Eliminate Acne & Restore Your Skin Health, with Dr. Yug Varma

There are different bacteria that are unique to our skin and there are different bacteria that are unique to our gut. And the gut has far more bacteria than the skin. But it's important not to neglect the skin microbiome because there are three times as many bacteria on our skin than there are skin cells.

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Hello and welcome to this episode of the Five Journeys podcast. Live like youe Matter. I'm Dr. Wendy Trubo. This is Dr. Ed Levitan. Our guest today is Dr. Yung Verma. Is he is the co founder and CEO of Phyla and has over 10 years of microbiome research experience. He received a scientific training at several distinguished institutions including Johns Hopkins and University of California. So in other Boston terms, he's wicked smart. So welcome. Thank you for being here.

Hey, Wendy.

Hey, Ed. Thank you so much for having me.

Yeah, this is super exciting conversation because we rarely speak about skin issues and microbiome and how that relates. So this is really. We speak a lot about the microbiome, but. Right. And we never really talk about skin and acne. So the skin does have a microbiome, as does the gut looks? Well, you tell us. Does it look the same? Does it look different?

How does it look? Yeah.

So, you know, as we get into our discussion, I think your listeners will probably find a lot of commonalities between the skin microbiome and the gut microbiome. You know, it looks same in some ways in the sense that they share some traits and it looks different in other ways in the sense that, you know, if you think of it as ecological terms, Right. If your gut is one kind of rainforest, your skin is another kind of rainforest. The trees look different. Right. So different. There are different bacteria that are unique to our skin and there are different bacteria that are unique to our gut for obvious reasons. Right. The skin is flooded with oxygen. The gut is not. The skin is a much more sort of dry, desiccated environment. It's very acidic, whereas the gut, you know, you have food coming in all.

The time and, you know, just the.

Numbers of bacteria are different. The gut has far more bacteria than the skin. But, for example, you know, it's important not to Neglect the skin microbiome, because there are three times as many bacteria on our skin than there are skin cells. So it's not insignificant.

I think the first question is, is the skin the same all over our body or are there different zones?

There are three types of skin microbiome, and they map to three kinds of broad environments. On our skin, there are oily, dry and wet. The oily microbiome is also known as the sebaceous microbiome. And that is our face, our upper chest, and our upper back. And that is because that's where our skin has a number of sebaceous glands.

These oil that pump out a lot.

Of oil on our skin. It's very interesting to know that the sebaceous microbiome doesn't actually occur as a separate microbiome until puberty because there are secondary sexual characteristics, one of which is a re characterization of your skin physiology. Your pores get deeper, your sebaceous bands activate, and when that oil starts getting produced on your skin, that is food in this relatively scarce, nutrient scarce environment that causes this one type of bacteria and a very special type of bacteria to grow. So that's the oily microbiome. That's really what is intimately involved in acne. Most of your body is dry skin, so your arms, your legs, your torso, and that has a particular kind of microbiome. And then there's a wet microbiome, which is the creases in your body, your armpits, your groin region, et cetera. And there's one subtype of the wet microbiome, which is your feet, which are very unique. They have higher proportion of fungi because we're wearing socks, they're encased in shoes all the time. And so it's a very particular microenvironment.

So from what you've said, it sounds like the different types of the microbiome on the skin would call for different treatments depending on whether they're oily, wet or dry. Is that accurate?

Yeah, exactly. And it depends on the disease you're treating. For example, that's one reason why you'll never get acne on your knee. It's because it has to do with a bacteria that live on the oily microbiome, which is only on our face and on our upper chest and upper back. That's why back acne or chest acne often responds to the same treatment that you use for your face, because it's the same kind. You know, I want to maybe introduce like a very interesting concept and very Interesting observation that helps understand what's really going on in the skin. And, you know, whoever is listening, whether it's they who suffer from acne or their kids who suffer from acne, we all know that acne is sort of a young person's disease, and now it's going more into young adulthood. But, you know, as you get older, acne just kind of slowly disappears, and no one knows why. Well, there was a study done in 2016 looking at healthy microbiomes and acne microbiomes on the skin and trying to find systematic differences. Can we train ourselves to pick out certain features of the microbiome that lead to health or lead to acne? What they found was the biggest difference, and really the only significant difference they could find was healthy people have a ton of these c. Acne stages on their skin, and people with acne basically don't. So the upshot of that is that we all have annoying friends who don't take a shower, eat whatever they want, never get acne, have clear skin, just wake up looking amazing, and the rest of us are on the straight and narrow, watching our diet, putting harsh products on our face, and wondering, what have we done to deserve this? Well, it turns out that those annoying friends of ours probably have phages or bacteriophages. Now, phages are tiny living viruses that infect bacteria. They're ubiquitous, they're all around us, and they're, in fact, the most numerous life form on earth. So they're in seawater, they're in soil, and in fact, billions of phages are on and in our body every day. They pass through pretty harmlessly if the.

