How to Fix Acne By Fixing Your Gut Health- The Gut Skin Connection_en (auto-generated)
hello and welcome to my talk the root causes of acne I'm Dr Julie Greenberg I'm a naturopathic doctor and I'm also a registered herbalist so whenever I start trying to kind of decode a disease and figure out you know how am I going to actually get to the root causes we have to start with a pathopysiology and the pathophysiology of acne is actually very well understood as it turns out the first step in acne is there's excess sebum or oil production in the sebaceous gland you see the hair follicle and then you see the sebaceous glands on the side and normal production of sebum is absolutely appropriate we need that but there's excess sebum or oil production that's occurring as the kickoff point in acne step number two in the pathophysiology of acne is going to be excess skin cell proliferation so we can get an accumulation of these said skin cells and then this excess sebum and it kind of gums up and clogs the hair follicles so that's step three that clogs hair follicle and then step four in the pathophysiology would be overgrowth so it can be bacterial overgrowth and most commonly we think of an organism called C acnes or cutie bacterium acnes they used to be called P acne or propri bacterium acnes but it was changed to C acnes it's the same organism and then there's a second type of overgrowth we can have which is fungal so everyone think of acne is bacterial but it can be fungal and the organism is called malesia and that is more commonly referred to as malesia foliculitis so what are the triggers of acne and I like to break up triggers and root causes is separate things to me a trigger is something that can definitely make a condition worse but if we take the trigger away the condition still doesn't clear so we're not quite at the root cause numerous triggers for acne of course excess hormones we all know excess testosterone or DHT di to hydr testosterone certainly can drive excess seabone production and drive acne but pressure so there used to be something that high school wrestlers would get with their kind of face masks and they would get this pressure acne but ever since Co there's something new which we call mask NE and so I think people have heard of that by now that obviously wearing that mask and breathing into it all day you can definitely get acne medications things like birth control pills steroids will absolutely potentially trigger acne birth control pills are interesting in that in some people it actually helps acne clear up and in other people it will actually inight it and bring it on stress for sure I think every chronic disease you know stress makes worse including all the dermatologic diseases and acne is no different we know this certain substances or like over production of too many substances things like fluoride for example can cause acne but also high dose vitamins so vitamin B12 and Biotin and high does can drive acne as well a Cosmetics so the things that we put on our skin we know can clog the pores they are cogenic and cause acne and the Western diet like meat wheat Dairy and sugar the things we love to eat the most in our standard American or Western diet definitely triggers acne so we've looked at the pathophysiology and kind of what's happening but where does this begin and where do things start going wrong and for that we're going to turn to something called the mtor pathway Mamon Target of Ramy and the mtor pathway has two components so there's mtor complex one and mtor complex 2 we happen to know a lot more about complex one than complex 2 but you'll see that mtor complex one is responsible for lipid synthesis and metabolism sebum is a lipid so remember that first kickoff point was over production of sebum we've got M to tothank for that and protein synthesis skin is a protein so those first two steps over production of seum over production of skin cells that is going to be due to mtor kind of Gone Wild and we have a Graphic here where we can see mtor where it is within the cell so here we have a picture of a cell and this section we've got outside the cell then we've got the cell membrane the Bop phospholipid layer and then we're here inside the cytoplasm and that's where we're going to find mtor complex one and mtor complex 2 we can see that there are factors outside the cell that are impacting mtor so we've got things like insulin or insulin like growth factor right that's that's telling the body we've got resources let's go build things so that's going to push on the mtor pathway growth factors glucose and in particular the amino acid Lucine is a big trigger for mtor production and inflamation can trigger mtor production so all of these things are going to be contributing factors to acne and then we also see something called foxo1 and we see foxo1 doing a little dance here so foxo1 can be in the nucleus or foxo1 can be in the cytoplasm and where foxo1 is in the cell is really critically important so let's first chat about foxo1 what is it what does it do if there's kind of always a yin and a Yang foxo one is the Yang to m t Yin so foxo one is kind of the opposite it's inhibit hepatic igf-1 secretion it's going to inhibit lipogenesis or SE buum production it's going to suppress the Androgen signaling so testosterone and dihydrotestosterone it's going to suppress that effect reduces oxidative stress and controls antimicrobial peptide synthesis so helps fight microbes on the skin things like C acnes now we talked about in fox01 doing this D between the cytoplasm and the nucleus and it's really important and here's why when fox01 is phosphorilated it gets kicked out into the cytoplasm of the cell and that's almost like a penalty box for it so it can't do anything it can't downregulate or control mtor at all which is its main job so out in the cytoplasm Penalty Box when foxo1 is Def phosphorated then it can move into the nucleus now it can do its job it can downregulate and control mtor and make sure that mtor doesn't get out of control so the problem could be mtor out of control the problem could also be a lack of fox01 and we're going to see that in a little bit so let's talk about the prevalence of