Treating Adult Acne & Rosacea From The Inside Out_en (auto-generated)
small intestinal bacterial overgrowth is also one of the triggers for rosacea a lot of patients that you see with rosacea will have irritable bowel type symptoms or bloating type symptoms uh and when you do some testing for that and you treat it that oftentimes will clear up their uh their rosacea [Music] [Applause] welcome to the doctor's pharmacy i'm dr mark hyman that's pharmacy with an f-f-a-r-m-a-c-y a place for conversations that matter and if you've got skin problems you should listen up because this conversation is going to matter to you particularly something called rosacea acne rosacea it's a terrible skin condition we'll talk about what it is but if you have it you know what i'm talking about and it is miserable and today we have with us none other than dr todd lepin who's my colleague a frequent guest here on the special episode of the doctor's pharmacy the house call episode he's a graduate of dartmouth medical school he's board certified internal medicine we've worked together for decades now it's almost 10 non three decades it's kind of scary holy cow you don't look any different than the day i met you so functional must be working uh he is an incredible guy and his teachers all over the world well not so much anymore but you know virtually now actually and and has been uh as part of the faculty in the institute for functional medicine uh american college of advancement of medicine age management medicine and many many other great great organizations so todd welcome back to the doctor's pharmacy thank you mark okay so first of all we're talking about this weird condition that some people never heard of called acne rosacea we're going to talk about what it is how traditional medicine deals with it why that's all wrong and how we approach it using functional medicine so what is acne rosacea okay well that's acne rosacea is a chronic inflammatory condition that adults get it's also another name for it is adult acne and patients who have it will get redness to the face usually over the the cheeks and the nose sometimes the chin and you can also be pretty severe you can get uh telangiectasias which are like little uh blood vessels there's like little like blood lines in your face vasodilation of the blood vessels papules pustules so it looks like adult acne is really what it is and interestingly it's fairly common about ten percent of the population has it uh it tends to be more common in people who have celtic origin so irish scottish uh english which is interesting i'll talk about that later i'm jewish from the middle east i'm safe yeah it might be absolutely it might be it might be yeah um and uh a lot of famous people have actually had this uh bill clinton yeah has won uh wc fields and bulbus yeah so one of the complications of rosacea is chronic inflammatory changes to the skin so you can get what's called rhinophyma which is basically when you see a clown with the red nose that's rhinophyma yeah that's what right red nose and it can be actually quite debilitating i mean when it gets really really bad you can uh get this distortion of the facial features especially over the nose yeah yeah so it's this really nasty kind of acne and it's what's what triggers it do we know from a traditional medicine point of view well there are a variety of different triggers when people have rosacea uh things that can trigger it are spicy foods uh alcohol can do it yeah i mean alcoholics tend to get this a lot right if you're an alcoholic and wc feels clearly was yeah yeah if those of you who don't know he has google it yeah that's probably before your time but it's it it is often driven by alcohol yeah and i i i my own theory on alcohol as it ties in with that is that alcohol does vasodilate blood vessels but also alcohol in excess is also a big contributor to leaky gut and i always you know i get my patients to understand this uh concept that alcohol can promote leaky gut so i took a shot of tequila and i threw it in your eye what would happen it would burn your eye would water right you're able to get leaky you have leaky eye leaky gut so chronic alcohol ingestion is probably one of the biggest things for low-grade endotoxin and leaky gut and that's also tied in as we'll talk about uh in terms of irritable bowel and yeah we're going to get into leaky gut because that is it's a very big issue general and particularly with things like skin disorders like acne rosacea yeah yeah exactly so so todd um you know in functional medicine we we take a very different view which is we treat things from the inside out not the outside in right dermatology is all about lotions potions and creams and slathering stone on your face to sort of get it good from the outside in but it's kind it's kind of backwards yeah so what what are the traditional treatments for rosacea and why are they not the best idea you know when i went through my medical training there was an old uh saying that the dermatologist basically if it's if it's dry wet it if it's wet moisturize it and if you don't know what's going on give it a steroid that's that's essentially pretty much right that's pretty much dermatology i learned the same lesson yeah right that's that's that's it and you know dermatology and if if it's wet dry it if it's dry wet it and if you don't know give it a stir exactly that's that's that's the the mantra of the modern uh uh dermatologist um but again it's like you said it's it's it's an external manifestation of something going on internally uh so the question is is what's driving this and uh in in preparing for this talk i mean i've i've seen so many patients with rosacea it's not funny but what do they put on there they give