10 Signs That You Have A Leaky Gut_en (auto-generated)
hello health champions today i want to go over the top 10 signs and symptoms that you may have an inflamed and leaky gut and if you stay with me and watch all the way to the end you'll be amazed at how many of your signs and symptoms that may be associated with inflammation and leaky gut number one is digestive problems and that's no big surprise obviously you may have things like chronic diarrhea constipation you may have gas or bloating and you could have things like ibs which is irritable bowel syndrome and that's a broad descriptive term like cover just about anything but very often it's associated with alternating between constipation and diarrhea sibo is something that's been popularized in recent years which is small intestine bacterial overgrowth and one of the main symptoms of that is gas and bloating what we want to understand is this are just the tip of the iceberg that there's so much more going on leaky gut is also known as intestinal permeability and how do you know if you got it well there are lab tests but they're not necessarily that reliable they're expensive there are lots of false positives so do you really need a lab test to figure out if you have it well not really because this is so common that if you think you got it then you probably do and the other thing just like a lot of other conditions in the body it's not necessarily that you have it or you don't but the question is how much do you have it what happens is you have these cells and there's different layers you're supposed to have a protective mucous layer on the inside on the lining of your gut and then on the top on the apex of these cells you have some hair cells and then this gray line which is enlarged here these are the tight junctions and they are supposed to keep to hold these cells really tightly together so that nothing can get through but if this loosens up if there is a poor nutrition or inflammation or autoimmune attack then we can get a loosening a weakening of these tight junctions and things can start leaking through in severe cases you could also have leaking both through the tight junction and through the cell if these membranes have been damaged we want to think about the gut a little differently than most people do because we think of it as putting food inside us when we eat something it goes inside but that's not really how it works the gut is really sort of outside of you because you put things in on one end and if your body didn't do anything with it if it didn't break it down and actively decide to use it and absorb it then it would come out the other end exactly the same way we put it but the gut is a tube and out of this tube we're only supposed to have single molecules cross and we'll take another look at that to get a bigger picture of that and then these single molecules they don't just happen to travel across it's a very purposeful activity there are carriers there's transport mechanisms to take these molecules across these cell layers from the gut into the bloodstream and then once they're in the bloodstream then we can take them further into the cell and that's really the whole purpose of this is to put things in the gut the blood is not really where it needs to be they need to be in the cell because that's where we can do things with it that's where we generate energy and we can reassemble these individual molecules into tissue and in the bloodstream is where the battle takes place this is where if some foreign particles if some unintended particles get into the blood now your immune system have to fight it out and make sure that we can neutralize them and they don't get into the cells and if everything works the way it's supposed to then what gets into the blood and into the cell intracellular that's only the approved stuff the second thing that can happen with leaky gut and inflammation in the gut is nutritional deficiencies and what happens is we have these villi or fingers in the gut and then if we magnify this we see that on the surface of the cells we have something called microvilli which are hair cells these are also known as brush border and there's something in about this brush border that that is the home for bacteria beneficial bacteria and the production enzymes that we need to break down the food and if we don't have a healthy environment in the gut then this brush border gets damaged and we don't have the proper bacteria and the proper production of enzymes now we can't break down the food properly and then we can't absorb it properly so now we get deficiencies and essential fatty acids we get deficiencies in essential amino acids and carbohydrates they're not essential but to the extent that we eat them we still need to break them down in a proper way because if we don't if we don't break them down and absorb them in the early portion of the digestive tract then they're going to drift further down they're going to travel further down the digestive tract and become food and particularly food for the pathogenic bacteria remember we're only supposed to absorb individual molecules one at a time and if we don't have the enzymes then these sugars the disaccharides which are two sugars linked together or polysaccharides they can't get through this barrier and now they travel down and become food for the bacteria that can harm us number three is multiple allergies and sensitivities and this is unfortunately something that we're seeing more and more of in recent years food intolerance and something called universal reactor is if you have a leaky gut and pretty much everything that you eat some of these proteins and antigens leak through your intestinal membrane now you're going to get multiple allergies and you can get to the point where you are a universal reactor pretty much anything that you eat you're going to have some kind of reaction to and then we're going to talk about size of particles the smallest unit size we're concerned with is called one dalton and it's like a base unit for the size of molecular matter that is the size of one proton and the next size up we're concerned with is a glucose molecule or an amino acid molecule these are the size that are supposed to readily pass across these membranes and get absorbed but anything larger is supposed to have trouble getting across so glucose is 180 daltons and an amino acid could vary a lot in size but they're generally in that same size range roughly the same size now if we increase this we blow this up antigen and this is about the size that's large enough for your immune system to recognize it and tag it an antigen is something that can produce an antibody and this is 50 times larger than the molecules that we're supposed to absorb and then we increase that eight more times and now we have the size of a typical protein so proteins can be rather small and they can be enormous but just to give you an idea what we'll call a protein about 60 to 80 thousand daltons and then if we blow that up a virus and they're at about 40 million daltons and the next step up would be a bacterium now we blow it up 30 000 more times so again body cells can vary quite a bit but a bacterium is about the scale of one of your body's cells so when we go from the size of the molecule we're supposed to absorb up to the size of a cell or a bacterium we're talking about increasing 6 billion times in size and why are we talking about this because i just want you to appreciate how fine-tuned how precise how delicate these barriers are in the body that they're only a certain size that we're supposed to absorb and they're infinitely smaller than the structures of of the body of the cells so when we're talking bacterium or a cell we're still talking something that is microscopic it is far too small to see by the naked eye and yet we're talking something that's billions of times smaller that your body is supposed to keep out number four is skin rashes so when we have things like acne or rosacea or eczema it's because when we have a lot of inflammation and we have a lot of immune reactions we also build up a whole lot more debris and waste products in the body we have certain organs of elimination and most people know about things like the liver and the kidney but we also eliminate a lot of stuff through the lungs and the largest organ of elimination is actually the skin now we could argue depending on what waste product we look and so forth which one of this is most important but these are the top four elimination organs that we have and your skin is super important to help your body in getting rid of waste and if you have more waste then it's going to cause some problems on the way out the fifth sign of a leaky gut is a poor immune system and why does that happen because your body gets busy with other things so if your immune system has two jobs basically it can fight off pathogens or it can fight off toxins and foods they get into the wrong place that's a toxin so when we have food reactions and the body starts making antigens and we have white blood cells that go after food that's in the wrong place now it creates a lot of inflammation and again we're using up resources on the food rather than the pathogens and the foreign intruders number six is autoimmune disease what is your immune system supposed to it is basically just telling the difference between your own cells your own tissue and those things that are not your own cells so like we talked about food particles and pathogens virus bacteria etc and then it's supposed to neutralize and eliminate and fight off those things that are not yourself but autoimmunity is when it gets confused and it can't clearly tell the difference between self and foreign so in a war analogy it's sort of like falling prey to friendly fire that the more chaos the more smoke the more stuff going on at the same time the more difficult it is to tell the difference between self and foreign and some examples of this are sle like systemic lupus erythematosus which is an autoimmune disease that starts attacking a lot of your organs and systems celiac disease we have crohn's disease we have hashimoto's thyroiditis or more examples of autoimmune diseases and these are becoming more and more prevalent in recent years and hashimoto's is probably the most common of all of them and very much under-diagnosed because when people have thyroid problems we just give them a synthetic hormone we don't necessarily go and look for the root cause but hashimoto's is an autoimmune attack of the thyroid rheumatoid arthritis is a devastating attack on the joints on the synovial membranes in the joint so you get crippling arthritis multiple sclerosis is when the autoimmune attack happens to your nervous system and you have messages your brain is trying to send messages out by these electrical wires and if you have an attack to the insulation of those wires called myelin now you're going to get short circuiting you're going to have signals jumping across at the wrong places causing multiple sclerosis and psoriatic arthritis is another example a lot of people think of psoriasis as just a skin issue but it's actually an arthritis it can be as crippling as rheumatoid arthritis and one more is vitiligo which is what this girl has it is when you're losing your pigment because the autoimmune attack is against the cells the melanin producing cells in the skin number seven is arthritis or osteoarthritis that you often find with joint pain and this is so common that basically most people over 60 have this to some degree and it it starts affecting the large joints of the body like the spine and the knees and hips and shoulders but also the joints of the fingers very common and unlike the autoimmune arthritises this one is usually looked upon as mechanical so people get over 50 or over 60 and they go to the doctor and they take some x-ray and they say you have arthritis your joints have worn down but this is the wrong way to look at it because your body wears down every minute of every day but when it's working it gets rebuilt so we don't want to think of it as a breakdown we want to think of it as a lack of repair so for example most people are going to have if they have knee pain then they're saying well your left knee wore out well you walked an equal number of steps on your right knee so why didn't that one wear down well the answer is they both wore down but one was better at repairing and this is because of multiple reasons like mechanical stability that we get from nervous system control but the other reason again is inflammation which unlike the arthritis with the autoimmunity this is not the erosive autoimmune kind this is more of a generalized type the eighth thing that can happen with the leaky gut and inflammation is you get cravings and this starts often with dysbiosis or unbalanced gut flora and how does that work well the little creatures that you have living in your gut your microbiome you have about 40 trillion of them there is one bacteria roughly for every cell in your body and they sort of have a voice they have a say in the matter which sounds strange because they're kind of living down there but there's a reason they call it your second brain and there's a huge relationship between what happens in your gut and what happens in your brain and in the rest of the body so these bacteria in your gut actually signal they participate in your body's overall communication and they can influence your reward and your satiety pathways and they can produce mood altering toxins and basically hijack your vagus nerve so the brain has cranial nerve outflow and the 10th cranial nerve is called the vagus nerve which is responsible for your parasympathetic nervous system or most of your digestion so the vagus nerve is what talks to your gut and to these bacteria and as part of that signaling system these bacteria can basically hijack the vagus nerves so if you have an unbalanced gut and they crave sugar then they can make you crave sugar as well number nine is brain issues cognitive issues mental issues and now you can see how it's starting to incorporate every system in the body starts being affected when your gut isn't working properly and we get things like headaches and brain fog and memory loss and what we have to understand is that there are two super important barriers in the body the first one we talked about that's your intestinal membrane the second one is to your brain and this is known as the bbb and that's not the better business bureau in this case it's the blood brain barrier and while the gut barrier is super selective the blood brain barrier is supposed to be even more selective because some things that are allowed into the blood are still not allowed into the brain and the same things that start compromising the integrity of your gut membrane those same factors also start compromising the blood brain barrier and now if you understood what i was just saying that it pretty much means that if you have a leaky gut now you also will have a leaky brain and if you start having dysbiosis and the wrong kind of bacteria producing toxins in your gut and they leak through that leaky gut now they're also going to be leaking into the brain and start causing brain fog and cognitive issues but there's even more to these cognitive issues much more far-reaching so i've talked in some videos about frontal lobe inhibition and when your brain starts to be affected when you get more inflammation and challenges to the brain now the frontal lobe also can't produce the same amount of energy and have the same control that it normally does and the frontal lobe is supposed to turn things off ninety percent of what the frontal lobe does is to turn off distractions basically and some of these distractions are depressive thoughts and anxious thoughts and worry and so forth and when your brain is working properly when the frontal lobe is strong like a bright light bulb then it's going to be able to turn off these depressive thoughts and turn off those anxious thoughts and put you in a stable mood when the frontal lobe is compromised now these things start to rise to the surface basically and the same exact mechanism happened with add and adhd that your brain has to turn things off in order for you to be able to focus when your brain can't turn things off now you don't focus and you have attention deficit number 10 consequence of leaky gut and an inflamed gut is chronic fatigue or chronic fatigue syndrome any time they call it a syndrome that means they can't really pin it on anything because there's so many different factors and it's expressing itself in so many different ways and it's very often associated with fibromyalgia because these kind of depend on the same factors things like decreased brain function overall poor nutrition and increased inflammation and like we talked about when all of this is going on now your body has to expend a lot of energy and resources on other things such as digestion and immune system both of those things are extremely expensive they use up a lot of your fuel a lot of the energy produced in the body goes to digestion and immune system and if your body gets busy with those now you don't have a lot of energy left over for the things you want to do if you enjoyed this video that'll be a great one for you next and if you really want to start understanding the body and mastering your health then make sure you subscribe hit that bell and turn on all the notifications so you never miss a life-saving video see you next time
