The Dr. Hyman Show - Treating Adult Acne & Rosacea From The Inside Out with Dr. Todd LePine

Starting point is 00:00:00 Coming up on this episode of The Doctor's Pharmacy. Small intestinal bacterial overgrowth is also one of the triggers for rosacea. A lot of patients that you see with rosacea will have irritable bowel type symptoms or bloating type symptoms. And when you do some testing for that and you treat it, that oftentimes will clear up their rosacea. Hey, it's Dr. Mark. One of today's episode's sponsors is ButcherBox, and I'm always being asked how I get enough high quality protein into my diet and where to find it. With all the convention-raised animal products flooding the supermarket, it can be hard to find meat that

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Starting point is 00:04:26 a place for conversations that matter. And if you've got skin problems, you should listen up because this conversation is going to matter to you, particularly something called rosacea, acne rosacea. It's a terrible skin condition. We'll talk about what it is, but if you have it, you know what I'm talking about. And it is miserable. And today we have with us, none other than Dr. Todd Lepine who's my colleague, a frequent guest here on the special episode of The Doctor's Pharmacy, the house call episode. He's a graduate of Dartmouth Medical School. He's board certified in internal medicine. We've worked together for decades now. It's almost heading on three decades.

Starting point is 00:04:58 It's kind of scary. Holy cow, you don't look any different than the day I met you. So functional medicine must be working. He is an incredible guy, and he teaches all over the world. Well, not so much anymore, but virtually now. And has been part of the faculty of the Institute for Functional Medicine, American College of Advancement Medicine, Age Management Medicine, and many, many other great organizations. So Todd, welcome back to The Doctor's Pharmacy. Thank you, Mark. Okay, so first of all, we're talking about this weird condition that some people never heard of called acne rosacea. We're going to talk about what it is, how traditional medicine deals with

Starting point is 00:05:32 it, why that's all wrong, and how we approach it using functional medicine. So what is acne rosacea? Okay, well, acne rosacea is a chronic inflammatory condition that adults get. It's also another name for it is adult acne. And patients who have it will get redness to the face, usually over the cheeks and the nose, sometimes the chin. And you can also be pretty severe. You can get telangiectasias, which are like little blood vessels. So there's like little like blood lines, blood vessel lines in your face. You can see vasodilation of the blood vessels, papules, pustules. So it's like little like blood lines, blood vessel lines in your face.

Starting point is 00:06:10 Vasodilation of the blood vessels, papules, pustules. So it looks like adult acne is really what it is. And interestingly, it's fairly common. About 10% of the population has it. It tends to be more common in people who have Celtic origins. So Irish, Scottish, English, which is interesting. I'll talk about that later. So I'm Jewish from the Middle East I'm safe yeah it might be yeah and a lot of famous people have actually had this Bill Clinton yeah is one WC Fields and the bulbous knows exactly so the extreme version of it yeah so one of the complications of rosacea is chronic inflammatory changes to the skin so you can get what's called rhinophae ma which is basically when you see a clown with a red nose, that's rhinophyma.

Starting point is 00:06:49 Yeah, that's what rhinophyma is. Big red nose. And it can be actually quite debilitating. I mean, when it gets really, really bad, you can get this distortion of the facial features, especially over the nose. Yeah. So it's this really nasty kind of acne. And what triggers it? Do we know from a traditional medicine point of view well there are a variety of different triggers when people have rosacea

Starting point is 00:07:09 uh things that can trigger it are spicy foods uh alcohol can do it yeah i mean alcoholics tend to get this a lot right if you're an alcoholic and wc feels clearly was yeah yeah if those of you who don't know who he is google it yeah it's probably before your time but it's it is often driven by alcohol yeah and i i my own theory on alcohol as it ties in with that is that alcohol does vasodilate blood vessels but also alcohol in excess is also a big contributor to leaky gut and i always you know i get my patients to understand this uh concept that alcohol can promote leaky gut. So if I took a shot of tequila and I threw it in your eye, what would happen?