antibiotics on the face yeah they'll give like give like uh uh you know metronidazole cream uh which is topical uh uh anti uh antibiotics it's like an antiparasite antibiotic yeah one of the newer one of the newer medications and this is sort of an interesting thing is a is a cream called ivermectin so this sort of blew me away because this is relatively new and i think we were talking about it it's a worm pill it's a it's a parasite uh they're using it for covet even really yeah yeah yeah so so it's really it was it so it said to my so i i i was reading and i had actually had a patient who came in and was on the ivermectin cream and was doing very very well on the ivermectin cream and then i said to myself well how is an anti-parasitic medication topically helping with uh words yeah well it's also that's also interesting because one of the things that uh is strongly tied in with uh uh rosacea now remember rosacea is just over the face it's it's it's this facial manifestation of an internal uh issue is that we have these little creepy crawlers on our face and they're called uh mites skin mites yeah uh uh uh dermadecks like dust mites we all have them we there everybody has these and the interesting thing is that patients who have rosacea have a much much higher density of skin mites on them for whatever reason and normally they they basically they're like little uh you call them like little parasites that they're ectoparasites and they sit on the skin and they they eat your dead tissues and they they eat off of the oils on the on the glands and normally you don't have a reaction to them they're sort of like a benign parasite but in some people who have high concentrations of these skin mites the body makes a very very high immune response to it so uh getting back to the ivermectin which is basically an anti-anti-parasitic it may be actually working as an anti-parasitic for some of these skin mites yeah so maybe there's an infectious cause to this yeah so yeah so yeah so the things they use are menocycline which is an antibiotic flagella or metronidazole which isn't any parasite an antibiotic every mechanin which is an anti-worm oh oral oral doxocycle is another one yeah oral antibiotics which probably is a really bad idea given yeah exactly you have a microbiome you don't want to be killing it to fix your skin exactly exactly yeah and why that why might that minicycline work why might antibiotics orally work well there's a there's a thought and there's actually it's actually in the literature is that uh small intestinal bacterial overgrowth is also one of the triggers for rosacea a lot of patients that you see with rosacea will have irritable bowel type symptoms or bloating type symptoms and when you do some testing for that and you treat it that oftentimes will clear up their uh their rosacea yeah um yeah absolutely yeah so i think i think you know we're not averse to using topicals and topical medication when necessary but if you really focus on root causes which is what functional medicine does you come up with a very different set of approaches that actually works better is longer lasting and doesn't require to keep putting on lotions potions and creams for the rest of your life or taking oral antibiotics right exactly and then the way getting back to the ivermectin ivermectin and i uh in preparing for this talk i did some little a little bit of research and the patients who are more prone towards uh rosacea have a problem with too much of what's called uh the catholic side and antimicrobial peptides so these are these mouthful yeah they called camps camp uh catholicism and antimicrobial peptides and these peptides are part of the built-in innate part of the immune system to protect our skin against various types of infections and it turns out that ivermectin actually uh helps with these uh these antimicrobial peptides because people who have rosacea have too much of these peptides they have like an over uh uh robust response to uh antimicrobials so it's it's thought that the uh one of the it's actually a breakdown products called ll-37 and uh ivermectin actually works on dampening down these uh antimicrobial peptides to decrease inflammation in the skin okay so in terms of in terms of the cause it seems to be a combination of internal and external factors right something on the skin and then some things internally but from traditional medicine there really isn't an approach to helping heal the skin from the inside out no no no and whether you have acne or eczema or psoriasis or rosacea or any one of the myriad skin conditions that we get most of them have their root cause inside not on the topical level exactly and and often it's the gut yeah absolutely yeah so you mentioned a little bit earlier leaky gut so take us through from a functional medicine perspective are thinking about the root causes what are what are the things that you think about when someone comes in your office and their face is all red and they've got all this acne on there and they've got like little intel injectation these little red lines everywhere and you can see the blood vessels dilated and they're kind of looking like uh santa claus yeah exactly yeah and also they get they also get photosensitivity too which is the other the other thing and the interesting they can't go in the sun without getting it worse and and that that also ties in with these uh antimicrobial peptides because uh it's thought it's theorized that the the the celts the ones who live in the higher northern uh latitudes they don't get as much sun as we do so it's thought that from an evolutionary standpoint that they benefit by having this they have a more robust immune system when there's not enough sunshine and and sunshine will