The Dr. Hyman Show - Healing Psoriasis From The Inside Out with Dr. Todd LePine

Starting point is 00:00:00 Coming up on this episode of The Doctor's Pharmacy. One of the key things I always ask my patients also is the component of stress. Not that stress causes psoriasis or stress causes autoimmunity, but stress affects the immune system. Hey everyone, it's Dr. Hyman. Supplements are one of those things that I'm always being asked about. Is it worth spending money on them? Do we need them if we really eat well? And can your body even absorb them? And the answer to most of these questions

Starting point is 00:00:28 is it depends. There are definitely certain supplements I'd never recommend taking because they aren't made in a way that your body can take advantage of and you just won't be able to use them. And there are definitely some supplements we can benefit from because our food supply, even if we're eating whole organic foods, just doesn't provide enough of certain nutrients that we need for optimal health. Now, a major one of those nutrients that I suggest people supplement with is magnesium. And see, most soils have become depleted in magnesium, so it's a tough mineral to get enough of through diet alone. And between 40 to 60 percent of Americans are deficient or insufficient in magnesium. And since it's a crucial mineral for hundreds of reactions in the body and impacts everything from metabolism to sleep,

Starting point is 00:01:10 neurologic health, energy, pain, muscle function, and lots more, it's really important that we get enough of it. Magnesium also plays a role in our stress response, and everyone I know could use a hand in better managing stress to promote their overall health. I like to call it the relaxation mineral. Now, our new favorite magnesium is from a company called BiOptimizers. Their magnesium breakthrough formula contains seven different forms of magnesium, all of which have different functions in the body. There's truly nothing like it on the market.

Starting point is 00:01:42 I really noticed a difference when I started taking it, and I've tried lots of different magnesium products out there. I also love that all their products are soy-free, gluten-free, lactose-free, non-GMO, free of chemicals and fillers, and made with all natural ingredients. Plus, they give back to their community. For every 10 bottles sold, they donate one to someone in need. Right now, you can try BiOptimizers

Starting point is 00:02:06 Magnesium Breakthrough for 10% off. Just go to bioptimizers.com slash hymen. That's B-I-O-P-T-I-M-I-Z-E-R-S dot com slash hymen and use the code hymen10 and you'll get 10% off this really great formula. I think you'll love it as much as I do. Do you have FLC? What's FLC? It's when you feel like crap. It's a problem that so many people suffer from and often have no idea that it's not normal or that you can fix it. I mean, you know the feeling. It's when you're super sluggish, your digestion's off, you can't think clearly, or you have brain fog, or you just feel run down. Can you relate? I know most people can. But the real question is, what the heck do we do about it? Well, I hate to break the news, but there's no magic bullet.

Starting point is 00:02:50 FLC isn't caused by one single thing, so there's not one single solution. However, there is a systems-based approach, a way to tackle the multiple root factors that contribute to FLC. And I call that system the 10-Day Reset. The 10-Day Reset combines food, key lifestyle habits, and targeted supplements to address FLC, and I call that system the 10-Day Reset. The 10-Day Reset combines food, key lifestyle habits, and targeted supplements to address FLC straight on. It's a protocol that I've used with thousands of my community members to help them get their health back on track. It's not a magic bullet. It's not a quick fix. It's a system that works. If you want to learn more and get your

Starting point is 00:03:21 health back on track, visit GetPharmacy.com. That's Get Pharmacy with an F, F-A-R-M-A-C-Y.com. Welcome to this special episode of The Doctor's Pharmacy that I call House Call. And I'm sitting down with my colleagues at the Ultra Wellness Center in Lenox, Massachusetts to discuss some difficult medical conditions that have amazing solutions using functional medicine that you won't get by going to your regular doctor. We're getting to the root cause of things. And today I'm sitting down with Dr. Todd Lepine, who's been one of our featured guests on The Doctor's Pharmacy, talking about all sorts of conditions and has the second most popular podcast on The Doctor's Pharmacy. I would say congratulations on that, which is no small feat. We've been working together for 25 years,

Starting point is 00:04:07 maybe 20, something like that at Canyon Ranch for 10 years. And then here at the Ultra Wellness Center for over a decade, Dr. Lapine went to Dartmouth Medical School. He's board certified in internal medicine and he's certified in functional medicine, integrated medicine. And he's one of the smartest guys out there when it comes to understanding the body and how to heal it. I've learned so much from Todd over the years as my colleague and friend, and we are privileged to take care of some really challenging cases at the Ultra Wellness Center. And today we're going to talk about psoriasis. So welcome, Todd. Thank you. Thank you, Mark. Now, this podcast is about things that matter. And if you have psoriasis, probably nothing

Starting point is 00:04:43 matters more than figuring out how to fix it because it's what they call the heartbreak of psoriasis. And the reason is it's a miserable condition where you get thick, scaly plaques and irritation on your skin, which itches like crazy and is scarring and disfiguring. And it's just a miserable disease. And traditional medicine doesn't really have a lot of great treatments except ones that are extremely expensive and often come with very significant side effects. Yeah, very exactly. So Todd, what's the general view of psoriasis in traditional medicine? The general view is that it's an external condition.

