The Dr. Hyman Show - Resolving Acne, Psoriasis, And Other Skin Issues Using Functional Medicine

Episode Date: June 17, 2022

This episode is brought to you by Mitopure and Levels.   Skin problems like acne, psoriasis, and eczema are often treated with over-the-counter lotions, creams, and potions or even with antibiotics. But while these options may reduce symptoms temporarily, they don't get to the root cause of the problem. In Functional Medicine, we dig deep to determine the underlying cause of skin issues, which often originate in the gut—treat the gut, and the skin clears up. In today’s episode, I talk with Dr. Elizabeth Boham, Dhru Purohit, and Dr. Todd LePine about the pathophysiology of acne, why diet matters for skin health, and how gut health is related to skin health.   Dr. Elizabeth Boham is a physician and nutritionist who practices Functional Medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing, she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing.   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. Dr. Todd LePine graduated from Dartmouth Medical School and is board certified in Internal Medicine, specializing in Integrative Functional Medicine. He is an Institute for Functional Medicine Certified Practitioner. Prior to joining The UltraWellness Center, he worked as a physician at Canyon Ranch in Lenox, MA, for 10 years. Dr. LePine’s focus at The UltraWellness Center is to help his patients achieve optimal health and vitality by restoring natural balance to both the mind and the body. His areas of interest include optimal aging, bio-detoxification, functional gastrointestinal health, systemic inflammation, autoimmune disorders, and the neurobiology of mood and cognitive disorders. Dr. LePine enjoys skiing, kayaking, hiking, camping, and golfing in the beautiful Berkshires and is a fitness enthusiast.   This episode is brought to you by Mitopure and Levels. Mitopure is the first and only clinically tested, pure form of a natural gut metabolite called urolithin A that clears damaged mitochondria away from our cells and supports the growth of new, healthy mitochondria. Get 10% off at timelinenutrition.com/drhyman and use code DRHYMAN10 at checkout. By leveraging biosensors like continuous glucose monitors (CGM), Levels provides real-time feedback on how diet and lifestyle choices impact your metabolic health. Learn more about Levels by going to levels.link/HYMAN. Full-length episodes of these interviews can be found here: Dr. Elizabeth Boham Masterclass with Dhru Purohit Dr. Todd LePine

Coming up on this episode of The Doctor's Pharmacy. Traditional dermatology, it doesn't really work that well. They can work in the short term, but in the long term, they make you more prone to getting it in the future. So if I see someone with skin problems, the first thing I think of, what's going on in their gut? Hey everyone, it's Dr. Mark. I always say I want it to be 120,

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That's TimelineNutrition.com, T-I-M-E-L-I-N-E.com, forward slash DrHyman, D-R-H-Y-M-A-N. And use the code DrHyman10 to get the discount. I've been using it for almost a year now and at 61, I feel stronger and more energized than ever. There's a reason I'm 62 years old and healthier than ever. And it's because I put a lot of effort into optimizing my health. And I know that if you're listening to this podcast, optimizing your health is important to you too. Like me, you're probably doing your best with your diet to get good nutrients into your body and limit the damage done by toxins.

Now, one of the keys I found to eating the right things is monitoring your glucose intake. Poor glucose control is tied to all kinds of issues like weight gain, fatigue, diabetes, Alzheimer's, heart disease, and stroke, just to name a few. But it can be hard to know exactly how much glucose you're getting in your diet and how your body responds to it. But I have found a solution that I'm excited about sharing with you. It's Levels Continuous Glucose Monitors. Now, I've been using Levels to track and understand my own unique metabolic data. I just stick the small glucose monitor onto my skin and the data starts transferring to my smartphone immediately. And it's helped me learn a lot about what foods work best to support my health and vitality based on my own physiology. In fact, I had one time where I thought, oh, I'm eating a really healthy meal and it was super

delicious. And it was really not too starchy or sugary, but I ate a ton of food. I way over ate because my friend ordered so much of this delicious food and it's all farm-raised and great and healthy, but eating a giant amount of food also spikes your blood sugar and your insulin levels. And we were both laughing because our levels monitors both showed levels of blood sugar over 150, which I'd never seen before. So I learned to moderate my food intake