actually activate this this innate immune system and that's why sun exposure oftentimes makes it worse because they produce more of these antimicrobial peptides and then those antimicrobial peptides have to get processed and in the process uh breaking them apart the immune system then starts responding to it so that's why there's a sort of a photosensitivity aspect to it and what are the other sort of things you think about when someone comes to your office with rosacea well uh one of the things i oftentimes look at is their vitamin d levels uh vitamin d is is is part of the uh immune system and it uh it's tied in with uh intimately with the antimicrobial peptides system in the body so oftentimes patients who have this have low vitamin d levels uh we'll look at the microbiome testing to see if there's any evidence of dysbiosis bacterial overgrowth testing the sibo testing checking for hydrogen and methane i mean probably the majority of patients who i see of rosacea have problems with with bacterial overgrowth other thing is low stomach acid which also promotes and contributes to bacterial overgrowth yeah so checking for the patients uh sometimes these patients are also on ppis uh acid blocking acid blocking medications absolutely yep yeah because we have acid in our stomach to help us to digest food it's also there to decrease uh the amount of bacteria higher up in the colon so uh it's good it's good to have stomach acid yeah it says if you don't have stomach acid then the ph of your small intestine changes becomes more alkaline and then bugs grow in there that wouldn't necessarily grow yeah and that's when you get this overgrowth of bad bugs in there and it it can be what we call sibo which is small intestinal bacterial overgrowth where bad bugs migrate up from the lower intestine into the small intestine and then when you eat foods you get bloating distension it causes leaky gut you end up causing damage to the lining of the gut and food particles and bacterial toxins leak in and create inflammation throughout the body and on the skin so you know leaky gut can cause hundreds of different manifestations one of which is rosacea and unless you think about that and learn how to treat it you may not be able to be successful with it there's also another condition that i've seen todd in a lot of my patients called sifo sifo small intestinal fungal overgrowth and a lot of people talk about it as candida but there's many many species of yeast and fungus and and so what i found often is that treating the gut through addressing the bacterial overgrowth the yeast overgrowth healing leaky gut dealing with the food sensitivities makes a profound impact yeah and a lot of times it is food sensitivities that can trigger i mean for example gluten we've talked about on the show that is one of the biggest drivers of leaky gut yeah and even even if you are not celiac and even if you don't think you have any symptoms or don't notice any symptoms when you eat gluten dr alessia fasano who's the world's expert at harvard on gluten he said everybody who eats gluten creates some level of leaky gut right now most people kind of handle it right transient leaky gut exactly so i don't know like it's probably not a good idea to eat that much gluten because of the potential to create leaky gut and how that is linked to so many chronic diseases including weight gain diabetes cancer heart disease alzheimer's autoimmune diseases allergies act i mean you just name it depression all this stuff is connected by by leaky gut so i really i think you know getting a very different thinking about this is key and you you did you talked about the stomach acid you talked about the acid blockers you talked about maybe other things that that you know are relevant in the gut and certain infections like h pylori which is a common bacteria that causes ulcers also has been linked to h pylori and food sensitivities hey everybody it's dr hyman thanks for tuning in to the doctor's pharmacy i hope you're loving this podcast it's one of my favorite things to do and introducing you all the experts that i know and i love and that i've learned so much from and i want to tell you about something else i'm doing which is called mark's picks it's my weekly newsletter and in it i share my favorite stuff from foods to supplements to gadgets to tools to enhance your health it's all the cool stuff that i use and that my team uses to optimize and enhance our health and i'd love you to sign up for the weekly newsletter i'll only send it to you once a week on fridays nothing else i promise and all you do is go to drhymen.com forward slash pics to sign up that's drhyman.com forward slash picks p-i-c-k-s and sign up for the newsletter and i'll share with you my favorite stuff that i use to enhance my health and get healthier and better and live younger longer now back to this week's episode so how do we approach these patients when they come in what are the kinds of things that we would do from a diagnostic point of view that you wouldn't get when you went to the dermatologist well from a diagnostic standpoint uh again i would do testing for um you know uh leaky gut that would do intestinal permeability testing checking for antibodies to zonulin with the cyrex testing that we do cyrex array number three so that's basically there's a test that we do at the center for uh at the ultra wellness center here in lenox massachusetts where we're recording live is uh cyrex testing it's a lab that looks antibodies that you produce against these proteins that are in your gut that come from gluten or even from bacteria and so if you're creating a lot of antibodies to these proteins it's clear that they're getting across the lining of your gut leaking into your