The Root Causes of Acne and Rosacea Revealed
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- Coming up on this episode of The Doctor's Pharmacy. - Even if you are not celiac, and even if you don't think you have any symptoms 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.

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Hi, I'm Dr. Mark Hyman, a practicing physician and proponent of systems medicine, a framework to help you understand the why or the root cause of your symptoms. Welcome to The Doctor's Pharmacy. Every week, I bring on interesting guests to discuss the latest topics in the field of functional medicine and do a deep dive on how these topics pertain to your health. In today's episode, I have some interesting discussions with other experts in the field. So let's just jump right in.

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. Yeah, absolutely. Yeah. So you mentioned a little bit earlier leaky gut. So take us through from a functional medicine perspective our

are 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're kind of looking like Santa Claus. Yeah.

Yeah, exactly. Yeah. And they also get photosensitivity too, which is the other thing. And the interesting thing-

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 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 a 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. 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 icigabrosacea 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. - Acid blocking medications, 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, 'cause if you don't have stomach acid, then the pH of your small intestine changes, 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.

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 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. Which is small intestinal fungal overgrowth. And a lot of people talk about it as candida, but there's many, many species of yeast and fungus. And

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 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,

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, Alzheimer's, autoimmune diseases, allergies, acne, I mean you just name it, depression, all of this stuff is connected by leaky gut. So I really, I think getting a very different thinking about this is key. And you did, you talked about the stomach acid, you talked about the acid blockers.

You talked about maybe other things that are relevant in the gut. Certain infections like H. pylori, which is a common bacteria that causes ulcers, also has been linked to H. pylori, and food sensitivity. So 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, checking for antibodies to zonulin with the Cyrex testing that we do, Cyrex Array No. 3. 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

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 stops, then you're all fine. The antibodies against zonulin is the one that tells you that there's this chronic leaky gut, which is really more valuable.

Because if I gave you a shot of tequila, then an hour later measure your zonulin, it's going to go up. Okay, where's the tequila? That sounds good. Right. So that's why I think that the testing for the antibodies against zonulin is even more valuable in these patients with chronic conditions.

- And then 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 test on bacterial overgrowth where we'll measure the production of fermentation products. So hydrogen and methane are gases that are normally produced in the body.

when people have small intestinal bacterial overgrowth, those will be produced at higher levels. So we can check that. And over time, or I think the test that we do is a three-hour test. So you measure baseline hydrogen 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

- So essentially what you're saying is that 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 get 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

bugs and get a healthier ecosystem. And that is what most physicians never were trained to do. And it's the foundation of functional medicine. It's the foundation of our practice here at the El Chobano 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, we'll look at whether you're reacting to gluten or dairy or eggs or other foods. And it's really helpful in drilling down on what's really going on with people.

Absolutely. Yeah. And that, you know, we're talking basically producing gases. That's basically a fermentation process. And normally fermentation happens lower in the colon. That's in the colonic area. It was more of 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 I mean, you want your upper intestine to be sterile and

Or 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 are low in magnesium, which half of us are, when we're under stress and our gut motility is slow, when we...

You know, taking 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. There really is. - Gold in them thar hills. - Gold in them thar 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 and we can do quantitative we can measure how many uh 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

Uh, look at bacteria that are, uh, associated with autoimmunity. So things like citrobacter, Klebsiella, Salmonella, uh, et cetera. Uh, we can look at now analyze, uh, for, uh, yeast overgrowth, various forms of yeast. Um,

and then also microbial markers of inflammation, things like calprotectin, looking for fat. So you can get a lot-- - Enzyme function. - Exactly, enzyme function, butyrate, checking for butyrate. - Short-chain fats. - Short-chain fatty acids. - Indicators of healthy ecosystems. So you know, Todd, what you're saying is that 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 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. So we look at the result, the function on the ecosystem. We look, like you said, at the enzyme function, are you absorbing your food? Is there inflammation?

Are you having good bugs in there that are producing the super fuel for the gut, these short chain fatty acids that are so important? - Oh, huge. - Do you have the right balance of gut? Are you missing some key bugs? Do you have overgrowth of bad bugs? Do you have yeast? 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 sleep. That's amazing. Yeah.