10 Signs That You Have A Leaky Gut_en
Hello Health champions. Today I want to go over the top 10 signs and symptoms that you may have an inflamed and leaky gut and if you stay with me and watch all the way to the end you'll be amazed at how many of your signs and symptoms that may be associated with inflammation and leaky gut. Number one is digestive problems and that's no big surprise obviously you may have things like chronic diarrhea constipation may have gas or bloating and you can have things like IBS which is irritable bowel syndrome and that's a broad descriptive term that covers just about anything but very often is associated with alternating between constipation and diarrhea SIBO is something that's been popularized in recent years which is small intestine bacterial overgrowth and one of the main symptoms of that is gas and bloating What we want to understand is that these are just the tip of the iceberg that there's so much more going on. Leaky gut is also known as intestinal permeability and how do you know if you got it? Well there are lab tests but they're not necessarily that reliable. They're expensive There are lots of false positives so do you really need a lab test to figure out if you have it. Well not really because this is so common that if you think you got it then you probably do and the other thing is it's just like a lot of other condition in the body it's not necessarily that you have it or you don't but the question is how much do you have it? what happens is you have these cells and there's different layers you're supposed to have a protective mucus layer on the inside fn the lining of your gut and then on the top on the apex of these cells you have some hair cells and then this gray line which is enlarged here these the tight junctions and they are supposed to keep, to hold these cells really tightly together so that nothing can get through but if this loosens up if there is a poor nutrition or inflammation or auto immune attack then we can get a loosening a weakening of these tight junctions and things can start leaking through in severe cases you could also have leaking both through the tight junction and through the cell if these membranes have been damaged We want to think about the gut a little differently than most people do because we think of it as putting food inside us when we eat something and goes inside but that's not really how it works gut is really sort of outside of you cuz you put things in on one end and if your body didn't do anything with it if it didn't break it down and actively decide to use it and absorb it then it would come out the other end exactly the same way you put it in but the gut is a tube and out of this tube we're only supposed to have single molecules cross and we'll take another look at that to get a bigger picture of that and then these single molecules they don't just happen to travel across it's a very purposeful activity there are carriers there's transport mechanisms to take these molecules across these cell layers from the gut into the bloodstream and then once they're in the bloodstream then we can take them further into the cell and that's really the whole purpose of this is to put things in the gut the blood is not really where it needs to be they need to be in the cell because that's where we can do things with it that's what we generate energy and we can reassemble these individual molecules into tissue and in the bloodstream is where the battle takes place this is where if some foreign particles if some unintended particles get into the blood now your immune system have to fight it out and make sure that we can neutralize them and that they just don't get into the cells and if everything works the way it's supposed to then what gets into the blood and into the cell intracellular that's only the approved stuff the second thing that can happen with leaky guts and inflammation in the gut is nutritional deficiencies and what happens is we have these villi or fingers in the gut and then if we magnify this we see that on the surface of the cells we have something called microvilli which are hair cells these are also known as brush border and there's something about this brush border that that is a home for bacteria beneficial bacteria and the production of enzymes that we need to break down the food and if we don't have a healthy environment in the gut then this brush border gets damaged and we don't have the proper bacteria and the proper production of enzymes now we can't break down the food properly and then we can't absorb it properly so now we get deficiencies in essential fatty acids we get deficiencies in essential amino acid and carbohydrates they're not essential but to the extent that we eat them we still need to break them down in a proper way. because if we don't if we don't break them down and absorb them in the early portion of the digestive tract then they're going to drift further down they're going to travel further down the digestive tract and become food and particularly food for the pathogenic bacteria remember we're only supposed to absorb individual molecules one at a time and if we don't have enzymes then these sugars the disaccharides which are two sugars linked together or polysaccharides they can't get through this barrier and now they travel down and become food for the bacteria that can harm us. Number 3 is multiple allergies and sensitivity and this is unfortunately something that we're seeing more and more of in recent years food intolerance and something called Universal Reactor is if you have a leaky gut and pretty much everything that you eat some of these proteins and antigens leak through your intestinal membrane now you're going to get multiple allergies and they can get to the point where you are a universal reactor pretty much anything that you eat you're going to have some kind of reaction to it and then we need to talk about size of particles the smallest unit size were concerned with is called one Dalton and it's like a base unit for the size of molecular matter that is the size of one proton and the next size up we're concerned with is a glucose molecule or an amino acid molecule these are the size that are supposed to readily pass across the membranes and get absorbed but anything larger is supposed to have trouble getting across so glucose is 180 Daltons and an amino acid can vary a lot in size but they're generally in that same size range roughly the same size now if we increase this. We blow this up 50 times now we have what's called an antigen and this is about the size that's large enough for your immune system to recognize it and tag it an antigen is something that can produce an antibody in this is 50 times larger than the molecules that we're supposed to absorb and then we increase that eight more times and now we have the size of a typical protein so proteins can be rather small and they can be an enormous but just to give you an idea what we'll call the protein about 60 to 80,000 Daltons and then if we blow that up 500 more times now we're at the size of a virus and they're at about forty million Daltons and the next step up would be a bacterium is now we blow it up 30 thousand more times so again body cells can vary quite a bit but a bacterium is about the scale of one of your body cells so when we go from the size of the molecule we're supposed to absorb up to the size of a cell or a bacterium we're talkin about increasing 6 billion times in size and why are we talkin about this because I just want you to appreciate how fine to how precise how delicate these barriers are in the body that they're only a certain size that were supposed to absorb and they're infinitely smaller than the structures of of the body of the cellso when we're talkin bout or cell would still talkin something that is microscopic it is far too small to see by the naked eye and yet we're talkin something that billions of times smaller that your body is supposed to keep out. number four is skin rashes so when we have things like acne or rosacea were eczema it's because when we have a lot of inflammation and we have a lot of immune reactions we also build up a whole lot more debris and waste products in the body we have certain organs of elimination and most people know about things like the liver and the kidney but we also eliminate a lot of stuff through the lungs and the largest organ of elimination is actually the skin Now we could argue depending on what waste product we look as and so forth which one of this is most important but these are the top four elimination organs that we have and your skin is super important to help your body in getting rid of waste and if you have more waste then it's going to cause some problems on the way out the fifth sign of a leaky gut is a poor immune system and why does that happen because your body gets busy with other things so if your immune system has two jobs basically it can fight off pathogens or it can fight off toxins and foods that get into the wrong place that's a toxin so when we have food reactions and the body starts making antigens and we have white blood cells that go after food that's in the wrong place now it creates a lot of inflammation and again we're using up resources on the food rather than the pathogens and foreign intruders number 6 is autoimmune disease what is your immune system supposed to do? It is basically just telling the difference between your own cells your own tissue and those things that are not your own cells so like we talked about food particles and pathogens, virus, bacteria Etc and then it supposed to neutralize and eliminate and fight off those things that are not yourself but auto immunity is when it gets confused and it can't clearly tell the difference between self and foreign so in a war analogy it's sort of like falling prey to Friendly Fire that the more chaos the more smoke the more stuff going on at the same the more difficult it is to tell the difference between self and foreign and some examples of this or SLE like systemic lupus erythematosus which is an autoimmune disease that start attacking a lot of your organs and systems. celiacs disease we have Crohn's disease and I have Hashimoto's thyroiditis are more examples of autoimmune diseases and these are becoming more and more prevalent in recent years and Hashimoto's is probably the most common of all of them and very much under diagnosed because when people have thyroid problems we just give them a synthetic hormone we don't necessarily go and look for the root cause but Hashimoto's is an autoimmune attack of the thyroid Rheumatoid arthritis is a devastating attack on the joints on the synovial membranes in the joint so you get crippling arthritis multiple sclerosis is when the autoimmune attack happens to your nervous system and you have messages your brain is trying to send messages out by the electrical wires and if you have an attack to the insulation of those wires called myelin now you're going to get short-circuiting you're going to have signals jumping across at the wrong places causing multiple sclerosis and psoriatic arthritis is another example A lot of people think of psoriasis as just a skin issue but it's actually an arthritis it can be as crippling as rheumatoid arthritis and one more is Vitiligo which is what this girl has it is when you're losing in the skin number seven is arthritis, or osteoarthritis that you often find with joint pain and this is so common that basically most people over effecting the large joints of the body like the spine and the knees and hips and shoulders but also the joints of the fingers very common and unlike the autoimmune arthritises this one is usually looked upon as mechanical so people get over 50 or over 60 and they go to the doctor and they take some X-ray and they say you have arthritis in your joint have worn down but this is the wrong way to look at it because your body wears down every minute of every day but when it's working it gets rebuilt so we don't want to think of it as a breakdown we want to think of it as a lack of repair so for example most people are going to have if they have knee pain then they're saying well your left knee wore out well you walked an equal number of steps on your right knee so why didn't that one wear down Well the answer is they both wore down but one was better at repairing and this is because of multiple reasons like mechanical stability that we get from nervous system control but the other reason again is inflammation which unlike the arthritis with the autoimmunity this is not the erosive autoimmune kind this is more of a generalized type the 8th thing that can happen with a leaky gut and inflammation as you get cravings and this starts often with dysbiosis or an unbalanced gut flora and how does that work well the little creatures that you have living in your gut your microbiome you have about 40 trillion of them there is one bacteria roughly for every cell in your body and they sort of have a voice they have a say in the matter sounds strange because they're kind of living down there but there's a reason they call it your second brain and there's a huge relationship between what happens in your gut and what happens in your brain and in the rest of the body so these bacteria in your gut actually signal they participate in your body over all communication and they can influence your reward and your satiety pathways and they can produce mood-altering toxins and basically hijack your vagus so the brain has cranial nerve outflow and the 10th cranial nerve is called the vagus nerve which is responsible for your parasympathetic nervous system or most of your digestion so the vagus nerve is what talks to your gut and to these bacteria and as part of that signaling system these bacteria can basically hijack the vagus nerve so if you have an unbalanced gut and they crave sugar than they can make you crave sugar as well. Number 9 is rain issues, cognitive issues, mental issues and now you can see how it's starting to incorporate every system in the body start being affected when you got isn't working properly and we get things like headaches and brain fog and memory loss and what we have to understand is that there are two super important barriers in the body the first one we talked about that's your intestinal membrane the second one is to your brain and this is known as the BBB that's not the Better Business Bureau in this case it's the blood-brain barrier and while the gut barrier is super selective the blood-brain barrier is supposed to be even more selective because some things that are allowed into the blood are still not allowed into the brain and the same things that start compromising the Integrity of your gut membrane those same factors also start compromising the blood-brain barrier and now if you understood what I was just saying that it pretty much means that if you have a leaky gut now we also will have a leaky brain and if you start having dysbiosis and the wrong kind of bacteria producing toxins in your gut and they leak through that leaky gut now they're also going to be leaking into the brain and start causing brain fog and cognitive issues. But there's even more to these cognitive issues much more far-reaching than talk to some videos about frontal lobe inhibition and when your brain starts to be affected when you get more inflammation and challenges to the brain now the frontal lobe also can't produce the same amount of energy and have the same control that it normally does and the frontal lobe is supposed to turn things off 90% of what the frontal lobe does his to turn off distractions basically and some of these distractions are depressive thoughts and anxious thoughts and worry and so forth and when your brain is working properly when the frontal lobe is strong like a bright light bulb then it's going to be able to turn off these depressive thoughts and turn off those anxious thoughts and put you in a stable mood when the frontal lobe is compromised now these things start to rise to the surface basically And the same exact mechanism happens with ADD and ADHD that your brain has to turn things off in order for you to be able to focus when your brain can't turn things off now you don't focus and you have attention deficit number gut is chronic fatigue chronic fatigue syndrome any time they call it a syndrome that means they can't really pin it on anything cuz there's so many different factors and it's expressing itself in so many different ways and it's very often associated with fibromyalgia because these kind of depend on the same factors things like decreased brain function overall poor nutrition and increased inflammation and like we talked about when all of this is going on now your body has to expend a lot of energy and resources on other things such as the digestion and immune system both of those things are extremely expensive they use up a lot of your fuel a lot of the energy produced in the body goes to digestion and immune system and if your body gets busy with those now you don't have a lot of energy left over for the things you want to do. if you enjoy this video that will be a great one for you next and if you've really want to start understanding the body and mastering your health then make sure you subscribe, hit that bell and turn on all the notifications so you never miss a life-saving video. See you next time.