bloodstream and causing an immune response which is not only local but systemic right and and i and there are there are other ways you can actually measure zonulin in the blood and you can measure it also in the stool and that's only like a snapshot in time so you can develop leaky gut for you know a couple hours or a day or so but if it if it stops then you're all so fine the antibodies against zonulin is the one that tells you that there's this chronic leaky gut which is really more valuable because if i gave you a shot at tequila then you know an hour later measure your zone it's going to go up okay where's the tequila that sounds good right so so that's why i think that the uh the the testing for the antibodies against uh zonulin is even more valuable in these patients with chronic conditions uh and what other kinds of tests besides the the uh the zonulin and the lipopolysaccharide test that we do to look at the antibodies against these proteins in the gut that come from a leaky gut we'll do the uh the small intestinal bacterial overgrowth where we'll measure the production of fermentation products so hydrogen and methane are gases that are normally produced in the body when people have small intestinal bacterial overgrowth those will be produced at higher levels so we can check that and over time i think the test that we do is a three hour test so you measure baseline hydrogen methane check it at uh intervals of about every half hour and you do that over three hour time period that can tell you definitively do or do you not have uh bacterial overgrowth and how bad is it and is it predominantly hydrogen or is it methyl so what you're saying is that is that when we eat foods you know humans don't produce gas it's the bacteria that are fermenting the foods we eat that produce the gas so absolutely bloated or distended or you're passing gas it's not you you can blame it on the bugs but but the problem is that we don't know how to regulate the bucks bugs and get a healthier ecosystem and that and that is what what most physicians never were trained to do yeah and it's the foundation of functional medicine it's the foundation of our practice here at the ultra chobano center where we really dig into these issues and we look at bacterial overgrowth we look at fungal overgrowth we look at a leaky gut we look at food sensitivities we'll do other testing look at whether you're reacting to gluten or dairy or eggs or other foods and it's really helpful in drilling down on what's really going on with people absolutely yeah and that you know we're talking basically producing gases that's basically a fermentation process and normally fermentation happens lower in the colon that's in the in the colonic area the ant when they it's more of an uh uh what's an anaerobic environment or a lack of oxygen and that's normal for that to be happening but when that process is taking place higher up in a different neighborhood it's not a good thing yeah and i mean you want your upper intestine to be sterile and they're mostly sterile mostly sterile and when and all that bacteria migrates up there it's just a bad situation and when we take acid blockers when we you know are low in magnesium which half of us are when we're under stress and our gut motility is slow when we uh you know taking lots of antibiotics and screws up our whole system in there you know all these are reasons why we get these bacterial overgrowth issues and they're super common and they're easy relatively easy to treat with functional medicine now the other thing we do is look at stool testing right so we look at not just the the proteins from leaky gut or we look at the food sensitivities or bacterial overgrowth gas production but we actually look at the poop yeah so what do we what are we looking for in the poop that helps us figure out what's going on well there's a lot of things uh you know there's gold in there uh there yeah it really is it's uh golden them there hills yeah so a lot of information can be uh determined by doing a microbial analysis so you can look at the overall balance of bacteria so there are you know everybody's got hundreds of different kinds of bacteria in the in the gi tract and we can measure those using dna pcr analysis and do we can do quantitative we can measure how many uh there are of each different species look at ones that are normally found look at ones that are found in the gut but normally they want to be at low levels look at bacteria that are associated with autoimmunity so things like citrobacter klebsiella salmonella yeah etc uh we can look at now analyze uh for uh yeast overgrowth various forms of yeast um and then also microbial markers of inflammation things like calprotectin looking for fat so you can get a lot of time functioning enzyme function uh butyrate uh checking for beauty chain factors fatty acids indicators of healthy ecosystems so you know todd what you're what you're saying is that you know traditional sort of microbiome testing they just look at the the genetic material of the the microbiome and they can't really test everything although they can do some really extraordinary tests now but there are kits out there where you can look at your microbiome but it it's far more than just what bugs you have in there it's what they're doing yeah so we look at the the result the function on the ecosystem we look like you said the enzyme function you're absorbing your food is your inflammation are you having good bugs in there that are producing the the super fuel for the gut these short chain fatty acids that are so important oh you do have the right balance i've got are you missing some key bugs you have overgrowth of bad bugs you have yeast you have parasites and it's such a much more