The Dr. Hyman Show - Prevent Acne By Getting To Its Root Cause

Episode Date: April 25, 2022

This episode is brought to you by Rupa Health, Athletic Greens, and Vuori. Acne is the number-one skin condition in the United States, affecting not just millions of teenagers but an increasing number of adults under the guise of hormones. Typically, the first thing we reach for to deal with acne is a lotion, potion, or cream to apply to the skin—and conventional medicine doctors frequently prescribe birth-control pills. However, these approaches do not target the root cause of acne. In this episode of my Masterclass series, I am interviewed by my good friend and podcast host, Dhru Purohit, about the biggest triggers of acne, why we all react differently, and the top nutrients for skin health. We also discuss some frequently asked questions from our community about acne during puberty and more. Dhru Purohit is a podcast host, serial entrepreneur, and investor in the health and wellness industry. His podcast, The Dhru Purohit Podcast, is a top 50 global health podcast with over 30 million unique downloads. His interviews focus on the inner workings of the brain and the body and feature the brightest minds in wellness, medicine, and mindset. This episode is brought to you by Rupa Health, Athletic Greens, and Vuori.   Rupa Health is a place where Functional Medicine practitioners can access more than 2,000 specialty lab tests from over 20 labs like DUTCH, Vibrant America, Genova, and Great Plains. You can check out a free, live demo with a Q&A or create an account at RupaHealth.com.   AG1 contains 75 high-quality vitamins, minerals, whole-food sourced superfoods, probiotics, and adaptogens to support your entire body. Right now when you purchase AG1 from Athletic Greens, you will receive 10 FREE travel packs with your first purchase by visiting athleticgreens.com/hyman.   It’s the perfect time to upgrade your wardrobe! Vuori is offering my community 20% off your first purchase. Just head over to vuori.com/farmacy to claim this deal.   In this episode, we discuss (audio version / Apple Subscriber version): The three biggest triggers of acne (4:45 / 1:37)  Why we all react differently (6:50 / 3:31)  Foods that can aggravate acne (9:30 / 4:44) Sugar as a main cause of acne (11:15 / 8:00) The importance of evaluating gut health (13:56 / 10:40)  Hormonal shifts and why birth control may not be the answer to combating acne (15:17 / 12:13) Nutrients for skin health (24:13 / 16:22) Questions from our community (27:07 / 22:04)

Coming up on this episode of The Doctor's Pharmacy. The best way to treat skin problems is from the inside out, whether it's eczema, acne, psoriasis, anything really on the skin often is coming from inside. Hey everyone, it's Dr. Mark. As a busy doctor with multiple jobs, I'm all about tools that make my life simpler. And since testing is something I rely on

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r-u-p-a-health.com. People are always surprised when I tell them that even with a whole foods diet rich in plants, we can still be nutrient deficient. And addressing nutrient deficiencies is one of the lowest hanging fruits for optimizing our health and feeling better at any age. And that is why I'm a huge fan of AGU1 from Athletic Greens. Since our soils are so damaged, the plants can't extract the nutrients because there's no living matter anymore. And we're up against issues like chronic stress and toxicity and sleep deprivation like never before. And our bodies need some extra help getting all the right information to work properly. Now that information comes in the form of vitamins and minerals and phytonutrients and good bacteria, all of which help our cells remember how to

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really well in most smoothies. If you're curious about trying AG1 from Athletic Greens for yourself, right now they're offering my community 10 free travel plaques with your first purchase. All you have to do is visit athleticgreens.com forward slash hyman. Again, that's athleticgreens.com forward slash hyman to take ownership over's athleticgreens.com forward slash Hyman to take ownership over your health and pick up the ultimate daily nutritional insurance. Now let's get back to this week's episode of The Doctor's Pharmacy. Hi everybody, it's Dr. Mark Hyman. Welcome to The Doctor's Pharmacy, a place where conversations matter. If you ever struggle with acne, you probably should listen up because this conversation

is going to matter to you. And it's part of our special masterclass series where we dive deep into topics that you all care about, including information, brain health, metabolic health, sleep, and much more. And I'm joined by my guest co-host, my good friend, my business partner in crime, Drew Prowitt, who's the host of the Drew Prod podcast. And we are going to dive deep in the topic of acne, which is the source of so much suffering for so many people. And it's not that hard to fix. And it doesn't mean you have to slather on all kinds of potions, lotions, and creams, or take nasty pills. Mark, this is a topic that a