Starting point is 00:07:49 It would burn. Your eye would water, right? Your eye would get leaky. You have a leaky eye, leaky gut. So chronic alcohol ingestion is probably one of the biggest things for low-grade endotoxin and leaky gut. And that's also tied in, as we'll talk about in terms of irritable bowel. Yeah, we're going to get into leaky gut because that is it's a very big issue general and particularly with things like skin disorders like acne rosacea yeah yeah so so Todd you know in functional medicine we take a very different view which is we treat things from the inside out not the outside in

Starting point is 00:08:24 right dermatology is all about lotions, potions, and creams, and slathering stuff on your face to sort of get it good from the outside in. But it's kind of backwards. So what are the traditional treatments for rosacea? And why are they not the best idea? You know, when I went through my medical training, there was an old saying that the dermatologist basically, if it's dry, wet it. If it's wet, moisturize it. and if you don't know what's going on give it a steroid that's

Starting point is 00:08:48 that's essentially pretty much right that's that's pretty much dermatology i learned the same lesson yeah right that's that's that's it and you know dermatology and if it's if it's wet dry it if it's dry wet it and if you don't know give it a steroid. Exactly. That's the mantra of the modern dermatologist. But again, like you said, it's an external manifestation of something going on internally. So the question is, what's driving this? And in preparing for this talk, I mean, I've seen so many patients with rosacea. It's not funny. What do they put on there?

Starting point is 00:09:20 They give antibiotics on the face? Yeah, they'll give like, you know, metronidazole cream, a topical antibiotic. It's like an anti-parasite antibiotic. Yeah, one of the newer medications, and this is sort of an interesting thing, is a cream called ivermectin. So this sort of blew me away because this is relatively new. And I think we were talking about it earlier. Yeah, it's a worm pill. It's a parasite pill.

Starting point is 00:09:44 They're using it for COVID even. Really? Yeah. Yeah. So it's really, so I was reading and I actually had a patient who came in and was on the ivermectin cream and was doing very, very well on the ivermectin cream. And then I said to myself, well, how is an anti-parasitic medication topically helping with- You got words in your face yeah well it's

Starting point is 00:10:08 also that's also interesting because one of the things that uh is strongly tied in with uh uh rosacea now remember rosacea is just over the face it's it's this it's this facial manifestation of an internal uh issue is that we have these little creepy crawlers on our face, and they're called mites, skin mites. Yeah. Dermadex. They're like dust mites. We all have them.

Starting point is 00:10:32 Everybody has these. And the interesting thing is that patients who have rosacea have a much, much higher density of skin mites on them for whatever reason. And normally, they basically, they're like little, you call them like little parasites, they're ectoparasites. And they sit on the skin and they eat your dead tissues and they eat off of the oils on the glands. And normally, you don't have a reaction to them. They're sort of like a benign parasite. But in some people who have high concentrations of these skin mites, the body makes a very, very high immune response to it.

Starting point is 00:11:10 So getting back to the ivermectin, which is basically an anti-parasitic, it may be actually working as an anti-parasitic for some of these skin mites. Yeah. So maybe there's an infectious cause to this. Yeah, so, yeah, so. The things they use are minocycline,

Starting point is 00:11:24 which is an antibiotic, flagellar metron minocycline which is an antibiotic flagyl or metronidazole which is an anti-parasite and an antibiotic ivermectin which is an anti-worm oral oral doxycycline is another one yeah oral antibiotics which probably is a really bad idea given yeah yeah that you have a microbiome you don't want to be killing it to fix your skin exactly exactly yeah and and why that why might that minocycline work? Why might antibiotics orally work? Well, there's a, there's a thought and there's actually, it's actually in the literature is that small intestinal bacterial overgrowth is also one of the triggers for rosacea. A lot of patients that you see with rosacea will have irritable bowel type symptoms or bloating type symptoms. And when you do some testing for that and you treat it, that oftentimes will clear

Starting point is 00:12:05 up their rosacea. Yeah. Yeah. Absolutely. So I think, you know, we're not averse to using topicals and topical medication when necessary. But if you really focus on root causes, which is what functional medicine does, you come up with a very different set of approaches that actually works better, is longer lasting, and doesn't require to keep putting on lotions, potions, and creams for the rest of your life, or taking oral antibiotics. Right, exactly. And then getting back to the ivermectin, ivermectin, in preparing for this talk, I did a little bit of research, and the patients who are more prone towards rosacea have a problem with too much of what's called the cathelicide and antimicrobial peptides.

