The Dr. Hyman Show - Why Your Skin Is Begging You to Heal Your Gut First

Episode Date: May 26, 2025

Skin issues like acne, eczema, and rosacea are deeply connected to internal imbalances, especially those originating in the gut. It is important to explore diet—particularly sugar, refined carbs, and dairy—because it can drive inflammation, insulin resistance, and hormonal disruption, all of which contribute to poor skin health. Topical treatments and antibiotics may provide short-term relief, but they often disrupt the skin and gut microbiome, worsening conditions over time. A Functional Medicine approach focuses on restoring gut balance, identifying food sensitivities, and supporting detoxification pathways with nutrient-dense foods, supplements, and lifestyle practices. Addressing the root causes not only improves skin but also promotes systemic healing and resilience. In this episode, I speak with three of our doctors at The UltraWellness Center—Dr. Elizabeth Boham, Dr. Cindy Geyer, and Dr. Todd LePine—about why, when it comes to skin care, we need to look inside the body first. Dr. Elizabeth Boham is Board Certified in Family Medicine from Albany Medical School, and she is an Institute for Functional Medicine Certified Practitioner and the Medical Director of The UltraWellness Center. Dr. Boham lectures on a variety of topics, including Women’s Health and Breast Cancer Prevention, insulin resistance, heart health, weight control and allergies. She is on the faculty for the Institute for Functional Medicine. Dr. Cindy Geyer received her bachelor of science and her doctor of medicine degrees, with honors, from the Ohio State University. She completed residency in internal medicine at Strong Memorial Hospital in Rochester, N.Y. and is triple board certified in internal medicine, integrative medicine and lifestyle medicine. 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 the 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 BIOptimizers. Head to bioptimizers.com/hyman and use code HYMAN10 to save 10%. Full-length episodes can be found here: Treating Acne From The Inside OutChoosing Skin Care Products that Won’t Make You SickTreating Adult Acne & Rosacea From The Inside Out

Coming up on this episode of the Dr. Hyman show. So we can do tests like you said on, is there increased intestinal permeability or leaky gut? Because we know that those imbalances cause inflammation. And we know inflammation causes all sorts of things, including acne. As a doctor, I've seen how chronic stress impacts nearly every system in the body, from sleep to mood, energy, and even inflammation. But what many people don't realize is that stress often depletes a critical mineral your

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Over 1,500 5-star reviews back it up and it comes with a full 365-day guarantee. Head to bioptimizers.com slash Hymen and use code HYMAN10 to save 10%. Now before we jump into today's episode, I'd like to note that while I wish I could help everyone by my personal practice, there's simply not enough time for me to do this at scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real-time lab

insights. And if you're in need of deepening your knowledge around your health journey, check out my membership community, the Hymen Hive. And if you're looking for curated and trusted supplements and health products for your health journey, visit my website at drhymen.com, or my website store for a summary of my favorite and thoroughly tested products. What you're eating is so much more important

than what you're putting on your skin. Yeah. You know, the food that you're putting in your mouth is so much more important than what topical things you're putting on your skin. Yeah. You know, what the food that you're putting in your mouth is so much more important than what topical things you're putting on your skin. And so it made us start to have this conversation, which I thought I was saying all the time, but that I think sometimes people don't realize or understand

or the connection is not made. Yeah. That how important what you're choosing to eat every minute of the day, how much that impacts your skin? Yeah, I mean, the traditional medicine focus 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 gonna 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 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. Yeah. 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 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 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 work we get people oral antibiotics which

not only describes the oral 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 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? 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 in blood sugar will cause a follicular hyperker 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 is, which just means that there's an 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 you can get 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 gonna cause that insulin spike. You can really see signs of insulin resistance on the skin in so many different ways.