acne I think it's very well understood globally that okay when we when we hear acne what population is affected people are going to think of teenagers and that makes a lot of sense within America about 85% plus of teens are going to be affected by acne males tend to be affected a little bit more than females just because they have higher levels of androgens like testosterone and dihydrotestosterone but it's it's pretty prevalent who who here has never gotten a pimple it's pretty widespread but the interesting thing is what is happening with adults and acne it's really been on the rise and I even would say I have more adult patients with acne now than teens and a lot of them it's adult onset acne something that they didn't really deal with previously and suddenly as an adult they're breaking out and it's very frustrating for them they don't understand why but when we look at adult populations up to 65% of menstrating females will report outbreaks of acne it's not not just women men and women ages 20 to 40 report persistent low grade acne up to 55% of people it's very widespread and even women in their 40s up to 25% are still reporting acne so it's absolutely no longer just a teenage thing and something that we can say well you know it's just a teen and you're going to grow out of it that's just not true so that begs the question that that kind of makes it seem like well okay so is how having acne just a part of the human condition is is it just something that we kind of need to suffer with because it's normal and regular but normal and natural are kind of two different things so what's really fascinating is research that's been done on indigenous societies so these are populations of humans that are living the way our ancestors used to live out in forests and jungles completely non-westernized lifestyle one study was done on the aset people in parway this is a group of 115 individuals all ages all genders and this population was repeatedly studied for 843 days so well over 2 and 1 half years what do you think the researchers found nothing not a single we call them Papu puls open comedones closed comedones nothing was observed in the entire population they have teenagers they have menstrating females nobody had anything okay maybe these St people in Paraguay of this amazing genetics and it's Unique and rare but the population Zone Okinawa prior to World War II were studied and this was Okinawa is a a southernmost island of of the country of Japan and at the time before World War II it was very remote island and they lived a very kind of natural Island non-westernized lifestyle and they asked the doctors who had been practicing on Oka between 8 and what's the prevalence how are you treating it and across the board all the Physicians said there's no acne here and we don't treat it and then there was a study done on the kitaban people in Papa New Guinea this tribe has about 1,200 people and this group was examined over well I think you can guess by now the answer is nothing yes no no papules no pules no comedones nothing this is 1200 people again all ages all genders so what we have come to understand is that Aki is not at all a normal condition of Being Human it has become a normalized condition of Western in society because it's so prevalent but it's not a natural thing indigenous people don't even have a word for acne because they've never seen it and they don't know what it is but we do find that when indigenous people leave their indigenous Lifestyles and if they move into urban areas and cities then they can and do develop acne so that's very interesting right what is going on well of course our Western diet is very different than an indigenous diet and we mentioned the four things that we love more than anything in a western diet are meat wheat Dairy and sugar and as it happens all four of those things are really going to push on the mtor pathway and as it happens these things are either not eaten or not eaten in abundance in indigenous cultures so our food sources are completely different Western versus indigenist and we do think that this is a big driver of the mtor pathway of why we see acne in Western society and not indigenous cultures how is it happening well with meat and again of course indigenous cultures do eat meat but not at the level lels of Western Society if you have to hunt and kill an animal with a bow and arrow it's unlikely you're going to be eating meat three times a day in large quantities it's going to be a lot more of a plant-based fibrous diet well meat as we talked about initially is it is high in Lucine and this is one of those big drivers of mtor it's an amino acid and it really tends to fire up the mtor pathway wheat also has Lucy so it's also going to push on that entor pathway milk and dairy I mean if we think about what is the purpose of milk it is to make baby mammals grow quickly so of course that's going to create insulin like growth factor one and insulin and those as we discuss going to push on mtor and then sugar or high glycemic load it's high in glucose it's going to push insulin like growth factor and Insulin so all of these things that we eat in large amounts in our Western diet push on that mtor pathway so there's so many different influences on the gut microbiome and this is also surely we have to look to the gut micro iome to understand what is happening with acne and we'll talk about in a bit how I really look to the gut microbiome to to test and treat this but there's so many factors that comprise our gut microbiome so we talked about our diet of course what we eat absolutely crafts what is living in our gut but Pharmaceuticals that we may be taking where we live on the planet the geography where we are in our life cycle are we a baby or a toddler are we elderly how you were given birth to how you were fed as an infant was it formula or breast milk and the everyday aspects of life and stressors do you get exercise and psychological State all of these things we know impact the gut microbiome all right so let's dive in and let's talk about the gut microbiome and how it relates to acne so just as we kind of get started a little bit the gut microbiome is a general overview the average