Nutrition Essentials - How Diet Affects Your Skin and Hair_en (auto-generated)
[music] Hello and welcome to another episode of Nutrition Essentials, an offshoot of our popular health essentials podcast.
I'm John Horton, your co-host with registered dietitian Julia Zunano.
>> Hey John, so happy to be here and I'm very excited about our topic [music] today, how nutrition can affect your skin.
Uh Julia, I have to say it's amazing how what we eat can have such a huge effect on your skin and your hair.
Um there's even something I learned about called the gut skin access [music] which is just not two parts of your body that you really connect together.
[music] Uh it's just really mind-blowing.
>> It's completely fascinating and I can't wait to dig in with our guest today, Dr.
Sheay Ronising, who is with the Cleveland Clinic Dermatology and Plastic Surgery Institute.
Well, we definitely have a lot to cover and uh we all have skin issues that we're curious about.
So, [music] let's find out what we can do about them with our diet.
[music] Dr.
Ronising, welcome to the podcast.
I I got to tell you, we're so happy to have you here.
Um getting anybody from dermatology to have a little spare time is usually impossible.
So, we really appreciate that you were able to make it in.
>> Thank you both so much for having me.
I'm excited to be here today.
>> So, so what made you go into dermatology? I mean, were you just kind of attracted to it because it is the largest organ in the body.
So, that does kind of put it, you know, high in the pecking order, I think.
>> Well, I actually grew up planning to go into obigine.
Uh, and I think when I reflected on that, I think it's because I grew up with a really strong female presence.
So, I have an older sister.
Both my grandmothers grew with um lived with us while we were growing up.
I went to an all girls school.
So when I went to med school, I had my blinders on.
I said, "Okay, I'm going to focus on women's health." And my research at the time in medical school was working with um our PCOS patient population in the gynecology department and also dermatology and hair loss.
So with that overlap, I was then exposed to the world of dermatology and my eyes were opened to how how many things I can treat and I can help more people.
Um, so you could say I I found my calling because as you said, the skin is the largest organ on our body.
So there's a lot a lot that um we need to to do.
>> It it does so much with just how we how we feel about ourselves.
I mean you how how your skin looks um your hair, everything.
I mean it it it's more than just appearance.
I mean it really does have a profound effect on on on us as as people and just how you kind of go about day-to-day life.
>> That is so true.
a big portion of my clinic actually I focus on hair loss.
Uh and I think the reason of why I'm so passionate about this condition is it's often overlooked when the reality is it's a sense of our identity.
It affects our self-esteem, our confidence, right? Look good, feel good.
Um so we can be the best version of ourselves.
>> So the hair the health of our hair really can also be a reflection of our internal health, right? Um, so that can tell us about yes, our genetics, our biological age, our stress, you know, those are all things that that can affect our hair, but we can't always control those things, but what we can control is actually our nutrition, right? What we put into our body is something we can control.
So, we we do talk actually quite a bit about nutrition um and diet in in my uh visits with my hair loss patients.
>> Well, that was a great segue.
You're I think you're going to end up getting my job here.
That was the perfect segue back into our into our kind of main conversation here which is connecting kind of what we eat to to the health of of our skin and our hair and you know I think when we look at our you know skin hair it kind of you just see appearance and how it looks but it really is kind of a there's a telltale sign of of what's happening in our body kind of can show on our skin and hair.
Correct.
>> Correct.
Yes.
Yes.
Um for example, if we are eating, you know, a specific diet where it's high in sugar, right? High in um processed foods, that's going to generate inflammation.
And inflammation can manifest in so many different ways on our skin, right? We have acne.
We have rosacea, psoriasis, eczema.
And I can go into those a little bit more in detail.
Um, depending on what direction we're going to go into, but exactly what we are putting in our bodies can trigger our genetics also to go in a certain direction too and lead to to these pro-inflammatory conditions.
>> One thing I want to note is we had a podcast on malnutrition and when we do screen for malnutrition, I look at skin, I look at hair.
Is the hair easily pluckable? Are we having hair loss? You know, are we looking at we're looking for reactions of the skin, drying, peeling skin? You know, even even the the skin around your eyes, the skin around your lips.
So, we do really look at that and and it can be a sign of malnutrition or nutritional deficiencies.
And I also wanted to note, I really think something you said was very important, how much our skin affects our psychological health.
Um, I struggled with acne as a teen and even as a young adult and it really decreased my personal self-esteem.