and not go overboard. Now, if you're interested in learning more about levels, go to levels.link forward slash Hyman. They've got a super well-researched in-depth blog that I recommend checking out if you want to learn even more about topics like metabolic health, longevity, and nutrition. Hi, this is Lauren Fee and one of the producers of the Doctors Pharmacy podcast. Treating common skin issues like acne, eczema, and psoriasis has become a billion-dollar industry, yet most over-the-counter lotions, creams, and serums only offer short-term relief, failing to address the root cause of these problems.

In today's episode, we feature three conversations from the doctor's pharmacy on a variety of skin issues and why the traditional dermatological approach misses the mark on treating skin problems from the inside out. Dr. Hyman speaks with Dr. Elizabeth Boehm on the importance of gut health and diet in relation to the skin, with Drew Pruitt on helpful nutrients for skincare and acne in children, and with Dr. Todd Lapine on the root cause of psoriasis. Let's dive in. The traditional medicine focuses on the outside in. What stuff you can slather on your face, what creams, potions, lotions, or maybe taking antibiotics, which is a whole problem we're going to talk about in a minute. But most of our skin health

comes from the inside out. Yes. So if you want great skin, if you want glowing skin, if you want clear skin, if you want to get rid of your acne, if you want to get rid of your eczema, if you want great skin, if you want glowing skin, if you want clear skin, if you want to get rid of your acne, if you want to get rid of your eczema, if you want to get rid of your psoriasis, if you want to get rid of rosacea, all these things come from the inside out. And traditional dermatology focuses on the outside in. And it doesn't really work that well most of the time, even when you work on the outside in. And it's difficult, it's expensive, these medications are absorbed.

You know, you basically, my rule is if you wouldn't eat it, you shouldn't put it on your skin. And a lot of times with the topical treatments, whether it's, you know, steroids for eczema or topical antibiotics for acne, they can work in the short term. But in the long term, they disrupt your skin and make you more prone to getting it in the future. For example, we know both topical steroids and topical antibiotics are going to get rid of that really important layer of good bacteria that's on our skin. So wait, you have a microbiome on your skin is what you're saying. I know. It's kind of cool, right? Not only in our digestive system, but lining our skin. And so those medications, though they can be helpful in

the short term, in the long term, they're damaging, they're getting rid of all of those good bacteria, which are really important first line of defense. And so then you create a dysbiosis or an imbalance in the good and bad bacteria on your skin. And then that just makes you more prone to getting more acne in the future. So it may be okay in the short term, but it's not getting to that underlying root cause. It's true. And so we put on antibiotics on the skin. We put on these agents that dry it out like benzoyl peroxide, which are most of these acne products. And if that doesn't work, we give people oral antibiotics, which not only describes the

facial microbiome, but also the gut microbiome. And what we know now in functional medicine and in medicine in general, if people paid attention to the research on acne, is a lot of it starts in the gut. Yes. So if I see someone with skin problems, the first thing I think of, what's going on in their gut? Absolutely. What's going on with their food that they're eating?

Yep. With inflammatory foods, with food sensitivities, with foods that trigger hormonal responses, with foods that increase something called insulin resistance. So tell us about the pathology and the pathophysiology of acne, because it's very interesting, because we often just think it's like a topical thing, but it's really not. Yeah. I mean, one of the things we know with foods is that when you eat foods that are really refined and processed, foods that are high in sugar and refined carbohydrates, you'll get a spike in your blood sugar. And you'll often get that spike in insulin after you get a spike in blood sugar, right? So you eat food, your blood sugar goes up, the body makes a lot of insulin, and that spike in insulin and blood sugar will cause a follicular hyperkeratinosis.

Wow, that's a big word. I know, right? Which just means that there's extra, that in the follicles of the skin, the skin's not turning over as well as it should. And so cells get stuck in the skin and then those stuck cells can get more inflamed and acne can get produced. So one of the major things we always start with is pulling away the refined and processed foods and the sugary foods. And starchy foods. And starchy foods, right? Anything that's going to cause that insulin spike.