It's like pre-diabetes, right? It's like you need to make sure your blood sugar goes up, your insulin goes up, and it creates a vicious cycle we've talked about so much, which is this pre-diabetes that affects one out of every two Americans. Yes. Right? Right. And 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 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 gonna talk about that on another podcast. It causes acne. 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 dutyduty drugs and hormones, it's actually changing your diet. Which is amazing to see. I mean when we you know 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 gotta go. Yeah. And then there's another food that is really common in this country,

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. They do 60 different hormones in milk 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 them grow. 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, there are 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 as 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. 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, what are the many ways that we react to food? What are 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, which is a dye that causes asthma.

It's an additive. Or whether it's MSG that can cause an amino acid. Yeah related cognitive effect or whether it's Yeah, or whether it's Something like high fructose corn syrup, which people can have fructose intolerance, right? I was intolerant food changes your microbiome and then that changes the inflammation. I mean, it's the you know, that's yeah By the way in this age of kovat and coronavirus. that's really clear that the more sugar we eat it affects our Immune system, but it also affects our microbiome and our gut health turns out is incredibly important for us to be resistant to the flu Through many many research studies and and likely to coronavirus as well. Absolutely

Absolutely, and you know, I think that this this first case that we were going to talk about this 22 year old Yeah, to see me, you know, she, it really kind of pulls in the importance of the microbiome in terms of your immune system, but also in terms of your skin. Yeah. Right? She was a 22 year old and she had, she started to develop acne when she was around 12. She, 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. 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 me a light candy, a little Moxacilla. Yeah. It's like family doctor. Remember it's like, Oh, give me a light candy, a little moxacilla. 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, 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 this 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 never was like, what's going on with your gut, right? No, right. Right, no, he didn't ask that. 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. Yeah. 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. 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

Yes, you look at your idea how you your enzymes are working and you're just in your food or absorbing your food Inflammation in there. It's like a it's like a window into a dark world Yeah, 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, 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. Now that we understand even more than we ever did, and we're learning better and better on how to actually optimize the microbiome and fix the problems of leaky gut and all these things that happen as a result of Like your patient who had all these antibiotics and it's crappy diet and developed, you know

Overgrowth of bacteria 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, 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. So we said, OK, 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 a 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 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, okay, 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 turnover. So you don't get so much of that hyper keratinosis, that elevated levels of the skin not turning over, which can cause more acne to develop. Accutane is a derivative of vitamin A, which is actually what is used for really bad acne. Yeah. 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. Yeah.

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, you know, both of those you can get too much caution listeners if you're not working with the 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 you have to, if you're gonna use a higher dose. KOD on it. Yeah, like I use 10,000, I use per day with her. A vitamin A. A vitamin A. But you don't want to be on that for a long long time. 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, 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. She felt good too, right?

Absolutely. Yeah, instead of the side effects being all bad, you're all good. If you're suffering from stress, poor sleep, low energy, these are all signs you might be low in magnesium. And not just one kind, your body needs seven different forms to truly feel calm and at ease.

That's why I recommend magnesium breakthrough from Bio-Optimizers, a complete formula with all seven types in one capsule. Head to biooptimizers.com slash Hymen and use code HYMAN10 to save 10% Let's take sunscreen for example. This is something summertime people want to get skin cancer and putting on a sunscreen in it and is it okay? Like what should we be doing and how do we figure out what's going on? I mean a lot of the sunscreens also have compounds that destroy reefs too.

There's like reef damage to the coral reefs so you're not only killing yourself but you're killing the reefs. Right. Well, there's a lot of the chemical sunscreens like Avaband zone, I don't even know all of the names of them, the chemical sunscreens. And many of those are potentially endocrine disrupting chemicals as well. The flip side is Mark, I'm one of those people who grew up in the South had more than my share of sunburns, had my first skin cancer when I was 37. So I also would slow down skin aging and wrinkles and skin cancer. So we kind of have to say, well, how do you get the protection you want without putting yourself at risk? I personally am a real

fan of the zinc and titanium, the mineral based sunscreens, or even just a hat covering your skin, staying out of the sun in the middle of the day. I mean, I think there's a lot of other things we can do that are going to be safer for us and safer for the planet. One of my favorite one stop shopping places to learn more about safety levels and which either skincare or sunscreens contain things we do or don't want is the environmental working group. And I know you've been a big supporter of their works for years. I think they were some of the pioneers really raising awareness. And what I love about them is they have a safe cosmetics database that you can