adult human has 3 to five pounds of microbes living in their gut it's kind of an astounding number if you think about it is trillions of microbes we house and feed these organisms for free why do we do this what do we get out of the steel well the answer is of course we can't survive without them they can't survive without us we've co-evolved together and they make things that we need so we need like vitamin B12 or butyrate from them they help Crow out pathogenic microbes when the good guys are there they can kind of elbow out anything that we might come into contact with it could be pathogenic so that it can't really set up shop in our gut and overall its job is to maintain a healthy ecosystem in our gut and it's just trillions of different kinds of organisms when we look at the sheer numbers yes that most of those are going to be bacterial but there's a wide array of organisms living in our gut fungal viral ARA bacteria fuzes protozoa worms it's really astounding to think of what might be going on in your own stomach but of course that's completely natural and it's how we've evolved when we look look at acne patients it's kind of interesting because we see that acne patients are at a higher risk for GI or gastrointestinal distress so the study was done with 13,000 adolescents and it showed that those adolescents who had acne were more likely to experience a GI symptoms like constipation hosis or bad breath and gastric reflx and abdominal bloating was 37% more likely to be associated with acne and other subaric diseases so let's drill down and talk about some specific organisms in the gut cuz we're going to see them come up let's talk about hpylori or helicobactor pylori so hpylori is an endotoxin producer it produces LPS which stands for lipopolysaccharides and those are endotoxins hpylori is a gr negative bacteria and we know that hpylori can be linked to GI diseases like gastritis peptic ulcers and gastric cancer but it's also linked to dermatologic problems things like acne rosacea chronic ticaria which are hives alipa Arata lylis and other diseases and while it is true that if you just sample any random population upwards of 50% of people may be infected with H pylori and there is a debate in the kind of functional medicine Community whether or not it's commensal I find that it is not commensal and I always treat it and we'll get into why that is so let's talk a little bit more about H pylori and why it's problematic so H pylori has ch chosen to live in the stomach that is a very strange place to choose to live in the human body because it's the most hostile place in the human body and that is of course due to our stomach acid it has a very low it's very acidic the whole point of acidic stomach acid is to digest our food and then to kill off organisms that we uh swallow either via saliva so we swallow 2,000 times a day about a liter to a liter and a half of saliva whenever we eat food or drink beverages they're not sterile there's microbes that were ingesting some of them can be pathogenic but their stomach acid is supposed to take care of that well here's the problem with hpylori so hpylori we get exposed to it and it falls into the stomach and then it drills a hole into the mucous layer of the stomach and it raises the pH so we talked about we need this nice low PH in the stomach but that's not comfortable for hpylori so hpylori is going to start doing things to raise the ph and make it more neutral so it induces a strong inflammatory response it's drilling into the mucosal lining it's embedding into the stomach wall it's producing all of these substances and some hpylori produce cytotoxin Associated antigens and other virulence factors and those are the ones that tend to lead to gastric cancers but even if it's not one of the types that's going to cause gastric cancer it is still causing gastric mucosal inflammation there's neutrophils and monocytes that are coming in to fight the h pylori that's drilled into the mucose and then the hpylori is producing all of these things like Urias and catalase proteas lipase fosol lipases all these enzymes to change the ph and to try to stay in the stomach the problem is it it can create a hypochlorhydria so too low stomach acid and it can reduce the acid secretion in the stomach the problem then is what we talked about the purpose of the suic acid is to digest food and to kill things that we bring in like pathogens when pylori is neutralizing the stomach acid it's going to cause a problem with digestion while it's in the stomach but also it's going to affect the signals going to the gallbladder and the pancreas so we may not get enough bile to break down fats we may not get enough elastase and pancreatic enzymes and then of course that decreased stomach acid or the very high pH or the higher pH stomach acid we're not going to be able to kill foodborn pathogens or things that come across and we can get overgrowth it's one of the reasons we know hpylori can be associated with sibo small intestinal bacterial overgrowth so is it just me saying that there's a problem with hpylori and acne as it turns out no so there was a case controlled study of 100 individuals they had 25 controls and 75 acne patients and what they found was that 56% of people in the control group so no acne they did have H pylori so half did half didn't but what was interesting was what they found in terms of the severity of acne and then the percentages of people who had hpylori so in the group of individuals who had mild acne 60% of them had hpylori in the moderate acne group the number went up to 72% and in the severe acne group that number went up to 88% 88% of them had hpylori now what could be going on with that well there's some interesting studies that was done and one study is looking at acne may be due to the deficiency of foxo1 within the nucleus of the cites so if we remember the foxo1 is in the nucleus of the siosite that it can keep mtor under control and we're not going to get an over production of sebum the siosite is the individual cell that produces sebum well what does that have to do with hpylori I have never been able to find studies on hpylori and cides but there are studies on hpylori