Starting point is 00:12:49 That's a big mouthful. Yeah. They're called CAMP, C-A-M-P, cathelicide and antimicrobial peptides. And these peptides are part of the built-in innate part of the immune system to protect our skin against various types of infections. And it turns out that ivermectin actually helps with these antimicrobial peptides because people who have rosacea have too much of these peptides. They have like an over robust response to antimicrobials. So it's thought that the, one of the, it's actually a breakdown product, it's called LL37. And ivermectin actually works on dampening down these antimicrobial peptides to decrease inflammation in the skin. Okay, so in terms of the cause, it seems to be a combination of internal and external

Starting point is 00:13:41 factors, right? Something's on the skin and then something's internally. But from traditional medicine, there really isn't an approach to helping heal the skin from the inside out. No, not at all. And whether you have acne or eczema or psoriasis or rosacea or any one of the myriad skin conditions that we get, most of them have their root cause inside, not on the topical level. Exactly. And often it's the gut the topical level. Exactly.

Starting point is 00:14:05 And often it's the gut. Yeah, absolutely. Yeah. So you mentioned a little bit earlier leaky gut. So take us through from a functional medicine perspective, our thinking about the root causes. What are the things that you think about when someone comes in your office and their face is all red and they got all this acne on there and they've got like telangiectasia, these little red lines everywhere and you can see the blood vessels dilated and they got all this acne on there and they've got like telangiectasia these little red lines everywhere and you can see the blood vessels dilated and they're kind of looking like

Starting point is 00:14:29 santa claus yeah yeah exactly yeah and they also get they also get photosensitivity too which is the other the other thing and the interesting thing they can't go in the sun without getting it worse and and that that also ties in with these antimicrobial peptides because uh it's thought it's theorized that the the the Celts, the ones who live in the higher northern latitudes, they don't get as much sun as we do. So it's thought that from an evolutionary standpoint that they benefit by having this. They have a more robust immune system when there's not enough sunshine. And sunshine will actually activate this innate immune system. And that's why sun exposure oftentimes makes it worse

Starting point is 00:15:06 because they produce more of these antimicrobial peptides. And then those antimicrobial peptides have to get processed. And in the process of breaking them apart, the immune system then starts responding to it. So that's why there's sort of a photosensitivity aspect to it. And what are the other sort of things you think about when someone comes to your office with rosacea? Well, one of the things I oftentimes look at is their vitamin D levels.

Starting point is 00:15:28 Vitamin D is part of the immune system, and it's tied in intimately with the antimicrobial peptides system in the body. So oftentimes patients who have this have low vitamin D levels. We'll look at the microbiome testing to see if there's any evidence of dysbiosis, bacterial overgrowth testing, the SIBO testing, checking for hydrogen and methane. I mean, probably the majority of patients who have rosacea have problems with bacterial overgrowth. Other thing is low stomach acid, which also promotes and contributes to bacterial overgrowth. So checking for the patients. Sometimes these patients are also on PPIs. Acid blocking medications.

Starting point is 00:16:08 Absolutely, yup. Because we have acid in our stomach to help us to digest food. It's also there to decrease the amount of bacteria higher up in the colon. So it's good to have stomach acid. Yeah, it says if you don't have stomach acid, then the pH of your small intestine changes,

Starting point is 00:16:23 becomes more alkaline, and then bugs grow in there that wouldn't necessarily grow. And that's when you get this overgrowth of bad bugs in there. And it can be what we call SIBO, which is small intestinal bacterial overgrowth, where bad bugs migrate up from the lower intestine into the small intestine. And then when you eat food, you get bloating, distension, it causes leaky gut. You end up causing damage to the lining of the gut and food particles and bacterial toxins leak in and create inflammation throughout the body and on the skin. So, you know, leaky gut can cause hundreds of different manifestations, one of which is rosacea. And unless you think about that and learn how to treat it, you may

Starting point is 00:17:00 not be able to be successful with it. There's also another condition that I've seen, Todd, in a lot of my patients called SIFO. SIFO. Small intestinal fungal. Small intestinal fungal overgrowth. Yeah. And a lot of people talk about it as candida, but there's many, many species of yeast and fungus. And so what I found often is that treating the gut through addressing the bacterial overgrowth, the yeast overgrowth, healing leaky gut, dealing with the food sensitivities

Starting point is 00:17:26 makes a profound impact. And a lot of times it is food sensitivities that can trigger. I mean, for example, gluten, we've talked about on the show, that is one of the biggest drivers of leaky gut. And even if you are not celiac, and even if you don't think you have any symptoms