So, I think it's also really important that we look at it from, you know, a a step that someone can actually take to help improve their skin because nutrition is something as you mentioned they can actually change.
So, it gives them a little bit of ownership and ability to, you know, feel better.
you know that that's what really people want to feel better and and that look really like the way they look feel good about the way they look.
>> Exactly.
Yes.
And and just to to go along with that malnutrition that you mentioned, you know, and tying it back to hair.
Um so so a lot of my patients are on these low protein diets um or they're vegetarian or vegan, right? So that really limits the amount of protein they're they're ingesting in their body.
And hair is made primarily of keratin which is a protein.
So protein intake is essential for hair growth.
Um so in th those patients that we were talking about right that are having a restrictive diet if you will or a limited diet that can push the hair from our growth phase which is called our antigen phase to tagen which is our resting phase and then we can lead to even a condition called telogenofluvium which is excessive shedding of the hair and the hair is very fine and short.
So we do go into a little bit about you know general protein guidelines um in terms of you know at least what I tell my patients is 08 to one gram um of protein per pound of body weight.
um we tailor it to everyone's needs, but that is something that we have to try to work with, you know, our nutritionists as well is how can we get more protein in if they are having a specific diet that we need to work with and respect, >> right? And we know that iron, which is found in protein rich foods, right, is another common deficiency that can lead to hair loss, especially in women because we're certainly, you know, having a menstrual cycle, menrating women, I should say.
So that is another really important reason why we want to meet our protein needs is because we're also meeting our iron needs and some of our B vitamins that are essential too for cell growth.
>> Now, now do you find is it just a matter of if you're low in protein, you end up with hair loss or maybe some some thinning hair.
If you then go overboard, if you you know get in a lot of protein, are you going to see uh you know better hair? [laughter] Is it going to look is it going to look fabulous if you if you put more protein in? >> I do think everything is a balance, right? Because if we have too much protein intake that can lead to other health conditions as well and put unnecessary stress on other organs in our body like kidneys for example.
Um, so that's why I do try to tailor it to their specific, for example, their body weight, right? Percentile and try to figure out, okay, like for example, for women between like 55 to 75 grams per day is what I typically tell for the average woman for hair growth.
Um, and then for males, of course, a little higher, right? 70 to 90 grams is is the typical average I have for my male patients.
So, we want to try to be within that range.
Not too low, not too high.
>> The Goldilocks rule.
>> Yes.
Another problem with consuming too much protein is that you may not be consuming enough of the other nutrient-dense foods that you do need for hair growth as well, like polyphenols and, you know, fruits and vegetables, antioxidants, which we'll discuss later.
And the other concern is most people don't recognize that their bodies can only absorb a certain amount of protein at a time.
So, if you're, you know, consuming twice the amount of protein that you're need that you need, you you're really not absorbing all that anyway.
you're putting more strain on those organs that we want to protect.
And um just to clarify, I think it's 08 to one gram of protein per kilogram body weight.
>> Really? >> Oh, yes.
Did I say pound? >> Yeah, it it's sure.
Sure.
>> Well, I'm glad you guys brought up the protein stuff because I know I've got two young sons and they are on that protein kick because seems like right now the trend is just to go bonkers on protein.
So, I keep telling >> it's so hot right now.
>> It is.
So, so I try to bring it down a little bit and it sounds like when we're looking at what protein does for your hair or skin maybe um you still want to hit that you want to get enough but not not too much.
>> Absolutely.
>> And I think what's also tough too is the forms of protein that you're also ingesting, right? So sometimes patients are are eating these products um that are heavily processed and I find that they also have a lot of preservatives and additives and excess sodium too and they're saying well you know I am eating a higher protein diet.
I I'm eating, you know, and they're showing me the packages and and the labels of these these processed foods that they're eating.
Um and they're not whole foods, right? um they're not actual when they look at their plate, it's it's something that they had to open a package for and they can't pronounce the the labels um the ingredients on the label, right? Um and that's contributing to their inflammation and their nutritional balance, too.
So, it's trying to shift their focus to eating more, you know, lentils or um seeds, nuts are really underutilized form of um nutrient-packed protein, for example, tofu, tempeh.
Um, I'm sure Julia can can tell us more examples of what to shift patients.
>> You're doing phenomenal.
You could take over the podcast for both of us.
We don't even need to be here.