You can really see signs of insulin resistance on the skin in so many different ways. It's like pre-iabetes, right? It's like you need to make sure your blood sugar goes up, your insulin goes up, and it creates this vicious cycle we've talked about so much, which is this prediabetes that affects one out of every two Americans. Yes. Right? Right.

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

foods causes changes in your skin. We know that, for example, PCOS, which is polycystic ovarian syndrome, it's a common condition that affects women that causes infertility. We're going to talk about that on another podcast. It causes acnetility. We're going to talk about that on another podcast. It causes acne. Yes. It causes really screwed up menstrual cycles and it causes hair growth. And we think of it as a ovarian problem. It's not. It's a mouth problem. It's a fork problem. It's a dietary problem. Often, yeah. Right? And so it's caused by insulin resistance. And the consequences of that are the acne and all these screw up hormones.

So when women have a lot of sugar, it actually can increase their testosterone, which causes acne, and it causes hair growth, and it causes infertility. So the treatment isn't heavy duty drugs and hormones. It's actually changing your diet. Which is amazing to see. I mean, we know that when we pull away those refined and processed foods and the sugary foods, most of our patients, so many of our patients see great improvement in their acne right away. Right away. Right away. So sugar, starch, processed foods,

they got to go. Yeah. And then there's another food that is really common in this country uh and it is a huge driver of acne yeah the dairy yeah dairy dairy i mean because dairy is you know all of our dairy food our milk our cheese our ice cream you know all of that is very high in hormones um there's 60 different hormones in milk. And these are not added like growth hormone. These are just naturally occurring hormones. Why? It's a growth food for calves.

It helps the calves grow, right? So it's got a lot of factors that are hormonally active that drive growth. Yes. And we know that those growth factors can stimulate acne in some people. You know, not everybody, but for some people, they're more sensitive to them and they definitely will cause more acne. Actually, for a lot of people. I'm one of them. If I have dairy, I get pimples.

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

And I'm like 60 years old to get pimples from dairy. Absolutely. And I think it depends, like the question of sheep or goat, I think it depends on the person. There's some people that it really, all types of dairy bother their skin. And for other people, there's some that is better than others. And what we know is sometimes the testing, like the food allergy testing or food sensitivity testing, doesn't always pick it up. I mean, we do it often, but there are times when we get a negative test result, but even if we still pull it away and people's skin improves. So this isn't like an allergy necessarily. Not necessarily. It could be just like you said, all the hormones in dairy too. But there's another category of things,

which are food sensitivities that do drive inflammation and drive leaky gut and can drive acne that are independent. So we've got sugar, we've got dairy, and we've got this other category, which is sort of more sort of amorphous, but it is a factor in a lot of people. Absolutely. Absolutely. So there's so many ways, and I always say this, there's so many ways that somebody can react to food, right? You can have, and people get confused all the time because they get one negative report and they say, oh, then I must be fine to eat that food, right? You can have, and people get confused all the time because they get one negative report and they say, oh, then I must be fine to eat that food, right? You can get an immediate reaction to food or an IgE.

You can get a delayed reaction to food or an IgG, but you can also have a food intolerance. There's just so many ways you can react to food. So just because you have one negative food test result doesn't necessarily mean that food is not causing you problems that's a whole other topic which is how are you know what are the many ways that we react to food you know the 50 ways i love you it's like what are the 50 ways you react to food and it's all kinds of stuff

from tartrazine and which is a dye that causes asthma it's an additive or whether it's msg that can cause a an amino acid related cognitive effect or whether cognitive effect, or whether it's something like high fructose corn syrup, which people can have fructose intolerance, or lactose intolerance. Or how food changes your microbiome, and then that changes the inflammation. I mean, that's a lot. Yeah, and by the way, in this age of COVID and coronavirus,

it's really clear that the more sugar we eat, it affects our immune system, but it also affects our microbiome. And our gut health, it turns out, is incredibly important for us to be resistant to the flu through many, many research studies and likely to coronavirus as well. Absolutely. Absolutely. And I think that this first case that we were going to talk about, this 22-year-old who came to see me, it really kind of pulls in the importance of the microbiome in terms of your immune system, but also in terms of your skin. She was a 22-year-old and she started to develop acne when she was around 12.