infection and what's happening in gastric cells so the cells of the stomach and what they find is that hpylori infection induces nuclear inactivation of foxo1 it's kicking foxo1 out of the gastric cell and into the cytoplasm where it's inactivated and so could there be something going on where hpylori is able to affect foxo1 in the sebocytes kicking it out of the nucleus and into the cytoplasm it remains to be seen but I think that that is really a potential explanation for why we see things like like as the severity of acne increases so do the number of people with hpylori infections the idea that there's a gut brain skin access has really been out there for a long time even back in the 1930s the researchers Stokes and Pillsbury hypothesize that the skin would be impacted by both the gut and emotional states and they found that hypochlorhydria so low stomach acid was very common in acne patients and they hypothesized before we even had sibo that suboptimal stomach acid would allow for basically sibo overgrowth of bacteria in the small intestine and this could lead to increased intestinal hyper pability this could lead to systemic inflammation skin inflammation and even back in the 1930s these guys were advocating for the use of probiotics to help restore gut microbiome function and there are also studies on leaky guts and acne so there was a little bit of an older study they used blood serum complement fixation test they found that acne patients were more likely to show enhanced reactivity to bacterial strains isolated from stool so 66% of the 57 patients with acne showed a positive reaction to stool isolated forms like ecoli and none of the control patients without active skin disease had a positive reaction so what does this mean that probably it was a leaky gut causing the reaction and then another study with of and high reactivity to those LPS lipopolysaccharides or endotoxins in the blood and again I think everyone knows what leaky gut is by now but it's the endotoxins are breaking down the gut mucosal barrier and allowing infiltrate from the gut into the bloodstream of things that don't belong there like lipopolysaccharides none of the healthy controls had a positive reaction okay so let me talk to you guys about what I find because I felt like I was seeing a certain pattern going on in my patients but I decided to do a kind of retrospective study a case study and analyze what were the numbers was I seeing what I thought I was seeing so I thought I was seeing a high level of H pylori in my patients candida and protozoa I went ahead and I analyzed 36 just random patients from my database with a icd10 code of acne and those 36 patients broke down into 28 females and eight males their ages range from 13 to years of age and what I found was that indeed what I thought I was seeing I was seeing so about 94% of those patients 34 out of 36 had high levels of candida 92% or 33 of the 36 had H pylori present or high and about half the patients had protozoa present but interestingly it was almost exclusively I only saw protozoa in patients with H pylori 95% and I see that across the board in all my patients who show up with protozoa it's about these numbers almost all of them have hpylori and I think it is that hypochlorhydria we were talking about where if the stomach acid has been decreased and neutralized by H pylori and you get exposed to protozoa it's not going to do as good a job killing it and then once the protozoa get out it's it's game time for them and they just set up shop in the gut in terms of the breakdown like how many had each number of things so you can see that 47% or 17 out of the 36 had all three so 47% had candida H pylori and protozoa 44% had two generally that was hpylori and candida two out of the 36 or 6% only had one and only one person with a kind of questionable acne diagnosis had zero and of course the question is well okay so there are these numbers but how does this compare to healthy normal controls it's a little bit hard to get that but I did my best so with the hpylori again I found 92% of my patients my AC patients having hpylori I found published research that said you know in a healthy population it was about a 36% rate and I worked with diagnostic Solutions labs and they went back and looked at almost what over 18,000 stool tests of theirs now remember that so diagnostic Solutions lab has the GI map people are generally running the GI map because because they're having gut problems so this is even a higher percentage than probably a normal healthy control but positive and then another company bianic ran about 3,000 stool tests that they had and they came back with the 41% hpylori rate so my rate of 92% was higher than anything else even in like the diagnostic Solutions population of issues so that seems significant for the candida prevalence again it's a little bit hard to tell but I did find some published research that kind of General Normal healthy controls they'll be about a 22% candida rate diagnostic Solutions lab again on the 18,000 Su test 25% and bioch canic about 3,000 was 21% so the protozoa so my protozoa rate of 53% was any protozoa so it could be anything from Gardia to endox Nana blastocyst isinis any protozoa was all packaged into that 53% group I couldn't find any published research that looked at any protozoa in the gut but the diagnostic Solutions 18,000 was at 12% bio panics was at 43% they couldn't figure out why they were that far off of diagnostic Solutions again this was 18,000 GI Maps so 53% of acne patients compared to 12% of people with GI problems okay so so the goal of naturopathic and functional medicine is always that we want to get below the symptoms right we know the symptoms of acne vules pules open chodon closed chodon painful it really impacts people's self-esteem it can cause depression and anxiety but that dealing with the stuff on the face and trying to suppress that that's just dealing with symptoms we want to get down to those root causes figure out what's driving it and clean them up and so in order to do that I test and treat the gut and go in and figure out what's going on so that I can look at all of these aspects of the gut and try to fix them