lot of people are passionate about and are curious about. I actually struggled with acne all throughout my high school. And for my freshman year, literally, it's like as if it was timed. My freshman year, I came in, had terrible acne, cystic acne. That's what made you such a compassionate person. I know. And it continued right up until. And then literally when I got out of school and I was getting ready for my summer vacation right before college, I found out that dairy, which we're going to be talking about in a little bit,

was a trigger for me and my gut health. But there's many other things besides that, that are connected to people's acne. So let's start off with the basics. What are some of the top things? Give us three things that are deeply connected to why acne is happening in the first place. So again, your disease is your body's best attempt to deal with a bad sort of circumstances. So acne occurs when things are out of balance. And we know a lot about what happens with acne. And the problem with most traditional dermatology is you're attacking it from the outside in, but it's actually an inside-out job to fix. And the things that are the biggest triggers for acne today are dairy. You mentioned dairy, which has 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 because I think I really fixed my gut a lot. But if I used to eat dairy, I would never eat dairy because I knew if I ate dairy, I would get pimples. And, you know, it's embarrassing to be like a 50-year-old guy with pimples.

So, especially if I had to go on TV, you know, it's a big one on my nose. So, I would just, it was like instant. I had some dairy, the next day I'd get pimples. So, it was like instant. I 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 phenomenon 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, in their immune system, in all the important ways that we're different. And so 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 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 the last time I had a pimple. Yeah, that's huge. So we talked a little bit

about some foods that can trigger it like dairy. And again, dairy is not dairy is not dairy because we just did a whole episode about some of the benefits of like goat's milk, for instance, 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 Ryland Englehart who started his family, the Gratitude Cafe and also then realized that regenerative agriculture was so important and started Kiss the Ground,

which is a nonprofit to raise awareness about soil health. There's 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 as a form of casein, is the protein in milk and then he says um it's all regenerative and it's a2 casein i'm like

oh you just said the two things that are my kryptonite so i'll try it okay send me the ice cream he sent me like five flavors 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 the A2 casein or maybe it was because I fixed my gut. But I was like really surprised because normally I would get a pimple. Right. And it's good that you have that awareness. But for a lot of people who don't, they don't realize that dairy could be a key component.

Huge. Huge. But like dairy, what are some other foods? Let's talk about foods first before we go into everything else. What are some other foods that can contribute or agitate the underlining root issues that can make acne more likely to happen for some people? Well, 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 flavanols 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. I mean, think about it. That's 6 out of 10 Americans. I mean, sorry, 60% of the average American. So 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 it's if you are prone to acne it's definitely the first thing to think about so sugar why, 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 for a lot of different mechanisms.

But, you know, 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 cell, it's a fancy word for fat cell, but it produce, and everybody's heard of the cytokine storm with COVID, it produce 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 to look down your belly fat, that's a sign you probably have cells in there that are driving inflammation in that whole cascade. And again, anything that can 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's a mess, you're going to be absorbing these bacterial byproducts called lipopolysaccharides, which essentially your immune system sees and goes, well, that's not good. It's a bacterial endotoxin. So then it creates more cytokines like TNF-alpha. And what that does is that blocks the 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 going to be causing inflammation, which then causes insulin resistance.

So insulin resistance causes inflammation, but inflammation causes insulin resistance. It's a vicious cycle. And so you really want to 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 going to be asking themselves to see, is my gut working the way that I want it to be working? Well, you know, Drew, I think it's important we all understand we live in a gut-busting culture and world. One-third of babies are born by C-section. Many babies are not breastfed.

Many babies are given antibiotics in the first year of life. Many babies are fed formula, which, I mean, 25% of the calories in breast milk is non-digestible by the baby. It's food for the bacteria. But if you have formula, it doesn't have that in it, and the microbiome is very, very different. you start out 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 a 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 isn't 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 an acne 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 hormonal systems are networked, right? So we call the chicken wire in medical school. If you look at like 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? And so for example, men who are overweight increase aromatase in their cells and they actually cause the testosterone to be turned to estrogen. So the men, they get man boobs and they get hair loss on their body and they get very soft skin and they get very estrogenized. Women, the 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 and 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 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 shifted 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, you know, 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? You know, 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 like 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. Like she added more fiber. She wasn't overweight. She wasn't overweight. Classically pre-diabetic, but it still made a difference, right? Exactly. It made a huge difference. She added more fiber. Yeah. And she wasn't overweight. She wasn't overweight. She wasn't overweight. Classically pre-diabetic, but it still made a difference,