Starting point is 00:05:22 It's a skin problem. It's a skin problem. Exactly. It's a skin problem. And it's a chronic condition. It's a skin problem. It's a skin problem. Exactly. It's a skin problem, and it's a chronic condition, and there's no cure for it. That's the take-home that you get in my training. And it really is not a skin condition. It's a systemic condition.

Starting point is 00:05:39 And the ways in which we're treating it is really, as you said, very expensive and potentially very toxic. So there are lots of things. And I think this is probably almost like the paradigm condition from a functional medicine approach is where you get so much leverage. Because there's not one thing that causes psoriasis. There's not just one case of psoriasis. There's many variables. We were talking about that earlier, how there's a genetic component to it there's the dietary component uh there's the environmental component uh vitamin d

Starting point is 00:06:10 is you know i i'm a big proponent for vitamin d and i have so many patients who have psoriasis who tell me that you know they get better in the summer when they go to the beach yeah and they're in the salt water yeah and they get sunshine well that's one of the medical treatments is u light, right? Absolutely. Yes. So they do stick people under lights and do light therapy and medicine, believe it or not. Yeah.

Starting point is 00:06:29 Well, I think they also, that's an older therapy. They used to use also, what is it? Puva therapy, sorrelins. You would inject it into you and then, yeah, it's like an older way. But nonetheless, UV light is very, very beneficial for modulating the immune system. So it's really, and the one thing that really, I'll never forget this case, and I don't know if you've probably seen it yourself, but when I was in my regular conventional practice, I had a patient who presented with gut-ache psoriasis.

Starting point is 00:06:57 Gut-ache psoriasis. Gut-ache psoriasis. And for those who don't know what gut-ache psoriasis is, it's what happens after- It gives you a gut ache? That's actually- It's actually gut ache with a T, but it sounds like gut ache, but it could be that. Exactly, that's it happens after you a gut ache that's actually not it's actually gutting with a t but it sounds like gut ache but it could be exactly that's actually it may be that it may be caused by the gut exactly get to that it's actually a good point so uh so g-u-t-t-a-t-e gut ache psoriasis and a patient who i had treated for a strep infect strep throat infection uh-huh

Starting point is 00:07:21 and then like a week or two later she comes back back and she's covered in these dime to quarter size circular psoriatic lesions. And I'm like, what's going on here? So I did a little bit of research and I found out that that is a well-known condition of a post-streptococcal gut-ache psoriasis. And I treated her with an antibiotic and guess what? Her gut-ache psoriasis went away. Amazing, because you treated the strep, the cause. Exactly, exactly. Now, the one thing that you need to realize is that strep bacteria is oftentimes involved in cross-reactivity.

Starting point is 00:07:55 That's why people are so on to strep throat, because if you get a strep throat in certain individuals, genetically susceptible individuals, they can get glomerulonephritis, which damages your kidneys. You can get rheumatic heart disease. You can get PANDAS syndrome, the Pediatric Autoimmune Neurodevelopmental Strep Infection. So you get this like OCD and behavioral type conditions. And then you get also-

Starting point is 00:08:21 So you get psychiatric issues, cardiac issues, kidney issues. Everything. Right. Exactly. And they can be deadly. Absolutely. So strep bacteria play, I think, probably are one of the key players in some cases of psoriasis in patients. Absolutely.

Starting point is 00:08:34 Yeah. Well, that is fascinating. So essentially, this is seen as a skin condition that's inflammatory. And the treatments are using powerful anti-inflammatory drugs including steroids a lot of them are topical steroids which though it's topical but they use very strong ones that get absorbed and they really suppress your own adrenal glands and have long-term consequences and thin the skin because they're very very powerful they're not like the over-the-counter hydrocortisone these are really high potency uh fluorinated uh steroids

Starting point is 00:09:02 and they get absorbed into the system. They do decrease inflammation, but they thin the skin and you get breakage of the skin and such. So even though they're creams, there are systemic side effects to them. Absolutely. Yeah. I also see that the drugs that are being used now that are promoted on television are these very expensive, we call them immunosuppressants, they're called TNF alpha blockers or biologics that are maybe $50,000 a year. And they can be effective and help people for sure,

Starting point is 00:09:36 but they do lead to immune suppression, especially in this time of COVID. If you're on one of these drugs, you're much more likely to have your immune system not work when you get an infection. Exactly, and there are times, you know, when there are some patients, I have seen some patients with either rheumatoid arthritis or significant psoriatic arthritis,

Starting point is 00:09:55 which is psoriasis to the next degree, where you're developing systemic symptoms of joint inflammation. Sometimes you do have to use the biologics to more or less put out the fire for a period of time. Absolutely. So it's not as though I'm against biologics. There's time and a place for everything, but those are sort of the last ditch. That's like, okay, break the glass, pull out the emergency fire extinguisher and put out the fire. Well, it reminds me of this case,

