yeah. Yeah.

So you have to have your, get your poop together to sleep better. I got it. Okay. That's a good, good strategy. It's better than taking the Ambien.

Yeah.

All right. So we also look at, you know, other things like omega-3 fats and, and other fats because a lot of inflammation come from not having the right balance of fats in your body.

Yep. Yeah.

And, and I think, you know, so, so. When you have a patient come in, what are the steps you would take initially to treat a patient with rosacea from a functional medicine perspective?

Again, taking the history is the big one. I always will ask people, what's your ethnic background? A lot of people say, I'm white. It's like, are you Irish, English, German, Jewish, Russian, whatever? Because rosacea is typically found in light-skinned, fair-skinned people. And from a genetic standpoint, they are the ones who are more likely to have that. It's just an interesting part to have in terms of the history. and then I'll just ask them, you know, what is it you're eating? Are you eating a standard American diet? How much alcohol are you drinking? How much stress do you have? Stress also. Caffeine. Caffeine can play a role.

Spicy foods.

Yeah, those are all things which can sort of, you know, it's like adding gasoline to the fire because literally Rosacea is the skin on fire in the facial area. But doing the testing for essential fatty acids, making sure that they have the right balance of the essential fats in their diet, a lot of people have too much Omega-6 which tends to be more pro-inflammatory lack of the Omega-3s one of the oils, I don't know if you've used it, that I found it very helpful with patients who have rosacea is borage oil and even criminal's oil. They tend to be very, they help to dampen down that inflammatory response.

And that's a very key Omega-6 that people don't think about much, but it's called gamma-linolenic acid, which is a very powerful anti-inflammatory it's not like the Omega-3s, but it's sort of like the Omega-3s, but on the Omega-6 side. Exactly. And it's something we really have a hard time getting in our diet. It's from like Borage oil and a few other things, but evening primrose oil. So yeah, that's very powerful, I agree. And I also think that when I see these patients, I also think about looking for other clues. Do they have yeast issues? Have they been in lots of antibiotics? Are they on acid blockers which caused yeast overgrowth? Do they have other fungal issues? Do they have dandruff? Do they have anal itching? Do they have thrush or a white coating in their tongue? do they have vaginal yeast infections? Do they have other skin markers of yeast like little tinea or other kinds of things? So you'll see often a pattern of other issues around fungal stuff. I'll check for H. Pylori, I'll check again all the tests we did talk about and see what's really going on. And then from the treatment point of view, you start with an elimination diet with an anti-inflammatory diet, right?

Exactly, yeah. Putting patients on an anti-inflammatory elimination diet 80% of the time, doesn't matter what they come in with, they'll actually get better. Getting them off of the pro-inflammatory foods and then putting in foods which are anti-inflammatory, cold water fish, sardines, wild salmon, the essential oils like evening primrose oil, help to sort of dampen down that inflammatory response.

Yeah, I agree. I think we don't understand most of us how powerful food is as medicine and how it can drive tremendous amounts of inflammation throughout the body. And, you know, obviously, if it's on your skin, it's visible, but there's also.

Invisible inflammation that you're not seeing that's driving all the chronic diseases. And, is that you actually just triggered a thought because there's actually a paper that says if you have rosacea, you have a higher instance of Alzheimer's disease.

Oh, wow. So, it's not just a cosmetic issue.

It's actually systemic. You have a red face and a red brain that's on fire. Exactly.

Yeah. I was sort of blown away by that. That's fascinating.

Yeah.

Especially in women. It's actually more common in women. so, so you, you know, you advise people, the obvious things, cut out the alcohol, the caffeine, stay away from the Sun, stay away from spicy foods. We also tell them stay away from gluten, which triggers leaky gut, often dairy. You, you, you actually add in all the anti-inflammatory foods that, that are important, the all the phytochemicals from plant foods and turmeric and Ginger and garlic and Rosemary and all these powerful foods that can really help to reduce inflammation. And, and then we often directly treat the issues that are going on. It could be leaky gut. So we, we give them a gut repair program. This could be fungal or bacterial overgrowth. So we'll, we'll take care of those with either herbs or antibiotics or antifungals. And you'll see these patients really dramatically improve when they change their diet and they resort their gut. And then sometimes we'll use, like, things like even primrose oil.