Starting point is 00:17:42 or don't notice any symptoms when you eat gluten, Dr. Alessio Fasano, who's the world's expert at Harvard on gluten, he said everybody who eats gluten creates some level of leaky gut. And most people kind of handle it. Right, transient leaky gut, exactly. So I don't know, like it's probably not a good idea to eat that much gluten because of the potential to create leaky gut and how that is linked to so many chronic diseases including weight gain diabetes cancer heart disease

Starting point is 00:18:11 alzheimer's autoimmune diseases allergies act i mean you just name it depression all this stuff is connected by by leaky gut so i really i think you know getting a very different thinking about this is key and you you did you talked about the stomach acid you talked about the acid blockers you talked about maybe other things that that you know are relevant in the gut and fix certain infections like h. pylori which is a common bacteria that causes ulcers also has been linked to h. pylori and food sensitivity so so how do how do we approach these patients when they come in what are the kinds of things that we would do from a diagnostic point of view that you wouldn't get when you went to the dermatologist? Well, from a diagnostic standpoint, again, I would do testing for leaky gut. I would do intestinal permeability testing,

Starting point is 00:18:55 checking for antibodies to zonulin with the Cyrex testing that we do, Cyrex array number three. So that's basically, there's a test that we do at the Ultra Wellness Center here in Lenox, Massachusetts, where we're recording live, is Cyrex testing. It's a lab that looks at antibodies that you produce against these proteins that are in your gut that come from gluten or even from bacteria. And so if you're creating a lot of antibodies to these proteins, it's clear that they're getting across the lining of your gut, leaking into your bloodstream, and causing an immune response,

Starting point is 00:19:30 which is not only local, but systemic. Right, and there are other ways. You can actually measure zonulin in the blood, and you can measure it also in the stool. And that's only like a snapshot in time. So you can develop leaky gut for a couple hours or a day or so but if it if it stops then you're all so fine the antibodies against zonulin is the one that tells you there's

Starting point is 00:19:50 this chronic leaky gut which is really more valuable because if i gave you a shot of tequila then you know an hour later measure your zion it's going to go up okay where's the tequila right so so that's why i think that the uh the testing for the antibodies against zonulin is even more valuable in these patients with chronic conditions. And what other kinds of tests besides the zonulin and the lipopolysaccharide tests that we do to look at the antibodies against these proteins in the gut that come from a leaky gut? We'll do the small intestinal bacterial overgrowth, where we'll measure the production of fermentation products. So hydrogen and methane are gases that are normally produced in the body.

Starting point is 00:20:32 When people have small intestinal bacterial overgrowth, those will be produced at higher levels. So we can check that. And over time, I think the test that we do is a three-hour test. So you measure baseline hydrogen and methane, check it at intervals of about every half hour, and you do that over a three hour time period, and that can tell you definitively, do you or do you not have bacterial overgrowth, and how bad is it, and is it predominantly hydrogen, or is it methane? So essentially what you're saying is that

Starting point is 00:20:54 when we eat foods, humans don't produce gas, it's the bacteria that are fermenting the foods we eat that produce the gas. So if you feel bloated or distended or you're passing gas, it's not you, you can blame it on the bugs. But the problem is that we don't know how to regulate the bugs and get a healthier ecosystem. And that is what most physicians never were trained to do.

Starting point is 00:21:16 And it's the foundation of functional medicine. It's the foundation of our practice here at the Altiwano Center, where we really dig into these issues. And we look at bacterial overgrowth, we look at fungal overgrowth, we look at a leaky gut we look at food sensitivities we'll do other testing look at whether you're reacting to gluten or dairy or eggs or other foods and and it's really helpful in drilling down on what's really going on with people absolutely yeah and that you know we're

Starting point is 00:21:37 talking basically producing gases that's basically a fermentation process and normally fermentation happens lower in the colon that's in the in the colonic area the ant with it was more of an uh uh what's an anaerobic environment or a lack of oxygen and that's normal for that to be happening but when that process is taking place higher up in a different neighborhood it's not a good thing yeah and and i mean you want your upper intestine to be sterile and they're mostly sterile. Mostly sterile. And when all that bacteria migrates up there, it's just a bad situation. And when we take acid blockers, when we, you know, are low in magnesium, which half of us are, when we're under stress and our gut motility is slow,

Starting point is 00:22:17 when we, you know, have taken lots of antibiotics and it screws up our whole system in there. You know, all these are reasons why we get these bacterial overgrowth issues and they're super common and they're easy, relatively easy to treat with functional medicine. Now, the other thing we do is look at stool testing, right? So, we look at not just the proteins from leaky gut or we look at the food sensitivities or bacterial overgrowth, gas production, but we actually look at the poop. So, what are we looking for in the poop that helps us figure out what's going on? Well, there's a lot of things. You know, there's gold in there.