Ananda Mahony - A Naturopathic Approach To Rosacea_en (auto-generated)
hello my name is Ananda mani and today my topic is a naturopathic approach to rosacea the why for this talk is that I see a lot of patients in clinic with rosacea but also it's personal through my 20s and early 30s I suffered from a rosacea um type one rosacea and it took a while to find the strategies to work my way through and out of that condition so today I'll talk to you about some of those strategies where the research is at which is pretty Grim when it comes to rosacea but I look also some translational ideas around what are some of the mechanisms that are driving rosacea and how can we apply nutrients or herbal um to those mechanisms to get good outcomes for the patients we see in our Clinic okay so let's talk a little bit about rosacea itself it's a chronic inflammatory condition it impacts between 2 to 5% of the population it's more predominant in women and women over condition that probably burbles along below the surface we say some flushing blushing propensities but it takes a while to see the fixed changes in the vasculature of the skin and so we see the condition itself emerging at a stage where it could be diagnosed in those third or fourth decade of Life the diagnosis is clinical there's no histological or serological markers that indicate the presence of the condition So it's b done based Bas on what's happening with uh the patient presentation and their medical history and the presence of one or more primary features necessary for a diagnosis such as flushing or non-transient aemma papules or pules um abnormal dilations of venules or capillaries and fattis changes in ocular symptoms acne I'm sorry it can be infused with other sorry it can be confused with other conditions such as acne or perioral dermatitis or soric dermatitis but usually you'll see other features that aren't commonly seen in those conditions for example with acne you'll see the pap Papio and pasture but you'll also see that flushing blushing tendency which you don't see with acne okay and there's also secondary features that may be present such as those ocular symptoms burning or stinging Sensations dry rough appearance of the skin and you can see them there on the slide so rotation classified into four subtypes and the first subtype is that facial redness and flushing and that's uh characterized by persistent skin redness then there's papulo pular racea which is subtype 2 and you see still the flushing blushing but also seen with bumps and pimples third subtype is fadus rosacea which is characterized by thicken skin and scars making it look bumpy or swollen and this type is most common in men we we also see Rhino so there's changes associated with that characteristic bumpy red bulbous nose and then ocular rosacea and you can see that diagram there the eyes appear watery red bloodshot and they might feel burning irritated or dry so the pathogenesis of rosacea is complex and it involves a variety of factors which can trigger both the vascular and the inflammatory factors seen in rosacea the genetic factors well they they haven't been pinned down completely but we do see genetics that are associated with greater levels of Rea oxitive greater levels of reactive oxygen species in the Skin So then that driving some of those skin changes potentially we also see some vitamin D Snips and even some HLA Snips that are associated with other autoimmune conditions and even though rosacea itself is not an autoimmune condition we may see that common um genetic pattern there the other things that are associated with the um pathogenesis is neurogenic disregulation there's immune system disregulation there's um disbiosis of both gut microorganisms and skin microorganisms are common um with the skin there's barrier function impairment and sebaceous gland dysfunction and of course there's the inflammatory response which plays a major role in the development of rosacea so the triggers and there quite a few known triggers which result in that flushing blushing propensity and that flushing blushing plays a vital role in the development of rosacea and as I said it's often present a long time even decades before a diagnosis of a rosacea is um confirmed um most significantly we see sun exposure um and that is common to 81% of people with rosacea but then also emotional stress along with those others on the slide we see humidity hot weather um spicy foods Etc but that emotional stress is the one that is most um commonly associated with the blushing rather than the flushing and that can affect or amplify rosace by modulating the hypothermic pituitary adrenal axis and releasing neuropeptides or neurotropins or lymoc kindes from nerve endings and dermal cells which then go on to of course further that Ros picture with the immune system there is significant immune disregulation and um I'm going to basically talk to this slide a little bit um first of all the innate immune system there is an augmented innate immune response and this leads to the upregulation of a pathway called the catholicon pathway that pathway then has Downstream inflammatory and physiochemical Cascades so in the skin of people with rosace there's higher levels of tollite to receptors and that's a danger recognition pathway it leads to an augmented danger recognition in the skin in response to a trigger such as UV light or spices and its signaling is involved in inflammatory Pathways and so once those inflammatory pathways are triggered by The tolik receptors there's upregulation and release of protolytic enzymes and we can see there on the slide mmk sorry MMP which is metalo Matrix metaloproteinases k5k um and that is calic related pepti a Cathy lidin pathway and its related peptide ll37 so ll37 and Cathy lidin act as inflammatory signals and they drive angiogenesis and stimulate the vef pathway which promotes the vascular changes that are seen in rosacea the role of mass cells is also key to rosacea mass cells are one of the major sources of Cathy lidin and klk5 in the skin and they are highly active in rosacea patients and in turn uh the release of ll37 exerts a powerful stimulus of the mass cells so we see M cells um stimulating the release of ll37 or stimulating the Cathy liin pathway and as such ll37 and ll37 in turn activating those mass cells so it's a kind of downward NE negative spiral once that pattern gets set off and this drives this inflammatory soup in the skin of rosacea patients and from there we see the changes in the skin vascular to responsiveness and then fixed physical changes in skin vasculature which is characteristic of rosacea the Adaptive immune system is also disregulated but the involvement of the Adaptive immune system is less well understood than the relevance of the innate immune system but what we do know is that this te- cell response is dominated by T helper 17 cells and there is an increase in interlan 17 as a result um we also see B cell mediated responses and we see an accumulation and activation of dendritic cells with over expression again that drives more il7 cyto kindes and it's these il7 cyto kindes and the elevated elevated levels of them in rosacea patients that have been linked to the formation of new blood vessels and then of course the induction of ll37 and again we see this link into driving more inflammation so with rosace PA with rosacea patients there's multiple Pathways in the skin that all Drive inflammatory responses that then go on and drive those changes in the vasculature of the Skin So looking at the neurovascular dysfunction and first of all the trigger and that trigger as we looked at there were some environmental triggers or also we could consider microbial triggers which I haven't discussed but I'll go on and discuss more but one of those that's well known is dermedex and so those triggers lead to increased skin blood flow angiogenesis and vasodilation and there essential to the process that drives rosacea and they are demonstrated in those typical clinical features such as facial athema and flushing and a key driver of this process is the activation of transient receptor Pro potential channels and there's two that are key to um rosacea and that's the trip V1 and the trip A1 and these channels activate sensory nerving endings in response to for example spices or alcohol or temperature changes and it leads to to the release of vasoactive neuropeptides such as amongst others substance P or calcitonin Gene related peptide these then in turn Drive inflammatory responses in the skin and vessels by activating mass cells macrofagos n nutrifil and tea cells and so you can see they feed into that innate and adaptive immune responses in the skin and an increased and prolonged expression of these trip V1 or trip VA um potential channels in rosacea results in facial flushing we also see then the disregulation of vascularity and neurog neurogenic inflammation and this is a part of the development of the fixed changes in vasculature which leads again to that persistent aemma or larged vessels or dilated vessels in the skin looking at the role of the gut skin axis in rosacea there is a high prevalence of um helicobactor pylori biosis small intestinal bacterial overgrowth inflammatory Bell disease and Celiac in patients with rosacea and if we just look at a dis biotic State such as sibo it's associated with intestinal permeability or leaky gut and that allows for movement or translocation of bacteria that should stay in the gut and or harmful components of bacterial origin such as lipop polysaccharides or lbs to move from the gut and out into the bloodstream so those components on they're in the once they're in the bloodstream can actually stimulate the immune system leading to say hyperresponsiveness of B cells or impair differentiation of tea cells but they can also directly reach the skin and impact skin physiology pathology and immune responses within the skin and in for example sibo in patients with rosacea has been linked to higher levels of inflammatory pyocin including tnf Alpha in addition I with uh to a dis biotic State and kind of that bacterial translocational leakiness there tends to be less production of um compounds such as butyrate in the gut and butyrate has that powerful anti-inflammatory effect as it suppresses immune responses and it does that by reducing cyto kind production of inflammatory cells and so we see more proinflammatory and less anti-inflammatory capacity of someone who has that gut skin acid access issues when they have rosacea as well we look at the pathophysiology of rosacea it involves the activation of skin immune and nervous systems in response to physical chemical or biological triggers such as um UV um sun exposure or spices and so these gut disbiosis driven changes could actually be one of those triggers and could lead to disease progression increased severity flare ups and even sustain symptomology and there is a little bit of research in this space there's some big correlational research showing that helicobactor pylori is seen in patients with rosacea and sibo is seening patients with rosacea but from a causitive perspective we need to look a little bit deeper but one of the research papers that came out was a three-year follow-up study and it it was in 2016 and it evaluated the role of sibo in the path of physiology of R and it showed that CBO treatment with refaim LED to clinical remission of rosacea in all participants in the trial and that persisted for the majority throughout the follow uh threeyear follow-up period and interestingly this study showed that the risk of sio is significantly higher in papular pular rosacea than the other subtypes and so that's subtype 2 so when you've got a patient presenting with subtype 2 rosacea you may um choose to investigate a little bit more deeply whether any of these gut skin issues may be part of the problem however I would generally state it is worth investigating the role of the gut in any presentation of rosacea helicobactor helicobactor pylori may also be a concern for rosacea and it's sought to uh progress rizia by increasing reactive oxygen species both in the gut but also in the skin and that can alter physiological processes in the skin including vasodilation inflammation and immunomodulation and we've seen that those changes can lead to the characteristic um flushing blushing and changes in the vasculature of patients in rosacea so certainly an area to focus on is that gut skin axis looking at sebaceous and Skin Barrier dysfunction we see sebaceous gland hyperplasia in fattis rosacea and this can lead to that thickening of the skin that's seen in this subtype and in patients generally with rosacea we see a shift in the fatty acid profile um of the spaceous secretion and we see a decrease in longchain saturated fatty acids that leads to skin dryness because there's less of that protective layer and more epidermal water loss and increased hyp sensitivity due to that lack of protection and more things getting directly into the skin and having the potential to impact them we also see micro Rial skin imbalance and this is likely because of Skin Barrier Integrity issues so we see either growth not just of dermedex but also of cutie bacterium acnes stap coccus epidermis and basilis alonis those are all hard to say fast these pathi likely play a role in the pathogenesis of racea by driving inflammation directly and indirectly by altering seum levels then to Skin Barrier integrity and that skin integrity acts as a barrier to microbes on the skin to toxins or even ingredients such as essential oils that might be in you know skin care products and to physical stress or such as UV radiation and it's also associated with this greater Skin Barrier leakiness so we have the potential for gut barrier leakiness and we also see Skin Barrier leak and this leak leakiness as I said it leads to loss of water and dryness and then hypers sensitivity which is commonly seen in rosacea skin there is an association with metabolic dysfunction and rosacea and it has been associated with dysliidemia obesity thyroid disorders and diabetes and there is potentially common mechanisms and so whether that's correlation or causation we don't know but there are common drivers or mechanisms that we see both in metabolic dysfunction and rosacea and they are increased levels of Cathy lidin and inflammatory cyto kindes so we see them driving both conditions which may mean that they independently develop but those mechanisms drive them both or that there is some crossover um with metabolic dysfunction furthering um worse outcomes for rosacea and I guess part of that story is um when we look at the research that there's a higher potential for insulin resistance in metabolic uh syndrome generally in patients with rosacea so lean in and again look for that in your patients particularly as they we see a rise in metabolic dysfunction in the third and fourth decade of life and that's when we also see rosacea being more likely to emerge of course inflammation is a big factor but I think stress induced chronic low grade inflammation might be the common soil of skin conditions like many other inflammatory skin conditions rosacea begins with the perception of external physical chemical or biological stimula by the Skin's nervous and immune systems and part of that picture is corticotropin releasing hormone and it's a central coordinator of the neuroimmune responses in the skin and it also participates of course in HPA AIS hypothermic pituitary adrenal axis activity and can has a potential if you like to promote Mass cell degranulation and increased vascular permeability so we see it potentially higher levels of CRP in the skin um pushing that inflammatory soup that is commonly seen mosaa so I guess generally what I would say is when we see a stressed person with rosacea we also consider stressed skin and I will I don't know that I've got this in the notes but one of the key ingredients that can or key herbs that can lower levels of cortico tropen releasing hormone in the skin is eonia so it's great for supporting the immune system but it will also reduce