When we got more history from her, I realized she had had multiple antibiotics as a kid. She had chronic ear infections. And especially when she was getting those ear infections, they were treating most of them with antibiotics. And I think we've kind of calmed down a lot on treating every ear infection with antibiotics, but she got a lot of antibiotics because of her ear infections. Yeah. I was a family doctor. Remember, it's like, oh, give them out like candy, a little moxicella. It's like nothing. Right, right. Now I'm like horrified by what I did 30 years ago. remember it's like oh give me like candy a little moxicella yeah it's like nothing right right i'm like horrified by what i did 30 years ago so she's you know she's um she came in to see us because

she was using a lot of different uh topical treatments she was also taking a low dose antibiotic and um and her skin was better but she didn't want to stay on these antibiotics and she wanted to really look at it a different way. And when she stopped taking the oral antibiotic, which she realized she didn't want to be on forever, her acne started to get worse again. So she said, okay, I really want to figure out- Which is not uncommon. And then doctors say, oh, you need more antibiotics.

Right. It's like, that's the vicious cycle. It becomes a vicious cycle. We see these vicious cycles all the time with medications, right? Because they're shifting because there's antibiotics, as we've mentioned, are shifting the microbiome. They're shifting the microbiome in your gut. They're shifting it on your skin. They're getting rid of that first line of defense. And then they're allowing, then it's more common to get the acne again when you stop them. And so just because of her history of all of those antibiotics as a kid and being on the antibiotics, and because we got more information, she was having a lot of digestive issues.

She was having some bloating, some diarrhea, constipation. Her digestion was off. And her dermatologist was never like, what's going on with your gut, right? No, right. Right. No, he didn't ask that. He didn't ask that. So because of that, I said, you know what? I really need to focus on the microbiome here for this woman to help improve her acne.

And so we did a stool test, which is kind of a neat, it's a neat way to get a sense of what's going on in the microbiome. It looks for real- How is this different than what a traditional doctor would do with a regular stool test? It looks at a lot of different biomarkers, right? So it's looking at all of your levels of commensal bacteria, like all the good bacteria, and is there an imbalance in the good and bad bacteria? So it does look for acute infections, for real infections as well, but it also is really paying attention

to something we call dysbiosis, which is an imbalance in the good and bad bacteria, and trying to get a sense of, is there an overgrowth of not good bacteria, or not good yeast, or it also looks at parasites. It looks at digestion and absorption and inflammatory markers. Yeah, so you look at how your enzymes are working and are you digesting your food or absorbing your food? Is there inflammation in there? It's like a window into a dark world, and we can learn so much from that through these tests which are really not available through traditional doctors.

I mean, they could order them if they wanted to, but it's just not something we're trained in which is how do we take a deep look in the gutter? We're talking about the microbiome, microbiome, but as some future state of medicine will somehow figure out what to do with it. Well, we've been doing this for 30 years in functional medicine, and now we understand even more than we ever did, and we're learning better and better how to actually optimize the microbiome and fix the problems of leaky gut and all these things that happen as a result of your patient who had all these antibiotics and this crappy diet and developed, you know, overgrowth of bacteria

that you found and yeast. Right. So when the stool test came back, we found that there was this overgrowth of unwanted bacteria and there was an overgrowth of unwanted yeast. And yeah. And so we can do tests like you said on, is there increased intestinal permeability or leaky gut? And she, of course, had that because of these imbalances and the inflammation going on in her digestive system. Because we know that those imbalances cause inflammation. And we know inflammation causes all sorts of things, including acne, right? So we said, okay, we need to work to fix.

