THE ROOT CAUSES Of Acne & How To Prevent It | Mark Hyman

Acne is a state of inflammation. If you want to get inflamed, eat sugar. Getting off the inflammatory foods is critical.

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 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 'cause I think I really fixed my gut a lot. But if I say 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, I had a big one on my nose. So I would just know. 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 the 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 people are the same genetically, 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 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 it 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 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 goats milk, for instance. Yeah, goats 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 with 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 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 Tryptonite. So I'll try it. Okay. Send me the ice cream. He sent me, like, five flavors of ice cream. I tried. 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 was—I was like really surprised because normally I would get people.

Dr. 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. Dr. Huge. Dr. 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 for some people? Dr. So acne is a state of inflammation.

Right?

Inflammation is anything that's red hot, swollen and tender, right? Which is a pimple. And 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 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 process 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, you know, maybe it's 90 or 100%, 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 going to get acne or anybody who eats sugar is going to get acne. But 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 if you want to get inflamed, eat sugar. Essentially, 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 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 this is important for people to 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. So 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 know, 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, and, 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, they 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 weight.

She wasn't overweight. She was classically pre-diabetic, but it still made a difference, right?

Exactly, 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, 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. 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. 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 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.

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?

I kind of laughed 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, the 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 inevitable. I mean, it's not like there's a design flaw in humans, especially in women, where 75% have PMS. That's just insane to think that that's normal. But it's sort of normalized in our culture. It's like, oh, 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 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 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 them a bill, taking 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 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, you know, 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. is 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, 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 on 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 dihydrotestosterone 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, He 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 is hard enough. Being a young woman today's side 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 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 through 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. It's 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's 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. What are 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 surgery, they have those like cones. Cones, right?

Yeah.

Give me one of those cones. That might help. But no, I'm just kidding aside, you know, I don't think that's a huge issue. Yes, you want to practice hygiene, you want to clean your face, you want to get the oils off, 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 working on their skin through various cleansers and even low dose benzoyl peroxide can be fine to just help kind of reduce the inflammation. It's very drying, so you're going to be careful that Retin-A can be often helpful. People get stuck, but I think The key is to actually clean up things from the inside out and not be worried about what you're, if you never wash your face and you stick your 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 different superstitions and tales and other stuff. When I first met my now wife, 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.

You get panic and you're like, don't touch my face. Don't do this. Don't do that. Again, I came over your face. She's like, don't touch my face. Oh, my face. And it's like, 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 of 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 cortisone, 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, 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 like my face would break out and I'd 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 like a lot of stuff that I had.

Yeah, yeah, yeah.

And I immediately took coconut oil out of 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 like a concentration of butter, you know, 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. Totally.

Like anything.

And so I think you have to find out 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 fluctuations in... Or also is it?

'Cause 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, 'cause 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, 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, and a gut issue and food sensitivity. So I would start with sugar and dairy, fixing the gut and taking the supplements that I recommended, and that usually will take care of it. The creams and lotions and soaps don't help. It's like 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 like 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. I don't know if everybody listening knows, but I majored in Asian Studies in college. I majored in Chinese, spoke fluent Chinese. forgotten a lot of it, but I guess I'll make my way in 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's 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-gatherers throwing Spears at them and. and a spear hits the bully man within the butt and he's like, wow, hey Joe, my neck pain's gone, what happened? And I think, you know, there's such an interconnected web of biology, physiology, electromagnetics, signals. So yeah, I mean, there's probably something to it. There's circadian rhythms in our body and I don't think we completely understand it all from a Western point of view, but it's definitely a very powerful cohesive system of thinking. And, you know, it's not bad 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? For sure. I mean, the top reasons we get 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 the, you know, this is usually a very soluble problem. Like I, 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, like the joke about the doctor with the take out 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 is going to 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.

When I went through my medical training, there was an old saying that the dermatologist basically, if it's dry, wet it, if it's wet, moisturize it, and if.

You don't know what's going on, give it a steroid. That's essentially that's pretty much right.

That's pretty much dermatology.

I learned the same lesson. Yeah, right.

That'S, that's it.

And, you know, dermatology and dry it. If it's, if it's wet, dry it.

If it's dry, wet it. And if you don't know, give it a steroid. Exactly. That's, that's, that's the, the Mantra of the modern dermatologist. But again, it's, like you said, it's, it's an, it's an external manifestation of something going on internally. So the question is, is what's driving this?

And in, in preparing for this talk.

I mean, I've seen so many patients with rosacea. It's not funny. What do they put on there? They give antibiotics on the face. Yeah, they'll give, like, metronidazole cream, a topical antibiotic. It's like an anti-parasite antibiotic. Yeah, one of the newer medications, and this is sort of an interesting thing, is a cream called ivermectin. So, this sort of blew me away because this is relatively new and I think we were talking about it right?