search by type. So you could search sunscreens or you could search by brand, plug in your favorite brand and see how it rates to others on their list. What about the sort of things like the tic stuff? Because people are worried about tics and DEET is really common, which is a terrible toxin. It's used to kill insects, but also it's a neurotoxin that can affect humans. So, you know, they say not to touch yourself, don't put your mouth, but like putting your skin, it goes straight. So tell us, tell us a little bit about DEET and what to do about that. Yeah. So that's, that's another one. I mean, you know, work in the Berkshires ticks are everywhere. So for those of us who love to be in the woods, you always have to be mindful

of enjoying your time in the beautiful woods and hiking without putting yourself at risk for getting a tick-borne illness. So how do we navigate that balance as well? For people who are super concerned, I don't know how you feel about this, but if you tucked your pants into your socks and put a little deed around where they join, maybe that's enough?

I don't know. I don't do it. I mean, I hike all the time. And you know, the other nice thing about being in the Berkshires, I can come home, strip on my front porch, put my gloves on the outside, go in and do my tick-tack, because I think that's probably the most important thing. The other interesting piece, though, is there's emerging science-based evidence that some essential oils may be almost effective at repelling ticks. There's been some research on lemon eucalyptus oil, on thyme oil, on citronella. So I think that is another reasonable option to try to get some of the tick repellent benefits

without causing harm. So those essential oils are basically plant chemicals that are repellent to insects. And this sort of leads back to a sort of view of functional medicine, which is that plants are highly intelligent. They're, in fact, sentient beings, believe it or not. They have 20 different senses and they do all kinds of smart stuff that we you know We don't really attribute to plants, but they produce these molecules to deter insects from the cells So and they communicate with other plants. So if there's a caterpillar eating a plant that plant goes ooh

I'm getting eaten by caterpillar. I'm gonna produce this molecule And by the way, I'm gonna send a message to my neighboring plant friends over there through the Mycelia rhizome network that you should secrete this chemical too. That's how these plants produce all these wonderful chemicals that we use for our own benefit, but they're really for their benefit. And I think the essential oils are great.

And there's a lot of natural alternative products out there that are for insects, for pellet, and for skincare, for makeup. The only thing you don't realize is makeup. There's a lot of natural alternative products out there that are for insects, for pellet, and for skincare, for makeup. The only thing you don't realize is makeup. There's like lead, you know? And a lot of makeup and a lot of lipstick, is leaded lipstick. Yes, oh my gosh.

Oh my gosh, me. And those things are really avoidable. It's just a matter of education. And I think the beautiful thing about it is we move in the right direction as people start to become conscious, as we push those companies by our financial choices, we actually can drive the marketplace into a better set of products. And that is really what we need to be doing.

Okay. So it's a big deal to think about what you put on your skin. I remember learning that basically you wouldn't eat it, you shouldn't put it on your skin. And you might go, no, that when we were in medical school, we delivered all kinds of drugs to the skin. I mean, one of the quickest ways to get someone relieved from chest pain if they came into the emergency room with a heart disease was to slap a toothpaste tube full of like nitro

blister and cream and put a bandage over it and that got right through the skin. There's hormone patches for women, there's pain patches, there's all sorts of patches that people use because the skin is a vehicle for delivering medicine. So it makes a logical sense to think that we should be aware of what we're putting on our skin in terms of sunblock, insect repellent, makeup, you know, body care products. And yet most of us never give a thought about it. So tell us, Cindy, why should we really care? And I think it's, it is, you know, because this is, it seems to be

like maybe a trivial issue, but how big of an issue is this? And why should we worry or should we? Well, I'm glad you pointed out that we absorb things through the skin. So we think we put it on our skin and it's just going to stay on the outside, but it can potentially get inside our bodies. And one of the challenges, Mark, is trying to do good research to actually prove cause and effect when you're looking at some of the carriers or preservatives that are added to the things like the cosmetics that we put on our skin. Our old model of what happens with toxicity is the dose makes the poison. You have to have massive amounts for it to have a negative impact, but there's so many things that are in our skincare products