Starting point is 00:10:17 I'm going to share for a minute, which is a little girl who came to see me, was probably like four at the time. And when she was and this is this is really how we think differently in functional medicine because in functional medicine we see this like you said it's a systemic problem that happens to affect the skin and if you're treating skin it's just putting you know topical stuff on that doesn't really have systemic effects or get to the root cause so functional medicine is always about the root cause and this little girl when I looked at her history born by c-section, not breastfed. So already, you know, she's got a reduction in her healthy microbiome formation because going through

Starting point is 00:10:51 the vaginal canal populates the gut with bacteria that are healthy. Breastfeeding provides these oligosaccharides that are essentially non-digestible food for the good bacteria. And so the kids already set up her problems. got ear infections antibiotics just layered on and then developed this horrible psoriasis you know at very young age like a year old skin was just covered with it and the kid was on and off steroids antibiotics for skin infections often if the psoriasis is bad it'll break down the skin the skin will get infected and you get this vicious cycle and this girl ended up on one of these drugs, these biologics to suppress her immune system because she had it all over her body. And she ended up in the intensive care unit with sepsis for a month. And the reason she got sepsis

Starting point is 00:11:34 or overwhelming systemic infection was because her immune system was suppressed on the drugs, and it was this vicious cycle. So the parents came to me, were desperate. And this little girl was so sweet. She had really head to toe psoriasis it was it was not the normal kind and and and she went to the bathroom in my office and she was screaming when she went to go pee because the peeing hurt because she had all over her vagina yeah this kid was just a mess mess and i'm like well you know let's start with the basics uh diet and also helping her gut get sorted out. And I think for most people with inflammation in their body or an autoimmune disease, the main thing we look at is the gut. And for this little girl, I started with an elimination diet, gluten, dairy. And gluten, if I look at psoriasis, probably one of the biggest factors. So I got rid of the gluten, got rid of the dairy,

Starting point is 00:12:26 cleaned up her diet, got rid of the sugar and stuff. And because of all the antibiotics and steroids and the immune suppressant shit, I gave her an antifungal just on an assumption because there's a lot of evidence that yeast plays a role or fungal infections play a role. That's why they use sort of antifungal shampoos for scalp psoriasis or dandruff.

Starting point is 00:12:43 And I put her on this program program i got a call from the father a couple weeks later and how's she doing and he said she's almost completely cleared her skin completely cleared within like a few weeks wow uh and then she did really really well for a long time and then her scalp just never recovered and And I said, what is she eating? Well, she's having gluten-free oats. And I'm like, I think, you know, oats, even though they say gluten-free, are often cross-contaminated or not perfectly gluten-free. And so I got her off of that and her scalp cleared and the kid's fine. And so this is a case where you do something really simple and when you get an incredible result by fixing the root cause.

Starting point is 00:13:25 And when I did her testing, she did. She had terrible gut microbiome on the stool testing. She had elevated antibodies to gluten. We use not just a regular celiac or antibody test, but we look at 20 different proteins that are in wheat and gluten and we look at antibodies against them and she just lit up like a Christmas tree. So I was like, wow, this is the worst I've ever seen. And yet she got better so fast by dealing with the right cause. Right. Well, that's, yeah, that's the kind of case that really sticks in your head. And the one thing about psoriasis is I think also it's, you know, people view it, people who have it, it's one thing if you have like a couple of lesions on your elbows and they're hidden, it's not a big deal.

Starting point is 00:14:05 But for people who have really bad psoriasis, it's pretty much like having leprosy. I mean, you just, you pretty much don't want to expose your skin. You don't want to go out bathing. It's embarrassing. It's embarrassing. And people think it's contagious. You know, it's all these, you know, these sort of myths about it. And it definitely has, I think, a psychological toll for people who have really significant psoriasis.

Starting point is 00:14:25 Absolutely. There definitely is that psychological component to it. And you see these advertisements where, I think, it shows people by the pool taking their biologics so that they can now go bathing. But you've got to take this expensive, toxic medication just to jump in the pool. You and I are old enough to remember a time when there was no advertising for drugs on television. Right, right. And what these advertisements do is they work. And the studies have shown that 40% of the time when the patient goes to the doctor and says,

Starting point is 00:14:56 hey doc, I saw this ad for blah-ba-dee-blah on TV. Can I get that drug? Right. They're like, sure. Yeah. So these are working. And that's why they spend billions and billions of dollars on these ads. And it's wrong because in functional medicine, there is an

Starting point is 00:15:11 incredible pathway to help these patients. Do you have any other cases that come to mind? Oh yeah, absolutely. I just had a recent case where, and this was like a very interesting case because the patient had a little bit of a perfect storm for getting set-ups for psoriasis. The patient developed a lot of strep throat infections in her 20s. So all of a sudden, she's developed lots of strep for whatever reason, maybe contamination from her kids or whatever, and then was put on a variety of different antibiotics and then uh after uh the birth of one of her children she had a colostectomy because she developed gallstones yeah or gallbladder out gallbladder out exactly gallbladder and there's actually some really interesting evidence about the role of the