that stress skin picture looking at some holistic treatment strategies one is uh the first one I think can um primarily support vascular Integrity we need to stabilize and support the blood vessels in the skin to slow or reduce progression uh of course avoiding known triggers um reduce inflammation and immune dis disregulation address skin and gut microbial imbalance reduce sebaceous and Skin Barrier dysfunction I think put here support stress responses but also emotional health because having a skin condition that is inflamed and red and obvious to the whole world also has impacts on quality of life and we see this in research about all chronic skin conditions that it significantly impairs quality of life of the PE people who are affected by it support High Health to reduce progression and that's from type three to type four quite often we'll see that progression um and so we can actually slow that whole process down but also a generally support Eye Health and address metabolic issues if they're identified so some ways to do that first reduce flushing and we can do this by supporting vascular integrity and uh there's only a little bit of research as I said in the space about rosacea and oral um dosing of herbs or nutrients but one of them and this is commercial research looked at this product that's listed there on the page on the slide and it was a turmeric poly herbal combination and it was shown that supplementation over a 4we period improved facial redness the interesting thing was they had the turmeric poly herbal combination they had a placebo but they also had a straight turmeric arm and the turmeric arm and the placebo arm showed no r reduction in facial redness after 4 weeks it was only the poly herbal combination and so I looked at that poly herbal combination and what I pulled out of that is that IT addresses many of the mechanisms that we see um that are underlying drivers in rosacea so herbs like hemidesmus might have an immune modulating effect things like goaa will work on that vascular support and microcirculation and then we've got turmeric and licorice who for anti-inflammatories and then and things like Al and philanthus which provide that digestive support so we could see that and I'm certainly not recommending that you go out and find this tablet for your um uh for your rosacea patients mainly because it's not an Australian product but we could easily replicate something similar that addresses the mechanisms that underly um or that drive rosacea by looking at immun modulating herbs supporting vascular Integrity supporting the gut health and reducing say sibo or helicobactor and having an anti-inflammatory effect the next level of research or the next um dot point there is about um Goa Cola and uh it is a useful herb that has uh microvascular support but also reduces the inflammatory response and it's shown to do that in a small study in patients with rosacea often the research is done on topical um approaches and if we have a look at here there's a couple of topical options all which have a little bit of research behind them so this one was a um 2.5% of egcg which is a cakin of green tea over a 6E period and that reduced athema and those changes to the microvascular that was antioxidant imuno immunomodulatory photoprotective and antien it also reduced inflam and suppress vef expression and that was a double blind Placebo control trial in and that showed benefit there another study that has shown benefit was the combination topical combination of Sly Marin and MSM or methanol sulur methane and that was used over a one month period and we saw more symptom control there they didn't talk about mechanism but it reduced itching redness and papules and I think only four weeks of application and I also think this about the topical um sorry about the oral poly herbal combination four weeks is a relatively short amount of time to see some good outcomes other and I'll just go to the next slide for this other combinations that have been studied are grape seed extract and these are all topical vitamin C and aoic acid and as isic acid is one of the standard medical treatments for rosace now but tropical vitamin C and grape seed extract in combination with bre veratrol green tea and polyphenols and caffeine have also shown to be beneficial what I'd say about any of these topical approaches is often rosacea skin is very sensitive um uh to any topical application so test first patch test for 48 hours before you get your patient to use anything in an ongoing way just to make sure that there's not flares other ways to reduce flushing is to avoid dietry triggers as discussed heat causes direct vasid dilation and stimulates the trip V1 channels which are implicated in Flushing stinging Sensations and sensitive skin so if your patient finds at hot foods or beverages are part of the problem they best avoid them and usually your patients will know what triggers there are but if they don't are a food trigger diary can be helpful other food categories include cinnamon alahh rich foods or capin rich foods alcohol is a classic one caffeine is interesting because it may have protective effect as a vasoconstrictive agent but as a hot drink it may trigger those trip V1 receptors so iced coffee may be beneficial in that case looking at histamine it causes cutaneous vessel dilation and the histamine receptor hs2 sorry H2 and H3 have been found to be upregulated in Rosia skin and they contribute to that hypers sensitivity and as always facial flushing now I consider histamine may be local it may be more local than systemic and so you may be dealing with local histamine issues rather than Global histamine issues in a patient so before putting them on a whole low histamine diet it's assess whether it's actually a factor or whether it is more Mass cell um strategies that you work with rather than cutting a large proportion of their diet out I'm very much against restrictive diets and so I prefer to excuse me only avoid the foods that the patients have to avoid and in meanwhile have a diverse and Rich diet that will feed that good healthy um gut microbiome high fat diets may be a problem which is associated with type one and type two so have a look at that it may also be a factor in metabolic indices or um for patients where metabolic um issues are contributing to their rosacea and as we saw the types of fats that um patients are eating may be contributing to the seen production uh Dairy may be protective and I found that interesting although I will comment here that it needs to be good quality Dairy so it may be a you know a natural tubs set yogurt rather than a lowfat sugar-free typ of of yogurt because when they take out the fat and the sugar they put in a whole lot of chemicals so that's more like a chemical storm in a tub rather than natural yogurt neurovascular support I think is an area that um naturopaths Can shine because yes it's avoiding triggers such as emotional stress and I found that was a big factor for me um so it was that I had to learn to manage emotionally in say um um group environments or in social engagement but it was also through supporting my nervous system through supporting stress regulation or resilience and HPA actess disregulation and I think that we really excel in this area as naturopaths and nutritionist I have put just some ideas but it's by no means extensive I also think we need to encourage our patients not just to take herbs and supplements but also to build their own stress resilience yoga meditation ta Chi mindfulness based stress reduction are some of those factors that might um support quality of life and indeed apart from building stress resilience they also have the potential to lower inflammation and a review of 26 randomized control trials looked at the effects of Mind Body Therapy specifically yoga meditation and Tai Chi and they looked at what effect it had on circulating cellular and those genomic markers of inflammation and overall there was a decreased expression of inflammated related genes and reduced signaling through NF Kappa B in patients or participants in that in those trials that had practiced for an extended period of time and generally it's 8 to potential mechanisms for these effects that reduction of inflammation is through alterations in the ne endocrine neural and physiological processes as well as behavioral processes so I think really um looking at some of those mindfulness-based stress um approaches or yoga meditation and taii can help with reducing anxiety but also acceptance of skin appearance looking at immune disregulation and inflammation and firstly just the role of mass cells and as I said they play that role in the inflammation um uh pathogenesis of rosacea they lead to the flushing the changes in vasculature and the formation of papales and pastures so uh looking at cistin because it reduces M Cell Activation and histamine we can consider lactobacillus parasia because it reduces inflammation in the sken in the skin by decreasing inflammatory cyto kindes and activating te regulatory cells I love Ginko and I think about it in this case as a skin anti inflammatory it inhibits VF reduces inflammation and promotes a net anti-inflammatory effect in the skin and it's also really great for supporting circulation and skin microvascular turmeric uh I think the jwy is out on that one particularly as a solo but maybe as part of a combined comprehensive or comprehensive herbal approach as and as an anti-inflammatory yes it may have benefit we want to specifically go after Cathy lidin and lower cathelicidin and therefore those Downstream inflammatory drivers and so cistin again and Bal skull cap because it reduces Mass Cell Activation and Cathy lidin release and then Vitamin D it re helps regulate cathd and expression so testing your patients to see where their vitamin D is at and making sure that they have sufficient levels we want to reduce immune disregulation andrographis is a good one here echin talked about its role in low cortico TR and releasing hormone before um so reducing stressed skin and astralis are just some of the recommendations and the things that I use in clinic and then um antioxidants and there was some research in with zinc vitaminc and selenium with 30 patients with stage one rosacea 15 were given the standard treatment which was antibiotics and antihistamines and 15 were given long acting vitamin C zinc and selenium in addition to the standard treatment and the group that received the supplement experiened less redness and frequency of reoccurrence and that's a good start um and then of course I include an antioxidant Rich diet and in particular red orange and yellow foods can really support skin health and lower reactive oxygen species in the [Music] skin looking at the microbi skin and gut I am not really going to SP talk to the detail of this slide I will just say that I have focused on in my clinical practice quite often berberine containing herbs um because they also are useful for managing insulin resistance and some of those met metabolic conditions um as well as that picture of uh small intestinal bacterial overgrowth but I think you'd choose herbs based on the specific presentation if they were indicated certainly I like prebiotics and probiotics to build up the health of the gut that anti-inflammatory rate we may give digestive support and epithelial support and of course um those nutrients that support the lining of the gut and reduce gut leakiness also reduce Skin leakiness So vitamin A and zinc and vitamin C looking at Skin Barrier Improvement these are quite specific vitamin B3 and uh it's been moderate um amounts of of topical vitamin b3. been shown benefit for Skin Barrier function and you will hear patients report back when they have oral B3 that their skin is holding moisture better so uh I will often use either topical and or oral um vitamin B3 where I think there's um Skin Barrier function issues um B3 is an anti-inflammatory when applied topically and oral use supports that topical use and oral use is also photoprotective and it reduces oxidative stress in response to UV light so if UV is one of the biggest triggers then consider B3 if you also think that Their Skin Barrier dysfunction omega3 is also useful for Skin Barrier Improvement so it reduces skin inflammation it supports the quality of sebum in fat fraia and it is particularly useful for um ocular race to reduce the risk of progression finally I look at metabolic support and I mentioned berberine coctus or hydrastis those berberine containing herbs because not only do they have potential benefit for that gut microbial picture They al support Al They also support lipid glucose and energy regulation where metabolic issues are present um it reduces Ox inflammation and oxidative stress and it has anti-angiogenic potential bya the reduction of V jef so it is one of the herbs or those berberine containing herbs I do lean on a little bit where I perceive any of those factors are present with the patient in front of me along with that have a look at homosysteine and consider measuring homosysteine levels because a recent study has shown a correlation between rosacea severity and decreased levels of B12 and Fallout and also a correlation between homosysteine levels and rosacea severity so addressing that where it is a factor for your rosacea patients so thank you for your time today I hope that you can use some of these strategies with your rosacea patients and get good outcomes for the future
Dr. Julie Greenberg, ND on Holistic Skincare for Acne, Eczema & Psoriasis_en (auto-generated)
lotion is a combination of oil and water well what happens when we put oil and water together i think we all did this science experiment in fifth grade and we see that they don't mix they float and they are completely separate so how does how do companies get a lotion well they have to use a chemical called an emulsifier to smash together the water and oil at the molecular level and keep them there so now we've got a ton of emulsifier and now that we have water in the product you have to have preservative there's no option so when you use a lotion as a moisturizer you've got oil water emulsifier preservative emulsifier and preservative that whole class of chemicals are going to be the ones that tend to fire up red on that type of ewg working database they are not natural they are not good for your skin they are not good for you have you ever wondered what you're really putting on your skin before you put on that moisturizer next time that is actually harming your skin you need to listen to this today we're jumping into the world of skin care and holistic approaches to healthy skin with dr julie greenberg dr greenberg is a licensed naturopathic doctor and registered herbalist who specializes in integrative dermatology i am dr andrew wong co-founder of capital integrative health this podcast is dedicated to transforming the consciousness around what it means to be healthy and also exploring and understanding the root causes of both disease and wellness and today we're going to take a deep dive into skin health our conversation with dr greenberg was a great conversation into how our skin is connected to our whole health and what we can do to heal our skin dr greenberg is passionate about natural skin care and believes that many of today's chronic skin diseases and conditions can be healed by using evidence-based alternative treatments so if you're suffering from skin conditions like acne or eczema or psoriasis this is a conversation for you or if you're just ready for healthy skin this is also a conversation that's a must listen well thank you dr greenberg for being on the podcast today and such a pleasure to have you on today thanks so much for having me dr wong it's a pleasure to be here so as an integrative dermatologist and naturopathic doctor and integrative dermatologist can you explain to all of us what the connection is between the gut and the skin yeah so first off let me say that i tell patients and prospective patients that i'm a naturopathic doctor who specializes in dermatology i don't call myself a dermatologist