We need to work to fix this imbalance. Let's work to rebalance the bacteria in her gut. And so for her, she wanted to use an herbal approach and I agreed with that. So we put her on a combination of a couple different herbs that can work to get rid of the overgrowth of bacteria and yeast. And that worked really well. The one thing I always say about skin, though, is you kind of have to be patient sometimes. So if you are pulling away a food like dairy, which we did with her, we took her off of dairy. We took away a lot of added sugar. If you're adding in something to treat the dysbiosis, and we also gave her a lot of

probiotics too, you got to give it some time for the skinbiosis. And we also gave her a lot of probiotics too. You gotta give it some time for the skin to improve. You might see some improvement in the inflammatory acne right away, but for the skin to really improve, it takes like six weeks for the skin to turn over. So you wanna give it some, we always give it some time to say,

how is this improving? And so, and we also added in some nutrients that are really important for skin turnover. So we know that zinc and vitamin A are really critical nutrients to help the skin turn over so you don't get so much of that hyperkeratinosis, that elevated levels of the skin not turning over, which can cause more acne to develop.

Yeah, Accutane is a derivative of vitamin A, which is actually what is used for really bad acne. And by using this comprehensive approach, we use in functional medicine that we do here at the Ultra Wellness Center. With the deep diagnostics we do and knowing how to optimize function, right? Of your skin, of your gut,

et cetera, we can get people better where often they don't get better and do it in a way that not only improves their skin, but improves their overall health. So very powerful. So we put her on some zinc and vitamin A. Now the both of those, you know, I just want to caution listeners, if you're not working with the doctor, a doctor, both of those you can get too much of, and they can cause imbalances in other vitamins. And vitamin A is fat-soluble, so if you're going to use a higher dose- You can't OD on it. Yeah. I use 10,000.

I use per day with her- Of vitamin A. Of vitamin A. But you don't want to be on that for a long, long time. No. We did it for three months, and then we started to spread it out, and I was monitoring her levels. And the same thing with zinc. No, we did it for like three months and then we started to spread it out and I was monitoring her levels.

And the same thing with zinc. You know, you just have to be a little bit cautious of just taking a lot of this on your own because it can throw off some of your vitamin levels or vitamin A can be toxic at high doses. But it really helped. I mean, the whole comprehensive approach really helped her skin improve. And she was able to stop using both the oral antibiotics and the topical antibiotics. She was able to get off of them.

And her skin, that dysbiosis started to rebalance and she wasn't getting all the acne all the time. And I bet there were a lot of great side effects too. I bet she lost weight and had more energy and felt better, right? Absolutely. Yeah, instead of the side effects being all bad, they're all good.

And there's really important nutrients for skin health that are essential for everybody, but particularly more important in terms of acne. Vitamin A, you've probably heard of retinol, which is a drug that's used to treat acne, but where does it come from? From vitamin A. You can take straight up vitamin A, not beta carotene, not carotenoids that are plant-based, not carrots, but actual vitamin A, which usually comes from animals like liver. Two would be zinc, which is really important for skin health and immunity. And also vitamin C is very helpful, but also, so because it's important in skin health and collagen, but fish oil is really important. So omega-3 fats are really critical. And there's

a particular also essential fatty acid that's not omega-3. It's an omega-6 fat. It's called GLA or gamma-linolenic acid, which is also found in even primrose oil and borage oil. So I'll often recommend even 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 women 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, you know, 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 blocks the conversion of testosterone to dihydrotestosterone. So to lower that 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 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 acne? She's in middle school,

very shy, and is struggling to make friends. She has a very limited diet, and she's a picky eater. Please help! Exclamation mark. Exclamation mark. I feel bad. You know, being a kid is hard enough. Being a young woman today's size is hard enough. Being 12 years old is hard enough. And having acne on top of that, it's rough. I mean, I can relate. I basically, when I was 13, I got glasses and braces and that was like the end for me. 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 sugar 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 sensitivity 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 young children understand that literally let's try this out for a month or two, and you could have a significant improvement in your health, people are willing to do a lot of different