I found that digestive enzymes and hydrochloric acid. Absolutely. Often are really helpful, too.

Yeah.

I've been so, I've been surprised at how many people have a, what I would call a relative lack of hydrochloric acid in the stomach. stomach. I was adventuring to say that, you know, the majority of people don't have too much acid. They have not enough acid in the stomach. Yeah.

Well, that's interesting because the third leading category of drugs are the acid blockers, like prilosec and prevacid and pepsi and all these other drugs, these Nexium, mass effects. I mean, they're just, like, out there everywhere, and now they're, now they're over the counter. And anybody. Exactly.

Yeah.

I mean, I, I just, I, we've talked about this before on the podcast, but when I was in medical school, the drug reps came in because it's drugs that just come out and they're like, listen guys, these guys, these drugs work. They're great. They will help you with ulcers if they're really bad.

You don't want to keep anybody on.

It for more than six weeks. Right, that's a huge, that big red flag. It was a stomach acid, it's really bad long term. These are the drug reps telling us this. And now it's like, people are on it for decades and it causes B12 deficiency, magnesium deficiency, zinc deficiency. Osteoporosis. Osteoporosis, pneumonia, bacterial overgrowth, irritable bowel syndrome. When you get rid of your heartburn.

But you got all these other problems.

Yeah, that's true. And then it's one of those drugs that's so sneaky because it's addictive. Once you get on it, it's hard to get off it because it causes this rebound. So when you suppress the stomach acid and you stop the drug, the acid production goes crazy, which makes you feel horrible. And then you go, I need the drug, but you can actually taper it.

Down and use other strategies to help people get off it. And you bring up a really good point because a lot of the pharmaceutical medications, especially some of the psychotropic. So the antidepressants are like that too. The PPIs on the antidepressants, when you try to get off of them, you get this rebound process. The body tries to get back into balance and it can be very difficult. So you've got to go low and slow when you're trying to taper off the PPIs or taper off antidepressant psychotropic meds.

Absolutely. Amazing. So what cases have you recalled about Rosacea that you want to share that can give you all a sense of this?

Yeah, well, I had a patient who came in and she was a undiagnosed celiac, not just a gluten sensitivity, she was an undiagnosed celiac. She was Irish and she was having a standard American diet and she was self-medicating for her heartburn with over-the-counter acid blocking medications. It had a lot of bloating type symptoms and came in and, you know, her major complaint was her skin, but she had all these other things, but her big thing was how I look, right? So, people are vain and- It gets people's attention. Exactly, right. And then when I did a dive into her testing, it turned out that she was deficient in her essential fatty acids, especially the gamma-linolenic acid. She had a lack of stomach acid because of the PPIs. You can actually measure a test, blood test is a commercially available test called Gastrin. and gastrin levels will go up when you block acid. So, and that's actually one of the tests that I actually like to use when I have patients where I'm trying to get them off of a PPI, because the higher the gastrin level, the more difficult it will be to get off the PPI. And that's sort of like, it'll tell you how easy you can get off of acid blockers.

That's a PPI.

Exactly. And then she also had low vitamin D levels. I mean, you know, we spend a lot of our time clothed and indoors, so we don't get an way enough, enough Sunshine. That's, that's one of the big things and Low vitamin D, you don't just fix low vitamin D. This is one of my, I get up on my soapbox all the time here is you don't just fix low vitamin D by taking vitamin D. Vitamin D deficiency is basically a sunshine deficiency. There are certain times when there can be other causes like you might have fat malabsorption that can cause low vitamin D or you may have problems with the synthesis because of lack of skin oils, which when you get exposed to the sun. But by and large, low vitamin D levels is related to sunshine deficiency. And it's, it's that, you know, low vitamin D is not the problem. It's a symptom of another problem.

Yeah.

And the immune system is also benefited by Sunshine exposure, healthy sunshine. I think you said you're going to be, you enjoy going to the, the tropics now and then.

Yeah.

Caribbean, Hawaii, whatever. And we, we also feel good. It's also, I, this is another thing that I find fascinating, is that there is a a condition which is called sunshine addiction. You know these people who are like suntan addicts? Well, it turns out that our bodies actually produce endorphins when we are exposed to the sun. So, there's a feedback mechanism.

That's incredible.