- Yeah. - So you have to get your poop together to sleep better? I got it, okay. That's a good strategy. It's better than taking Ambien. All right, so we also look at other things like omega-3 fats and other fats, 'cause a lot of inflammation come from not having the right balance of fats in your body. - Absolutely, 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. 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.

from a genetic standpoint, they are the ones who are more likely to have that. It's just an interesting part to know, 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? How much alcohol are you drinking? How much stress do you have? Stress also. Caffeine. Yeah, caffeine can play a role. Spicy foods. Yeah, those are all things which can sort of, you know, 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've found very helpful with patients who have rosacea is porridge oil and even criminal's oil. Yeah. Yeah.

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-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. - Exactly. - And it's something we really have a hard time getting in our diet, it's from like borage oil and,

you know, a few other things, but evening primrose oil. So yeah, that's very powerful. I agree. And I also think that, you know, 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? 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? 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. 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, right? - Exactly, yeah. Putting patients on an anti-inflammatory elimination diet 80% of the time, doesn't matter what they come in with, they're gonna actually, they'll 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. 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. Yeah, especially in women. It's actually more common in women.

So, you know, you advise people the obvious things, cut out the alcohol, the caffeine, stay away from the sun, stay away from spicy foods. We 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 primrose oil. I found that digestive enzymes and hydrochloric acid often are really helpful too. - I've been surprised at how many people have what I would call a relative lack of hydrochloric acid in the stomach. I venture to say that the majority of people don't have too much acid, they have not enough acid in the stomach.

- Yeah, well that's interesting 'cause 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, I mean they're just like out there everywhere. And now they're over the counter and anybody can-- - Yeah, exactly. - I mean, we've talked about this before on the podcast but when I was in medical school, the drug reps came in 'cause it's drugs that 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 going to 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 B12 deficiency, magnesium deficiency, zinc deficiency. - Osteoporosis. - Osteoporosis, pneumonia, bacterial overgrowth, irritable bowel syndrome. You get rid of your heartburn but you get all your other problems. And then it's one of those drugs, it's so sneaky because it's addictive. Once you get on it, it's hard to get off it 'cause it causes this rebound. So when you suppress the stomach acid and you stop the drug,

That as a production goes crazy exactly 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 it you bring up a really good point because a lot of the the pharmaceutical medications, especially some of the psychotropic so the antidepressants are like that to The the PPI's on the antidepressants when you try to get off of them you get this rebound process the body tries to get back into balance and

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 you 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. She was Irish celiac.

and she was having a standard American diet. 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 she had all these other things, but her big thing was how I look, right? So people are vain and people- It 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 linoleic acid. Ah.

She had 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 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 as a PPI, right? Exactly. And then she also had low vitamin D levels. I mean, 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.

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 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 exposure.

I think you said you enjoy going to the tropics now and then, Caribbean, Hawaii, whatever. And we also feel good. 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. 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 have-- - 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 that's like, 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 our 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 Xifaxim 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. 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. 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. It literally goes away by the next morning. - It is, it's pretty powerful.

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If you have skin issues, if you want to keep your skin healthy, you have to learn how to take care of your skin. Now, when you take the stuff that dermatologists give you, typically like steroid creams, peelers, antibiotics, they actually can cause more problems down the road. They can screw up your gut, like antibiotics are given for acne, and they actually make the problem worse. And most dermatologists somehow don't realize that skin problems are a sign of what's going on inside, whether you have dry scaly patches,

For example, it could be a sign that you're having omega-3 fatty acid deficiency or whether you're having acne, which can be caused by insulin resistance or eating dairy or whether you have dry skin. It could be related to thyroid function. It could be a sign of food sensitivities. Little bumpy patches in your arms can be a sign of vitamin A deficiency. So it's really important to understand how the inside affects the outside.

Well, so we eat a diet that's really high in refined oils and they're out of balance with our omega-3 oils and we also eat trans fats, it's still in the diet and those also cause skin inflammation and can cause all sorts of issues and inflammation doesn't just affect your skin but affects everything. It causes heart disease, cancer, diabetes, dementia, it can cause behavioral issues, anxiety, depression and so when I see people with inflammatory skin conditions,

like dermatitis, right? Eczema, acne, rashes. It's always because there's some inflammation on the inside, not just on the outside. So what is the functional medicine approach to getting healthy skin? Well, it's figuring out how to

reset your biology by focusing on the root causes of disease. The medicine of why, not what disease you have, but why do you have it? You know, think about functional medicine doctors. They're more like soil farmers. Instead of growing vegetables like monocrop corn or soy or wheat, they basically take care of the soil. When you take care of the soil,