because as we saw the mtor pathway is really impacted by what's going on in the gut and so for me I'm using the functional medicine test I used to use a base for my patient so every patient who comes in my door has the GI map stool test the diagnostic Solutions one and then I do an O organic acid test and I use the findings of those and really I get these functional medicine tests done on every patient and I use them as my road map cuz I know where we're starting and now that I've seen what's going on in their gut now I know what I need to do to fix things all the pieces I need to fix and then I can get us to our final destination which is going to be clear skin but not through suppressive medications but by actually finding and treating the root cause Okay so let's put this all together by looking at some cases we're going to look at two cases so you can kind of get a little bit of a flavor for what you might see obviously in different patients and and what you might do about it so for our first case we're going to be looking at a 23-year-old male and here we are going to call him David of course David is not his real name but we we'll call him that and we can see very clearly that this male has nodulocystic acne and and acne on his back as well so you see these really large nodules they're deep cystic acne it's a pretty severe situation David has had acne since puberty and he's tried a myriad of things so he's done doxy cycling so doxy cycling is an antibiotic it's in the Tetra Cycling group and doxic and Minocycline are kind of go-to they are the go-to antibiotics for trying to treat acne heed tro and cream so that's kind of like a vitamin a derivative many other topicals he is trying to avoid going on acutane really the proper term is isot trean it used to be called acutane but officially acutane is no longer in existence but people still refer to it as such isotret noan is pretty serious medicine is we know it's teratogenic meaning if somebody is pregnant while they're taking it is very likely to result in birth defects so likely actually that for females who are going to go on ISO trat noan they have to have a birth control clean birth control test prior to going on every month that they're on isot trepn and for the month following and they have to to sign an eye pledge basically a pledge that they're going to be using at least two forms of birth control the entire time that they are on isotret noan because should they get pregnant basically the fetus would have major major birth defects so it's a pretty Dangerous Drug and whether it's a teen or a 20 or somebody older if it's if it's that damaging to a fetus we can understand why many patients want to avoid it and not use it themselves so the next step is I'm going to run that GI map stool test and then an o organic acid test so we can see here David's results so let's kind of go through this and I I've just plucked out the highlights from the GI Maps it's not everything but we can see his H pylori is very high so when we see 2.2 E3 that way that we interpret this value is 2.2 * 10 the 3 power so we move the decimal point over three and the value is actually 2200 here's the kind of commensal uh more normal friendly bacteria we see down here the Fila and Fila is an organ classification system so for example for humans our Fila is cordada so anything that's got a spinal cord were part of it so it's a very high level you know all the way down to species and genus of course we're homos sapian but f is a catchall so these two bacterial Fila bacteroides and Fikes are showing us a snapshot of about 85% of good bacteria in the gut and we can see very clearly that this patient is low on both of them low on 85% of the beneficial bacteria this is something that I call insufficiency disbiosis there are insufficient amounts of good bacteria and that really is a problem because this creates an inflammatory situation we need good bacteria and uh we need them in sufficient amounts part of the reasons why we have this is a lack of fiber in the diet they they do like fiber but there can be many reasons antibiotics we know he did doxy cycling low fiber diets like LOD map keto carnivore and just having disbiosis it can just end up with too low of the good guys and twoo many of the bad guys when we look at some of his kind of more opportunistic or not so good guy bacteria we we do see some things here I would say that billus come up pretty frequently I'm not that bothered by it the staff orus and streptococus are pretty common an E4 again that's times is pretty high I would like to see that a little lower nothing too crazy happening here and then we look at his digestion and if you remember we talked a lot about hpylori causing hypochlorhydria or too low stomach acid and what we're seeing is an effect of that here so when we look at the elastase elastase is the marker of pancreatic enzymes and this happens so this is a suboptimal level the 254 we really want to see at least 500 for elastis so that we know that there there's sufficient enzymes to properly digest food and when there's hypochlorhydria and there's not enough stomach acid we can get deficient pancreatic enzymes because what happens is as you start eating the stomach is supposed to kick up production of acid and if it's normal healthy levels of acid that's going to Signal the pancreas hey food is coming your way in anywhere from 30 to 90 minutes look alive be ready you're going to need to give us some pancreatic enzymes and it gets that signal from the stomach acid but when there is hypochlor hadria instead of getting a nice strong signal it's more like a whisper and the stomach is like's coming get ready and the pancreas might not even know did did I hear it did I not I'm not sure what I'm supposed to be doing and we see this suboptimal level with the hypochlor hyria so I think his very high hpylori in this case is causing a hypop hyria and then secretory IGA being high uh this is a marker of inflammation in the gut and again there's many reasons why this can be even just not having sufficient levels of of berate and and the things that our commensal bacteria produce for us his the oat wasn't super significant there was a Candida