No, you you're you're spot on.
And you know, one thing I always say, you want to try to limit supplemental protein and really increase real food protein, whether that comes from meats or plant-based sources or fish, of course, or dairy.
Um, the other, you know, quick thing to note, and I think I think we're going to talk about this in more detail later, but some of those supplemental proteins like whey protein powder can actually increase your likelihood of having acne.
So, you want to be cautious with some of these supplements.
I mean, anything and anything and everything in moderation can fit, but it's just finding that balance.
And some of those supplements can be very quick and convenient, but I really encourage my patients, use those for convenience only, not as a routine basis or a source of protein.
Just use it when you need it to help meet your protein needs.
>> And and Julie, I'm glad you brought that up because I think now we should really maybe transition into some of these skin conditions that that we want to spend a little bit of time on.
And obviously, a big one is acne.
I mean, we've all had that zit that comes out at the absolute worst time.
and just and other issues.
It can be it can be really really tough.
Um is what we're eating really kind of triggering a lot of that? >> So, you know, acne is multiffactorial, right? So, yes, dietary factors are something to to consider, but also environmental factors.
What I mean by that is stress.
So, if we're coming up to, you know, a big event or, you know, I have my brides, for example, a week before their wedding, they're calling me telling me, "Oh my gosh, I'm having the worst breakout ever." Um, so, uh, and other things to consider are genetics.
Um, some patients can be just genetically predisposed to certain forms of acne and hormones, too.
um you know closer to a female's menstrual cycle for example a week before that um they are experiencing a bout of acne as well.
So diet can influence those um you know modifiable risk factors that we could consider but it's not the end- all beall.
Um there are certain dietary um factors we consider in terms of are they eating you know high glycemic index foods.
So, what I mean by that, I always ask, you know, what did you eat today? And a lot of my patients, for example, they'll start with eery eating, you know, a sugary cereal.
Um, or they're eating um these these protein bars again, high sugar content in them.
>> Granola bars, those bar that whole bar category, the whole packaged snack food category, right? >> Yes.
Pack.
Exactly.
And then, um, you they're drinking Coke or something like that.
So, high sugary um drinks as well.
So, what's happening then is that's spiking our insulin and that's spiking insulin like growth factors and that stimulates um our sebaceous glands or oil glands to produce more oils and what does that do? That clogs our pores, right? So, that leads to more acne.
Well, >> it's amazing how it's all connected like that.
And you you just wouldn't think that, you know, you eat something real sugary, it kicks off this whole process and you know, the end result is you have, you know, you have a pimple popup.
But it's not just sugary foods too, John.
You you want to keep in mind it's any high glycemic index foods, which is white bread, white rice, white pasta, crackers, snacky foods like potato chips.
Those are high glycemic index foods, too.
>> What What about dairy? Because I I I feel like you hear that tied to to acne a lot, too.
>> So dairy is has been a a common trigger I've seen in my clinic and specifically actually skin milk um is linked more to acne than whole milk.
And I think it it boils down to actually the skimming process in terms of when they're removing the fat from the milk.
Um what happens is then we have more bioavailable hormones specifically again insulin like growth factor one and androgens actually.
So again those are um promoting our oil production and again leads to inflammation and clogging our pores.
So, if patients find that when they're ingesting certain forms of dairy, I I you know, I tell them, you know, to to actually food journal and look and see, okay, this past week, what did I eat? Okay, 3 days ago, I've been eating, you know, dairy Monday, Tuesday, Wednesday, and I had a terrible breakout on Thursday.
Right? So, so then we have to try to swap that out in terms of can we find a different form of a dairy alternative that they can still enjoy that is not going to be causing them to have this inflammatory acne breakout for example.
>> I think another reason why the skim milk could lead to increased risk of acne would be because there's no fat slows down the rate of glucose going into your bloodstream.
So, right, you're getting a much less reaction of, you know, a blood sugar spike when you pair it with fatter protein.
So, there could be some of that fat component that's slowing down that glucose, which is then less likely to stimulate insulin, too.
>> And Dr.
Roning, I know you mentioned earlier, too, but a lot of the the things that people take when they're working out, if you're a big fitness buff, um you might be into those like the supplements, the muscle building uh you know, things that everybody's t that everyone is taking.
um how how do those then contribute to to acne? >> Yes.
So again, when I'm screening my patients with our dietary intake form, I'm asking about whey protein intake and branch chain amino acids.