Starting point is 00:22:48 There really is. It's gold in them, there are hills. It's gold in them, there are hills. Yeah. So a lot of information can be determined by doing a microbial analysis. So you can look at the overall balance of bacteria. So there are, you know, everybody's got hundreds of different kinds of bacteria in the GI tract. And we can measure those using DNA, PCR analysis,

Starting point is 00:23:12 and we can do quantitative, we can measure how many there are of each different species. Look at ones that are normally found, look at ones that are found in the gut, but normally they want to be at low levels. Look at bacteria that are associated with autoimmunity so things like citrobacter clebsiella salmonella yeah etc uh we can look at now analyze uh for uh yeast overgrowth various uh forms of yeast um and then also microbial markers

Starting point is 00:23:39 of inflammation things like calprotectin looking for fat so you can get a enzyme function exactly enzyme function uh butyrate checking for butyrate. Short-chain fats. Short-chain fatty acids. Indicators of healthy ecosystem. So, you know, Todd, what you're saying is that, you know, traditional sort of microbiome testing, they just look at the genetic material of the microbiome, and they can't really test everything, although they can do some really extraordinary tests now but there are there are kits out there where you can look at your microbiome but it's far more than just what bugs you have in there it's what they're doing and so we look at

Starting point is 00:24:13 the the the result the function on the ecosystem we look like you said the enzyme function you're absorbing your food is there inflammation are you having good bugs in there that are producing the the super fuel for the gut, these short-chain fatty acids that are so important? Do you have the right balance? Are you missing some key bugs? Do you have overgrowth of bad bugs? Do you have yeast?

Starting point is 00:24:32 Do you have parasites? And it's such a much more comprehensive stool test that we do here at Delta Wellness Center. We were talking earlier about Delta Sleep. And the interesting thing is that when you have good bugs in the digestive tract and you're eating in a fibrin your diet and you're producing higher levels of butyrate that has an effect on the brain and also improves uh sleep that's amazing yeah yeah so you have to have your get your poop together to sleep better i got it okay that's that's a good good strategy it's better than taking the ambien yeah um all right so we also look at you know, other things like omega-3 fats and other fats because a

Starting point is 00:25:07 lot of inflammation come from not having the right balance of fats in your body. Yep. Yeah. And I think, you know, so when you have a patient come in, what are the steps you would take initially to treat a patient with rosacea from a functional medicine perspective? You know, again, taking the history is the big one. You know, I always will ask people, what's your ethnic background? A lot of people say, you know, I'm white.

Starting point is 00:25:30 No, it's like, you know, are you Irish, English, German, Jewish, Russian, whatever? Because the rosacea is typically found in light skin, fair skin people. And from a genetic standpoint, they are the ones who are more likely to have that. It's just an interesting part to know, uh, to have in terms of the history. And then I'll just ask them, you know, what is it you're eating? Are you eating a standard American diet? Uh, how much alcohol are you drinking? Um, how much stress do you have? Stress also caffeine. Yeah. Caffeine can play. Yeah. Those are, those are all things which can sort of, you know, it's like adding gasoline to the fire, uh, because literally rosacea is the skin on fire in the facial area.

Starting point is 00:26:10 But doing the testing for essential fatty acids, making sure that they have the right balance of the essential fats in their diet. A lot of people have too much omega-6, which tends to be more pro-inflammatory. Yeah. Lack of the omega-3s. One of the oils, I don't know if you've used it, that I've found very helpful with patients who have rosacea is porridge oil and even criminal's oil. They tend to be very, they help to dampen down that inflammatory response. And that's a very key omega-6 that people don't think about much, but it's called

Starting point is 00:26:41 gamma-linolenic acid, which is a very powerful anti-inflammatory. It's not like the omega-3s, but it's sort of like the omega-3s, but on the omega-6 side. And it's something we really have a hard time getting in our diet, it's like borage oil, and a few other things, but evening primrose oil. So yeah, this is very powerful, I agree. And I also think that when I see these patients,

Starting point is 00:27:02 I also think about looking for other clues, like do they have yeast issues have they been in lots of antibiotics are they on acid blockers which cause yeast overgrowth yeah do they have other fungal issues they have dandruff do they have anal itching do they have thrush or white coating in their tongue uh you know do they have vaginal yeast infections do they have other skin markers of yeast like little tinea or other kinds of things? So you'll see often a pattern of other issues around fungal stuff. I'll check for H. pylori.