was basically high for him so he had the H pylori and the candida and this is just a general marker for a bacterial overgrowth we see it's a little bit High most of the information for this patient was on the GI map okay so now the question is what do I do to help a patient when I I get the results I see the issues how do I help so I'm going to go through and mentally for myself now list out all the issues that the person is having so for this patient we know that there's bacterial overgrowth there's candida overgrowth there's hpylori overgrowth there's low commensal to low bacteria and so those are the issues I'm going to go after I'm going to show you the pictures as we met up and as his skin changed from protocol to protocol but it's important to keep note of the fact that all Protocols are individualized right this is naturopathic medicine Functional Medicine of course we individualize protocols to the patient in front of us and for me I see patients on an ongoing basis every two to three months and I move through different protocols each time so the protocols don't stay the same like for example I switch up the antimicro wheels every time so I'm giving you some examples here but this was not all done in one plan and not for the whole time for bacterial overgrowth and I guess I should have said from the beginning I don't use any Pharmaceuticals in my plan I'm I'm an naturopathic doctor so this is all herbal and natural medicine so antibacterial herbs some of the go-to that I love thyme clove oregano antifungal herbs grape seed neem many more than this but they're kind of Classics hpylori I do use a lot of Mastic Gum DGL bismuth zinc for the low commensal bacteria so that we really got to focus on fiber right so all of my adult patients I tried it to Target 35 gr of fiber at least per day and we work up to that most patients are much lower than this and you want to go nice and slow so they get used to it they don't have any gas or bloating or any sort of dyspepsia but you can get them things like pomegranate whether you want pomegranate supplement powders or actually just eating pomegranates in brightly colored fruits and plants high and polyphenols that really helps feed the good gut bacteria and of course probiotics so Spore based biotics like basell strains so like I'll use bio cidon proflora 4r it's one of my favorites and I use a lot of herbal Blends as well and then with topicals so for Botanical topicals I like oils and I like essential oils a lot of people get a little bit worried like oh you're going to use oil on acne prone skin but you have to use the right oils never use for example coconut oil on the face that is cogenic it can cause acne in people who don't even otherwise have any acne but I also like things like niin amide and zinc and AIC acid so there's many things that we can use to help reduce sebum production while we're targeting these kind of underlying root causes and so I'll show you what things look like so uh this was David at the first visit then after two months of treatment we can see significant Improvement and this is usually the exactly what I see and it's not that it's completely disappeared we can still see the aemma we still see a pul here there's still things happening on the skin but it's a whole different ball game we can see that there's no more raised nodules and all that cystic acne is gone everything is flat and so these kind of reddish scabs this is where I always want to see it going because this means we're getting away from that super inflammatory phase and it's actually starting to heal and what I tell my patients is it's not like I can wave a magic wand and make AC disappear overnight but it's like turning down the dial on it we want to keep turning turning turning that dial until it's gone and this picture lets me know yes we are well in our way this is what I want to see so then I would meet up with David update the protocol with some of the things you saw on the previous page and then we met up after 3 months and we can see again yes things are still improving now we're not really seeing any like pules or active lesions at all this is what we call post-inflammatory hyperpigmentation and scarring Pi but this is great because nothing is active and then here after two more months so total of 7 months the skin has really repaired itself so much and I think if you look back at the first photo you would never think that this individual 7 months ago was having this kind of dramatic nodulos cystic acne and then on his back we see a similar progression we had the very red angry nules and puls going on at first the photos aren't great and it's hard to take pictures of your back but it's it's dialed down after 2 months and then after 3 months months we also see still getting better and then another two months so at the seven-month bark this is something actually the white is on the mirror it was like a cleaning leftover solution but you can see that there's not these cystic acne or nules or anything like was happening uh when we when we started and so this is the power of treating the gut and getting to the root cause no Pharmaceuticals at all okay we going to look at case number two now and case number two we are going to look at Emerson Emerson is a 30-year-old nonbinary individual his person was assigned female at Birth but their preferred pronouns or she or they Emerson also not their real name started having acne at age 11 it got worse starting 3 months ago and it got very bad several years ago in high school but it's never been as bad as it is now and there's very painful nodules and they said I don't feel comfortable in my own skin they started seeing D dermatologists at age 12 they have tried many different topicals so kendomycin salicylic acid benzo peroxide tretinoin sulfur Tartine adapalene retinols glycolic acid lactic acid natural products I mean they said they've really tried them all and it sounds like they have for orals and did antibiotics I took that doxy cycling that we talked about for three months and the acutane or the isotret noan one course but cut it short after four months they felt like they were having some mental health issues and I also did spol