Starting point is 00:15:58 bile acids in psoriasis it's really quite. And that's what sort of triggered it. And then, then to sort of add fuel to the fire, the patient was on, guess what, a PPI. Acid blocking. Proton pump inhibitor, you know, the purple pill, right? Exactly. So, and that's, we're going to talk about that in the next podcast. So this patient was a little bit of a setup for a perfect storm for developing psoriasis, then also had some stress in their life. And then also one of the other things that you see in psoriasis in some patients is metabolic syndrome. If you're overweight, if you have prediabetes, that's another potential risk factor for developing

Starting point is 00:16:37 psoriasis. And then originally the patient had, if I recall recall had a vitamin d level originally uh that was in the single digits yeah it should be like 40 or 50 and you're saying it was like less than 10 less than 10 less than 10 which is very very very so this is i get on my i get on my soapbox here because um this is my my one of my things that i'm really i just love to talk about this is that a low vitamin d level is not the problem it It's a symptom of the problem. Okay. So what do you mean? So vitamin D is a biomarker for sunshine exposure. We talked earlier about the use of sunshine and ultraviolet light, which you get through sunlight exposure. So yes, sunlight

Starting point is 00:17:17 can cause skin cancer. It's associated with photo aging and wrinkles and all that kind of thing. So excess amount of sunlight and sunburn is not healthy for you. But healthy sun exposure is really, really beneficial. Just cover your face and put a hat on. Yeah. Put sunblock on your face. But the rest of your body. Get exposed to healthy sunshine. Absolutely.

Starting point is 00:17:39 And then in the winter, I personally will take vitamin D during the fall and the winter because you're not going to get it. If you live north of the Mason-Dixon line, you're not going to get the healthy sunshine. But I'll push back on that talk because I see patients in the summer and think, oh, I'm not taking my vitamin D in the summer. And, you know, they think it's fine. They're just out walking. But you need to have full body exposure for 20 minutes between 10 and 2 above, you know,

Starting point is 00:18:01 and if you live below Atlanta, you know, it's tough to get. And I think it's only in the summer, but people aren't getting that exposure. So they're often low in the summer. And the other clinical pearl to this, Mark, and I learned this from another doctor who was, she practiced down in Mexico and she used to see a lot of people in Mexico with low vitamin D. And you figure, oh, they got plenty of sun down there. Well, lo and behold, on your skin is sebum, which is a waxy substance. And that sebum material is a cholesterol derivative. And you have to have healthy oil on your skin to get photoactivated by the ultraviolet light. So guess what?

Starting point is 00:18:39 What do most people do every day? They bathe in hot soap and water all the time. And it's one thing if you're outside, you know, you're digging in the dirt and you really get dirty. But most people don't need to be bathing in hot soap and water every day. They bathe in hot soap and water all the time. And now it's one thing if you're outside, you know, you're digging in the dirt and you really get dirty, but most people don't need to be bathing in hot soap and water every day. I mean, you can, you know, bathe with soap and water to your, the private parts in your armpits, but we over bathe. So guess what we do? We wash off that healthy oil on the skin, which prevents the synthesis of vitamin D. That's a clinical perk. Oh, that's a clinical pearl that's good because see i i only use soap and water on those you know private parts as you say

Starting point is 00:19:09 and the rest i just water exactly i don't actually wash my body with soap and i think and i i you know there are some people that you know they'll bathe like twice a day i think i smell okay i don't know how am i doing yeah So vitamin D, again, is a biomarker for the sunshine exposure. And there's a great video, which I oftentimes will have my patients watch. It's on YouTube. I would highly recommend everybody go to it. It's a two-minute video. It's called The Indoor Generation.

Starting point is 00:19:41 I don't know if you've seen it. It's fantastic. And it talks about how we, as human beings beings spend most of our time clothed and indoors. And it actually has an effect on the immune system. And it has an effect on our immune system indirectly because of lack of sunshine and vitamin D. And it's a great visual about trying to get ourselves outside in fresh air and sunshine. So good. Well, you know, I just listened to you talk.

Starting point is 00:20:08 And, you know, the problem with traditional medicine is we don't have a methodology to navigate to the cause of the problem. And we have the ability to diagnose something based on what it looks like, where it is in the body, and the pathology. And that's what we follow. So psoriasis is a diagnosis that tells you the name of what's wrong with you, but doesn't tell you the cause. Exactly. Right. And so you can have psoriasis, but it could be four or five different things like gluten, yeast, the microbiome issue, the strep, the heavy metals, all kinds of issues that the people aren't, vitamin D issue.