Starting point is 00:27:34 I'll check, again, all the tests we did talk about and see what's really going on. And then, you know, from the treatment point of view, you know, you start with an elimination diet with an anti-inflammatory diet, right? Exactly. Yeah. Putting patients on an anti-inflammatory elimination diet, you know, 80% of the time, it doesn't matter what they come in with. They're gonna actually, they'll actually get better.

Starting point is 00:27:51 They, you know, getting them off of the pro-inflammatory foods and then putting in foods which are anti-inflammatory, cold water fish, sardines, wild salmon, the essential oils like evening primrose oil help to sort of dampen down that inflammatory response. Yeah, I agree. I think, you know, we don't understand, most of us, how powerful food is as medicine and

Starting point is 00:28:14 how it can drive tremendous amounts of inflammation throughout the body. And, you know, obviously if it's on your skin, it's visible, but there's also invisible inflammation that you're not seeing that's driving all the chronic diseases. And is that, you actually just, you triggered a thought but there's also invisible inflammation that you're not seeing that's driving all the chronic diseases. And you actually just triggered a thought because there's actually a paper that says if you have rosacea, you have a higher incidence of Alzheimer's disease. Oh, wow. So it's not just a cosmetic issue. It's actually systemic inflammation. You have a red face and a red brain that's on fire.

Starting point is 00:28:39 Exactly. Yeah. I'm sort of blown away by that. That's fascinating. Yeah, especially in women. It's actually more common in women. So you advise people the obvious things, cut out the alcohol, the caffeine, stay away from the sun,

Starting point is 00:28:51 stay away from spicy foods, but you also tell them to stay away from gluten, which triggers leaky gut, often dairy. You actually add in all the anti-inflammatory foods that are important, all the phytochemicals from plant foods and turmeric and ginger and garlic and rosemary and all these powerful foods that are important, all the phytochemicals from plant foods and turmeric and ginger and garlic and rosemary and all these powerful foods that can really help to reduce inflammation. And then we often directly treat the issues that are going on.

Starting point is 00:29:14 It could be leaky gut. So we give them a gut repair program. This could be fungal or bacterial overgrowth. So we'll take care of those with either herbs or antibiotics or any fungals. And you'll see these patients really dramatically improve when they change their diet and they resort their gut. And then sometimes we'll use like things like even primrose oil. I found that digestive enzymes and hydrochloric acid.

Starting point is 00:29:34 Absolutely. Often are really helpful too. Yeah. I've been, I've been surprised at how many people have a, what I would call a relative lack of hydrochloric acid in the stomach. I was, I venture to say that the majority of people don't have too much acid,

Starting point is 00:29:48 they have not enough acid in the stomach. Yeah, well that's interesting, because the third leading category of drugs are the acid blockers, like Prilosec and Prevacid and Pepcid and all these other drugs, these Nexium, Mass Effect, they're just out out there everywhere and now they're now they're over the counter and anybody exactly yeah i mean i i just i we've talked about

Starting point is 00:30:09 this before on the podcast but when i was in medical school the drug reps came in because it's drugs that just come out and they're like listen guys these guys these drugs work they're great uh they will help people with ulcers if they're really bad you don't want to keep anybody on it for more than six weeks right those are huge stomach acid it's really bad long term these are the drug reps telling us this and now it's like people are on it for decades and it causes b12 deficiency magnesium deficiency zinc deficiency osteoporosis osteoporosis pneumonia bacterial overgrowth irritable bowel syndrome yeah you get rid of your heartburn but you get all your other problems yeah it's yeah that's that's and then and then it's one of those drugs it's so it's so sneaky because it's addictive once you get rid of your heartburn, but you get all these other problems. Yeah, it's, yeah, that's it. And then it's one of those drugs.

Starting point is 00:30:45 It's so sneaky because it's addictive. Once you get on it, it's hard to get off it because it causes this rebound. So when you suppress the stomach acid and you stop the drug, the acid production goes crazy. Exactly. Which makes you feel horrible.