Um and also casein too, which is another uh dairy derived protein that that some patients have been taking as well.
Again, that is that is they all funnel into the same mechanism of spiking our insulin, spiking our insulin growth factors and overprouction of oil.
So, I see this a lot in my young teens, um, and my young adult athletes as well.
Um, so then we try to say, okay, how can we swap that out for a plant-based alternative like pea protein or hemp protein, for example, to add that in so they can still get the protein that they wanted to try to incorporate into their diet, um, but hopefully in a way that's not going to produce acne.
Um, there are also supplements, too.
Then I make sure I screen for patients um particularly vitamin B6 and B12 um when we're having too much of that again too much of a good thing is is can can cause a lot of problems right so when taken in high doses particularly 5 to 10 milligrams um per week that can worsen acne in some individuals the reason being um the B6 and B12 gets into our pores localizes in the pores and it actually acts as a nutrient source for a particular bacteria called cutie bacterium acnes which is an acne um which is a bacteria that is involved in the acne formation process.
Um so that is something again patients don't connect um but could be uh triggering their acne.
>> That's just amazing.
I mean, you look at your skin and it just does not seem all that complicated, yet there's all this going on and, you know, oils being produced and the pores and and and like you just said, these things in there.
Um, you I don't think we we we think enough about how it is connected to everything in our body and and just, you know, and that's why we see some of the issues we do.
>> Yeah.
Another supplement I I didn't want to forget to mention was iodine.
So, some patients take iodine supplements to optimize their thyroid health.
And we have seen excessive amounts of iodine can cause irritation around the hair follicle then leads to inflammation and then leads to red blotchy skin.
Um so whether it be kelp supplements is something a lot of my patients have been telling me they're taking recently um or eating like seaweed cracker crisps um as like a healthy alternative to potato chips um and just or just eating a lot of iodonized salt for example.
So just a few little things that maybe we didn't think about could again be contributing to your acne.
>> Do you know if there's a difference between food specific contributors to more of like that deeprooted cystic acne versus more of like those small topical pimples with >> so there's two two main categories of acne.
Um so one is those superficial comedonal acne otherwise known as the whitehead blackheads and then the other form of acne or inflammatory acne called nodular cystic acne.
So I find that the more superficial acne you know could could be due to yes dietary but I will say I've seen it more due to products that patients are putting on the skin >> and that's causing um inflammation at a superficial level.
um all these, you know, Tik Tok, Instagram, um trends that patients are trying out at the comfort of their home are causing these bumps versus more of what you're eating internally is causing more systemic inflammation and then that manifests as more of these deeper noduleistic um inflammatory um papules or nodules on the face.
>> What about like bacterial overgrowth? Do you know if there's any connections to like a bacterial overgrowth like the gut microbiome versus the skin microbiome that could be leading to acne or any of these other conditions? >> So we have seen that if there is overgrowth of you know our unhealthy um bacteria in our gut if there's dysregulation of the gut microbiome that can manifest as inflammation in various forms in our body.
So, not just acne.
Acne is one form, right? But also eczema and also psoriasis.
>> So, there's those are, you know, there's definitely a subsection to all of those.
But if I had to keep things kind of big picture, there's three big categories that um patients can experience these skin conditions if they have disregulation of the bad um gut uh bacteria um overgrowing.
Let's break some of those down then because now you had mentioned psoriasis and and what what are the things in your diet that might kind of contribute to that or really cause some flare-ups.
>> So I guess let me take a couple steps back as in terms of what is psoriasis, right? Because sometimes patients might come >> do get it messed up.
Yeah.
Like what it is? You kind of you heard it but you don't really know >> what what it is.
Yeah.
>> So what psoriasis is is it's an autoimmune condition.
It's an autoimmune skin condition where um the immune system speeds up s skin cell turnover and that leads to the skins to build up on itself rather than shed like it normally should every 28 days is how often our skin cells should be shedding and then you get these thick red kind of scaly plaques um commonly on the scalp.
It can be on the elbows, the knees, the lower back.
Um, and we're seeing more and more research actually that psoriasis actually is not just limited to the skin.
It is a systemic inflammatory disease.
And patients that have severe psoriasis actually have a three to four times higher risk of cardiovascular disease or stroke.
>> Oh wow.