Starting point is 00:20:46 Genetics. Genetics, right. So we have to really navigate for that particular person what the cause is. And it's different for different people. I'll just show one more case, then I want to talk about how we work up the cases. So this was a patient that came to see me who had psoriatic arthritis. Yeah, the patient I was talking about, same thing. Yeah, which means that joints get destroyed.

Starting point is 00:21:04 So it's not just the skin, but it's starting to affect the joints. It's an autoimmune issue. And these drugs are inexpensive. And she had all these other issues that she complained about. So she goes to the dermatologist and he's like, okay, I'm going to treat your psoriasis and psoriatic arthritis. And the rheumatologist gives her the rheumatology drugs. But she also had terrible bloating and irritable bowel and reflux. And she was on acid blockers and she was struggling with bloating after eating and bacterial overgrowth. And she had depression and she had prediabetes and she was overweight and she was inflamed everywhere. And she was depressed and she couldn't sleep. I mean, it was like, she was a mess. And I'm like,

Starting point is 00:21:40 okay, well, what's going on? Well, one of her most bothersome symptoms was this terrible bloating after eating, which we call SIBO or bacterial overgrowth. We've talked about it on the podcast. Essentially, the bugs grow in the small intestine. You eat food and then they ferment and it blows up and you feel like you have a food baby. Well, I treated her with an antibiotic to clear out the bad bugs. I gave her an antifungal to clear out the yeast and I rebuilt her gut using what we call the 5R program in functional medicine, which is a gut restoration program.

Starting point is 00:22:09 And I gave her basic multivitamin, vitamin D and fish oil, not a whole lot of stuff, probiotics, you know, get her gut healthy. And she comes back six weeks later and she's lost 25 pounds. Her depression's gone. She's sleeping. She's got no more bacterial overgrowth, no more reflux, no more heartburn. She's drug she's she i didn't tell her to stop the biologic she was on for arthritis she stopped it her psoriasis was gone her arthritis was gone her bacterial overgrowth got everything was gone in six weeks and i'm like it it may sound like a miracle but it's not a miracle it's just using the right strategy and the right map to figure what's wrong with the person.

Starting point is 00:22:45 And we do this over and over in functional medicine. So if you're out there suffering from the heartbreak of psoriasis or eczema or acne, all these skin conditions, there are systemic conditions that we have to think about the cause. So Todd, tell us how do we figure out in functional medicine what the root cause is? What are the tests that we do? How do we look at patients differently? And let's get into what we do to treat them. Yeah, so some of the testing that I like to use is looking at gluten sensitivity, as you mentioned before.

Starting point is 00:23:11 We'll do the testing where we check for the antibodies against gluten and the breakdown products of gluten. So gluten is this big, long protein. Proteins are made up of amino acids, and they have to get chopped up. And the test that we do, which is the Cyrex testing, and it looks at a whole bunch of different protein fragments of the gluten protein, and that shows antibodies to this. That's, I think, a very, very valuable test.

Starting point is 00:23:37 The one caveat is that if patients are on immunosuppressant medications or steroids, you may get a false negative test. Yeah, or if they've been taking immunoglobulins which is like uh for different disease treatments they can get false positives yeah yeah yeah that's true uh so that test is very helpful and then testing for uh intestinal permeability uh the test that uh leaky gut leaky gut leaky leaky gut so in my explanation to patients patients what is leaky gut okay it's very very simple just imagine you have a screen door in your house and the screen door lets the air in right but it keeps the mosquitoes out yeah

Starting point is 00:24:09 and it when you have leaky gut your screen door has holes in it and the mosquitoes are coming in that's that's essentially leaky gut that's the best way to understand it i mean it's more complicated than that but i use a coffee filter i'm like you've got coffee filter lets in the coffee but not the grinds right right same idea. Same idea. Same idea, same idea. And so the leaky gut test is really good because what it does is it checks for the antibodies to zonulin. So zonulin is this molecule. Alessio Fasano did a whole bunch of research. It was fantastic.

Starting point is 00:24:34 He's a Harvard expert on celiac. Yeah, Harvard expert on celiac and the connection between celiac and all different kinds of autoimmune conditions. So when your body has leaky gut, it produces zonulin. And over time, zonulin can cause antibody formation to the zonulin. So when you have antibodies to zonulin, it tells you that over time, you've had long- You've got a leaky gut. Leaky gut, exactly. And you can have transient leaky gut. Like every time anybody, even if you don't have celiac, anybody who eats gluten will have transient leaky gut.

Starting point is 00:25:06 Your zonulin levels will go up, but then they come down. But when you have antibodies to the zonulin, that's when you really know that it's more of a chronic kind of addiction. And then the other- And you don't have to have celiac, by the way. Exactly. So you could just have gluten sensitivity. Yes. And this whole phenomenon of non-celiac gluten sensitivity is very real.

Starting point is 00:25:24 It affects millions and millions of people. Absolutely. And it's linked to all sorts of conditions, including a lot of autoimmune diseases. And it's a spectrum illness. Because I've had patients who had no symptoms throughout their life. And all of a sudden, they developed full-blown celiac disease. Yes. You've seen that, I'm sure.