Oh, yeah, yeah. There's a compound, it's called pro-opiomelanocorticotropin hormone. And, what it means is that our bodies give a reward when we're in the sun. so we feel good. We have these feel-good molecules, these endorphins, that make us want to get the sun.

Oh, that's interesting. That's why I love going in the sun.

Exactly. No, and there are these people who-.

I always feel so good when I go to the beach in the summer.

It just makes me so happy. Exactly. And the interesting is it actually, you can get addicted to the sun. And that's like, it's like you can get addicted to food. I mean, your body needs food to survive and your body actually needs sunshine to survive. So nature has built in these feedback.

Mechanisms so that it encourages us to do it.

Do it.

That's incredible. Yeah.

Isn't it?

Wow. So what happened with this patient? What did you do for her?

Well, I did a lot. I mean, I had her work with our nutritionist and got her off of her standard American diet. I treated her bacterial overgrowth. She had a significant SIBO test, so I treated that primarily with herbs. A lot of people will use antibiotics, things like rifaximin or Xifaxan for SIBO. I actually find that I do just as well using antimicrobial herb preparations. I supported her stomach acid using betaine HCL. Some patients don't respond to that. They don't tolerate as well. So sometimes I'll use things like apple cider vinegar. And then got her fatty acids up, gave her a little bit of borage oil and a combination of that. And then also just told her to get some healthy sunshine. It doesn't necessarily mean that you need to go out and sunbathe or go to a suntanning booth, but just getting healthy sunshine. can help with down regulating the immune system. And interestingly, just off topic, but with COVID there are some really interesting studies that giving high dose vitamin D helps with COVID infections. And so COVID, it actually, or vitamin D when it's at high enough levels, actually helps to keep the immune system in balance. It keeps it from getting out of control.

It controls hundreds of genes that regulate immunity and inflammation. It's pretty amazing. vitamin. It's more like a hormone.

Exactly. Exactly. It's like a hormone. And it's also, it actually likes us. Acts like a steroid, too. It's. Yeah, it's a cholesterol molecule. Moyity. And I oftentimes, when, if I'm gonna.

Come down with a cold or flu, I'll up my dose of vitamin D, especially in the winter. Absolutely. It's true. And I, when I feel like something's.

Coming on and I take, like, 50.

000 units for three or four days and I never, I never get sick. Yeah, it literally goes away by the next morning.

It is.

It's pretty powerful. We all know how crucial good sleep.