because i think that implies uh four years of medical school as an md and then ongoing training for residency so i'm not a dermatologist in that sense but i am a naturopathic doctor who specializes in dermatology meaning i only see patients with dermatological complaints um and your first question just hits the nail on the head uh because the main way that i go about addressing the root crop cause of chronic skin conditions and hair things like alopecia aryata is to go for the gut there is a very intimate connection between the gut and skin of course we have a whole microbiome on the skin and a whole different microbiome in the gut and they are very different but there's crosstalk in between all of our systems and all of our microbiomes and they influence one another um so if we think about how the human is structured right the outside is our skin it's made of a tissue called epithelial tissue the inside we've got the whole gi tract also made of epithelial tissue and the bridge is the mouth so there's a lot of crosstalk that's going to happen between the skin via the mouth and through the gut but also through the gut i mean the whole point of eating is to absorb nutrients so things get from the gut into the bloodstream and the bloodstream is the super highway of the body we have to get those nutrients to every living cell on the body from the hair on your head to your you know pinky toenail things are moving through the gut into the bloodstream and getting out all over the place so they're they're intimately connected so would you say that when you see a dermatologic condition as a naturopathic dermatologist is that where you would start is is with the gut you know if someone's coming to you with a huge rash or something and they say hey can you help me with the rash you know where do you kind of where do you kind of start with them right so i have a two-pronged approach um i am going to prescribe botanical topicals and um those are gonna you know i want to alleviate some of the issues that are happening on the skin right and we can we can address even some root causes on the skin and we can get into that like with eczema and psoriasis but again the root causes i've got to go to the gut so on pretty much every patient i do gut microbiome testing and i'll just take a minute to explain to your listener base if they've never heard that term gut microbiome what i'm talking about is that the average adult human has between three to five pounds of microbes living in their gut and it's everything from bacteria to fungal organisms that can be yeast and molds even critters like protozoa or worms you know we don't want those guys but sometimes they get in there so it's a whole host of microorganisms and it's three to five pounds that's that's a lot um and who's in there really really matters so when i say you got micro biome testing i want to see who's in there what specifically which organisms who is there too much of that it doesn't belong there or it's overgrowing and where is it uh deficient where are there too little or there's missing good ones that we actually need and in order to do that i run two functional medicine tests on virtually every patient one is a stool test i warm my patients you will be pooping into a tray you will be collecting your own stool it's going to be gross for a few minutes and it will be over the second is a urine test that's a lot easier for most people just pee in a cup and the reason i'm asking them to do this is because i get a picture i get reports on the actual microbes in the gut and i've done hundreds and hundreds of these gut microbiome tests on patients and i started seeing patterns and i started when i was looking at the labs i would forget oh you know i forgot what that patient had but i would look at the labs and i would say oh somehow i know this is this is an acne gut i think this is an acne patient or i would say you know this is an eczema gut and last year i actually published the research on the gut microbiome of my acne patients and the specific set of problems i see pretty much unique to acne it's very different than the other conditions this year i hope to publish a similar paper and medical research poster on the gut microbiome of my eczema patients because it really varies by disease what's happening in the gut it's it's truly fascinating great we'll take a deep dive into those and we'd like to definitely post your research uh too that's that would be great thank you um and then how does nutrition impact our skin and then a follow-up to that i think would be do you recommend certain diets or i guess dietary patterns to improve skin health yeah so i mean i think when we talk about nutrition there's kind of a micronutrient discussion and a macronutrient discussion and again for your listeners maybe they've heard those terms they don't know exactly what's the difference macronutrients are things like proteins carbohydrates and fats the body breaks down foods into those various component parts and we utilize that for energy and building and then there's micronutrients which encapsulate things like vitamins and minerals that are also essential for our health and they they come a long package with the food so we get micro and macro nutrients from the food i think there's a huge industry for micronutrients and supplementing hair skin and nail stuff um for example for example biotin we in in the dermatology world there's a little bit of i think we're a little perplexed like who does the pr for biotin because it's some amazing pr that gets done but really if you look at the research most of the studies show that you can supplement all the biotin you want but unless someone's really deficient it's it's really not going to start sprouting hair on their head or you know doing magical things but still every hair skin and nail supplement has a huge load of biotin in it and patients will actually ask for bias tin so again a great pr rep for biotin whoever's doing that i i don't know how that got started it might it might mess up the tsh level though that's the only thing not just tsh there's a whole host of labs a troponin which is super serious because we use that to determine heart attacks testosterone uh yeah there's a whole slew of labs you're right that if a patient is supplementing biotin they should absolutely go off for many days before doing the test because it can completely come back with false levels so yeah so for micronutrients i don't have a like oh here's the hair skin and nail supplement for some of the tests the organic acid urine test that i do it does test for metabolites of b vitamins and and there are certainly times when i'll see some b vitamins are deficient uh for example riboflavin or vitamin b2 is often deficient with candida and or other fungal overgrowth so i may like supplement that while i'm treating the fungal overgrowth but in general i'm not going at it with like hair skin and nail formulas by any stretch of the imagination for macronutrients every patient has homework after our first visit and the homework is that they have to track the food that they're eating for about three or four days but all i care about is their fiber totals so i focus a lot on getting fiber up to 35 grams a day and 30 different vegetables a week for patients there are times where there's a gluten sensitivity marker on the stool test there's indications that they really shouldn't be eating gluten i'm also not a big fan of dairy especially for my acne patients there is no friend to you if you have acne but in general what i'm i'm focused less on what they can't do and more on what they can do which is we gotta work on 35 grams of fiber and 30 different vegetables a week the reason for that we need that level of fiber intake to maintain a healthy gut microbiome so i'm going to see a lot of gut dysfunction i'm going to have them on a lot of herbal protocols and supplements to fix that what we call dysbiosis and correct it but i always say to my patients my goal for you is for you not to have this derm problem for you not to have to see me and for you not to have to be on a ton of supplements that's not the way the body has evolved to work and though i'm going to get you there you know working you through all these protocols but i want to send you on your way and the way to say smooth sailing is to eat that much fiber because that is going to keep the good guys in your gut happy and that really just keeps your balance in your gut so that's mostly what we work on got it i love the idea of the 30 different vegetables per week i think the last time i thought about that was doing a csa and then finding vegetables that i never saw before you know yeah i have patients to do something called a rainbow check which is when they go to the market they do a first pass around the produce aisle and then they look in their basket and they go through the colors of the rainbow red orange yellow green blue violet what color is missing from my basket and they do a second pass and get those in and it's actually not hard to get 30 different plants a week i mean things like you know nuts and you know all plants count but we wanted to really focus on fiber but once you focus on different colors and you know you're shopping with seasonal changes you're going to work diversity into your diet which is the key because a diverse diet crafts a diverse microbiome and that instills resiliency and health into someone this is a this is something i wasn't thinking we would talk about today but i think we really should because it's like a chicken or the egg thing with with um people that have had damaged guts and maybe they can't maybe they even have sibo like small intestine bacterial overgrowth the question is can they tolerate that much fiber this many vegetables how do you how do you deal with that with your patients yeah so i have a lot of sibo patients who come to me um and it's with them what bothers me is when i get sibo patients who have been on a low fodmap diet for like six months or more they've starved the good bacteria and i already know what i'm going to see on the stool test which is something known insufficiency dysbiosis it means that they like all of the good guys are just at so low such low levels and every single time anyone on a ketogenic or a low fodmap diet for long periods of time they all come back with insufficiency dysbiosis so i don't do a low fodmap diet but what i do do is say okay where are you at with your fiber now and for most patients i'm trying to ramp them up to 35 grams of fiber a day adding a vegetable a week for my sibo patients we don't do that at first we say okay here's your you're averaging 12 grams of fiber a day okay we know that we're gonna put a pin in it for now and i try to use my herbs and supplements to decrease the gas and bloating um you know and it depends if it's more constipation i want to move the stool if it's more diarrhea basibo i want to slow the stool down so i want to make life comfortable for them first and then once the gut once their you know digestive tract has calmed down and they're not suffering in the same way that most sibo patients are suffering then we can slowly start to work in foods and i'm you know i'm not going to start with like large amounts of garlic and onion or high fodmap foods but i don't even really worry about that i just i just have them very slowly you know add in try different vegetables see what's working but i can i can usually get the gut calmed down enough in in a protocol like in a two-month cycle that the next time we can start working on adding in some vegetables and they tend to do pretty well with it that seems to be a very sensible approach another question about this skin i know this is something a lot of lester to be interested in is what can we do to improve collagen in our skin you know we know that their collagen is really helpful for skin health overall yeah so i think there's a couple things that we can do um i mean there's there's collagen supplements and and you know i've heard vegans and vegetarians ask like oh is there something i can take their collagen is from animal sources so it can be marine based so if you're a pescetarian you can have fish or you know chicken or beef or whatever but it's it's going to come from an animal and there are actually studies there was a meta-analysis and systematic review that was done at the end of last year that actually shows that supplementing with at least five grams of collagen which normally it's eight or eleven if you do a scoop actually did decrease wrinkles and improve skin texture after three months so i don't i don't mind if patients want to supplement with a high quality collagen supplement it can drive histamine though so if you've got a patient with mast cell or eczema or an underlying histamine issue it might not be a great time to supplement with collagen um but in general you know of course i'm gonna like natural food sources so a bone broth soup that kind of thing um you know people eat people eat chicken feet and things with collagen like if you if you can stomach it eat the actual animal we used to eat the entire animal we throw away most of the animal now so but a lot of people can't stomach that but there's also things that we can do to support the existing collagen so when people eat sugar it creates something called an advanced glycation end product or an age and basically you can think of it like it's the same thing that happens if you caramelize sugar in a pan what happens it turns crispy crunchy and brown right and i talked to patients that when you eat sugar it's doing that to your collagen it actually connects up to your collagen and creates like crunchy crispy collagen and nothing will age someone faster than sugar so one thing is like let's preserve the good collagen that we're making and not add in ages and and you know mess up the collagen um so again we're going to go back to the fiber and the plants the phytonutrients you know those are going to all create healthy good collagen um but then there's also topicals um things like aloe vera gel will enhance collagen production and there's an enzyme we have in our skin called collagenase and there's also so there's collagen and elastin and there's also elastase those two enzymes break down the collagen and elastin in skin and as we age we starting unfortunately increasing the production of those enzymes which is why we start to wrinkle and get laugh lines as we age um there are botanicals again like aloe but there's essential oils that i use in serum base oil serum blends like frankincense and lavender that have been shown to suppress the production of those enzymes in the skin now i don't want your listeners to go out now and buy essential oils and start putting them on first of all never use essential oils neat which means never put the essential oil directly on your skin that's a very good way to create a contact allergy and possibly burn your skin i always work with you know a licensed health care provider who's knowledgeable in essential oils and products but i do love essential oils when they are being prescribed by someone who is knowledgeable about them nice uh so many things so many pearls of wisdom just dropped there definitely one of my favorites is on the ages because it's such an appropriately named mnemonic advanced like constellation end products sugar will age our skin it sounds like by creating ages with the collagen yeah great let's get into another vitamin or i should say vitamin hormone vitamin d and we know that there's probably two camps and everywhere in between in terms of some people are like you know and i'm curious your thoughts on this as well um some people you know wearing sunscreen when you wear sunscreen when do you when do you not to get the vitamin d and so how do you manage getting vitamin d which we know is a hormone right as well through sunlight but also wearing sunscreen to take care of your skin yeah it's an excellent question and one that i've been moving much more in the direction of what you just said getting it through sunlight versus supplementation if you do a