It's a worm pill.

It's a parasite.

They're using it for COVID even.

Really? Yeah. Yeah. So, it's really, it was, so it said to my, sorry, I I was reading and I actually had a patient who came in and was on the ivermectin cream and was doing very, very well on the ivermectin cream. And then I said to myself, well, how is an anti-parasitic medication topically helping with worms in your face?

Yeah.

Well, it's also, that's also interesting because one of the things that is strongly tied in with rosacea. Now, remember, rosacea is just over the face. It's this facial manifestation of an internal issue is that we have these little creepy crawlers on our face and they're called mites, skin mites. Yeah. Dermadex.

Kind of like dust mites.

We all have them. Everybody has these. And the interesting thing is that patients who have rosacea have a much, much higher density of skin mites on them for whatever reason. And normally they basically, they're like little, you call them like little parasites, they're ectoparasites and they sit on the skin and they they eat your dead tissues and they eat off of the oils on the glands. And normally you don't have a reaction to them. They're sort of like a benign parasite. But in some people who have high concentrations of these skin mites, the body makes a very, very high immune response to it. So getting back to the ivermectin, which is basically an antiparasitic, it may be actually working as an antiparasitic for some of these skin mites.

Yeah, so maybe there's an infectious cause to this.

Yeah, so yeah.

The things they use are Minocycline, which is an antibiotic, Flagyl or Metronidazole, which is any parasite antibiotic. Ivermectin, which is an anti-worm.

Oral doxycycline is another one.

Yeah, oral antibiotics, which probably is a really bad idea given the fact that.

You have a microbiome and you don't.

Want to be killing it to fix your skin. Exactly, exactly, yeah.

And, why might the Minocycline work? Why might antibiotics orally work? Well, there's a thought and it's actually in the literature is that small intestinal bacterial overgrowth is also one of the triggers for rosacea. A lot of patients that you see with rosacea will have irritable bowel type symptoms or bloating type symptoms. And when you do some testing for that and you treat it, that oftentimes will clear up their rosacea.

Yeah, yeah, absolutely. So I think, you know, we're not averse to using topicals and topical medication when necessary, but if you really focus on root causes, which is what functional medicine does, you come up with a very different set of approaches that actually work works better, is longer lasting, and doesn't require you to keep putting on lotions, potions and creams for the rest of your life or taking oral antibiotics.

Right, exactly. And then the, getting back to the ivermectin, ivermectin, and I, in preparing for this talk, it did some, a little, little bit of research. And the patients who are more prone towards rosacea have a problem with too much of what's called the cathartic and antimicrobial peptides.

So these are, that's a big mouthful.

Yeah, they called camps, C-A-M-P, cathartic and antimicrobial peptides. And these peptides are part of the built-in innate part of the immune system to protect our skin against various types of infections. And it turns out that ivermectin actually helps with these antimicrobial peptides because people who have rosacea have too much of these peptides. They have an over robust response to antimicrobials. So it's thought that the, it's actually a breakdown product is called LL-37. and ivermectin actually works on dampening down these antimicrobial peptides to decrease inflammation in the skin.

Okay, so in terms of the cause, it seems to be a combination of internal and external factors. Yeah, something on the skin and then something internally, but from traditional medicine, there really isn't an approach to helping heal the skin from the inside out.

No, no 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 a leaky gut. So take us through from a functional medicine perspective our 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.

Yeah.

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 because 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 a 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, 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. Acid blocking medications, absolutely. Because we have acid in our stomach to help us to digest food, it's also there to to decrease the amount of bacteria higher up in the colon. So it's good to have stomach acid.

Yeah. It says 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 eat foods, 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 in 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 learn 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. CIFO, which is 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.

Yeah.

And even, 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, acne. I mean, you just name it. Depression, all this stuff is connected by, by leaky guts. So I really, I think, you know, getting a very different thinking about this is key. And you, you did. You talked about the stomach acid. You talked about the acid blockers. You talked about maybe other things that, 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 sensitivities. 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. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to DrHyman.com/picks to sign up. That's DrHyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health. and get healthier and better and live younger longer. Now back to this week's episode. 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 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 a snapshot in time. So, you can develop leaky gut for 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 if there's this chronic leaky gut, which is really more valuable. Because if I gave you a shot of tequila then an hour later measure your zonulin, it's gonna go up.

Okay, where's the tequila at?

Sounds good.

Right. So that's why I think that the testing for the antibodies against zonulin is even more valuable in these patients with chronic conditions.

And then what other kinds of tests besides the zonulin and the lipopolysaccharide tests that we do to look at the antibodies against these proteins in the gut.