like phthalates or parabens that have been dubbed endocrine disrupting chemicals. And what that means is even tiny amounts, especially at critical windows may actually muck up hormonal signaling and have long lasting impacts that's less related to the dose, but the cumulative exposure over time And so it's hard to tease out. I mean, you might be having exposures every day in teeny tiny amounts that don't seem immediately problematic, but down the road, when you're struggling with insulin resistance

or breast cancer or uterine fibroids or thyroid issues, it could be related to these endocrine-disrupting chemicals that have wreaked havoc on our hormone balance. I mean, see, yeah. So why are all these compounds used in these products? I mean, why do we need all these petrochemical, endocrine disrupting, hormone busting, disrupting compounds? Why are they there?

It's a great question. So, parabens typically are added as a preservative to extend the shelf life of your skin creams or your topical creams. And phalates. And rancid. Yeah, so local rancid. So, you can keep it on your shelf for a year or two and it won't smell funny or it won't go bad. And so, you don't get bacteria. I mean, some of them are trying to keep contaminants out. Phalates tend to be embedded with fragrances to make things smell pleasing to us. We would put them on our bodies and those are also endocrine disrupting chemicals. And is there a way to measure

in the body whether there are these chemicals that are there from these products that people are using? That's a great question Mark. In studies that are trying to tease products that people are using? That's a great question, Mark. In studies that are trying to tease out how they influence our health, they often look at urinary levels to see how much people are exposed to. It's a little bit challenging, however, because it turns out that all of us show evidence of exposure to these chemicals. So it's a little bit hard to know what to do with measurements other than trying to do it from a scientific standpoint. Say do the levels track with health

outcomes in clinical practice? I have not done that. I don't know if you found it helpful or not. And when I was first looking at it, we ended up coming back to the same recommendations anyway. We need to reduce exposure and find ways to support your body's getting rid of them. Right. I mean, everybody should cut out toxins from your life and everybody should do all the things they can to upregulate their biology to detoxify these compounds for sure. But sometimes it's really helpful. Like, you know, people just don't know about their exposures. I had one woman who was in a sunblock for years and her makeup, we checked her urine

since super high levels of parabens. I'm like, oh, this isn't good. And other people have high levels of phthalates because they're drinking plastic water bottles or people have BPA because they're not aware of where it's coming from, which is best female aid, some sort of credit card receipts or restaurant receipts or just all kinds of, you know, gas station, all that stuff.

It's in plastics bottles. So I think, I think we really can raise awareness by seeing that it's in your system. You know, I think, I think I find that often helpful to be able to change their behavior too. Like, and then, then you can actually track it and see that it's coming down and see what's happening. This, and I think, you know, it is a little amorphous

because, you know, when you look at, you know, on an individual level, it's hard to draw the connections in a one-to-one level of whether this caused the problem or not. But if you look at a population-wide level, these toxins clearly are linked to all sorts of harmful effects in terms of endocrine disorders, heart disease, cancers, and more. And I think it really is important for people to understand what they're doing, what they're putting on their body. So the, the, um, no, the other thing I'd love you to talk about is some of the, the epigenetic effects of the, um, toxins on the fetus when the mother

is exposed to the products that could cause this hormone destructive chemicals to get in the blood of the baby. Yeah. I think that's really important to understand that there are critical windows or critical timeframes, but it's even more important to reduce exposure. One of those classic timeframes is when a woman is pregnant. Even little bits of exposures in utero may affect the fetus, and then those impacts persist into adolescence. A study a few years ago, what they did, a lot of the data has to be correlative, but

they measured urinary levels of phthalates and parabens in women at two different points in their pregnancy. And then when their babies were born, they tracked them for nine, 10, 11 years. And they found that higher levels of phthalates and parabens in the urine, the daughters of women with those higher levels ended up going into puberty earlier, which now that does approve cause and effect. But sometimes you can't ethically design a study. And when we see research like that, that it does correlate with endocrine challenges down the road, we have to take that seriously. We have to take that seriously. There's been some other research linking exposure in utero in particular or early childhood to phthalates and parabens to higher