things. Okay, great. Next question from our audience. We have, my daughter has reoccurring acne on one side of her face. She's right-handed and it's the right side of her face. I'm assuming that's because she's touching her face on that side more often. She sleeps on the left side of her face at night. What are helpful tips, yada, yada, yada. Mark, do you think this idea of touching our face is a little bit overblown in this world? And what are your thoughts on this component? Well, you know when your dog gets a surgery,

they have those like cones they put on their head? Cones, right, yeah. You can 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 work on your inside out first, but you also have to work on the outside in. So I'm not opposed to people

working on their skin through various cleansers. And even low-dose benzoyl peroxide can be fine to just help kind of reduce the inflammation. It's very drying, so you 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 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 like different superstitions and tales and other stuff when i first met uh my now wife you know sorry i'm telling all your stories here yasmin um when she was just my girlfriend

you know she would be very sensitive about if i went to go like touch her face like if you're grabbing her like give her a kiss or whatever she just doesn't want me to touch her face yeah and i'm thinking like anytime my face touches yours, there's also like oils on my face and they're touching your face. We think, and again, it's so tough because when you're suffering with acne and you don't know what it's coming from. You get 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. I have a friend like that. She's 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 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 and have 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 this 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, Kiran Krishnan from Microbiome

Labs. And he was telling me I was having this, after only really suffering with acne in high school, I had this resurgence of like my face would break out and I 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 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. 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. Think cookies. 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 you know fluctuations in um or or also is it because if it's you know there's these days like kids are getting right i mean that's the other thing like it's a nine-year-old girl, as a nine-year-old boy, it's a little bit different. But part of the problem is we're seeing a lot of premature puberty. Right. And the reason we're seeing it is because of our diet. Number one, sugar, for sure, because it increases estrogen. Right. So estrogen, 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, it's like trying to like,

the gasoline's on your fire. And one hand you're pouring water out with the other. It's just, it doesn't make sense. You've got to. 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 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 guess I'll make my way on a Chinese restaurant, okay? Because that's what counts. And I studied a lot about traditional Chinese medicine. And it's fascinating because everything is connected.

And everything is connected along meridian lines. And so how can you stick a needle in your foot and your neck pain goes away, right? It's like that funny cartoon I used to show, which was this woolly mammoth and these little hunter-gatherers throwing spears at them, and a spear hits the woolly mammoth in the butt,

and he's like, wow, hey, Joe, my neck pain's gone. What happened? And I think 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, you know, 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, you know, a summary of what we were talking about today. You know, what are the top reasons that we get acne and what are the top things that we can do to address it? Yeah, for sure. I mean, the top reasons we get acne are, one, sugar and starch in flour and sugar which is 60 of our diet or more two it's dairy and usually modern dairy not cheaper goat so much but traditional dairy big factor driving hormones and acne a third would be leaky gut and food sensitivities in general which need to be sorted out on an individual basis but 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 it's my book I wrote years ago, but it's still pretty much what I use for clinical care because it's so effective. And then 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 uh all very very helpful in terms of regulating immune function skin health uh and then for 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 palmetto. So there's a lot of different things that 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 out the appendix, it's like if you know what to do, it's easy, right? Yeah.

And especially with the most underrated area being just like, again, as you mentioned, look at some of the food sensitivities, dairy in particular, and then focus on starch and sugar, right? Like that already is going to be so underrated by people. You know, a colleague of mine, Dr. Val Trulor, 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, you know, 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. 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. There's the environmental component.

Vitamin D is, I'm a big proponent for vitamin D. I have so many patients who have psoriasis who tell me that they get better in the summer when they go to the beach and they're in the salt water and they get sunshine. Well, that's one of the medical treatments is UV light, right? Absolutely, yes. better in the summer when they go to the beach and they're in the salt water and they get sunshine. Well, that's one of the medical treatments is UV light, right? Absolutely, yes. So they do stick people under lights and do light therapy and medicine, believe it or not. Yeah, well, I think they also, that's an older therapy. They used to use also, or is it PUVA therapy, sorolens, 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. 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? A gut-ache. That's actually- It's actually gut ache with a T. It sounds like gut ache, but it could be that. Exactly. That's it.