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

sugar bombs, even if they think that they eat really clean yeah and that has a significant impact on especially breaking out right before they get their period 100 i think i think that's as i mean for me day one i mean the connection between insulin resistance and acne i've known for 30 years you know um but it's not really permeated popular culture it's surprising how most people don't really get it and and it's the easiest thing you can do. Just quit dairy. And if you want to try sheep and 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, if you're a 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. Hey everyone, it's Dr. Mark Hyman. When I get dressed in the morning, I want to feel comfortable and ready for the whole day from my meditation and workout to grabbing lunch or going to a meeting, which is why I'm obsessed with Viore. Ever since I tried Viore's clothes on, I've been hooked and I literally have not wanted to wear anything else. They're that comfortable. I've turned so many of my friends onto Viore and now my team is hooked too. The women's performance jogger has become a staff favorite because they are super soft

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why my team and i love their stuff so much now let's get back to this week's episode of the doctor's pharmacy 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 laugh because pretty much any menstrual disorder or any hormonal disorder, the knee-jerk response of most doctors is give you a pill. Shut everything off. Block it. So what happens is you shut off your own hormone production when you take a pill, an external form of hormones.

So your natural cycles are all interrupted. And yes, it can help, but it's not the solution because often when you stop, then it'll come back with vengeance. And so you don't want to do that if you don't have to. Plus the pill causes more yeast overgrowth, more leaky gut, B6 deficiency. It's not that it's terrible to take the pill and I don't, if women are taking the pill, it's okay, but you got to be aware. You want to make sure your gut's healthy, Make sure you're taking probiotics against yeast. Make sure you're, you know, actually making sure you're taking care of your gut and taking the right vitamins and so forth. So really, it's important.

So the hormonal changes that happen with the pill are just to shut everything off. But there's a lot of ways to create hormone balance without having to take the pill. And I've worked with women for decades. In fact, at Kenya 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, 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. Like, that's just insane to think that that's normal. But it's sort of normalized in our culture. It's like, oh, I mean, I had a friend who was a very healthy young woman, very awesome, who thought she was great. But she had like debilitating menstrual cramps, debilitating PMS.

And I just saw her like a couple of weeks ago. She's like, you changed my life. You just made a few little changes in my diet and a few little supplements. And like, I'm good. I don't even know my period is coming. I don't have any PMS. I don't have any cramps. Right?

So the body has the ability to heal and repair given the right conditions. And that's really what's so powerful about functional medicine. But it's hard because people don't know what to do. And really, it's honestly not that hard. It's like that joke from the doctor who gives his patient a bill for an appendectomy and it's $1,000. And the patient goes, God, that's a lot of money for such a simple operation. Is that too much? He's like, well, let me think about it. I think you're right. I'll send you a new bill. Send me a new bill. Taking out your appendix, $1. Knowing that's what needs to be taken out, $999. So it's knowing where to push and 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 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 linoleic acid which is also found in evening primrose oil and borage oil so i'll often

recommend evening primrose oil fish oil zinc oil. So I'll often recommend evening primrose oil, fish oil, zinc, vitamin A. And that can be really, really helpful. So I think, 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 used actually for prostate health. And often it has prostate related names on the label when you buy it. My women, 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 of why it works. And if you have the high levels of androgens or testosterone in your 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 fertility. It's great for facial hair, hair loss in the head. A lot of the things that women use this for are related to this PCOS phenomena. One of the drugs we use called spironolactone is a diuretic that can really help acne because it blocks the testosterone. But also it actually, you know actually blocks the conversion of testosterone to dihydrotestosterone. So to lower

the more inflammatory androgenic testosterone. So there's a lot of ways to hack this, but you can try the herbs and supplements, the diet. If that doesn't work, there's other things to do. Beautiful. So let's go into some community questions. So we talked about most classifications and groups of people, but for individuals that are in that sort of prime puberty age group, this is a question from the Dr. Hyman Plus group. There's somebody that says that, what are your suggestions to help a 12-year-old girl that has and is suffering with acne? She's in middle school, very shy, and is struggling to make friends. She has a very limited diet and she's a picky eater please help exclamation mark exclamation

word i feel bad you know it's being a kid is hard enough being a young woman today size hard enough being 12 years old is hard enough and having acne on top of that it's rough i mean i can relate i i basically when i was 13 i got glasses and braces and that was like the end for me until 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 and dairy, but if that doesn't work,

what happens, Drew, is that, and I listed this at the beginning, one of the key reasons besides sugar and dairy is leaky gut. Yeah. And leaky gut leads to food sensitivities. Not true allergies, but food sensitivities. So it might be some random thing like soy or corn

or who the heck knows. So someone's 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. Uh, people are willing to do a lot of different things. Okay, great. Um, next question from our audience, we have, uh, 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 water helpful tips but yada yada yada uh 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 that you know when your dog gets a surgery, they have those like cones they put on. Cones, right, yeah.