That come from a leaky gut? 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 intestine bacterial overgrowth, those would 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. 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 methane?

So essentially what you're saying is that, 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 feel 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 El Chavoano Center where we really dig into these issues and we look at bacterial overgrowth, we look at fungal overgrowth, we look at 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 it's really helpful in drilling down on what's really going on with people. Absolutely. 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 colonic area, it was more of an anaerobic environment or a lack of oxygen. and 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, and, I mean, you want your upper intestine to be sterile and.

Or mostly sterile.

Mostly sterile. And when, and all that bacteria migrates up there, it's just a bad situation. And when we take acid blockers, when we, you know, are low in magnesium, which half us are, when we're under stress and our gut motility is slow, when we you know, taking lots of antibiotics and it screws up our whole system in there. You know, 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, the proteins from leaky gut or we look at the food sensitivities or Bacterial overgrowth, gas production, but we actually look at the poop.

Yeah.

So what are we, 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. There really is. It's, it's golden. And they're Hills. Yeah. So a lot of information can be determined by doing a 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, in the GI tract, and we can measure those using DNA, PCR, uh, analysis. And do 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 a lot. Exact enzyme function, butyrate, checking for butyrate.

Short-Chain fatty acids, indicators of healthy ecosystem. So, you know, Todd, what you're, 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, 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. Yeah. So we look at 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 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 other fats because a lot of inflammation come from not having the right balance of fats in your body.

Absolutely.

And I think, you know, 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? You know, again, taking the history is the big one.

You know, I always will ask people, what's your ethnic background? A lot of people say, you know, I'm white. No, it's like, you know, are you Irish, English, German, Jewish? Russian, whatever, because the rosacea is typically found in, in light skin, 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 know, 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. Yeah, caffeine can play a role. Yeah, those are, those are all things which can sort of, you know, it's like adding gasoline to 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've found it very helpful with patients who have rosacea is borage oil and even criminal's oil. well. Yeah, 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, you know, a few other things, but evening primrose oil. So, yeah, that's very powerful. I agree. And I also think that, you when I see these patients, I also think about looking for other Clues, like, do they have yeast issues? Have they been in lots of antibiotics? Are they on acid blockers, which caused yeast overgrowth?

Yeah.

Do they have other fungal issues? They have dandruff. Do they have anal itching? Do they have thrush or a white coating in their tongue? You know, do they have vaginal yeast infections? Do they have other skin markers of use, 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, you know, from the treatment point of view, you know, you start with an elimination diet with an anti-inflammatory diet, right? Exactly.

Yeah. Putting patients on an anti-inflammatory elimination diet, you know, 80 of the time, doesn't matter what they come in with, they're gonna actually, they'll actually get better. They, you know, 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 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, you triggered a thought because there's actually a paper that says if you have rosacea, you have a higher incidence of Alzheimer's disease.

Oh, wow.

So it's not just, it's not just a, you know, a cosmetic issue.

It's actually systemic. You have a red face and a.

Red brain that's on fire. Exactly. Yeah. Isn't that, that's, I, I was sort.

Of Blown Away by that. That's fascinating.

Yeah.

Especially in women. It's actually more, 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 actually add in all the anti-inflammatory foods that are important, 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 then we often directly treat the issues that are going on. It could be leaky gut. So we give them a gut repair program. This could be fungal or bacterial overgrowth. So 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 things like even primrose oil. I found that digestive enzymes and hydrochloric.

Acid often are really helpful, too. Yeah, I've been surprised at how many people have what I would call a relative lack of hydrochloric acid in the 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 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, 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's a big red flag. 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, pneumonia, bacterial overgrowth, irritable bowel syndrome, when you get rid of your heartburn, but you.

Got all these other problems.

Yeah, that's, 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, absolutely. When you suppress the stomach acid and you stop the drug, the acid production goes crazy. Exactly. 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. They had a lot of bloating type symptoms. and came in and 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 people-- It's 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.

Acid blockers.

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 way enough sunshine. 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 that low vitamin D is not the problem, it's a symptom of another problem. 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 tropics now and then, Caribbean, Hawaii, whatever. and we also feel good. It's also this is another thing that I find fascinating is that there is 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.

Yeah, yeah, it's there's a compound. It's called pro-opiomelanocorticotropin hormone. And what it means is that 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 to the sun. Exactly.

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 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.

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, you know, 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.

If you loved that last video, you're.

Gonna love the next one.

Check it out here.

The Hunter-Gatherers didn't have all the chronic.

Diseases of Western civilization, but the city dwellers did.

And he found that the city dwellers.

Their stool weight was four ounces.

The Hunter-Gatherers' stool weight was two pounds.

Why?