comprehensive stool test that we do here at the ultra wellness center we were talking earlier about delta sleep and the interesting thing is is that when you have good bugs in the in the digestive tract and you're eating in a fiber in your diet and you're producing higher levels of butyrate that has an effect on the brain and also improves uh uh sleep that's amazing yeah yeah so you have to have your get your poop together to sleep better i got it okay that's the same that's a good good strategy it's better than taking the ambien yeah um all right so we also look at uh you know other things like omega-3 fats and and other fats because a lot of uh inflammation can come from not having the right balance of fat absolutely in your body yep yeah um and and i think you know so so when you have a patient come in what are the what are the steps you would take initially to treat a patient with rosacea from a functional medicine perspective you know the again taking the history is the big one you know um i always will ask people what's your ethnic background a lot of people say you know i'm white you know it's like you know are you irish english german jewish russian whatever because the rosacea is typically found in in light-skinned fair-skinned people and from a genetic standpoint they are the ones who are more likely to have that it's just an interesting part to know to have in terms of the history and then i'll just ask them you know what is it you're eating are you eating a standard american diet uh how much alcohol are you drinking um how much stress do you have stress also caffeine yeah caffeine can play right yeah those are those are all things which can sort you know it's like adding gasoline to the fire uh because literally rosacea is the skin on fire in the in the in the uh in the facial area but um doing the testing for essential fatty acids making sure that um uh they have the right balance of the essential fats in their diet a lot of people uh are have too much omega-6 which tends to be more pro-inflammatory yeah lack of the omega 3s one of the oils i don't know if you've used it that i found it very helpful with um patients who have rosacea is uh porridge oil and even criminals oil yeah they tend to be very they help to dampen down that inflammatory resistance that's a very key omega-6 that people don't think about much but it's called gamma linolenic acid which is a very powerful anti-inflammatory it's not like the omega-3s but it's sort of like the omega-3s but on the omega-6 side exactly and it and it's something we really have a hard time getting in our diet it's like borage oil and you know a few other things but evening primrose oil so yeah that's very powerful i agree and i also think that you know um when i see these patients i also think about looking for other clues like do they have yeast issues have they been in lots of antibiotics are they on acid blockers which cause yeast overgrowth yeah do they have other fungal issues dandruff do they have anal itching do they have thrush or a white coating in their tongue uh you know do they have vaginal yeast infections do they have other skin markers of use like little tinea or other kinds of things so you'll see often a pattern of other issues around fungal stuff i'll check for h pylori i'll check again all the tests we did talk about and and see what's really going on and then and then you know from the treatment point of view um you know you start with an elimination diet with an anti-inflammatory diet right exactly yeah put it putting patients on an anti-inflammatory elimination diet you know eighty percent of the time doesn't matter what they come in with they're gonna actually they'll actually get better they you know getting them off of the pro-inflammatory foods uh and then putting in foods which are uh anti-inflammatory uh cold water fish sardines wild salmon um uh the essential oils like uh evening primrose oil helped to sort of dampen down that inflammatory response yeah i agree i think you know we don't understand most of us how powerful food is as medicine and how it can drive tremendous amounts of inflammation throughout the body and you know obviously if it's on your skin it's visible but there's also invisible inflammation that you're not seeing that's driving all the chronic diseases yeah and is that you actually just you just you triggered a thought because there's actually a paper that says if you have rosacea you have a higher instance of alzheimer's disease oh wow so it's not just it's not just a you know a cosmetic issue it's actually systemic it's a rich face and a red brain that's on fire exactly yeah is that yeah that's i i was sort of blown away by that that's fascinating yeah especially in women it's actually more more common in women so so you you know you advise people the obvious things cut out the alcohol the caffeine stay away from the sun it's away from spicy foods but we also sell them stereo from gluten which triggers leaky gut often dairy you you you actually add in all the anti-inflammatory foods that are important though all the phytochemicals from plant foods and turmeric and ginger and garlic and rosemary and all these powerful foods that can really help to reduce inflammation and and then we often directly treat the issues that are going on it could be leaky gut so we give them a gut repair program this could be fungal or bacterial overgrowth so we'll we'll take care of those with either herbs or antibiotics or any fungals and you'll see these patients really dramatically improve when they change their diet and they resort their gut and incentives will use like things like even primrose oil i found the digestive enzymes and hydrochloric acid absolutely often are really helpful too