Then plants are healthier and you're healthier. So a healthy soil means disease can't really spread We call this the biological terrain in functional medicine, you know Louis Pasteur talked about how disease was caused by pathogens But actually it's often related to what the terrain is the health of the host so when you use

When you use an approach of functional medicine by dealing with the root causes, when you look at the health of the gut, when you look at your nutritional status, toxic exposures, et cetera, you actually can change those things and lead to a dramatic improvement in your skin health. I see this all the time with my patients. I'm not a dermatologist, but I treat people with all kinds of

health issues and their skin gets better or I treat people with skin issues using a functional medicine approach and they get better. So it's pretty powerful stuff. So what are my strategies for keeping your skin healthy? It doesn't start with better cleansers or beauty products or all the stuff that people put on their face. It really starts with getting rid of the crap.

Getting rid of sugar and starch processed foods. You know, what's interesting is that sugar is one of the biggest causes of acne. It's also the biggest cause of inflammation. It can cause yeast overgrowth in the gut, which can lead to eczema, for example. So when...

Sugar sticks to amino acids that are in collagen and elastin. In your skin, for example, they produce something called advanced glycation end products or ages. And they age your skin and they age your other organs. There's lots of ways to get rid of it. I wrote a book on how I help people detox from sugar called the Blood Sugar Solution 10-Day Detox Diet. It's a great book.

was a best seller, it's really easy to implement and it's super powerful and you can get rid of sugar and processed food in 10 days, get rid of all your cravings and reset your biology and you'll see within a very short time your skin starts to clear up. Also food sensitivities are a big factor when it comes to bad skin. It's not necessarily an allergy but it's a sensitivity like dairy for example is hugely impactful with acne and I know when I eat cow dairy I tend to get acne. It can be also a trigger for eczema, for many other things.

It can be linked to autoimmune diseases, to allergic disorders. Psoriasis all can be linked, for example, to gluten. So gluten can cause a lot of skin disease. In fact, one of the diagnostic features of celiac disease is something called dermatitis herpetiformis, which is a

a horrible condition of skin which causes all kinds of like herpes like bumps and blood dust like little like blisters on your skin but it's coming from gluten coming from your gut so doing the blood sugar solution 10-day detox diet is essentially an elimination diet it can help you get rid of those food sensitivities the next thing you have to do is work on your gut i know i'm telling a broken record but the gut is the seed of your health and when you have a healthy gut you have healthy skin

And it has huge effects, driving inflammation, oxidative stress, affects your blood sugar control. So if you have imbalance in your gut, you might even have symptoms, but it can really be a factor. So if you suspect leaky gut or other gut issues,

I encourage you to do my gut repair program that is included in many of my blogs. We'll link to them in the show notes here. But you can also work with a functional medicine doctor to actually get your body in balance again and to do the right kinds of stool tests and to heal your gut. The next thing is you need omega-3 fats. Your skin is so critically dependent on omega-3 fats for health. So if you have dry skin, itchy skin, flaking skin, scaly skin,

Scaly patches, it could be the sign of an omega-3 fat deficiency. So you want to increase those by eating wild-caught small fish like salmon, sardines, herring, mackerel, anchovies, and also take omega-3 fat supplements, really important.

Also, make sure your nutritional levels are good. Lots of nutrients play a role in skin health. Zinc, if zinc is low, for example, it can contribute to eczema, acne, and other rashes. Vitamin D plays a huge role in things like psoriasis and acne. So get a good multivitamin, good fish oil, good vitamin D. That'll cover most of it.

Getting your blood circulation going is really important. Sweating, exercise, sweating helps remove toxins. Sauna, steam mask, great for your skin. One study found that regular sauna has great impact on skin physiology. Get the toxins off your skin with sauna or steam. You wash it with soap, use a hot shower because your toxins basically come on your body when you're in those saunas and from being released from your fat tissue. So you want to use a scrubber or brush or hot soap.

Also, sleep's important. You know, if you're having poor sleep, it increases aging, it diminishes barrier function, lowers, you know, the quality of your overall health. And you basically when people don't sleep, you can see how bad they look. So sleep is really pretty important.

Eight hours sleep is key. Stress, also very important. If you have emotional stress, it can really make skin worse in whether it's psoriasis or eczema. People get hives when they're stressed. So really important. I recommend meditation. I have an Ultra Calm CD, which is a great way to meditate and get rid of stress. Also, make sure you're watching your skin products. Stop using

all these creams and cosmetics that contain chemicals like paraben, petrochemicals, lead. Use the Environmental Working Group database called Skin Deep to identify toxins in your products and find ones that actually have no toxins that can be great for you. Also know that drugs and chemicals are absorbed through your skin, so anything that goes on your skin gets absorbed. So be worried about it. And you can go to the Environmental Working Group page, it's ewd.org, and see how to reduce your exposure to environmental chemicals.