lactone which is a very common prescription 200 milligrams is is a pretty high dose for two years it did help with the acne but they discontinued it due to side effects there's many side effects associated with spironolactone including kind of like heart palpitations and blood pressure issues right now Emerson is on the Tartine cream three times a week they have also been diagnosed with PCOS so the polycystic ovarian syndrome and heroism or hair growth the next steps I'm actually going to do three tests three functional medicine tests on this patient GI map um the oat and a Dutch okay so and here we just see a closeup of what does it look like it's pretty pretty severe acne so now we're looking at the GI map results for Emerson and we see that actually this patient has no hpy Lori once I see that there's no hpy Lori then I get a little suspicious and I am thinking I'm probably going to do that DCH hormone test will we look at the overall back IIA in their gut it's pretty good pretty healthy levels except we do see this acromania mop is not found in some of my other videos I discuss acromania mcop it is a commensal bacteria that helps with that gut mual barrier and it's a a keystone species so when this is a present we'll talk about when we get to the plan what I do but but it is an important species now when we look at the dis biotic or not so good guy bacteria we actually do see some overgrowth so we see billus interus phum high sapph orus high streptococus things that we definitely want to get down and the yeast showed up on the stol test as as quite high as well so I know that there's candida overgrowth the odan wasn't particularly helpful on this patient the GI map was really kind of the hero functional medicine lab as well as the Dutch I will say so this is the Dutch test it's a hormone test and I really love this test because it tests for a lot of different hormones so it tests for three types of estrogen progesterone testosterone dihydrotestosterone cortisol right so we've got the adrenal glands as well this is just a snapshot page but when we look at this we get a lot of information when you drill down into the specifics of it you'll see the three different types of estrogen estradi or E2 is the main estrogen of cycling or menstrating people so the most important for Emerson and we can see the estrogen is perfectly normal for eston however is is on the low side so there is still and when we look at the ratio between estrogen and progesterone there is an estrogen dominance even though estrogen is normal we see testosterone is quite literally off the charts these two yellow stars and then the green band shows us what would be appropriate for a menstruating female and this is off the charts with testosterone we are also off the charts with DHEA production and off the charts with cortisol and we can see here the nice thing about about the Dutch is it's a four-point test so the problem with taking a cortisol a a blood draw or spit test once in the day is we we don't really know what it's doing cortisol is a dial hormone it's a rising and falling hormone and so we need several points in the day in Dutch is a dried urine test where you're just peeing on these strips of paper throughout the day and it's really nice because it's a very easy way for us to measure and track the cortisol throughout the day and we can see for this patient it's high at every Point almost right well waking up we're still on the high end and then it shoots up and then it's still high in the afternoon and then at night finally it goes back into normal range but there's a lot of work to be done here on the hormone piece so I wanted to show you that yes it is a lot about the gut but there can be other pieces as well and so the Dutch can be super useful as well when I look at the issues that I have to deal with for Emerson I definitely have theosis bacterial overgrowth that we saw the no acromania is a sign of a leaky gut and we looked at leaky gut for acne there's fungal overgrowth going on and there's some hormones out of whack high testosterone High DHT in in the rest of the Dutch there's much more detailed information so there's some other markers that are high listed here like DHEA sulfate the cortisol and cortisone andren 5 Alpha androdiol and the DHE of course and then the progesterone is is on the low side okay so what am I going to do to help this patient out well again I need to kind of get together what are my main issues and for bacterial overgrowth again antibacterial herbs The Usual Suspects you know berbery neem oregano the ones we looked at before for the candida overgrowth of course are beautiful antifungal herbs so some some other options are like caprylic acid powder Arco Uber ersy for the no acromania pendulum probiotics makes an acromania product and they're the only ones with live of acromania so when I see the results I see here which is no acromania or very low acromania I will give the pendulum probiotic for the low commensal bacteria again you can do like pomegranate where there's pomegranate blends of prebiotics like pure encapsulations has a a poly Prebiotic powder that has pomegranate and cranberry and some other ones I really like working on 35 grams of fiber a day working on 30 plants a week for the high androgens right that's my first step is I want to get those androgens under control and we have a lot of beautiful herbs that work on the five Alpha reduct days pathway so Sal pal pum and nettle root are some of my favorites want to try to calm that aspect down and for topicals again I use the Botanical topicals to reduce the SE production and start to heal the skin and of course again Protools are individualized and plans change every 2 to 3 months so this is not done within one plant so now to show you what happened with this patient so you can see we had several visits here and what you'll notice is that that dial turning right the turning down the dial on the acne so at the first visit and then two months later we start to see what we saw before which is those kind of more flat scabs happening I'm very happy about this I'm always happy to see this this is forward progress this is a reduction of inflammation at the 4month