yeah i've been so i've been surprised at how many people have a what i would call a relative lack of hydrochloric acid in the stomach i i was a venture to say that you know the majority of people don't have too much acid that have not enough acid in the stomach yeah well that's interesting because the third leading category of drugs are the acid blockers like prolossic and prevacid and pepsi pepsi and all these other drugs these uh nexium mass effects i mean they're just like out there everywhere and now they're now they're over the counter and everybody exactly yeah i mean i i just i we've talked about this before in the podcast but when i was in medical school the drug reps came in because it's drugs that just come out and they're like listen guys these guys these drugs work they're they're great uh they will help people with ulcers if they're really bad you don't want to keep anybody on it for more than six weeks right those are huge stomach acid it's really bad long term these are the drug reps telling us this and now it's like people are on it for decades and it causes b12 deficiency magnesium deficiency zinc deficiency osteoporosis osteoporosis pneumonia bacterial overgrowth irritable bowel syndrome when you get rid of your heartburn but you get all the other problems yeah it's yeah that's that's amazing and then it's one of those drugs it's so it's so sneaky because it's addictive once you get on it it's hard to get off it because it it causes this rebound so absolutely when you suppress the stomach acid and you stop the drug the acid production goes crazy exactly which makes you feel horrible and then you go i need the drug but you can actually taper it down and use other strategies to help people get off it and you bring it you bring up a really good point because a lot of the the pharmaceutical medications especially some of the psychotropic so the antidepressants are like that too uh the the ppis and the antidepressants when you try to get off of them you get this rebound process the body tries to get back into balance and it's it can be very difficult so you've got to go low and slow when you're trying to taper off the ppis or taper off uh antidepressant psychotropic meds absolutely amazing so so what what cases have you recalled about rosacea that you want to share that can give you a sense yeah well i i had a patient who came in and she was a undiagnosed celiac not just a gluten sensitivity she was undiagnosed uh celiac um she was irish and she was having a standard american diet and she was self-medicating for her heartburn with over-the-counter uh acid blocking medications it had a lot of bloating type symptoms and came in uh and you know her her major complaint was her skin but you know she had all these other things but her big thing was you know it's how i look right so you know it's it's you know people are vain and people get people's attention exactly right and and then when i uh did a dive into uh her testing you know it turned out that she was deficient in her essential fatty acids especially the gamma linoleic acid um she she had lack of stomach acid because of the ppis you can actually measure a test blood test is a commercially available test called gastrin and gastrin levels will go up when you block acid um so and that's actually one of the tests that i actually like to use when i have patients when i'm trying to get them off of a ppi because the higher the gastrin level the more difficult it will be to get off the ppi uh and that's sort of like it'll tell you how easy uh you can use blockers exactly and then uh she also had uh low vitamin d levels i mean you know we spend a lot of our time clothed and indoors so we don't get enough way enough enough sunshine uh that's that's one of the big things and low vitamin d you don't just fix low vitamin d this is one of my i get up on my soapbox all the time with here is you don't just fix low vitamin d by taking vitamin d now vitamin d deficiency is basically a sunshine deficiency there are certain times when there can be other causes like you might have fat malabsorption that can cause low vitamin d or you may have problems with the synthesis because of uh lack of skin oils which when you get exposed to the sun but by and large low vitamin d levels is related to sunshine deficiency and it's it's that you know low vitamin d is not the problem it's a symptom of another problem yeah and the immune system is also benefited by sunshine exposure healthy sunshine uh i think you said you're gonna be you enjoy going to the uh the tropics now and then caribbean hawaii whatever and we we also feel good it's also i this is another thing that i find fascinating is that there is a uh uh a condition which is called sunshine addiction you know these people who are like suntan addicts well it turns out that our bodies actually produce um uh endorphins when we are exposed to the sun so there's a feedback mechanism that's incredible yeah yeah it's it's there's a it's a there's a compound it's called pro-opio melanocorticotropin hormone and what it means is that our bodies give a reward when we're in the sun so we feel good we have these feel-good molecules these endorphins uh that make us want to get the sun oh that's interesting that's why i love going in the sun exactly no and then there are these people who i always feel so good when i go to the beach in the summer it just makes me so happy exactly and and the interesting thing is it actually you can get addicted to the sun and that's like it's like you get addicted to food i mean your body needs food to survive and your body actually needs sunshine to survive so our nature has built in these feedback mechanisms so that it we encourages us to do it that's incredible yeah