Microbiome wasn't creepy enough, now there's the macro, the bacteriophages, too.

Yeah. You know, and if you've been, you know, consumed over the last three or so years about bad news from viruses, here's a. Here's a good news story that involves a virus as a hero instead of a villain. But, you know, viruses, sorry, phages have two superpowers. The first is that they're nature's best defense against bacteria. And the second superpower is that they're incredibly specific. So a phage that goes after acne bacteria is not going to kill any of the other bacteria on your skin that's naturally recalibrating the microbiome and keeping the acne bacteria in check.

Is there like a prebiotic or do you add probiotics or postbiotic or anything of that nature? Maybe we should define that a little bit.

Yeah, we can define Sort of all three of those and chat about those. So there's three terms that you need to know. Prebiotics, probiotics, and postbiotics, right? So think of it as a tree, right? Think of a bacteria in your microbiome as a tree, right? Now, let's say the tree bears fruit, and that's why we love having that tree around, because it provides us nourishment and maybe, you know, you can make something from the leaves. And there are a few other benefits to that tree. Now, the tree itself is the probiotic. It's a living thing that provides us a benefit, right? So one thing we can do to encourage the growth of that tree and to encourage, you know, the fruit, the seeds from that tree to make more trees and is to add fertilizer to keep the soil fertile. And that's what prebiotics are. They are specific nutrients that certain bacteria, certain good bacteria in our microbiome prefer, and that makes them grow much faster at the expense of other bad bacteria or other kind of neutral commensal bacteria. So prebiotics are kind of like adding manure or compost to the soil to feed this living tree. That gives us human effin. Of course, if you don't have that tree, you need to have that tree. So that's why we consume probiotics in a pill form or more preferably, in its fermented active form, right? You eat yogurt, you eat kimchi and sauerkraut, et cetera. So there's the benefit to having that. If you don't have that tree, or if you want more of it in your system, you grow more trees or you consume the probiotics. The postbiotics are basically the fruit of the tree. It's the whole reason why that tree is valuable to you, right? So just like that, gut bacteria or skin bacteria produce molecules that tamp down our immune system, make our skin cells or gut cells feel really healthy, et cetera, et cetera, and send a ton of signaling through our system that makes us healthy. So if that is really the end game, there's an argument that, oh, why don't we just find out what those postbiotics are? They're all small molecules. We put them in a pill and then you just take the pill. So you're just eating the fruit. You're just making the fruit in a lab and eating it. The problem with the postbiotics, though, is we don't know all the small molecules that these bacteria make better. Good for us. We know a few, and certainly there are more yet to be discovered. Secondly, the probiotic is a factory that is in the right place at the right time, producing the right amount of the right molecule.

Right.

And it's really, really hard to replicate that by just putting it in a pill. So that is one of the reasons why postbiotics, it's still really early. And I don't know if you'll ever get it as good as just having a factory that produces the right molecule at the right time.

Sure.

Being smarter than nature is not yet our purview.

Exactly. And the more we try, the more we realize how far, how far we fall short.

Yes, got it. So you referenced watching our diet and putting these harsh chemicals on our skin. What are the things that we do that we don't really think about doing that are really bad for our skin, particularly our face?

One thing, because acne is caused by C. Acnes and because C. Acnes major food source is the oil that are face produces, a lot of people and a lot of solutions actually out there are to dry your skin out.

Right.

To remove the sebum, to deprive the bacteria from the food that it needs to overgrow. Now, acne is obviously a complex disease. It is affected by diet and stress and hormones and genetics. But these are all secondary causes that actually influence the growth of the bacteria, the prime cause of acne. And let me just give you an example for diet. You may have a trigger food for everyone. It's different for someone. It's spicy food. For some people, it's chocolate. For some people, it's oily food. But whatever it is, what happens is when you consume that food, your body responds by producing more oil on the skin. The oil is food for the bacteria. The bacteria overgrows and causes inflammation. Your body's responding to more bacteria of that particular kind. And it says, oh, wait, wait, wait, I need to tamp down this bacteria. I'm going to produce inflammation. That's basically what it is. The pimples and zits are just inflammation. When you try to dry out your skin to prevent the bacterial overgrowth, you're actually doing your skin a big disservice. Because the oil is naturally produced by our body for a very good reason. It keeps the layers of skin hydrated. It is an important moisture barrier to keep the moisture in. And it keeps your skin cells supple. It prevents fine lines and wrinkles.