incidence of ADHD like symptoms in adolescents. So even neurodevelopment. Again, a lot of the data is correlative at epidemiologic, but we can't really design a placebo-controlled double-blinded trial to willingly expose one group of women and not expose another, attract their children for 20 years. Yeah, it's linked to ADD, to neurodevelopmental issues, behavioral issues, later stage symptoms of obesity even, diabetes, heart disease, cancer, when they're exposed to these compounds in utero, which is kind of striking because I think people don't seriously think about what they're putting on their skin, but it is one of the most important things that you do every single day.

Literally, you're doing, besides eating, most of us put stuff on their skin, but it is one of the most important things that you do every single day. Literally, besides eating, most of us put stuff on our skin every day, whether it's shampoo, whether it's base cream, whether it's makeup, whether it's sunblock, whether it's insect repellent. These are things that we use a lot of in America, and unfortunately, they're really problematic. So I'll say, you say, oh, geez,

I've been using this stuff for a while. I'm gonna switch to all these other products. But what do I do to get rid of these embedded toxins? Because if we did a fat biopsy of every American, you know, it wouldn't be too pretty. There'd be a lot of these compounds in there. They're stored in there. We begin to help get them down. And we've done we've done podcasts on detoxification, but we're not talking about like a water fast or some crazy thing.

We're talking about supporting the body's natural built-in detox pathways. How do we do that? You know, Mark, before we jump into that, I want to come back to something that you just said about the fat biopsy. And I know that urine levels can sometimes be really helpful at motivating people to say, oh my gosh, I need to look at this. But we have to be aware that even if they're not showing up in the urine, if we've had old exposures, they do tend to get positive. It's fat and we're not doing fat myopsies on people. I just want to point that out. So don't use an okay looking urine to say, okay, not a problem for me. Right. Right. For sure. And it's been a concern as well if those are all residing as deposits in fat tissue, if somebody really rapidly loses weight and starts to mobilize all those stored toxins, it could

potentially put extra burden on a lot of different processes in the body. So it's just food for thought. And you have done a lot of podcasts on detoxification and it really is coming back to the basics. I mean, how do we get rid of things? We sweat by, we break a sweat by going out in the woods or exercising or sitting in a sauna. We really have to focus on optimal gut function, fiber dense diet, a healthy microbiome and specific foods that support all of our detoxification pathways. We can talk about a few of those. Drinking enough water. I mean, it's really, I don't know that there is a super magic for these endocrine disrupting chemicals, except it's really important to make sure our detoxifying

enzymes have the nutrients they need to do their job. And what are those things that our body needs most of to actually get rid of these toxins? Yeah, we need B vitamins, we need magnesium, we need the sulfur containing amino acids that are rich in shoots like broccoli, kale, Brussels sprouts, garlic, onions, the allium family. Antioxidant rich foods can kind of fill the gap. Some of the deeply pigmented fruits and vegetables. It has similar things, I think, that's come up in other areas, but those are some of the foods that are most important. Prebiotic rich foods that can select out a healthy, robust, diverse microbiome that can also kind of, if we have detoxified and mobilized things, can help us get rid of it and clear it out of our system.

No, I was just saying, other practices that we can do to help our detox system, like saunas, exercise, lip balm, drainage, and infrared saunas, hot and cold therapy, all those things help mobilize toxins through our system. Right, right. Do you have any favorites yourself? Do I have any favorites? I do have a lot of things that I do to actually mobilize my toxins every day. Make sure that I eat brassicas every day.

So last night we had a good bunch of broccoli rabe for that night, with Brussels sprouts, lots of garlic and onions. I use a lot of spices in my cooking. And I also make sure I do saunas. I do ice baths. I sweat. I actually like to sweat a lot. So my exercise is great. Yoga is great for lymphatic drainage, getting massages is great. Can mobilize tissue at lymph stores.