conventional blood test and get back your labs the threshold for like a low vitamin d is like around 30 or 32 depending on the lab so it has to be quite low for you to come back as truly frank lowe from for most naturopathic or more kind of functional medicine doctors i mean it varies like for me i'd like to see it much more up around 50. i used to do vitamin d supplementation to try to get it up there but the more research i did and the more i heard about it and thought about it you know all the studies show yes absolutely vitamin d levels correlate to a whole variety of diseases you know everything from multiple sclerosis to even you know eczema and psoriasis people tend to have low levels of d but the problem is when they do studies and they supplement them with artificial d to get their levels up the levels go up in the blood but the conditions there's just a lot of like very conflicting evidence about whether it makes it better and if you look at you know more like a meta-analysis or systematic review and for your listeners that's where instead of just looking at one study we're looking at a lot of different studies and seeing like across all the studies that were done you know did we actually see that this thing is helping the answer kind of seems to be no that artificial supplementation of vitamin d doesn't really seem to do much to help these types of dermatological conditions so i moved away from vitamin d supplements and moved towards in my treatment plan there's a line that says lifestyle and underneath it it says aim to get between 5 to 20 minutes of sun a day now the caveats on that are i don't actually want them to expose their face uv radiation and sunlight for sure is one of the greatest agers of skin that we are exposed to so there's no doubt about it that you know the the sun and uv radiation will age your skin and we don't actually make a lot of vitamin d from our facial skin anyways so i feel like this is not the area where we need to get the exposure so you know we talk about trying to expose you know arms legs and torso for those five to twenty minutes if they have a balcony or a backyard you know walking out i live in la so shorts and a tank top pretty easy year round it was just um i know that's not always feasible in other places but um i really am moving towards sun exposure and it's that we never want to burn right so we're never going to stay out long enough if they get a little bit pink so i say when you if you take your finger and you push it on your skin and you get a little pink blanching that's okay but it should disappear within 30 minutes of going inside if you still got pink after that time then you've stayed out too long and you've burned yourself and it is going to change in terms of the time of year and what latitude a patient is at and their skin tone so they need to figure that out but all of my patients i recommend that they get some daily sun exposure because i think the answer that you know what we're seeing in that people are low in vitamin d but supplementing doesn't help is that there's probably a lot more benefits that we get from sunlight and we are discovering some of those benefits and that vitamin d may be more a marker of appropriate levels of sun exposure um i mean we know that there's things that d can do for us but either the form that we get it in supplement is not equivalent to you know what we get from nature which i think that's true of most things and or that it is also just a marker of sun exposure but we're missing out on the other benefits of the sun by supplementing artificial d and and i think there's so much left to discover about the sun i mean we know there's seasonal affective disorders sad people literally get depressed when they don't get exposed to the sun in some places um that's not just vitamin d that's that's the sun we are not vampires you know we are meant to be in the sun and uh participate with sunlight and i i think that it's really um a problem when peop patients aren't in the sun and there there are studies big long-term large studies that show that a lack of sunlight is actually a huge um morbidity and mortality factor um and that we do need sunlight so one of the big take homes i'm getting so far is we have to move to la or at least take a vacation there beautiful area yes i mean right prescribing a patient a vacation in a sunny tropical place for winter i think most patients are gonna be pretty okay with that yes exactly that's great uh we're just interviewing a a phd who did her dissertation and vitamin d research and she was saying and i don't understand the details fully but she was saying that when you take a supplement orally it's almost like mimicking your gut microbiome instead of where the skin is kind of stimulating your skin microbiome so there could be something with that too yeah yeah it's true because you know we make i mean we make sunlight through the skin and that is a different way i mean there's certain plants like mushrooms that have been exposed to the sun where we can get small amounts of vitamin d from food but you know really the majority of the the sun the vitamin d that we make comes from sun so that's fascinating yeah so so kind of balancing that um getting the vitamin d through sunlight when when appropriate in the right season the right latitude etc but also wearing some sunscreen to take care of the skin when needed speaking of sunscreen do you recommend uh you know to prevent burning and things like that once people have gotten that 15-20 minutes depending on their melanin content and stuff what kind of sunscreen would you recommend at that point so across the board i recommend physical sunscreen only a physical sunscreen is going to use an active ingredient most often zinc oxide it could be titanium dioxide as well they're a chemical sunscreen for your listeners are other things like octanoxide able benzone they are chemicals and the sunscreen will say put this on at least 30 minutes before you go in the sun the reason is for chemical sunscreen it has to absorb into the skin and have a chemical reaction and then be ready for you to go in the sun a physical sunscreen like a zinc oxide you put it on you can go immediately into the sun it is called a physical sunscreen because it is a physical blocker it sits on top of the sun and reflects back the rays of the sun so you don't need it's not seeping in you don't need to put it on 30 minutes before going out so i only recommend physical sunscreens there was a study in jama it was maybe 2020 that showed that we do absorb even with one application significant amounts of chemicals from chemical sunscreens and um i just don't think we need that in our system especially when the physical sunscreens are good options and i actually also like a tinted sunscreen especially for the face the tint in the physical sunscreen is something called iron oxide so it's another natural mineral but what's great about it is it blocks blue light from the sun and blue light from the sun is not stopped by the uv blockers so none of the zinc oxide or chemicals will stop blue light but blue light can cause hyperpigmentation so either if someone has melasma or even if they have inflammatory problems like acne there's something called post-inflammatory hyperpigmentation where basically the skin darkens but the tinted sunscreen with iron oxide will block the blue light and prevent that from happening got it specifically for the face i do yeah there are body um tinted ones but that can get a little bit messy yeah got it um and then for the zinc oxide and the physical sunscreens is there a difference between the ones with and without nanoparticles aren't some don't some have or is it all yeah if there's there's different sized particles and there's debate like do the nanoparticles actually get through into the bloodstream and what's happening i think that a lot kind of remains to be seen in this area exactly what's happening i don't tend to concentrate on it too much the reason they created the nanoparticles was because you know when they first made the physical sunscreens with zinc oxide if you put it on everyone would look like casper the friendly ghost and it just was this white crazy you know mess on them now most companies have done a good job of creating physical sunscreen so that you don't look like you're wearing a white paste um but yeah i i'm kind of like waiting to see where the research goes on the the nano versus non-nano i'm not sure how i feel about it yet yeah maybe more research needs to be done done thank you well let's let's get into some of the root causes some of the common skin conditions that you see first of all what are the top three four skin conditions that you you see in your clinic jet typically yeah so i think it mimics the population my top two for sure are eczema and acne um then after that probably like psoriasis or maybe even alopecia areata i treat a lot of alopecia areata uh but i see rosacea and um seborrheic dermatitis usually kind of overlaps with other stuff as well but there's definitely a lot of subderm as well let's just start with something basic before we get into x-men editing and everything we're really excited to to look into all that um what if someone just has dry skin you know and they're you know what's what's kind of going on with that and and this is a really general question that that you know i think would be you know helpful for listeners is what do you think about showering and like how often do you shower in relation to healthy skin yeah so um all of my patients um for the first visit there's there's an education portion that usually lasts about 30 minutes so i'm a naturopathic doctor we have very long visits my first visit is either 90 minutes or two hours and 30 minutes of it is is educating that's a tenant of naturopathic doctors is doceri or doctors teacher and part of the thing that we go through is skin health and it's ph so ph is really important and just to remind your listeners you probably studied ph back in junior high you had the little litmus strips of paper and you were testing them on different liquids to see if they were acids or bases and they'd change color and you'd line them up on the color strip and um it's they run from 0 to 14. so 0 1 2 low ph are acids high ph up at like 12 13 those are basic or alkaline substances and things at the middle like at 7 are neutral and that's things like water and the body has evolved to operate at an optimal ph um depending on where you're at so the blood is neutral and it has to be very tightly regulated the skin is surprisingly acidic and most people when i have them guess where do you think the ph of skin is most people will go for seven which is neutral because it's like blood water that feels safe that should be skin but we have something on the skin called a fatty acid mantle and we just heard the word acid so we actually know automatically that skin is meant to be acidic and for me healthy skin starts with acidic skin we cannot have healthy skin without the correct ph there's a couple reasons for that one is that we have things called antimicrobial peptides on the skin like dermcidin and defensin and their job is to just be there and if if some bad guy gets on the skin it's their job to kill it and beat it up and make sure that that doesn't happen but the second thing that most of my patients don't know and like hearing is that when we have acidic skin it actually ages slower acidic skin will naturally have fewer wrinkles and dark spots than a more neutral or alkaline skin so we always start with how are we going to find topicals and how are we going to keep the skin in its happy acidic state because our general protocol for skin what do we like to do in america we use soap and hot water well soap is always going to be alkaline because it is a chemical reaction between lye and fats so that's just by nature soap is alkaline so whenever you wash your body especially with hot water you're stripping off the fatty acid mantle that protects your skin you're raising the ph of your skin and then you kind of wish it good luck that is going to dry out your skin that is going to raise the ph of your skin and i have never treated more hand eczema and hand dermatitis since covet started because people are like compulsively washing their hands with soap and hot water they're stripping off the fatty acid mantle they are raising the ph of their skin and they're setting themselves up for hand eczema so the first thing is we always work on these natural products that are going to support the skin of course soap is good we love soap right we don't want to stink we there's covid a foot we can handle raw chicken we use the toilet lots of excellent reasons to use soap but we want to use natural soaps we don't need to over scrub and then we want to re-acidify the skin pull that ph back down that is going to make the skin more moisturized and healthier so those are some basic things that i talk about with every patient and then for me i don't like lotions i separate uh my topicals with oil-based and water-based products um and so we go through all the different things to use to keep skin healthy basically great i have some follow-up to that but let's let's go into some of the conditions so you said one of the top conditions that you see is eczema what are the root causes of eczema and then what kind of general kind of treatment do you recommend just as a general kind of category yeah so fundamentally eczema is a problem with skin barrier dysfunction we can see that an inflammation and it's not just inflammation on the skin it's inflammation in the gut i so i definitely have a two-pronged approach to eczema um i guess we can start with the skin stuff one you know we talked about ph and that the skin is acidic well how does the skin get acidic why is the skin acidic we have to go to a protein in the skin called falagrin and it's what we call the master regulator of the skin barrier and out of falagrin we make something called natural moisturizing factor nmf what a great name substance right i don't even need to explain to patients what natural moisturizing factor is it's like quite obvious so it's one of the main things in keeping your skin moisturized but natural moisturizing factor is made up of acids so of course it's acidic it's what sets the acidic tone for your skin well in eczema especially my patients who have had eczema since they were infants or small children you can have something called a falagran gene mutation flg or in african americans flg2 and what that means is that those patients they just naturally don't produce as much falagran and natural moisturizing factor on a daily basis as other people might that doesn't mean that they are doomed to a life of eczema it just means that they're predisposed to getting it and so um a lagrangian mutation and a lack of flagrant and natural moisturizing factor is one of the problems with eczema but the other problem is staph aureus on the skin so staph aureus is an organism a bacteria that we think about as like infections like if you've heard of impetigo that's a full-blown staph or strep infection but staph can cause problems even when it's at lower levels than infections but it's over colonizing the skin so staph is intimately tied with eczema and anyone who's having an eczema flare is basically having an overgrowth of staph aureus on the skin and it absolutely needs to be addressed now you don't need to have like a prescription topical antibiotic like me pearson i treat it every day with antimicrobial topicals and one of the best ways to beat staph is to again pull that skin down to a healthy ph because staff likes the skin at about 7.5 and if we get it down to a five staff has a real miserable time and it's gonna go find another home but the other problem with staff is it colonizes the nose so i also treat all of my eczema patients with a nasal spray to get the staff where it's colonized it's on the skin it's in the nose and we'll get to it it's in the gut so staph is a huge topical problem in eczema a malassezia yeast can be another problem it's why a lot of