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Take care of your sleep health and ultimately your well-being. If you have skin issues, if you want to keep your skin healthy, you have to learn how to take care of your skin. Now, when you take the stuff that dermatologists give you, typically like steroid creams, peelers, antibiotics, they actually can cause more problems down the road. They can screw up your gut, like antibiotics are given for acne, and they actually make the problem worse. And most dermatologists somehow don't realize that skin problems are a sign of what's going on inside. whether you have dry scaly patches, for example, that could be a sign that you're having Omega-3 fatty acid deficiency, or whether you're having acne, which can be caused by insulin resistance or eating dairy, or whether you have dry skin, it could be related to thyroid function, it could be a sign of food sensitivities, little bumpy patches in your arms can be a sign of vitamin A deficiency. So, it's really important to understand how the inside affects the outside. side. Also, we eat a diet that's really high in refined oils and they're out of balance with our omega-3 oils. And we also eat trans fats that are still in the diet. And those also cause skin inflammation and can cause all sorts of issues. And inflammation doesn't just affect your skin, but affects everything. It causes heart disease, cancer, diabetes, dementia, it can cause behavioral issues, anxiety, depression. And so when I see people with inflammatory skin conditions, like dermatitis, right? Eczema, acne, rashes. It's always because there's some inflammation on the inside, not just on the outside. So what is the functional medicine approach to getting healthy skin? Well, it's figuring out how to reset your biology by focusing on the root causes of disease, the medicine of why, not what disease you have, but why do you have it? You know, think about functional medicine doctors. They're more like soil farmers. Instead of growing vegetables like or monocrop corn or soy or wheat, they basically take care of the soil. When you take care of the soil, then plants are healthier and you're healthier. So a healthy soil means disease can't really spread. We call this the biological terrain in functional medicine. You know, Louis Pasteur talked about how disease was caused by pathogens, but actually it's often related to what the terrain is, the health of the so when you use, when you use an approach of functional medicine by dealing with the root causes, when you look at the health of the gut, when you look at nutritional status, toxic exposures, Etc. You actually can change those things and lead to a dramatic Improvement in your skin health. I see this all the time with my patients. I'm not a dermatologist, but I treat people with all kinds of health issues and their skin gets better, or I treat people with skin issues. using a functional medicine approach and they get better. So it's pretty powerful stuff. So what are my strategies for keeping your skin healthy? It doesn't start with better cleansers or beauty products or all the stuff that people put on their face. It really starts with getting rid of the crap. Getting rid of sugar and starch processed foods. You know what's interesting is that sugar is one of the biggest cause of acne. It's also the biggest cause of inflammation. It can cause yeast overgrowth in the gut, which can lead to eczema, for example. When sugar sticks to amino acids that are in collagen and elastin, in your skin, for example, they produce something called advanced glycation end products or AGEs. They age your skin and they age your other organs. There's lots of ways to get rid of it. I wrote a book on how I help people detox from sugar called the Blood Sugar Solution 10-Day Detox Diet. It's a great book. book was a bestseller. It's really easy to implement and it's super powerful and you can get rid of sugar and processed food in 10 days, get rid of all your cravings and reset your biology and you'll see within a very short time your skin starts to clear up. Also, food sensitivities are a big factor when it comes to bad skin. It's not necessarily an allergy, but it's a sensitivity like dairy, for example, is hugely impactful with acne. And I know when I eat cow dairy, I tend to get acne. It can be also trigger for eczema for many other things. it can be linked to autoimmune diseases, to allergic disorders, psoriasis, all can be linked, for example, to gluten. So gluten can cause a lot of skin disease. In fact, one of the diagnostic features of celiac disease is something called dermatitis herpetiformis, which is a horrible condition of skin which causes all kinds of herpes-like bumps and blood blisters on your skin, but it's coming from gluten. coming from your gut. So doing the blood sugar solution, 10 day detox diet is essentially an elimination diet. It can help you get rid of those food sensitivities. The next thing you have to do is work on your gut. I know I'm feeling like a broken record, but the gut is the seed of your health. And when you have a healthy gut, you have healthy skin. And it has huge effects, driving inflammation, oxidative stress, affects your blood sugar control. So if you have a imbalance in your gut. You might not even have symptoms, but it can really be a factor. So, if you suspect leaky gut or other gut issues, I encourage you to do my gut repair program that is included in many of my blogs. We'll link to them in the show notes here. But you can also work with a functional medicine doctor to actually get your body in balance again and to do the right kinds of stool tests and to heal your gut. The next thing is you need Omega-3 fats. Your skin is so critically dependent on Omega-3 fats for so if you have dry skin, itchy skin, flaking skin, scaly skin, scaly patches, it could be the sign of an omega-3 fat deficiency. So you want to increase those by eating wild-caught small fish like salmon, sardines, herring, mackerel, anchovies, and also take omega-3 fat supplements, really important. Also make sure your nutritional levels are good. Lots of nutrients play a role in skin health. if zinc is low, for example, it can contribute to eczema, acne, and other rashes. Vitamin D plays a huge role in things like psoriasis and acne. So get a good multivitamin, good fish oil, good vitamin D. That'll cover most of it. Also, getting your blood circulation going is really important. Sweating, exercise, sweating helps remove toxins. Sauna, steam masks, great for your skin. One study found that regular sauna has great impact on skin physiology. get the toxins off your skin with sauna or steam. You wash with soap, use a hot shower because your toxins basically come on your body when you're in those saunas and from being released from your fat tissue. So you want to use a scrubber or brush or hot soap. Also, sleep's important. If you're having poor sleep, it increases aging, it diminishes barrier function, lowers the quality of your overall health and you basically when people don't sleep you can see how bad they look. So sleep is really pretty important. Eight hours sleep is key. Stress also very important. If you have emotional stress it can really make skin worse in psoriasis or eczema. People get hives when they're stressed. So really important. I recommend meditation. I have an ultra calm CD which is a great way to meditate and get rid of stress Also, make sure you're watching your skin products. Stop using all these creams and cosmetics that contain chemicals like parabens, petrochemicals, lead. Use the Environmental Working Group database called Skin Deep to identify toxins near products and find ones that actually have no toxins that can be great for you. Also know that drugs and chemicals are absorbed through your skin, so anything that goes on your skin gets absorbed. So be worried about it. And, you can go to the Environmental.