Starting point is 00:30:59 And then you go, I need the drug, but you can actually taper it down and use other strategies to help people get off it. And you bring up a really good point because a lot of the pharmaceutical medications, And then you go, I need the drug. But you can actually taper it down and use other strategies to help people get off it. And you bring up a really good point because a lot of the pharmaceutical medications, especially some of the psychotropics, so the antidepressants are like that too. The PPIs and the antidepressants, when you try to get off of them, you get this rebound process. So the body tries to get back into balance. And it can be very difficult. So you've got to go low and slow when you're trying to taper off the PPIs or taper off antidepressant,

Starting point is 00:31:28 psychotropic meds, absolutely. Amazing, so what cases have you recalled about rosacea that you want to share that can give a little sense of this? Yeah, well, I had a patient who came in and she was a undiagnosed celiac, not just a gluten sensitivity. She was an undiagnosed celiac, not just a gluten sensitivity. She was an undiagnosed celiac. She was Irish and she was having a standard American diet.

Starting point is 00:31:50 And she was self-medicating for her heartburn with over-the-counter acid blocking medications. It had a lot of bloating type symptoms. And came in and her major complaint was her skin but you know she had all these other things but her big thing was you know it's how i look right so you know it's it's you know people are vain and people it's people's attention exactly right and and then when i uh did a dive into uh her uh testing you know it turned out that she was deficient in her essential fatty acids especially the gamma linoleic acid. She had lack of stomach acid because of the PPIs.

Starting point is 00:32:30 You can actually measure a test, blood test is a commercially available test called gastrin. And gastrin levels will go up when you block acid. So, and that's actually one of the tests that I actually like to use when I have patients where I'm trying to get them off of a PPI. Because the higher the gastrin level, the more difficult it will be to get off the PPI. And that's sort of like it'll tell you how easy you can get off of it. These acid blockers, that's the PPI, right? Exactly.

Starting point is 00:32:55 And then she also had low vitamin D levels. I mean, you know, we spend a lot of our time clothed and indoors. So, we don't get way enough sunshine. That's one of the big things and low vitamin d you don't just fix low vitamin d this is one of my i get up on my soapbox all the time with here is you don't just fix low vitamin d by taking vitamin d yeah vitamin d deficiency is basically a sunshine deficiency ah there are certain uh times when there can be other causes like you might have fat malabsorption uh that can be other causes, like you might have fat

Starting point is 00:33:25 malabsorption that can cause low vitamin D, or you may have problems with the synthesis because of lack of skin oils, which when you get exposed to the sun, but by and large, low vitamin D levels is related to sunshine deficiency. And it's that, you know, low vitamin D is not the problem. It's a symptom of another problem. Yeah. And the immune system is also benefited by sunshine exposure, healthy sunshine. I think you said you're going to be, you enjoy going to the tropics now and then. Caribbean, Hawaii, whatever. And we also feel good.

Starting point is 00:33:59 It's also, this is another thing that I find fascinating, is that there is a condition which is called sunshine addiction. You know, these people who are like suntan addicts. Well, it turns out that our bodies actually produce endorphins when we are exposed to the sun. So there's a feedback mechanism. That's incredible. Oh, yeah, yeah. There's a compound that's called pro-opio-melanocortico-tropin hormone.

Starting point is 00:34:26 And what it means is that our bodies give a reward when we're in the sun. So we feel good. We have these feel-good molecules, these endorphins that make us want to get the sun. Oh, that's interesting. That's why I love going in the sun. Exactly. And there are these people who- I always feel so good when I go to the beach in the summer.

Starting point is 00:34:43 It just makes me so happy. Exactly. And the interesting thing is it actually, you can get addicted to the sun. And it's like you can get addicted to food. I mean, your body needs food to survive and your body actually needs sunshine to survive. So, nature has built in these feedback mechanisms so that it encourages us to do it. That's incredible. Yeah, isn't it wild?

Starting point is 00:35:03 So, what happened with this patient? What did you do for her? Well, I did a lot. I mean, I had her work with our nutritionist and got her off of her standard American diet. I treated her bacterial overgrowth. She had a significant SIBO test. So I treated that primarily with herbs. A lot of people will use antibiotics, things like rifaximin or xfaxim for SIBO. I actually find that I do just as well using antimicrobial herb preparations. I supported her stomach acid using betaine HCL. Some patients don't respond to that. They don't tolerate it as well. So sometimes I'll use things like apple cider vinegar. And then got her fatty acids up, gave her a little bit of borage oil and, you know, a combination of that.