Um so in terms of the diet that we promote for our psoriasis patients, it's the same diet we promote for our patients that are at higher risk for cardiovascular um diseases, which is the Mediterranean diet.
um is at least what I recommend for my patients to follow and um look into a little bit more and do some research when they're trying to meal prep and um get their grocery list in order is is Google what that means and look and see are there some you know foods that they want to start incorporating into their diet.
>> You could also check out our website that has really good credible sciencebacked information on the Mediterranean diet.
So if you're looking at um to look at and they have great recipes.
So clevelandCl clinic.org or health.
>> Okay.
Well, see, this is why we do this.
I'm >> We can take over Google.
[laughter] >> We We have talked about meditarian diet once or twice, Julie.
>> Thousands of times.
[laughter] >> Well, and I know and that's always the thing that comes up and you always get so excited talking about, you know, foods that limit inflammation.
And I know the Mediterranean diet is so key for that.
And it sounds like with psoriasis, you're kind of dealing with th those same inflammatory issues that that can kind of kick things off or really get things going.
So, so what are the things that you want to really try to try to limit and make sure that you that you get in? Well, so when in when when you're talking about a general Mediterranean diet, um you really want to limit what we've already addressed simple sugars, which are also called, you know, um high glycemic index foods, which are those white food, white breads and products and bread type products, snacky foods, sugary foods, highfat foods, specifically foods that are high in saturated or trans fats, which can be processed meats, processed cheeses.
against some of those um butter, lard, bacon fat, of course, and those animal fats, but mainly bad fats are found in processed foods again.
So, we're really limiting that processed category.
>> That's not a pro salami sort of diet, it sounds like.
>> No, no, not a pro- salami type diet or pepperoni or, you know, whatever your vice might be.
And that doesn't mean you can't ever have it.
So, you know, again, I work anything in that patients really want, I will help them work it in.
We can there's no no to anything really.
We can work anything in.
It's just a matter of frequency and portion and like supporting the other nutrients very positively.
So we're just, you know, not going down a slippery slope when we add these other foods in, right? But um high fruits and vegetables.
So when we talk about skin health, we talk about antioxidants and polyphenol rich foods which are found in colorful foods like berries and green tea and cocoa and grapes etc.
And so we're looking at very the colors of the rainbow fruits and vegetables that are abundant in different colors and that's where you're going to get the most bang for your buck because those are also f they also provide other very strong nutrients that support skin health.
Um, and you know, of course, fiber that supports the gut microbiome and they help decrease inflammation.
So, there's so many benefits to whole foods.
We're looking at lean proteins and and increasing fish.
We've talked about plant-based sources of protein.
So, that that's an abundant source of protein in the Mediterranean diet.
So, frequently eating legumes, which are dried beans and lentils.
Nuts and seeds are a regular um consumption source of protein and healthy fat in the Mediterranean diet.
Extra virgin olive oil.
So, a lot of the stuff we've already talked about.
Um but just reinforcing again one additional reason why the Mediterranean diet or just in general a whole whole foods anti-inflammatory diet can really be helpful.
>> Yeah.
Now, now we've mentioned this a few times here and I don't want to forget to talk about it.
So this whole idea of a gut skin axis which is just not something I think most of us naturally connect that somehow your gut is connected to to what's happening on on the surface.
So explain how this exactly works.
So what we are it's there's definitely a lot of ongoing research that's still occurring with this but what we're learning is if there is disregulation of the gut microbiome meaning there's overgrowth of that unhealthy bacteria compared to the good healthy bacteria.
We then have patients that have an impaired skin barrier and we have they these patients then have cracks in their skin and that allows for you know environmental allergens or something as simple as you know a fragrance that someone's wearing gets into our skin and then stimulates our immune response to then create this you know immune cascade that leads to red scaly itchy rashes.
You know, I'm talking about eczema now at this point.
Um because this is the most common uh scenario where we see if there's disregulation of the gut microbiome, it's it's eczema.
If I had to pick between, you know, the the common um conditions I see.
Now, when we have a healthy gut microbiome, which can be promoted by eating the Mediterranean diet, we have a lot of data supporting that.
that can regulate inflammation and then that produces beneficial compounds specifically called short- chain fatty acids and that improves the skin barrier function.
It helps retain the moisture, keep our skin barrier intact and keep the irritants out, right? So then we don't have as severe or as frequent of these eczema flares.