Right.

So a lot of people with really severe acne medication, when it dries out your skin, you know, at the time, you'll do Anything to get rid of your acne and you don't care, you know, what you throw at your skin. But you know, five years down the line, 10 years down the line, when you have chronic dryness and you're seeing fine lines and wrinkles appear and you're looking around and you're saying, oh, wow, my skin looks a lot worse than other people my age. That's when you realize the damage has been done and at that point it's irreversible. So I would recommend do not dry out your skin. There's a better way. And if you're really worried about your acne, try Phyla first. Because even if Phyla doesn't work, absolute worst case scenario, which we don't see, except for a small sliver of our patients, you won't have damaged your skin. And then you can go on to something more harsh if you think that you're all for it.

Now you're the co founder of Phyla. What does Phyla do in all this? What role is Phyla?

So Phyla is a consumer brand that's part of my startup, Phi Therapeutics, and we are really trying to change the way we treat chronic bacterial diseases. Like I said, this includes acne or eczema in skin health. It includes oral health as well as gut health. We see acne really as the first application of this technology. The basic upshot of how the technology works is it kills the bad bacteria, specifically without hurting the good bacteria. It recalibrates your microbiome and makes it more balanced and diverse. Not only are you dealing with the direct cause, which is an overgrowth of the bad bacteria, but in balancing your microbiome, you're ensuring that you have long term skin health. Your microbiome gets more diverse. It's able to suppress any returning bad bacteria growing back. And over time, that's what a healthy, functioning microbiome does on the skin of people who don't get acne.

This literally sounds like a magic pill.

Well, is this a pill? Is this a cream?

How is this magic treatment? I'll put it that way.

Yeah. For acne, we have a topical treatment. So you apply the product on your skin and it targets the bacteria right on the skin, because that's where the action is.

You've developed a way to kill the bad guys, keep the good guys, boost the good guys and make the skin more resilient.

Right. And the way we do this is using this amazing organism called bacteriophages or phages. And our mission was to democratize this amazing Organism, put it in a bottle so that you can have the benefit of it, even if you were born with it. And that's really a superpower that we've harnessed to deliver this solution on your skin.

This literally sounds so obvious and I don't understand why we're here and it's taken so long to get here because this sounds so just like, well, of.

Course, I guess I want to know what kind of results have you seen? Can you help those acne teenagers asking for a friend?

We only have three teenagers at this point.

It's not personal, just for.

I know, right? Well, wait, hold on a second. And also, will it counteract the bad habits that teenagers have?

Well, nothing.

Okay, we'll come back to that. So, so does it work?

Yeah.

So the short answer is yes. And we know this because we ran a clinical study to evaluate this and we asked ourselves four basic questions. Right? Question one, is this safe? The answer was 100% yes. In fact, Phyllo is probably the only acne product on the market with zero side effects. There's no drying, there's no redness, there's no irritation, unlike benzoyl peroxide, antibiotics, retinoids, etc. That's again because you're understanding the root cause of acne just hitting that really specifically and not causing any collateral damage. The second question was, we know these stages kill the acne bacteria, which is cute bacterium acnes or C. Acnes in a test tube in the lab. Really, really well, our question was, can we see a significant reduction of C. Acnes on the skin? We found that there is a statistically significant reduction of C. Acnes on the skin. The third question was, okay, we're reducing C. Acnes, we're targeting the bad bacteria, but the million dollar question is, does the acne get better? The answer to that was yes as well. With a p value of 0.0041 highly statistically significant, we saw that our phage group versus placebo has a statistically significant improvement of acne symptoms. Now the last question we asked was more a long term question, which is what is the impact of phages on microbiome diversity? What are they doing? We know that they're suppressing this one bacteria that's present on our skin in a big way. But how is that affecting other bacteria?

What we found was in the phage.