Working Group page at ewg.org.

And see how to reduce your exposure to environmental chemicals.

Acne is the number one skin condition in the United States. So it's the number one issue that people in the United States are dealing with in terms of their skin. As you mentioned, 50 million Americans are dealing with this. And we know that it's more common when we're going through puberty, when our hormones are shifting, we often will see acne in the adolescent age group. but we're seeing more and more acne in adults now as well. And that is definitely increasing. You know, I remember I was having a conversation with my daughter about skincare products, you know, and okay, what's the best thing to use for my skin? And all of a sudden I realized even though we had been, she'd lived with me her whole life, you know, I don't think I ever said this, I said, what you're eating is so much more important than what you're putting on your skin.

Yeah.

You know, what the, the food that you're putting in your mouth is so much more important than what topical things you're putting on your skin. And so it made us start to have this conversation, which I thought I was saying all the time, but that I think sometimes people don't realize or understand or the connection is not made, that how important what you're choosing to eat every minute of the day, how much that impacts your skin.

Yeah, I mean the traditional medicine focuses on the outside in. What stuff you can slather on your face, what creams, potions, lotions, or maybe taking antibiotics, which is a whole problem we're going to talk about in a minute. But most of our skin health comes from the inside out. Yes. So if you want great skin, if you want glowing skin, if you want clear skin, if you want to get rid of your acne, if you want to get rid of your eczema, if you want to get rid of your psoriasis, if you want to get rid of, you know, rosacea, all these things come from the inside out. And traditional dermatology focuses on the outside. in. And it doesn't really work that well most of the time, even when you work on the outside in. And it's difficult, it's expensive, these medications are absorbed. You know, you basically, my rule is if you wouldn't eat it, you shouldn't put it on your skin.

And a lot of times with the topical treatments, whether it's, you know, steroids for eczema or topical antibiotics for acne, they can work in the short term, but in the long term, they disrupt your skin and make you more prone to getting it in the future. For example, we know both topical steroids and topical antibiotics are going to get rid of that really important layer of good bacteria that's on our skin.

So wait, you have a microbiome on your skin as well?

Dr. Yeah, it's kind of cool, right? Not only in our digestive system but lining our skin. And so those medications, though they can be helpful in the short term, in the long term, they're damaging, they're getting rid of all of those good bacteria, which are really important first line of defense. And so then you create a dysbiosis or an imbalance in the good and bad bacteria on your skin, and then that just makes you more prone to getting more acne in the future. So it may be okay in the short term, but it's not getting to that underlying root cause.

It's true. And so we put on antibiotics on the skin, We put on these agents that dry it out like benzoyl peroxide, which are most of these acne products. And if that doesn't work, we give people oral antibiotics, which not only disrupts the facial microbiome, but also the gut microbiome. And what we know now in functional medicine and in medicine in general, if people paid attention to the research on acne, is a lot of this starts in the gut. So if I see someone with skin problems, the first thing I think of, what's going on in their gut.

Absolutely.

What's going on with their food that they're eating, with inflammatory foods, with food sensitivities, with foods that trigger hormonal responses, with foods that increase something called insulin resistance. So tell us about the pathology and the pathophysiology of acne because it's very interesting because we often just think it's.

Like a topical thing but it's really not. Yeah, I mean one of the things we know with foods is that when you eat foods that are really refined and processed, foods that are high in sugar and refined carbohydrates, you'll get a spike in your blood sugar and you'll often get that spike in insulin after you get a spike in blood sugar, right? So you eat food, your blood sugar goes up, the body makes a lot of insulin and that spike in insulin and blood sugar will cause a follicular hyperkeratosis. Wow, that's a big word. I know. Which just means that there's an in the follicles of the skin, the skin's not turning over as well as it should. And so cells get stuck in the skin, and then those stuck cells can get more inflamed and acne can get produced. So one of the major things we always start with is pulling away the refined and processed foods and the sugary foods.

And starchy foods.

And starchy foods, right? Anything that's gonna cause that insulin spike spike, you can really see signs of insulin resistance on the skin in so many different ways.

It's like pre-diabetes, right? So you have to make sure your blood sugar goes up, your insulin goes up, and it creates a vicious cycle.