Give her one of those cones. That might help. But no, just kidding aside, you know, I don't think that's a huge issue. 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, you know, 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 want to be careful of that. Retin-A can be often helpful if 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, you know, if you never wash your face and you stick your dirty hands on your face all the time, you know, clog pores, yeah, that's a thing. But I think that's probably not it for most people. Yeah, and there's so many like different superstitions and tales and other stuff. When I first met my now wife, you know, sorry, I'm telling all your stories here, Yasmin.

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. 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 in a panic, right? You get panic. And you're like, don't touch my face. Don't do this.

Don't do that. Again, it came from a beautiful place. You're like, don't touch my face. 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 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 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 and have high cortisol, that may be a factor. If you are someone who's taking anabolic steroids or you have high testosterone, that can cause back acne, chest acne. So you see a lot of bodybuilders who

are jacked up on testosterone have like terrible acne over the chest and back. Also, sometimes it's weird stuff, Drew. I had a patient, there's different kinds of acne, cystic acne, because often you get the big cystic stuff, which is nasty and painful and big, deep cysts. That's kind of a different kind of acne. And I had this one patient years ago who had parasites. And we cleared up her parasites and the cystic acne went away. I was like, wow, this is amazing. So I've seen all kinds of stuff.

You know, gut for sure is a big factor. And I think that's a 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 in 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 if 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, Kieran 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 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. 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 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 I 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 hormones. Or also is it? Because if it's, these days 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. And the reason we're seeing it is because of our diet, number one, sugar, for sure, because it increases estrogen. So high estrogen will start to trigger puberty. Second is what we call xenoestrogens or foreign estrogens, which are basically toxins that are in our environment.

And there's thousands of them that our estrogen mimics. And we're seeing a lot of hormonal dysregulation because of these environmental toxins. So I would look for that. But I think ultimately with somebody who's nine years old, it most likely is going to be an inflammatory diet and a gut issue and food sensitivity. So I would start with sugar and dairy, fixing the gut and taking the supplements that I recommended and that usually will take care of it. The creams and lotions and soaps don't help. It's like trying to like, the gasoline's on your fire, and one hand you're pouring water over 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. And I don't know if everybody listening knows, but I majored in Asian studies in college. I majored in Chinese, spoke fluent Chinese, forgot a lot of it, but I can still make

my way on a Chinese restaurant. Okay. Cause that's what counts. And I studied a lot of it but i guess i'll make my way on a chinese restaurant okay because that's what counts uh and uh i studied a lot about traditional chinese medicine and it's fascinating because everything is connected and everything's connected along meridian lines uh 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 uh funny cartoon i used to show which was this know, woolly mammoth and these little hunter-gatherers throwing spears at them. And a spear hits the woolly mammoth in the butt. 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, electromagnetic 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 it's not bad to explore it. So traditional Chinese medicine can 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 a summary of what we were talking about today. What are the top reasons that we get acne and what are the top things that we can do to address it? Yeah, for sure.

I mean, the top reasons 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 sheep or 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 an 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 that'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 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 salt and meadow. 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 don't think I've ever had a patient who I couldn't fix their acne, which sounds crazy. But when you understand like the joke about the doctor with the thing on the appendix, it's like if you know what to do, it's easy, right? Yeah. about the doctor with the thing 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 val dr val truller is a dermatologist and she wrote a book years ago called The Clear Skin Diet, which talks about a functional medicine approach to acne and skin health. And she's a dermatologist. So thank God some dermatologists are getting into functional medicine because it's the best way to treat skin problems is from the inside out, whether it's

eczema, acne, psoriasis, anything really on the skin often is coming from inside. So that's why I say beauty starts from the inside out. Great, Mark. Well, those are all the questions that we have for today. Thank you. It's great to be with you again, Drew, on the Masterclass on Dr. Sormage Podcast. For those of you listening, if you have had acne, you should read this up, listen to this podcast carefully.

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

And I'd love you to sign up for the weekly newsletter. 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, 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. 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 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 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.