Group versus the placebo. In the placebo group, almost everyone's microbiome diversity was the same or went down. In the phage group, almost everyone's microbiome Diversity went up quite significantly and ended up in a very rich place. Now why is that important? For two reasons. The first is that we know that people with acne have a lower microbiome diversity than healthy people. And it's thought that if we can just boost this diversity, we can actually see a lot of good effects. The second is all over the world, whether you're in America or Asia or Europe or Africa, the incidence of acne is about 85% of the population. Almost everyone gets it. It's a sort of passage of a rite of passage, as it were. But there are some human populations on Earth where acne is either very rare or it just doesn't exist at all. One such population is the Yanomami tribe in Brazil. They're a pre contact tribal civilization, very remote and live a very riparian and hunter gatherer lifestyle. They do not have acne. There's no history of anyone getting acne there. Their teenagers don't have acne and their incidence of acne is 0% compared to 85%. It's a huge difference. It can be explained by the fact that their microbiome diversity is off the charts. If high microbiome diversity is clearly a marker of long term skin health and if phages, even a short term application like the eight weeks that our clinical study was conducted in can show a significant improvement in microbiome diversity and richness, that tells us that you're likely to avoid the endless cycle of relapses that most acne sufferers go through with their medication and that this is a path to getting clear skin for life.

Does it? So it. So after your study, did you follow up with people to see what happened with their skin after eight weeks?

Unfortunately, we couldn't for a couple of reasons. That wasn't how the trial was designed due to various constraints. The other reason was that we finished our trial just as Covid was coming down and so there was no possibility of getting people in the clinic or doing follow up visits, even though we tried really hard.

Got it.

So is there any comparison between the standard treatment of benzoyl peroxidase or the clindamycin gel or metronidazole or whatever?

Yeah, that's something that we very much like to do and we're considering how and when we can do that. And even to the first question, right, what happens over the long term? We have a lot of questions that we want to answer because fundamentally this is a brand new technology that is really actioning what we knew all along, that C Acnes plays a central role in acne pathogenesis. And if we get rid of C. Acnes without hurting other bacteria, we have a good chance of actually solving this disease in a much more, not just elegant way, but in a more complete way.

Right.

So you don't get relapses. This isn't a condition that you're just dragging through for most of your adult life. So we have many questions, such as what happens when you use the phages long term, because they're a living thing, they should embed and engraft and be a part of your microbiome. What we've seen is people with acne, you do have to regularly apply this because, you know, for some reason it keeps falling off your skin. For healthy people, that's not the case. The second question that we want to ask, similar to that, is, what happens if you stop using it? If you use it for six months and you stop using it longitudinally, what is the decay rate of the phage on the skin? Can we correlate the presence or absence of the phage on the skin with acne symptoms returning or abating?

I haven't done my derma rotation in forever. I'm going to use baby language. The acne, that's the zits form, the whiteheads and the dark heads. And then there's the cystic form. Does phyla or the bacteriophages distinguish between those? Is phyla effective more than one or the other? What's been your experience?

Yeah, what we found is that our product and our approach really works for all kinds of acne. And I'm talking about acne vulgaris. There's fungal acne, which is actually not acne. It's a type of fungal dermatitis. But all acne, this includes mild, moderate, severe. It includes hormonal acne, cystic acne, it includes chest acne and back acne, and even includes the hormonal acne that pregnant women and breastfeeding mothers get. In fact, we're probably only. But certainly one of the few acne systems out there that are safe for pregnant and breastfeeding mothers, because a lot of these products, from benzoyl peroxide to obviously antibiotics and certainly retinoids, are not safe for pregnant women and breastfeeding mothers.

So I think the question I have and Ed has is where do people find you?

Yeah. So we are@phylabiotics.com, the company is Phyla P H Y L a. And at Phylabiotics.com, we have all of our science, we have our clinical results and we love to educate people because although we're the most sophisticated and educated skincare consumers we've ever been, we know what ingredients we want and don't want. We are still in the dark ages when it comes to acne. So we do a lot of myth busting and talking about what really is the science of acne. And you'll find all of that at our website. You'll also find all of our products at our website, biobiotics.com and then you can find us on social as well, on Twitter and Instagram and Facebook and TikTok at Phylabiotics. So go there, learn more about acne if that's what's bothering you, and find the best solution for yourself.

That's amazing.

Sweet. I think this is really cool.

I think our teenagers are going to be the experiment that we're going to.

Be using it on, test it out. This is great. First off, thank you for being here.

This has been very educational.

Yeah, this is really cool. We'll put all of the links in the show notes so people can get to that. I'll close out the show by saying, Dr. Yogvarma, thank you for being here and for the listeners, thanks for being here. We'll see you again.

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