Mark we can see a dramatic Improvement in the amount of active acne I mean we see something active here but we can also see interestingly the skin starting to heal itself skin is an amazingly resilient organ and the minute the inflammation stops it will start to repair itself and then here we are at 6 and 1/2 months and we can see that there's actually no active acne going on but we do have scarring and hyperpigmentation and some divots in the skin again as a result of that very prolonged inflammation that's been going on since like Agee 12 so what you'll notice is most of these pictures for the rest of the treatment here there's really not a lot going on maybe one spot or maybe nothing but the reason why I kept working with the patient until this point is that this patient felt very psychologically traumatized by their acne and their scarring one they were very worried it was going to come back and two they really wanted to work on the scarring and you can see by the time we get here a lot of the skin damage that had been done that we saw earlier on has repaired itself and it's looking really great you can go from this to this and you can do it 100% naturally when you're getting at those root causes this is just the other cheek again we can see that actually in some ways it it may look a little worse here but again it's flatter and less inflamed and then by that 4month Mark the third visit uh we could see a significant reduction and then we can start to see the damage that happened to the skin the scar the pock marks the hyperpigmentation stuff like that and just a vast Improvement by the Tai War double treatment so this is just a first visit last visit and she show you and she was really thrilled with the progress and and where we left off so what are some things to consider if you want to try to treat this way well I would say if you're treating a patient with skin disorders think of the gut go ahead order functional medicine lab test test that gut see what's going on then you're going to analyze all the problems that you'll need to addess on all the tests that you do decide what order you want to treat them in don't try to treat everything all at once that's a mistake you've got to kind of batch it down figure out what's most important and do things as as they kind of come see how the patient is responding and then change your plans you're going to have to learn the best Protocols of course to treat all the issues both internal and topical and adjust obviously basing on your patient in front of you are they an infant a toddler is this a breastfeeding mom do they have allergies I like to move through different protocols calls about every 2 to 3 months and I treat Beyond skin clearance so what that means is that you could see that just because the skin cleared up doesn't mean we immediately stop treatment we have to make sure to treat all those issues all those root causes clear them up and then the patient can go on their own and that's the best chance at not having it return does it work for other deric conditions is is just the thing for acne nope this is the method that I use on all of my patients so whether I'm treating eczema psoriasis rosacea keratosis Polaris seber dermatitis obviously acne all the things hair loss alopecia Arata this is my foundation for treating the root cause of all of these diseases and if you liked what you saw here and you're really passionate about Derm you can check out L rot cause functional Dermatology professional courses it's a comprehensive functional medicine training courses teaching you how to order and use these labs to treat these Derm conditions and get to the root cause so you get taught how to analyze the GI map the Dutch tests oats mot toxins all about shating the gut and many different conditions and there's two options there's a live four-month mentorship cohort course and they are at different times of the year so you can check out rot caus dermatology.com sourses for medical professionals and see when the next ones are running this is for licensed Healthcare professionals but the self-paced course is for maybe non-licensed Healthcare professionals who can still order Labs something like a functional nutrition type situation so there's two options to choose from and you can download the PDF and get more information you can also see reviews from other students who have taken and completed the course and see what they thought about it of course if you are interested in doing this you can order these functional medicine tests through Rupal labs they make it easy you're going to put in the patient information once and then you can just take off all the labs that you want send them off to the patient and they will help the patient get them done and give them instructions and and all that and help troubleshoot so ruple lab is going to make it easy for you to help get this done for patients so I hope you've enjoyed this talk on acne and the root causes of acne and I hope you'll join me in my future talks thank you welcome to rot the health the best place to order advantage and track results from over 30 different lab companies in one single place for free it's going to take you under 2 minutes to sign up and you can order any functional medicine lab for your client in under 30 seconds let me show you how it's done so here's our beautiful interface I'm typing in the name of my client selecting the lab that want to order for them and hitting send from there Rupa and their amazing team handle the rest they email the client collect payment and even offer an interest free the world's largest library of information about chronic health conditions the lab test that can help you find the root cause and the evidence-based interventions that you you can use to help people heal from them it's called the Ruba Help magazine there we have in-depth articles about almost any health condition you can imagine and we give you step-by-step protocols that other clinicians have used to help their clients heal and that are verified by evidence-based sources you should totally check it out and it'll transform your practice and we can't wait to see you so make sure you sign up today at Ru the health.com