Starting point is 00:25:38 Sure, of course, many times. And that's probably related to, yes, there's a genetic component. Yes, there's an exposure component. It's probably also related to the microbiome because the microbiome is also tied in with celiac too. So it's really interesting. And then the other part of the leaky gut test, which I really like, is checking for antibodies against the LPS or lipopolysaccharides. These are the coatings of the gram-negative bacteria in the gut. They're like bacterial toxins.

Starting point is 00:26:04 Exactly. And they get absorbed. Endotoxins, exactly. And then your immune system reacts. And your immune system does not like these things. It's like when it sees the gram-negative endotoxins, it says, okay, full steam ahead. We're going to really try to counteract this. And that's where you get this real systemic inflammation.

Starting point is 00:26:22 I mean, that's essentially what you talk you know, we talk about sepsis. I mean, that's, when you get sepsis, you're getting bacterial endotoxins in your bloodstream. And then you get a full cytokine storm. Yeah. Yeah, exactly. Yeah. It's incredible. So we'll look at antibodies against gluten, against things that relate to leaky gut.

Starting point is 00:26:41 We'll look at cross reactions to other proteins that are in your food, whether it's dairy or other grains, which are really common. So what happens is the gluten often opens the door, literally the leaky gut, and then all these other food proteins leak in and your body starts to react to those. So you get in this vicious cycle. And getting rid of the gluten and healing the gut can usually help reverse a lot of that, but it's a big issue. And we also look at stool testing. Absolutely. So why are we looking at poop for the skin?

Starting point is 00:27:08 Exactly. That's a good point. So the microbiome, and it's interesting because what is a healthy microbiome, Mark? What is what we call a eubiosis? It varies. It's a very interesting concept. And what do we call dysbiosis? What is an unhealthy microbiome? you know it's it varies it's a very interesting concept and what do we call dysbiosis what is a

Starting point is 00:27:25 you know uh what is an unhealthy microbiome yeah i often want to write a book called paleo poop paleo poop right which is right what is the what is the indigenous microbiome exactly what is it we actually had as we were exactly evolving exactly yeah absolutely there's no autoimmune diseases there's no psoriasis in hunter gatherer yeah yeah there's no autoimmune diseases. There's no psoriasis in hunter-gatherers. Yeah. There's no autoimmune disease. Exactly. Right? There's no allergies. Yeah.

Starting point is 00:27:47 And to some degree, just like there's a museum, not a museum, but it's a research institute that actually has in cold storage all the seeds of the world. Yes. And I think that we actually need to freeze good poop. I agree. I 100% agree. Because we may be running out of good poop. We need to go to the Amazon and find that paleo poop.

Starting point is 00:28:07 Exactly. The Hadza in Africa. We need to go. Yeah, it's true because we really don't know even what the total healthy microbiome looks like. And it can change very quickly depending on your diet. If you become a vegan, it looks one way. If you go paleo, it looks another way.

Starting point is 00:28:18 So it changes very quickly in response to your diet. Exactly. And the thing about it is that the microbiome is a dynamic. It's not a static process. It's always changing. And there are a variety of different companies out there that do testing. The test that I like, and right now, I think it's probably the clinically most beneficial one is the GI map test, because it does quantitative PCR. It's a great test. It's not a perfect test. And there is no perfect test out there. There really isn't. It's a great test. It's not a perfect test and there is no perfect test out there. There really isn't. There's a lot of like controversy over like,

Starting point is 00:28:49 well, what tests? There's all different ones. There's the Viome one and the- Genova we use. GIF. Yeah, there's a whole bunch of them out there and they all have their role. But I think the quantitative PCR, which is very, very sensitive, and the key thing about that particular test is it's so sensitive it'll pick up bacterial DNA, which may or may not be significant. Like, oftentimes, sometimes you'll see like the- They have RNA, right?

Starting point is 00:29:16 Yeah, RNA. And it'll pick up bacterial DNA that, you know, let's say you ate a hamburger and it's a little bit raw, you might have a little bit of enterohemorrhagic E. coli, and it may come up on the stool test. Does that mean you have an infection from it? No. But I'd rather have a test showing me lots of data, and then I can use my clinical judgment to say, okay, what's going on here? And some people don't know how to really read the test, in my opinion, because they over-read the test. You need to read it in the context. And I think that as time goes on, the stool tests are gonna get better.

Starting point is 00:29:51 We're gonna have more clinical utility of them. And again, we're still, we're just in the infancy stage of learning about the gut microbiome. So we do food sensitivity testing, gluten testing, stool testing, vitamin D. The other thing I often think about is heavy metals. And there's a subset of patients who have autoimmune disease that have heavy metals because these compounds are toxic and they're immunotoxic at very low levels. So it's not like

Starting point is 00:30:17 you have to have a toxic load of this, but it may just trigger an immune response. Often I've helped patients looking at their heavy metal load. So we do maybe challenge tests and other approaches. So now we've got the data. We're looking at their gut. We're looking at food. We're looking at vitamin D. We're looking at metals. Maybe look at other factors. What do we do for these patients? How do we start to treat these patients? What is the functional medicine approach? Well, one of the key things I always ask my patients also is the component of stress. Not that stress causes psoriasis or stress causes autoimmunity, but stress affects the immune system. It affects everything else.