Acne is the number one skin condition in the United States. So it's the number one issue that people in the United States are dealing with in terms of their skin. As you mentioned, 50 million Americans are dealing with this. And we know that it's more common when we're going through puberty, when our hormones are shifting, we often will see acne in the adolescent age group.

but we're seeing more and more acne in adults now as well. And that is definitely increasing. I remember I was having a conversation with my daughter about skincare products, and okay, what's the best thing to use for my skin? And all of a sudden I realized, even though we had been, she'd lived with me her whole life,

I don't think I ever said this. I said, "What you're eating is so much more important than what you're putting on your skin." - Yeah. - 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. That how important what you're choosing to eat every minute of the day,

You know 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 wanna get rid of your acne, if you wanna get rid of your eczema, if you wanna get rid of your psoriasis, if you wanna 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, you know, steroids for eczema or endometriosis,

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 gonna 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, huh? 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 yeah and so then you create a dysbiosis or an imbalance in the good and bad bacteria on your skin and then that just makes you more prone to getting more acne in the future so it may be okay in the short term but it's not getting to that underlying root cause

It's true. And so we put on antibiotics on the skin. We put on these agents that dry it out like benzoyl peroxide, which are most of these acne products. And if that doesn't work, we give people oral antibiotics, which not only describes the facial microbiome, but also the gut microbiome. And what we know now in functional medicine and in medicine in general, if people paid attention to the research on acne, is a lot of it starts in the gut.

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 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 extra, that in the follicles of the skin, the skin's not turning over as well as it should. And so cells get stuck in the skin. And then those stuck cells can get more inflamed and acne can get produced. So one of the major things we always start with is pulling away the refined and processed foods and the sugary foods. And starchy foods.

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

higher than, 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 um the the growth factors the high inflammation from eating these high sugary foods causes changes in your skin we know we know that you know for example pcos which is polycystic ovarian syndrome it's a common condition that affects women that causes infertility we're going to talk about that on another podcast it causes acne yes it causes really screwed up menstrual cycles and it causes hair growth

And we think of it as a ovarian problem. It's not, it's a mouth problem, it's a fork problem, it's a dietary problem. - Often, yeah. - Right? And so it's caused by insulin resistance. And the consequences of that are the acne and all these screw up hormones. So when women have a lot of sugar, it actually can increase their testosterone.

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

They got to go. Yeah. And then there's another food that is really common in this country, 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. There's 60 different hormones in milk, and these are not added like growth hormone. These are just naturally occurring hormones. Why? It's a growth hormone.

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

I can't eat dairy. I don't usually eat dairy, but if I have sheep or goat, it's a little different. It's not as inflammatory for some reason. But if I have regular dairy, you can count on me getting pimples. And I'm like 60 years old, I get pimples from dairy.

Absolutely. And I think it depends, like the question of sheep or goat, I think it depends on the person. There's some people that it really, all types of dairy bother their skin. And for other people, there's some that is better than others. And what we know is sometimes the testing, like the food allergy testing or food sensitivity testing, doesn't always

pick it up. I mean, we do it often, but there are times when we get a negative test result, but even if we still pull it away and people's skin improves. So this isn't like an allergy necessarily. Not necessarily. It could be just like you said, all the hormones in dairy too. But there's another category of things, which are food sensitivities that do drive inflammation and drive leaky gut and can drive acne that are independent. So we've got sugar, we've got dairy, and we've got this other category, which is

sort of more sort of amorphous, but it is a factor in a lot of people. - Absolutely, absolutely. So there's so many ways, and I always say this, there's so many ways that somebody can react to food, right? You can have, and people get confused all the time 'cause they get one negative report and they say, "Oh, then I must be fine to eat that food," right? You can get an immediate reaction to food or an IgE, you can get a delayed reaction to food or an IgG, but you can also have a food intolerance. There's just so many ways you can react to food.

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This podcast is separate from my clinical practice at the Ultra Wellness Center and my work at Cleveland Clinic and Function Health, where I'm the chief medical officer. This podcast represents my opinions and my guests' opinions, and neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional.

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