So there's a lot of techniques you can use to actually help. And then I take the right supplements. I make sure I take a cocktail. Because I've had mercury poisoning. I have weak detox enzymes. I take N-acetylcysteine. I take all the methylation vitamins. I take a lot of the things that actually help

to mobilize these toxins, even the sulfuric acid boosting compounds. I even use indole diendelmethane as a way of helping with some of the effects on hormone metabolism. So I'm pretty fanatic about it because I've been so sick from being toxic and I don't want to be toxic anymore. But the truth is it's hard. I didn't stop eating fish. And I got my mercury levels down years and years ago from like almost 200 to like eight or five. And I was like, oh, it's been a bunch of years. And I've been sort of a little bit lazy about fish.

I don't eat tuna, I don't eat swordfish. But occasionally I have a piece of tuna when I go out. Occasionally I'll eat hell of it. I never eat swordfish. Occasionally I'll have more fish than I would think and I thought I'm good but I just checked my levels and again my level was super high at like 37 on a challenge test. I think we're just in such a toxic world and it's hard. It's hard. I mean last last night I made a delicious, you know, Spanish sheet, kind of Greek baked cod with tomato sauce, but like cod is not terrible. It's not the worst, but it's definitely got mercury and I'm just like,

oh, what am I doing? Like, what are you gonna eat? You know, so I've come to believe that, you know, rasp bed regenerative meat or wild meat is probably the safest protein on the planet. I know it's maybe controversial to say that but you know even you know even um you've got unless you've got really well your own whole grains and beans uh that are generally raised and have no glyphosate spray on them and are not you know genetically altered. There's like a lot of messy stuff on the plant world. What are the what are the steps you would take initially to to treat a patient with rosacea from a functional medicine perspective? You know, again, taking the history is the big one. I always will ask people, what's your ethnic background? A lot of people say, I'm white.

No, it's like, are you Irish, English, German, Jewish, Russian, whatever? Because rosacea is typically found in light skinned, fair skinned people. And from a genetic standpoint, they are the ones who are more likely to have that. It's just an interesting part to have in terms of the history. And then I'll just ask them, what is it you're eating? Are you eating a standard American diet? How much alcohol are you drinking?

How much stress do you have? Stress also. Caffeine. Yeah, caffeine can play a role. Spicy foods can figure it out. Yeah, those are all things which can sort of, it's like adding gasoline to the fire because literally rosacea is the skin on fire

in the facial area. 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, lack of the omega-3s. One of the oils, I don't know if you've used it,

that I found very helpful with patients who have rosacea is borage oil and even criminals 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 gamma-linoleic acid, which is a very powerful anti-inflammatory. It's not like the omega-3s, but it's sort of likelinoleic 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. Exactly. 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 permosoil. So yeah, this is very powerful, I agree.

And I also think that when I see these patients, 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? Do they have other fungal issues? Do they have dandruff? Do they have anal itching?

Do they have thrush or white coating in their tongue? Do they have vaginal yeast infections? Do they have other skin markers of yeast, like the 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, I'll check again all the tests we did talk about and see what's really going on. And then from the treatment point of view, you start with an elimination diet with an anti-inflammatory diet. Yeah, exactly. Yeah, putting patients on an anti-inflammatory elimination diet 80% of the time, it doesn't

matter what they come in with. They're going to actually get better. 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 we don't understand, most of us, how powerful food is as medicine

and how it can drive tremendous amounts of inflammation throughout the body. And 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 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. So you have a red face and a red brain that's on fire. Exactly, yeah. I'm sort of blown away by that.

That's fascinating. Especially in women, It's actually more common in women. So you know, you advise people the obvious things, cut off the alcohol, the caffeine, stay away from the sun, stay away from spicy foods, but also tell them 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 can really help to reduce inflammation and,

and then we often directly treat the issues that are going on. 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 things like even primose oil. I found that digestive enzymes and hydrochloric acid often are really helpful too. Yeah, I've been surprised at how many people have what I would call a relative lack of hydrochloric acid in the stomach. I was adventure to say that, you know,

the majority of people don't have too much acid, 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 Pepsid and all these other drugs, these Nexium, Asifax, I mean, they're just like out there everywhere. And now they're over the counter, and anybody can. Yeah, these Nexium, Massifx, I mean, they're just like out there everywhere.