Starting point is 00:30:50 Exactly. Yeah, exactly. So I always get a handle on how much stress are you having in your life and also how is your sleep? Those two things, if you're not getting good sleep and if you're under stress, that's like throwing gasoline on a fire. Yeah. And you're not going to fix the issue until you address a good circadian rhythm and you also address a person's stress and lifestyle. Those are key things because that's not going to cure your autoimmune condition. But I can't tell you the number of times that I've had a patient who had an autoimmune condition that was triggered by a very stressful event, a divorce, loss of a job, loss of a child, you name it. And stress alone can cause leaky gut. Absolutely.

Starting point is 00:31:31 Yes. Yeah. Even in healthy people. Exactly. Absolutely. Yes. Yeah. So, you know, as you said, you know, you address diet and, you know, the low hanging fruit

Starting point is 00:31:39 are things like gluten, dairy, sugar. What about grains? Do you put people on an autoimmune paleo diet? The autoimmune paleo diet, for people who have significant autoimmune conditions, the AIP diet, I think, is probably the go-to diet. What is that? That's where you eliminate gluten, sugar, grains, dairy, and beans. Yeah, like, well, and lectins. Lectins are another thing that potentially can play a role in some

Starting point is 00:32:06 individuals causing leaky gut. And nuts and seeds and eggs even are taken out. So if you're really in an extreme situation, the idea isn't to be extremely restricted your whole life, but to remove all the things that are potentially a trigger for a short time, see what happens. If your skin clears up, then you can start adding these back. Add the nuts, add the eggs, add the nitrates, add all those things and see what happens. Yeah. And the point of an elimination diet is not to eliminate all those foods for the rest of your life. Because a lot of patients say, well, I can't do that. Well, I tell them, well, let's do it for like two months and let's see what happens. And it's sort of like cleaning the slate. It's basically decreasing the immunogenic

Starting point is 00:32:40 load to the immune system via the gut. Most of your immune system is in the gut. So when you're eating these foods, it can trigger the immune system. It can feed the bacteria. Not only are you eating the food, but the bacteria are eating the food. So it's not just eliminating the foods, but it's also feeding the good microbiome. Key, key thing. Lots of polyphenols and fibers and good foods. Right. And we talked about that earlier earlier about the acromantia and you know the acromantia uh uh shake if you will using polyphenols to increase that and it's a protective

Starting point is 00:33:12 type of bacteria so again and then eventually you can then start adding in those foods the one food that i'll never add in if somebody has a gluten sensitivity i just like that's it that's it right i tell them it's kryptonite don. Don't go near it. I like that. I like that. Don't go near it. Yeah, don't go near it. So we do that, but then not just eliminating food, but then we have to repair the gut. So, and how do we do that?

Starting point is 00:33:32 Well, you repair the gut. You can use food also. Ghee can be also very helpful. Bone broth, which is high in collagen peptides. You can also use butyrate. Butyrate is probably one of my favorite go-to things nowadays. Our body produces butyrate. So when we eat beneficial fibers, high fibers will actually get broken down

Starting point is 00:33:56 and the body produces butyrate. But some people don't have those bugs that produce the butyrate. So you can actually use butyrate in supplement form. And actually some conventional or integrative doctors have used butyrate enemas for people with ulcerative colitis and ulcerative proctitis. Absolutely. So those are things. And glutamine can be helpful. Aloe can be really beneficial.

Starting point is 00:34:18 And probiotics and prebiotics. Probiotics, exactly, yeah. And sometimes we also use medication to clear out all the bad guys. I call it the weeding, seeding, and feeding program. Yep. Because if there's a lot, and particularly in psoriasis, I think, you know,

Starting point is 00:34:30 people are cautious about any fungals like Diflucan. But, you know, I've used this for 30 years. It's an extremely safe drug. It really not quite had that one complication. People get some die-off. One patient I think had, with another doctor in our practice, had a liver issue and tried it, and it made the liver issue worse. But if your liver is okay,

Starting point is 00:34:49 it's really a pretty safe drug. And it can be profoundly effective in a subset of patients. Are you talking about Diflucan? Yes. Yeah, Diflucan. I mean, the one thing with that is, I think, drug-drug interaction. So if somebody's not on any drugs, they're much less likely to get complications. Like you said, if you have underlying liver disease, you've got to be very cautious. But if you're not on any drugs, they're much less likely to get complications. Like you said, if you have underlying liver disease, you've got to be very cautious. But if you're not on any other medications and there's no underlying liver disease, it is quite safe. Yeah. I mean, people are afraid of antifungals because when we were in training, you and I, back in the day,