Also, when you have, you know, a healthy gut microbiome, that allows us that good bacteria helps us to absorb those nutrients better.
all the wonderful nutrients that Julia was just referencing and that helps us to promote better building blocks, a better foundation for healthier skin and healthier hair.
>> Now, correct me if I'm wrong, there's thousands of microbes on our skin as well.
Correct? So, you know, we heavily focus on the gut microbiome, but the skin has its own microbiome.
And if we can build the healthier bacteria on our skin, they'll be more protective against those bad invaders.
Just like how we view the gut, we can view the skin in the same way.
>> And you know, I I always say your skin is, you know, a reflection of your internal self, right? So we want to look at, you know, your your your insides are kind of turned on the outside.
So you can see that there is some disregulation if you're seeing signs in your skin or your scalp as you mentioned.
>> Definitely.
>> Well, and I love when you mentioned the skin barrier because you know it sounds so sci-fi like somehow we have like a force field all around us like if your skin's healthy that that just kind of protects you and wards things off.
But it sounds like there there really is something to that and we contribute to the strength of that um by by what we eat.
>> Yes.
So, you know, in terms of also I will say a supplement that I do promote is actually eating either taking a probiotic or eating probiotic rich foods, right? Because the reason is when we're doing that, I want I want patients to think about that as medicine.
Honestly, food as medicine.
I know I'm not the first person to say that.
That is definitely something you you all have talked about that on on your podcast as well, but it's true, right? And an analogy that sticks with me that I tell my patients actually um it's something that I learned when I was in training and I'm probably going to botch it right now, but probiot you want to think about probiotics as seeds in your garden and prebiotics as fertilizers for the seeds to grow.
So whether it be patients are eating certain foods that are probiotic rich foods um meaning those fermented foods like um yogurt or sauerkraut um miso kimchi which I would love Julia to teach me even offline how to incorporate that more into my diet because I want to be eating these foods more rather than taking pills.
Um, you know, by eating those types of foods though, naturally we are going to have a healthier skin barrier and naturally our skin's going to look better and we won't be having to um be putting all the topical steroids or putting all these other medicines in and on our body if we can just eat um a more mindful diet.
>> Yeah.
And you you did great job listing those probiotic foods.
To add a couple more, you mentioned fermented vegetables.
So, you mentioned sauerkraut, but kimchi, pickles, and apple cider vinegar.
That's an easy one for people to add.
You know, if you do a dressing on a salad or some people just put it in their water.
So, you know, sourdough bread.
Um, so real sourdough bread that's been fermented, though.
Um, olives, kombucha is another source.
So, you want to look for low sugar kombucha, of course.
But there's a lot of great opportunities to consume, you know, some of these probiotic foods.
And the prebiotics that you mentioned were again just as essential because we need that bacteria to keep thriving and growing.
And prebiotic foods are essentially fiber.
So resistant starch and fiber, which we've talked a ton about on this podcast.
>> Dr.
Ronson, you were asking earlier like how uh if I've had changes in my diet because of this podcast.
I'm telling you, I drink kombucha now because of everything Julia has said about it.
[laughter] So, that's always in my fridge.
>> Nice.
>> Well, I'll need to know what brand you guys drink because I'd like to join the kombucha train as well.
[laughter] >> Mine usually is whatever's on sale, but you know, that's a whole different discussion.
Um, so, so we've tackled like a bunch of, you said there were five things that you wanted to make sure we hit and we kind of we've talked about hair loss, >> acne, psoriasis, eczema.
The last one is kind of rosacea which I remember we were talking before you said that that's a little more nuanced with with how diet is kind of related to that.
>> Yes.
So first you know what is rosacea? Um again that's another condition when I look at a patient I tell them they have they go what is that? So so let's let's go into that a little bit.
So rosacea is a chronic inflammatory skin condition like everything else we've been talking about but it's particularly affecting the central face.
So what happens is these patients can have frequent facial flushing, persistent redness, sometimes these background um broken blood vessels on the skin otherwise known as tenjectas and they can also get papules and postules on the skin too.
Um it's commonly due to um just having a genetic predisposition to this condition.
But there are risk factors um triggers for patients that I do have them you know be mindful about meaning you know UV radiation.
So sun exposure is a main thing and patients will tell me well I don't go outside in the sun and then the next question I ask a lot of my patients is okay do you work from home? Um and a lot of my patients that work from home have big windows around them.
Um and that can promote their rosacea flares which you know people don't commonly think about.
>> Yeah.