And now they're over the counter and anybody's- Yeah, exactly. I mean, I just, we've talked about this before on the podcast, but when I was in medical school, the drug reps came in, because these drugs had just come out and they're like, listen guys, these guys, these drugs work, they're great.

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. It's gonna suppress your 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 speech well deficiency, magnesium deficiency, zinc deficiency. Osteoporosis. Osteoporosis, pneumonia, bacterial overgrowth, irritable bowel syndrome. When you get rid of your heartburn but you get all these other problems. Yeah, it's, yeah, that's- And then it's one of those drugs that'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, which makes you feel horrible. 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 makes you feel horrible 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 psychotropic, so the antidepressants are like that too. The PPIs on 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 psychotropic meds, absolutely. Amazing, so what cases have you recalled about Rosacea that you want to share that can give you 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. And she was self-medicating for her heartburn with over-the-counter acid-blocking medications. Had a lot of bloating-type symptoms. And came in and her major complaint was her skin. But she had all these other things but her big thing was how I look, right?

So people are vain and people- That gets people's attention. Exactly, right. And then when I did a dive into her testing, it turned out that she was deficient in her essential fatty acids, especially the gamma-linolenic acid. She had a lack of stomach acid because of the PPIs. 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. And that's actually one of the tests that I actually like to use when I have patients where I'm trying to use when I have patients

when 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 a little tell you how easy you can get off of it. These acid blockers, that's the PPI, right? Exactly. And then she also had low vitamin D levels. We spend a lot of our time clothed and indoors, so we don't get enough sunshine. That's one of the big things.

Low vitamin D, you don't just fix low vitamin D. This is one of my, I get up on my soap box all the time here is you don't just fix low vitamin D by taking vitamin D. Vitamin D deficiency is basically a sunshine deficiency. There are certain times when there can be other causes like you might have fat 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. And the immune system is also benefited by sunshine exposure, healthy sunshine. I think you said you're gonna be, you enjoy going to the tropics now and then,

Caribbean, Hawaii, whatever. And we also feel good. It's also, this is another thing that I find fascinating is that there is a condition which is called sunshine addiction. 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. Yeah. Yeah. There's a compound called pro-opio-melanocorticotropin

hormone. 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. No, and there are these people who- I always feel so good when I go to the beach in the summer. 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? And 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 zifaxim

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 a combination of that. And then also just told her to get some healthy sunshine. It doesn't necessarily mean that you need to go out and sunbathe or go to a sun tanning booth, but just getting healthy sunshine can help with down regulating the immune system. Yeah. And interestingly, you know, just off topic,

but with COVID, there's some really interesting studies that giving high dose vitamin D helps with COVID infections. Absolutely. And so COVID actually, or vitamin D, when it's at high enough levels, actually helps to keep the immune system in balance. It keeps it from getting over.

Yeah, it controls hundreds of genes that regulate immunity and inflammation. It'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 acts like a steroid too. It's a cholesterol molecule moiety. And I oftentimes, if I'm coming down with a cold or a flu,

I'll up my dose of vitamin D, especially in the winter, absolutely. It's true, and when I feel like something's coming on I take like 50,000 units for three or four days and I never get sick. Yeah. Literally goes away by the next morning. It is, it's pretty powerful.

So Todd, we've just covered a lot here and I recall a lot of cases of mine that have had rosacea and it's always one of those things where I love seeing because it's so easy to treat and people suffer so much from it. Yep. 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 don't just take it at face value. Yeah, good pun. Pun intended, but we actually go under the hood

and look at what's going on. Exactly. You know, if you love... Have you ever wished there was a trusted space where you could get real support on your health journey, where your questions get answered and you don't feel like you're doing it all alone? That's exactly what's happening inside my brand new membership community, the Hymen Hive, and I couldn't be more excited about it.

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