i don't know why so what happened with this patient uh what did you do for her well i did a lot i mean i had her work with our nutritionist and got her off of her standard american diet i treated her bacterial overgrowth she had a significant sibo test so i treated that primarily with herbs a lot of people will use antibiotics things like rifaximin or xifaxim for sibo i actually find that i do just as well using antimicrobial herb preparations i supported her stomach acid using betaine hcl uh some patients don't respond to that they they don't tolerate as well so sometimes i'll use things like apple cider vinegar and then uh got her fatty acids up gave her a little bit of borage oil and you know a combination of that and then also just told her to get some healthy sunshine uh it doesn't necessarily mean that you need to go out and sunbathe or go to a sun tanning booth but just getting healthy sunshine can help with down regulating the immune system yeah um and interestingly you know just off topic but with covid there are some really interesting studies that giving high-dose vitamin d helps with uh covet infections absolutely and and so covet actually or vitamin d uh when it's at high enough levels actually helps to keep the immune system in balance it keeps it from getting yeah it controls hundreds of genes it regulates immunity and inflammation it's pretty amazing it's not really a vitamin it's more like a hormone exactly exactly it's like a hormone and it's also it actually likes this acts like a steroid too it's it's a it's a cholesterol molecule moiety and uh um i often times when if i'm getting coming down with a cold or flu i'll up my dosage especially in the winter absolutely it's true and i when i feel like something's coming on and i take like fifty thousand units for three or four days and yeah i never i never get sick yeah it goes away by the next morning it is it's pretty powerful so so todd we've just covered a lot here and i i recall a lot of cases of mine that have had rosacea it's always one of those things where i love seeing because it's so easy to treat and people suffer so much from it and just by following the functional medicine approach looking at the root causes treating the skin from the inside out addressing the gut addressing food sensitivities addressing nutritional deficiencies which is really the foundations of functional medicine these people get better and we we don't just take it at face value but we we actually go under the hood and look at what's going on exactly you know i think there was one great quote i heard somewhere that traditional medicine is like uh trying to diagnose uh what's wrong with your car by listening to the noises it makes instead of looking under the hood exactly and functional medicine is about looking under the hood absolutely and here at the ultra wellness center in lenox massachusetts we've been doing this for decades we have the most incredible team here who collectively have probably 70 years of clinical experience in functional medicine and we're doing most of our care virtually now so wherever you live in the world we can take care of it using virtual zoom consults and uh it's pretty gratifying to see how many people are taking advantage of that and getting better uh and and uh i think that uh you know this is a this is a challenging moment for everybody and i think we we often neglect our own health and our own health care uh nobody wants to go to the doctor nobody wants to go to the hospital anymore but but i think you know people can get virtual care now which is super awesome and uh and we invite you to check it out you go to ultrawellnesscenter.com uh if you're suffering from any skin disorder whether it's acne or acne rosacea or eczema or psoriasis we've had some podcasts on that go listen to them but this is really uh an approach that works for skin disorders i love skin problems because they are so easy to treat whether like i said it's eczema acne rosacea whatever it is it's pretty striking and and it's just heartbreaking to see how many patients struggle with these conditions because they're often so embarrassing that's one thing if you have you know bacterial overgrowth and bloating you're the only one who knows your stomach exploded right but if you've got this nasty looking face or skin issues you don't want to be seen like that and i think this is it affects people's uh sense of well-being and their self-worth and absolutely and i just want to know there is really clear approaches that help this yeah and the exciting thing is is is it's a lot of the conferences that i go to there are now functional medicine dermatologists who get it you know because most dermatologists do not realize or remember that the skin and the gut are contiguous they are connected so when you have a skin problem it's oftentimes an internal problem yeah and the functional medicine dermatologists which are um you know growing um are getting that and they're really helpful yeah i agree it is one of the most exciting parts of functional medicine is dermatology because it's like it's like oh it's such a slam dunk yeah and and uh there are a number of really great functional medicine doctors out there who are dermatologists and and you know the stories are amazing i just i just uh you know see so many people suffer on this unnecessary unnecessarily exactly yeah so if you've been loving this podcast and you know someone with a skin problem or you've got a skin problem come see us here share with your friends and family on social media leave a comment we'd love to hear how you've addressed your skin issues what's worked what hasn't worked subscribe wherever you get your podcast and we'll see you next time on the doctor's pharmacy you