You don't think of being inside you're going to end up with that.
>> Yeah.
Yes.
So, so that's that's something to consider.
Um, another one is excessive caffeine intake.
Um, spicy food, uh, red wine and alcohol.
What all these all these triggers are doing, it's again dil dilating those blood vessels and creating inflammation at the center of the face.
Um, dark chocolate and then also emotional stress.
Um, so those are the main um factors that patients need to consider about um trying to mitigating and and decreasing so that they don't get as many flares on the center of their face with the rosacea.
>> Doesn't it it doesn't it flare also if you're in heat like if you're in a sauna or hot yoga or exercising in a hot room or running outside where you're you know just promoting that your body is really sweating and very hot >> dilation.
Exactly.
So, so, um, when patients are on vacation, they always come, that's when they come back to see me and say, "Can you help me fix what happened to my face?" Because they've, you know, we're outside in a different environment versus our cooler, um, climate here in Cleveland.
Um, that's something for their body to adjust to and and that can trigger inflammation.
>> Okay.
So, we've kind of tackled all these issues and kind of what's causing them a little bit.
I I want to make sure that we focus and really kind of break down what people can do to kind of resolve some of these issues.
Um, you know, how we can adjust our diet to to kind of lessen some of these skin issues.
And I know it's kind of all over the board here, but let's just try to break down some of them.
It looks like one you said, uh, probiotics, prebiotics, uh, get them in your cart when you're at the store.
>> Yes.
Get get those types of foods in your cart when you're at the store.
Um, with rosacea is trying to avoid those triggers.
um that we've already reviewed um with psoriasis actually, you know, yes, going along the lines of the Mediterranean diet, but also you know, out of all the conditions uh that we talked about, I will actually say weight loss um has been shown to actually improve the severity of psoriasis.
And the reason is actually our fat cells are producing poor inflammatory hormones that can lead to the whole body um inflammation and lead to worsening psoriasis.
So weight loss as little as total body weight has been shown to reduce the psoriasis severity.
So what I mean by that you know for example if we have a 200 lb um patient and they lose improvement in their severity of their psoriasis.
So out of all the conditions, having structured nutrition counseling is something I do tell patients to do as part of their adjunctive therapy, as part of their psoriasis treatment plan.
Um, because it really can help make a difference.
>> Well, another bonus to that is most chronic conditions can be improved significantly with a weight loss of 5 to improving your psoriis, but any chronic condition or risk factor surrounding that chronic condition can really be improved, too.
You Dr.
Ron Singh, how often do you pair uh one of your patients with with a with a dietitian to try to work through some nutritional things they can do to to maybe make a difference >> daily? >> Wow, >> that's great to hear.
>> Thank you.
>> I don't know how many of them have seen Julie in particular.
Um but >> but I really do treat patients holistically, right? And I think I already brushed on it earlier.
I don't I yes I'm a physician but I don't like patients to have to use medicines.
I don't like patients to have to be putting a topical steroid twice a day every day for six months.
You know if we can just do minor lifestyle changes um they can make drastic results in living like I said earlier living our best life.
Um so so having the the help of a skilled nutritionist to work together to try to figure out what are the dietary changes that we can you know swap out for you know instead of eating you know this highly processed chicken sausage every morning what's a different alternative to try to get that high protein intake in that's a whole whole foodbased um product.
How often do you see them when when when you talk to your patients about this and they kind of meet with a dietitian that they have that that light bulb moment that you know they they really just see the results you know take hold.
>> So I will say it's the the most obvious changes have been in my hair loss patients.
I think that's just because what what I see the most um is I see them after about four to five months.
Um that's how often our follow-up is on average.
And they'll they'll come back and they'll say Dr.
promising.
I started eating Greek yogurt every morning.
I'm adding my chia seeds and flax seeds and hemp seeds, little little things on top of their yogurt, but they have a big impact on the amount of protein they're having in the morning.
Um, and yes, they're also doing the the other changes that we talked about medically wise, but we have the photos.
That's what I love to see is we have the before and after photos.
Um, and and they're telling me that they're using apps on their phone, for example, to track how much protein intake they're having, too.
Um, and they're telling me also they're feeling better, right? They're feeling better um not just because of their hair, but they're feeling better because they're feeling, you know, more satisfied with um actually nourishing themselves more adequately.
Um, but like I said, yes, going with the photos, having them side by side, patients can really see that what they're doing, the changes that they're making are really making a difference.