eczema patients infants will have cradle cap but a lot of the adult patients will also have um either dandruff or kind of a secondary subderm on top of the eczema so there's the skin problems that i need to take care of but as far as the gut goes um based on the labs that i see and run i would say there's two main problems there's overgrowth of three specific organisms and there's a leaky gut and the leaky gut is there because two of the very good species what we call keystone species that help maintain a healthy gut are gone or they're at very low levels and these are long names but it's vicali bacterium presidency eye and acromancium eosinophilia um so but it's a whole leaky gut picture and the organisms that are overgrown in the vast majority of my economic patients are staph aureus in the gut so now we've seen it three places on the skin in the nose and in the gut again that crosstalk that we talked about candida yeast um and strep those are the three organisms that are overgrown now everyone's an individual so there's usually more going on but that's the eczema gut is those markers and when i'm looking at the labs that's pretty much i know my eggs and my patients i love treating the root cause and how you beautifully explain the the bifurcated you know skin and gut treatment it just makes it so clear so thank you so much for that uh let's kind of go to um let's kind of go to acne you know acne does uh really torture or bother a lot of a lot of people out there i'm sure not only starting with teenage years but even afterwards right i mean how is there an is there an age limit to acne or is it kind of a yeah it's amazing so um you know when i was growing up but my generation it was really much more of a teenage problem and those numbers have shifted adult acne is is hugely prevalent men and women in their 20s 30s and 40s up to 50 percent report ongoing issues with acne and even up to 25 of women in their 40s are still dealing with acne um you know at some point it will burn out i don't think i have any 60 or 70 year old patients with acne but i've got so it's it's ongoing um for me acne is also a very much a gut problem um i mean we know that there's stuff happening on the skin and in the hair follicle we can get into that um but yeah it's hugely an adult problem now in a western society and um i probably treat more adults than teens even what do you think that's from that shift in the uh the age you know demographics of acne patients so i think puberty is a kind of a setup to again like in the same way that a falagran gene mutation will kind of predispose you to have eczema but it doesn't mean you need to puberty is a kind of setup for acne right because this is a time of high growth and high hormone production and what one of the when we look at okay well what's actually happening that that is causing a pimple there's kind of four steps in what we call the pathophysiology of acne or what's actually happening the first step is overproduction of sebum and sebum is oil in a hair follicle and most people don't realize that acne only occurs in a hair follicle and your listeners might think well i'm a woman i don't i don't have hair on my face but you do you have tiny little bellis hairs the little blonde guys and um even those little vellus hairs have a sebaceous gland whose job it is to produce sebum so the first step in acne is too much sebum production then we can get too much skin cell production that hair follicle becomes clogged and we can either have bacterial acne it's often due to an organism called cutie bacterium acnes or fungal acne due to malassezia yeast which i mentioned with eczema and so when we look at being a teen you know we think of acne associating with being a teen because that is a period of high growth and high hormones like testosterone and even insulin and those drive sebum production so it's not that every teen has to have acne but it's certainly a setup and within a cell there's a growth process called mtor mammalian target arapamycin and we know that mtor is going a little bit out of control in acne and mtor is already fired up in puberty because it's meant to be growing things so i think we that's why we certainly see it in up to 90 percent of american teens are going to get acne because their their mtor is already cranking and on fire and if it just gets a little bit too much of a push then it's like well we're building all these things i guess let's let's start pumping out some sebum too but in the adults you know we've seen this switch now which is why are we getting all this adult acne and for that you know it's it's not mtor on fire because of puberty we have to figure out why is mtor activated and there's a whole other host of reasons that i go through with my presentation with patients they all know these terms mtor is being activated in adults for a variety of other things but our western diet meat wheat dairy and sugar they all drive mtor but some of the organisms in our gut seem to impact the process as well and it's completely in line with what i see on the gut microbiome of my acne patients so yeah i just love how you keep on drilling down on how the gut is so important in the microbiome whether it's insufficiency dysbiosis or an overgrowth it's so and it's so interesting i'm i'm really excited to read the research you've been doing on uh you know different uh i guess microbial signatures and we might be talking about the same stool test i imagine we are but you know different stool tests that are that are very specific towards you know different organisms um and yeah let's let's kind of get into uh so you know for treatments for acne i mean there's obviously the conventional type of treatments and we all know that they can be you know helpful at time but then there's a lot of side effects potentially too so what are your thoughts on treatments there yeah so i'm going to go at it um i guess kind of there's like a three-pronged approach for acne so there's a topical is one i want to use things that are going to naturally try to calm down inflammation and reduce sebum production i don't use things like oh i don't i don't generally use pharmaceuticals so i'm not going to be using like retinols or topical antibiotics or anything like that i use um natural botanical topicals so and things like you know aloe and hydrosols which are water-based plant extractions gonna get that skin down to an acidic ph so that the either the malassezia or the bacteria on the skin is not able to dive into that follicle as much and get trapped um and there's there's actually oils that are very good for acne um we think of oh no if you have acne don't put an oil on it because that's going to make it worse it's not true there are comedogenic oils or clogging oils like i would never put coconut oil on the face but there's other very good oils for the skin um that are light and will not can actually calm acne down like a grape seed oil or pumpkin seed oil can be beneficial and a blend of essential oils to reduce that sebum production then internally i want to reduce the sebum production but i need to address the gut and the issues that i see most commonly in the acne gut are candida overgrowth h pylori overgrowth and protozoa overgrowth and for your listeners protozoa are it means uh first animal so it's a little single celled we group it as an animal organism and there's lots of different types of protozoa everything from a more pathogenic like giardia to a blastocystis hominis or an endo limex nana all of them for me i treat all h pylori i treat um and so i'm going to use specific herbs and supplements to treat whatever i see on the labs but then i can also use some supplements to try to reduce sebum production and calm things down and slow down that mtor process and of course we're always working on fiber and plants which naturally calm mtor and sebum production as well yeah fiber's the base get the get the short chain fatty acids and got it yeah yeah and speaking of short chain fatty acids so in my eczema patients the ones that are lacking the ficale bacterium presidency eye that's a main butyrate producer butyrate is a short chain fatty acid i will often supplement with butyrate um while i'm trying to restore the gut because those short chain fatty acids and butyrate are so important to colonic health to lowering inflammation to enhancing tight junctions of the cells in our gut um our you know i always tell my patients it's kind of weird to think about like why why are we housing three to five pounds of microbes in our gut like that's weird right it's a freeloader we're carrying them around everywhere you go you're carrying an extra five pounds and you're feeding them why in the world have we evolved like this and the answer is of course they do things for us that we need we cannot live without them we can't be healthy without them and so we really need to craft think of them as you know your pets that are doing good things for you without them everything goes wrong and it's so much easier just to build a healthy gut microbiome and let them do what they're supposed to do rather than trying to supplement 50 000 things and fix it on the back end yeah i was just laughing because um you know a lot of the microbiome micro biome scientists say that we're freeloading on them right yeah but i like to think we're kind of like a b right we're a bed and breakfast it's like we give you a home and we're going to feed you three meals that's right that's right it's it's a pretty good bmv for for yeah that's great um let's talk about psoriasis you know psoriasis is another condition that isn't quite as common as eczema acne but it is there's some genetic genetics there there's some certainly nutritional factors things like that what are some root causes you found for psoriasis and what are some of the natural treatments that you recommend yeah so psoriasis is an interesting disease you know we obviously see it happening i mean there's different types of psoriasis but plaque psoriasis this is the most common one there's mutate and inverse and all sorts of stuff it got put in the dermatology bucket like back in the before the 80s because it was like oh we're seeing these plaques so it's a derm problem and then over the years we've really realized that it's it's much more of an actual immune problem and it's a systemic inflammatory immune disease with many more repercussions than just plaques on the skin honestly pick it pick an organ system and people are to increase risk for problems with just about any system um and so we think about that inflammation and there's a lot of conventional drugs now that are offered for treatment of psoriasis that are effective they are effective in suppressing inflammation and getting rid of the plaques but they are not effective in terms of getting to the root cause so as a naturopathic doctor we're always asking but why why we're like two-year-olds we don't stop asking why and you know the real question is why is the body creating all this inflammation instead of just trying to push the inflammation down let's figure out why the body is creating the inflammation and catch it and stop it here so when it comes to psoriasis not surprisingly i do the stool test i do the urine test and i do usually see a large amount of overgrowth in the gut leaky gut and there's often this kind of third component of a toxic element whether it's mycotoxins or heavy metals or environmental toxins but one thing i talk through with all my patients is the immune system so in psoriasis there's something called th17 cells and they're so t cells are a type of immune cell we have in our body and th17 cells are a specific type of immune cell and anyone who has psoriasis has a huge army that they're building of these th17 cells and there's other cells th1 and some other ones but we'll just make it simple and talk about th17 cells so all the inflammation is coming from this army of th17 cells when we just look at immunology why does a body create an army of th17 cells well it's bacterial and fungal invaders at mucocutaneous sites okay let's break that work down what's mucocutaneous well muco is mucus cutaneous is skin and a lot of people don't realize that one of the largest yugocutaneous sites in the body is the gut we have to create a thick layer of mucus along the whole gut and that is the barrier so if we don't have that thick layer of mucus we have a leaky gut that's fundamentally what leaky gut is and with psoriasis if you have a leaky gut and there's bacteria and fungal elements like candida yeast for example that are getting in through your gut into the bloodstream that is a very good reason for your body to start building an army of th17 cells now th17 cells are are kind of patho mnemonic for all autoimmune disease so this is true for my vitiligo patients my alopecia ariata patients i love treating alopecia aryata so much because you just work you just work the gut and the hair grows back it's just beautiful so really i think with psoriasis it really is again being driven through the gut and we know there's lots of studies that show that there are in the psoriatic plaques there are contents from the gut microbiome um there are things like polyamines um so things are absolutely escaping from the gut and getting through into the bloodstream and then into the skin now why why do somebody have psoriasis versus alopecia areata or a different autoimmune disease that is going to be there's a genetic component to it right someone is pre-diseased predisposed to getting certain diseases because of their genetics again it doesn't mean that you're going to necessarily get psoriasis even if it runs in your family it's in in functional and naturopathic medicine we like to say that genes load the gun but environment pulls the trigger so unless you pull the trigger you're not going to get the disease but for me psoriasis it is this th17 cell army being driven by fungal and bacterial problems at mucocutaneous sites i think the immunology explains it beautifully i do do things topically to kind of slow down the production of skin cells and calm the plaques down there's a beautiful herb called indigo naturalis which as the name might give you a hint it's blue so you got to be a little bit careful with where patients are putting the indigo bomb because it will rub off onto sheets and clothes and stuff but it's very good at decreasing those th17 cells and increasing um t regulatory cells which are another type of immune cell that kind of came for tolerance and a calming force on the immune system so decreasing those th-17s and increasing the t-regs it sounds like is what we want to do with most autoimmune conditions you know we're um there's you know you're such a wealth of information here dr greenberg love to have you on for another session if you can um i think i just wanted to conclude with first of all thank you thanking you for being on this episode i know a lot of listeners are going to like find value in all this and you know skin health is really uh everyone knows it's important but it's not just important for the cosmetic reasons we all want shiny vibrant skin but it really is obviously the large organ our bodies and communicating with the gut microbiome and really affecting a whole system so so thank you for all that um i just have one question are there any resources you recommend for finding reputable products for skin care you know we all go to you know giant or whole foods or whatever and it's like what do you what do you get from from there yeah and it's tough because we don't have a lot of regulation in this country when it comes to our skin care products um in europe it's it's much better and more tightly regulated so the quality of skin care products that you would get there are going to be much cleaner naturally than here because companies can get away with using cheaper chemicals that are not so great for us so there's a couple of tips i can give to your listeners one is um there's the ewg environmental working groups uh skin uh skin deep or something database um if i'm saying that wrong you can yeah yeah that's right yeah everybody