Starting point is 00:35:51 And then also just told her to get some healthy sunshine. It doesn't necessarily mean that, you know, you need to go out and sunbathe or go to a sun tanning booth. But just getting healthy sunshine can help with downregulating the immune system. Yeah. And interestingly, you know, just off topic, but with COVID, there are some really interesting studies that giving high-dose vitamin D helps with COVID infections. Absolutely. And so COVID, or vitamin D, when it's at high enough levels, actually helps to keep the immune system in balance.

Starting point is 00:36:21 It keeps it from getting over. Yeah, it controls hundreds of genes that regulate immunity and inflammation.'s pretty amazing it's not really a vitamin it's more like a hormone exactly exactly it's like a hormone and it's also it actually likes us acts like a steroid too it's yeah it's a cholesterol molecule moiety and uh um i oftentimes when if i'm gonna come down with a cold or flu i'll up my dose especially in the winter absolutely it's true and i when i feel like something's coming on and i take like 50 000000 units for three or four days and I never get sick. Yeah. It goes away by the next morning. It is. It's pretty powerful. So Todd, we just covered a lot here. And I recall a lot of cases of mine that have had rosacea. And it's

Starting point is 00:36:57 always one of those things where I love seeing because it's so easy to treat and people suffer so much from it. And just by following the functional medicine approach looking at the root causes treating the skin from the inside out addressing the gut addressing food sensitivities addressing nutritional deficiencies which is really the foundations of functional medicine these people get better and we we don't just take it at face value pun intended but we we actually go under the hood and look at what's going on. Exactly. I think it was one great quote I heard somewhere that traditional medicine is like trying to diagnose what's wrong with your car by listening to the noises it makes instead of looking

Starting point is 00:37:35 under the hood. Exactly. And functional medicine is about looking under the hood. Absolutely. And here at the Ultra Wellness Center in Lenox, Massachusetts, we've been doing this for decades. We have the most incredible team here who collectively have probably 70 years of clinical experience in functional medicine. And we're doing most of our care virtually now. So wherever you live in the world, we can take care of you using virtual Zoom consults. And it's pretty gratifying to see how many people are

Starting point is 00:37:59 taking advantage of that and getting better. And I think that this is a challenging moment for everybody. And I think we often neglect our own health and our own healthcare. Nobody wants to go to the doctor, nobody wants to go to the hospital anymore. But I think people can get virtual care now, which is super awesome. And we invite you to check it out. You go to ultrawellnesscenter.com. If you're suffering from any skin disorder, whether it's acne or acne rosacea or eczema or psoriasis, we've had some podcasts on that. Go listen to them. But this is really an approach that works for skin disorders. I love skin problems because they are so easy to treat, whether, like I said, it's eczema, acne, rosacea, whatever it is.

Starting point is 00:38:41 It's pretty striking. And it's just heartbreaking to see how many patients struggle with these conditions because they're often so embarrassing. It's one thing if you have bacterial overgrowth and bloating, you're the only one who knows your stomach's bloated. But if you've got this nasty looking face or skin issues, you don't want to be seen like that.

Starting point is 00:38:59 And I think this affects people's sense of well-being and their self-worth. And I just want to point out, there is really clear approaches that help this. Yeah. And the exciting thing is, is it's a lot of the conferences that I go to, there are now functional medicine dermatologists who get it, you know,

Starting point is 00:39:15 because most dermatologists do not realize or remember that the skin and the gut are contiguous. They're connected. So when you have a skin problem, it's oftentimes an internal problem. Yeah. And the functional medicine dermatologists, which are, you know, growing, are getting that and they're really helping. I agree. It is one of the most exciting parts of functional medicine is dermatology because it's like, yeah, it's like, oh, it's such a slam dunk.

Starting point is 00:39:39 Yeah. And and there are a number of really great functional medicine doctors out there who are dermatologists. And the stories are amazing. I just see so many people suffer unnecessarily. So if you've been loving this podcast and you know someone with a skin problem or you've got a skin problem, come see us here. Share it with your friends and family on social media. Leave a comment.

Starting point is 00:40:02 We'd love to hear how you've addressed your skin issues, what's worked, what hasn't worked. Subscribe wherever you get your podcasts, and we'll see you next time 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 to 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,

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Starting point is 00:41:21 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.

The Dr. Hyman Show - Treating Adult Acne & Rosacea From The Inside Out with Dr. Todd LePine

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