We'Ve talked about so much, which is this pre-diabetes that affects one out of every two Americans. Yes.

Right. Right.

And so their insulin is higher than somebody who doesn't have insulin resistance, and that high level of insulin causes a lot of shifts in the skin. It causes that follicular hyperkeratosis that causes the acne. It can cause more skin tags. It can cause something called acanthosis nigricans, which is this darkening of the skin folds, like in your neck and in your armpit. And so you can, by just examining somebody right away, you can get a sense of do they have insulin resistance or that pre-diabetes state because it shifts the growth factors, the high inflammation from eating these high sugary foods causes changes in your skin.

We know that, for example, PCOS, which is polycystic ovarian syndrome, it's a common condition that affects women, that causes infertility. We're going to talk about that on another podcast. It causes acne, it causes really screwed up menstrual cycles, and it causes hair growth. And we think of it as a ovarian problem. It's not, it's a mouth problem, it's a fork problem, it's a dietary problem.

Often, yeah.

It's caused by insulin resistance and the consequences of that are the acne and all these screw up hormones. So when women have a lot of sugar, it actually can increase their testosterone, which causes acne and it causes hair growth and it causes infertility. So the treatment isn't heavy duty drugs and hormones, it's actually changing your diet.

Which is amazing to see. we know that when we pull away those refined and processed foods and the sugary foods, most of our patients, so many of our patients see great improvement in their acne right away.

Right away.

Right away.

So sugar, starch, processed foods, they gotta go. And then there's another food that is really common in this country and it is a huge driver of acne.

Yeah, the dairy.

Yeah, yeah. Dairy.

I mean, because dairy is, you know, all of our dairy food, our milk, our cheese, our ice cream, you know, all of that is very high in hormones.

There's 60 different hormones in milk. And these are not added like growth hormone. These are just naturally occurring hormones. Why? It's a growth food for calves. It helps them grow. It helps them grow, right? So it's got a lot of factors.

That are hormonally active that drive growth. Yes. And we know that those growth factors can stimulate acne in some people. You know, not everybody, but for some people, they're more sensitive to them and they definitely will cause more acne.

Actually, I'm one of them. I'm one of them. If I have dairy, I get pimples. So if I know I'm going on a TV, I can't eat dairy. I don't usually eat dairy, but if I have sheep or goat, it's a little different. It's not as inflammatory for some reason. But if I have regular dairy, you.

Can count on me getting pimples. And I'm like 60 years old to get pimples from dairy. Absolutely. And I think it depends, like the question of sheep or goat, I think it depends on the person. There's some people that it really, all types of dairy bother their skin and for other people there's some that is better than others. And what we know is sometimes the testing, like the food allergy testing or food sensitivity testing, doesn't always pick it up. I mean, we do it often, but there are times when we get a negative test result but even we still pull it away and people's skin improves.

So, this isn't like an allergy necessarily.

Not necessarily. It could be.

Like you said, all the hormones in dairy too. But there's another category of things which are food sensitivities that do drive inflammation and drive leaky gut and can drive acne that are independent. So, we've got sugar, we've got dairy, and we've got this other category which is sort of more amorphous, but it.

Is a factor in a lot of people. Absolutely, absolutely. So, there's so many ways, and I always say this, this. There's so many ways that somebody can react to food, right? You can have, and people get confused all the time because they get one negative report and they say, oh, then I must be fine to eat that food, right? You can get an immediate reaction to food or an IGE. You can get a delayed reaction to food or an IGG, but you can also have a food intolerance. There's just so many ways you can react to food.

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Thank you again and we'll see you.

Next time on the Doctor's Pharmacy. This podcast is separate from my clinical practice at the UltraWellness Center and my work at Cleveland Clinic and Function Health where I'm the Chief Medical Officer. This podcast represents my opinions and my guests' opinions, and neither myself nor the podcast endorse the views or statements of my guests. This podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. you can come see us at the Ultra Wellness Center in Lenox, Massachusetts. Just go to ultrawellnesscenter.com if you're looking for a functional medicine practitioner near you, you can visit ifm.org and search find a practitioner database. It's important that you have someone in your corner who is trained, who is a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health. Keeping this podcast free is part of my mission to bring practical ways of improving health to the general public.

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