Starting point is 00:35:16 there weren't a lot of these newer antifungals. There was the old one called amphotericin, which we called amphoterable because it had terrible side effects. But now the new ones are not so bad. So we also may have to go deeper than that, even maybe looking at heavy metals and detoxification. So we really have a systematic way. And believe it or not, if you really focus on your diet and clean up your gut, it often goes a long way. And you can do this on your own without even seeing a doctor by following the instructions we gave or looking at some of my books like the 10-Day Detox Diet, which provides that kind of anti-inflammatory diet. So I'm really kind of

Starting point is 00:35:50 excited that people can have hope for psoriasis. Because when I see someone's psoriasis, I get so excited. I'm like, slam dunk. This is what we got in functional medicine. Some things are harder. Some things are harder to treat for sure. You have cancer, other problems. But this is one of those diseases in functional medicine that people should just not suffer from this. Absolutely. Acne, eczema, psoriasis, all these things are skin conditions that are starting as systemic problems that show up on the skin.

Starting point is 00:36:14 And you can't just lather it on the skin and hope it's going to work. Exactly. And then also the whole aspect that psoriasis can lead into psoriatic arthritis, which really tells you it's not a skin condition. You really shouldn't be seeing a dermatologist, in my opinion, for psoriasis can lead into psoriatic arthritis, which really tells you it's not a skin condition. You really shouldn't be seeing a dermatologist, in my opinion, for psoriasis. So if you're seeing- You need to see an inflammologist. Yeah, right.

Starting point is 00:36:31 That's us. A psychoneuroimmunoendogutologist like us. Well, Todd, this is great. So for you listening out there, if you know anybody, if you've been suffering from psoriasis or skin conditions, have hope. Because using this way of thinking, functional medicine, we can really help these patients tremendously. We've shared a bunch of cases.

Starting point is 00:36:51 Some of them are pretty extreme. And they do well. So we at the Ultra Wellness Center here have been doing this for 15 years. Before that, we all were at the Kenya Ranch together for another 10 years before that. So we have literally decades and decades of experience with these kinds of problems. And we'd love to see you. We're doing all virtual consults now, so people don't have to travel here and they can do it over Zoom. And we can really help you with remote consultations and testing and working up what's going on and helping you. So I think for those of you who are interested, we're here to help and we'd love to see you. So I think, Todd,

Starting point is 00:37:22 you are just one of those incredible thinkers in functional medicine. You teach all over the world. Not anymore. All over Zoom, maybe. I'm like teaching from my office up in my house. And I'm just so thrilled that we get to have these conversations about problems that are causing so much needless suffering. And now we can really solve them. So thank you for joining us again on The Doctor's Pharmacy. If you love this podcast, please share with your friends and family on social media. Leave a comment.

Starting point is 00:37:49 We'd love to hear from you. Tell us about your issues and how you've maybe found a way to help them and show everybody else what can be done. And subscribe wherever you get your podcasts. We'll see you next time on The Doctor's Pharmacy. All right, great. Thank you, Mario.

Starting point is 00:38:01 I'm going to end right there because there's really a wonderful video on YouTube. It's called The Big Pharma Rant. You probably have seen it. No. With Bill Maher. It's a really good one. Oh. And he basically ends it by saying, you know, because in functional medicine, what we do is we try to get patients better so that we don't see them anymore. Yeah. I mean, it's like I'm trying to put myself out of business.

Starting point is 00:38:21 It's true. And what he says is there's no money in healthy people. Yeah. And there's no money in dead people. Yeah. But you can make a lot of money in really sick people who are chronic, who keep seeing you. That's the whole point. And they spend $50,000 a year on, you know, medications.

Starting point is 00:38:34 Right. Absolutely. Yeah, no, it's true. But, you know, it's true. We definitely have the problem where we see people, we get them better, and then we don't hear from them. Yeah, which is good. And then you go, what happened? And then, well, you know, five years later,

Starting point is 00:38:47 they call about something else. Oh, I was totally better. I'm cured. I don't know why I'm fine. Like, I just talked to someone like that yesterday. It was like, oh, wow, that's awesome. Yeah, yeah, it is. So anyway, thank you for joining us

Starting point is 00:38:56 in the Doctor's Pharmacy. Thanks. Thanks. 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

Starting point is 00:39:21 stuff from foods to supplements, to gadgets 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 do is go to drhyman.com forward slash pics to sign up. That's drhyman.com forward slash pics,S, 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

Starting point is 00:39:52 my health and get healthier and better and live younger, longer. Hi, everyone. I hope you enjoyed this week's episode. Just a reminder that 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. If you're looking for a functional medicine practitioner, you can visit ifm.org and search

Starting point is 00:40:23 their Find a Practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.

The Dr. Hyman Show - Healing Psoriasis From The Inside Out with Dr. Todd LePine

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