Actually, it may be that. It may be caused by the gut. Exactly. We'll get to that. It's actually a good point. So it's G-U-T-T-A-T-E, gut-ache psoriasis. And a patient who I had treated for a strep infection, strep throat infection. And then like a week or two later, she comes back and she's covered in these

dimed 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-ate psoriasis went away. Amazing. Because you treated the strep, the cause. Exactly. Exactly. Now, the one thing that you don't need to realize is that strep bacteria is oftentimes involved in cross-reactivity. That's why people are so onto 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 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. 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 and they get absorbed into the system they do decrease inflammation but they thin the skin and you get you know uh breakage of the skin and such so there's even though they're creams there's systemic side effects to them absolutely yeah you know i i um i also see that that uh the the drugs that

are being used now that are promoted on television are these very expensive we call them immunosuppressants they call tnf alpha blockers yeah or biologics that yes maybe fifty thousand dollars a year and they they they can be effective and help people for sure but they do lead to immune suppression especially this time of covid if you're 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, you know, either rheumatoid arthritis or significant psoriatic arthritis, 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. Yeah. Absolutely. So it's not as though I'm against biologics. There's time and a place for everything. For sure. But those are sort of the last ditch. Yeah.

That's like, OK, break the glass, pull out the emergency fire extinguisher and put out the fire. Well, it reminds me of this case I'm going to share for a minute, which is a little girl came to see me. She was probably like four at the time. And when she was little, 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 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. Then got ear infections, antibiotics, 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 that suppress your 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, or overwhelming systemic infection, was because her immune system was suppressed in the drugs,

and it was this vicious cycle. So parents came to me who 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 know, let's start with the basics, 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, you know, if I look at psoriasis, probably one of the biggest factors. Yeah, absolutely. So I got rid of the gluten, got rid of the dairy, cleaned up her diet, got rid of the sugar and stuff. And because of all the antibiotics and steroids and the immune suppressants and 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 and i got i put her on this 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 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 i and when you get an incredible result by fixing the root cause.

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. 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 the kind of case that really sticks in your head. And the one thing about

psoriasis, as I think also, it's people view it, people who have it. It's one thing if you have a couple of lesions on your elbows and they're hidden, it's not a big deal. 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, you know, 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. Absolutely. There definitely is that psychological component to it. You know, and you see these advertisements where, you know, I think there shows people like by the pool with, you know, taking their biologics so that they can, you know, now go bathing. But, you know, you got to take this expensive, toxic medications 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. Absolutely. 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, 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 incredible pathway to help these patients. Do you have any other cases that come to mind? Oh, yeah. 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 up 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, you know, contamination from her kids or whatever. And then was put on a variety of different antibiotics. And then after the birth of one of her children, she had a cholecystectomy because she developed gallstones. Yeah, or gallbladder out. Gallbladder out, exactly, gallbladder out. And there's actually some really interesting evidence about the role of the bile acids in psoriasis. It's really quite interesting, and that's what sort of triggered it. And 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 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 psoriasis. And then originally the patient had, if I 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's a symptom of the problem. 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 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. And then in the winter, I personally will take vitamin D during the fall and the winter because you know i personally will take vitamin d uh during the fall in the winter because you're not going to get it you live north of mason-dixon line you're

not going to get the uh the healthy uh sunshine but i'll push back on that talk because i see patients in the summer think i'm not taking my vitamin in the summer and you know they think it's fine and just out walking but you need to have full body exposure for 20 minutes between 10 and 2 above you know above and 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? What do most people do 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, your, uh, the, the private parts in your, your armpits, but we overbathe. 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 pearl.

Oh, that's good. Because see, I only use soap and water on those private parts, as you say. And the rest, I just water. Exactly. And I don't actually wash my body with soap. And I think it may- And there are some people that- I should announce that.

They'll bathe like twice a day. I think I smell okay. I don't know. How am I doing? Exactly. 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. I don't know if you've seen it. It's fantastic. And it talks about how we as human 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, vitamin D. And it's a great visual about trying to get ourselves outside in fresh air and sunshine. I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in. Hey everybody, it's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one. 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

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