Um, so that's like the best feeling to see.
>> I I would agree with you completely.
And you mentioned one thing about using an app and or food journaling.
I think that's one thing we didn't mention and I think it's a phenomenal way to really troubleshoot if there is a connection to what you're eating with your skin condition.
And I think it also helps you make sure you're meeting your protein needs.
Make sure you're getting in that fiber, which is a again a prebiotic.
Making sure you're getting those polyphenol rich foods and those fruits and vegetables.
It gives you a a a really accountability.
So you can look every day and see what you're getting.
If you choose to use an app, the apps like the Cleveland Clinic diet app will track all of these, you know, nutrients for you.
They'll track your protein, your fiber, your vitamins, minerals, etc.
And and they'll tell you if you're on target or not.
If you choose to use a journal, great.
You can just note that yourself.
Note like if you have a skin reaction after a certain food or if you even can calculate your protein grams.
So, there's so many benefits to just writing down.
And I usually tell patients, you don't have to do it forever.
I say commit to two weeks.
Most of us recycle the same foods within two weeks.
So commit to two weeks of journaling and you'll probably get a good understanding on where you fall with nutrients or you know with any triggers.
So I think that's one big piece to consider.
And I also think um you know just looking at simple changes too.
So I think some of this can be very overwhelming.
There's a lot to change but you know just starting with one step you you know your body well.
one step that you think that will make the biggest impact such as maybe we start with cutting out sugary foods or processed meats or maybe we start with adding something like a probiotic food.
Well, and as a we've covered so much here today and and so I'd like to as we kind of wrap things up, uh, if you guys could just maybe kind of summarize kind of key points you want people to kind of walk away from this discussion with um, you know, maybe some best practices they can adapt and and and maybe some resources that they can use to kind of get get their diet squared away and get their skin and hair at the best it can be.
So I think what I would say is the bottom line is a balance right we need to enjoy our life um but we also need to consume things in moderation right like we started talking about we don't want too much protein too little protein with our hair loss patients right in the middle with with the guidelines that we provided earlier today with our acne patients you know trying to step away from our heavily processed um highly very um let's see pro-inflammatory foods that have a high glycemic index or our our skim milk.
Um or considering swapping out that whey protein for a plant-based protein.
Um with our eczema patients, reaching for more probiotic rich foods or foods that are prebiotics that are going to promote those probiotics.
Um and with our rosacea patients, being aware of our triggers um and making intentional choices that support your skin health.
Um, and learning more about the Mediterranean diet using our Cleveland Clinic um, resources that Julia has so nicely um, laid out for us too.
Um, is something that I also am going to do a better job about linking my patients um, to to instead of going on Google look and look look and see what our wonderful institution has been able to to compile.
>> Yeah, just to second that.
I think everything you said was spoton, but I would I would reinforce again educating yourself.
It's always a key for me.
I always try to empower my patients to educate themselves.
Educate is your education is your key to success, right? It's your key to resolving whatever health issue you may have, you can take a little bit of ownership and get a little bit closer to where you want to be.
So, you know, looking at the Cleveland Clinic website, the Cleveland Clinic diet app, looking at the resources we have, the recipes we have, we have meal plan options.
We have many many dieticians that you can see if you want more individualized help.
But if that's not the path for you, we have free information that you can access at any time that has been written and developed by registered dietitians.
So just really educating yourself is key.
>> Well, well, folks certainly got an education with us here today.
Uh, so I want to thank both of you for for just sharing so much uh, great info and uh, really helping people see that connection between what [music] they eat and how their skin and hair look.
So, thank you very much.
>> Thanks, John.
Thank you both.
>> So, Julia, I have to tell you that that conversation, we [music] hit so many things that I think affect people in in their day-to-day life.
Uh because I mean we all kind of have skin issues that we deal with.
>> I completely agree.
I learned so much about the specific different kinds of [music] skin issues.
I didn't realize they were all influenced by so many factors and you know really reinforcing the fact that diet [music] and nutrition can play such an integral role in treating these skin conditions.
[music] >> I always love hearing just how much of a difference it makes and that she sees that in the patients [music] that she's working with.
It's great to see the visual changes.
I've seen that well as well with my patients and it's it's really encouraging.
>> Agreed.
Um so if you liked what you heard today, please hit the subscribe button and leave a comment to share [music] your thoughts.
And until next time, eat well.