that's ewg.org yeah and they've they've got um just a whole really easy to use website where you can key in the name of like products and it will tell you kind of the safety rating now i don't agree with like all of their ratings but by and large it kind of gives you this green yellow red picture that's pretty easy to understand so that's one thing check your products there on another level um i think just very basic treat it like your food so most of my patients are gonna if they're picking up a packaged food they're gonna turn over the label and read the ingredients and i think with ingredients you know we're going for ingredients that we understand once you get to a long label with a lot of multi-syllabic chemical sounding names it's probably not a food item you want to put in your basket and bring home for you and your family it's it's not going to be healthy the the fewer ingredients the more you understand what it is the better it is your skincare is that way too the tip i can give listeners is what i said before you separate your water and your oil based products i don't like lotions i'll get on my little lotion soap box here for two minutes the reason is lotion is a combination of oil and water well what happens when we put oil and water together i think we all did this science experiment in fifth grade and we see that they don't mix they float and they are completely separate so how does how do companies get a lotion well they have to use a chemical called an emulsifier to smash together the water and oil at the molecular level and keep them there so now we've got a ton of emulsifier and now that we have water in the product you have to have preservative there's no option so when you use a lotion as a moisturizer you've got oil water emulsifier preservative emulsifier and preservative that whole class of chemicals are going to be the ones that tend to fire up red on that type of ewg working database they are not natural they are not good for your skin they are not good for you so and the oil that is used in a lot of cosmetic problems are petroleum or mineral oil which are byproducts of the gas and you know oil industry these are not good oils so by taking away lotions we have solved the problem we don't need emulsifiers we don't need preservatives and we don't need to use petrolatum or petroleum or mineral oil so what do you want to look for a natural base soap something like a hydrosol is a great toner it's a water-based plant extract almost like a tea and then for the quote-unquote moisturizer i just use a serum which is a blend of oils and essential oils they're going to be plant oils and you know essential oils and again you want somebody who knows what they're doing to have formulated it but it is great for your skin these are acidic you're going to age slower your skin is going to be healthier it's just all good thank you dr greenberg love to have you back for round two of this because i think we have a few other things to talk about but thank you so much and uh thank you for all of you listening out there we know that this episode is going to be really well received this is a really important thing to talk about skin a lot of things you know maybe we need to buy more european i know there's a lot of european products on the market as well um they are more regulated there yes i agree with that um just from other things knowing about supplements but i didn't realize that about the the skin products so um so yeah uh thank you so much dr greenberg again and uh looking forward to having you back sometime thank you so much i'd love to come back thank you for taking the time to listen to us today if you enjoyed this conversation please take a moment to leave us a review it helps our podcast to reach more listeners don't forget to subscribe so you don't miss our next episodes and conversations and thank you so much again for being with us you
Goodbye Rosacea!_en (auto-generated)
website i've been formulating skin health products for many years and uh sharing advice about how to take care of the skin i've learned a lot about how you take care of the skin a lot of stuff about how you take care of the skin that flies in the face of conventional wisdom conventional wisdom as many of you know is often wrong and it's often wrong hi janae and tom and it's often wrong especially when it comes to how we take care of our skin so today i thought i would talk about rosacea a very uncomfortable and unappealing skin condition that affects 16 million americans the most important thing in my opinion to understand about rosacea is that it's not a skin condition yes it shows up on the skin i understand that but like many things that show up on the skin uh rosacea is not caused by a skin problem it's caused by something inside the body and it's so ironic because everybody who has rosacea knows hello kendra hello susan everybody has rosacea and miranda everybody who has rosacea knows that they'll eat certain foods and then they'll get their rosacea symptoms typically it'll be alcohol or chocolate but it can be a lot of things and that's really the most important thing to understand about a lot of skin problems there's an intimate connection between the digestive system and the foods we eat and how our skin shows up for better or worse in the case of rosacea there's a couple clues a couple red flags anybody who understands biochemistry that will tell you or tell that person that rosacea begins inside the body the first clue as i say specific foods will trigger rosacea symptoms the second clue is vascularity or redness whenever you see redness or vascularity or or inflamed vascularity you're witnessing the body's immune response you're witnessing a defensive response so in combination with the fact that we know that rosacea symptoms are associated with certain foods when you throw in the fact that you've got an inflammatory vascular response it's very obvious that you're dealing with a food slash digestive system condition not a day goes by when we don't uh a truth and when i don't get questions when i'm the truth about skincare products topical skincare products for treating rosacea you can't treat rosacea with topical skin care products at best if you go to a uh dermatologist you'll probably get either a steroid cream which is anti-inflammatory or you'll get an anti-biotic cream which is also anti-inflammatory so the strategies the dermatological strategies for dealing with rosacea address the symptoms not the cause and you may get some temporary relief but here's the real problem as with a lot of skin conditions if you are if the skin condition is being caused by something that you're dealing with internally you may end up with further bodily breakdown further unpleasant bodily distress chronic disease autoimmune diseases cancer shorten longevity further down the road if you don't address the cause so yeah you can use an antibiotic cream or steroid cream to minimize if it even works but let's say that it works to minimize the symptoms associated with rosacea but if you haven't corrected the underlying leaky gut which we'll talk about here in a moment are food allergies which we'll talk about here in a moment or or a chlorhydria or hypochlorhydria low hydrochloric acid or h pylori all of these are internal issues in the digestive system that are associated with rosacea if you haven't haven't corrected those even if you've mitigated or reduced or even eliminated the symptoms with a dermatological topical like a steroid or metronidazole an antibiotic which they give sometimes topical antibiotic you haven't corrected the problems underneath and that could lead to further health issues unpleasant health issues even shortened longevity down the road so how do you deal with rosacea truly first of all you want to associate your symptoms with specific foods it seems so obvious but it's just something that we don't always do you want to associate specific symptoms uh flare-ups oiliness uh whatever your rosacea symptoms are redness obviously rosacea means redness with specific foods eliminate those foods that's step number one now it's not necessarily easy to do this because foods have lots of different things in them and how we eat when we eat a meal we eat a lot of different foods so sometimes it's hard to isolate the specific foods that are causing our skin symptoms but it's worth the effort best way to do is by keeping a food diary writing down everything you eat and then associating specific skin symptoms or any other symptoms with foods it's just kind of keeping track this is what you what a physician will do or a nurse will do in a hospital they'll chart everything you want to be like your own physician you want to chart and that's uh that's called doing a food diary that's first of all now you can also fast for a day or two if you fast for a day or two when you start eating again things are going to become more obvious to you so if you want a shortcut stop eating for a day or two this is really tricky for some food it's really tricky for everybody to stop eating for a day or two but if you really want a shortcut stop eating for a day or two and then when you start eating again uh you'll notice that your rosacea symptoms are triggered by specific foods more clearly they'll become more dramatic to you more noticeable to you if you lay off the food for a couple of days the most likely suspects and i always hate saying the most likely suspects because we always have to kind of uh find what our particular problems are our specific problems are but you know the most likely suspect hey robert eggs uh peanuts and legumes soy dairy gluten and and other compounds that are found in cereal grains so-called lectins and as i say those are kind of you know that's a guideline for things but really you have to go by your own you go by your own experience spicy foods alcohol chocolate caffeine coffee all these can be problematic for some folks when it comes to rosacea secondly there is a very important connection between a bacteria called h pylori which you may have heard of and uh and rosacea so it's thought that it may be an h pylori infection a topic a cutaneous or topical manifestation of an internal h pylori infection it's also known that stomach acid low stomach acid a condition called a chlorhydria or hypochlorhydria low stomach acid can be caused by and can exacerbate h pylori infection so acidification of the stomach is very uh can be very helpful and that is uh acidification with apple cider vinegar using apple cider vinegar with your meals also you can use stomach bitters or swedish bitters which will stimulate gastric juices you can also get hydrochloric acid drops from a pharmacy you'll have to get a prescription for that and you put a couple hydrochloric acid drops in a glass of water before your meals now hydrochloric acid will do a couple things first of all it will help eliminate h pylori infection and second of all when we don't make enough stomach acid we don't break down our foods effectively stomach acid is necessary for the activation of enzymes particularly proteases that is enzymes that break up protein when you hear ace at the end of the word hey doug whenever you hear an ace at the end of word asc you're talking about an enzyme a protease is an enzyme that breaks down protein proteases are activated by hydrochloric acid under conditions of low hydrochloric acid hypochlorhydria you're not going to activate your enzymes you're not going to activate your proteases and that means your proteins are not going to get digested completely that's very important because when proteins don't get digested completely that is they don't get broken down into their component of their building block amino acids they'll get semi broken down into something called peptides you all heard of peptides in fact i'm going to do a i'm going to do a live next week or the week after on topical peptides peptides are large amino acids or long chains of amino acids and uh they're shorter than proteins a peptide is a maybe it could be anywhere from like two pep two amino acids to ten amino acids a polypeptide can have like a hundred amino acids so peptides are just chunks of protein and they're made up of amino acids and here's the thing about peptides they're very or they can be very immunoactive so if you're not breaking down your proteins and effectively and you're leaving behind peptides those peptides under certain conditions which i'll talk about in a sec can enter into the bloodstream and activate an immune response and all of this is because you're not breaking down your pep your proteins because you're not making enough you're not activating your enzymes because you're not making enough stomach acid that's the second way that using stomach acid supplements or acidification with apple cider vinegar can be helpful this can also help you with autoimmune diseases because those same peptides that can trigger vasodilation some of the uh the cutaneous manifestations of rosacea can also result in autoimmune problems in the nerves or in the joints or in the connective tissue or in the skin for that matter so acidification of of the stomach with meals is a very important health strategy in general i absolutely love apple cider vinegar bragg's organic apple cider vinegar it's not only it's not just a source of acid acetic acid it's also a source of electrolytes source of b vitamins and you can even use it topically on your skin to exfoliate i'm going to talk about topical strategies for rosacea here in a sec um so acidification of the stomach is another strategy both for taking care of h pylori and also taking care of uh protein digestion and eliminating these the formation of these these active peptides then there's the whole issue of leaky gut now these days nobody who's interested certainly nobody listens to these facebook lives but most people in general have heard of leaky gut when i first started working with leaky gut back in the 1990s i remember there was a chiropractor in boulder and i was writing a prescription for something called an intestinal permeability drink that you would drink and you would measure how much of that fluid got into the stool and by virtue of the difference between what you drank and what was in the stool they would assess whether you had a leaky gut or not and i remember that was first i'd heard of it and i didn't really it didn't really make sense to me i didn't quite understand it but then as i started to study more and more i started to realize that this leaky gut phenomenon is something that is really affecting a lot of people and affecting a lot of people they don't know it now cut to 30 years later today and almost everybody's heard at least of leaky gut syndrome but we still have not made the connection between leaky gut and the skin as evidenced by all the topical strategies that we use to try to take care of skin care problems which really initiate in the digestive system via this leaky gut so real quick because i'm sure most of you guys understand what leaky gut is you got a tube and that's your intestine and then on the other side of the tube is blood right so we'll do the tube this way and then on the other side of the tube is blood and the way food broken down particles of food are supposed to get into the bloodstream through the intestine is uh very tightly controlled the food is supposed to contact cells and then those cells flip over and then they put the food into the and when i say food i'm talking about really nutrients into the bloodstream but when we have leaky gut as the name implies we get leaks and those leaks allow food to enter into the bloodstream willy-nilly without any control especially this can be especially problematic those those food particles or those nutrients are these peptides that we talked about earlier because now you've got the entrance of peptides but it could be a lot of things in fact one of the most important elements that gets into a toxic elements that gets into the bloodstream that causes wreaks havoc causes probably almost all immune reactions in the body uh autoimmune disease type of reactions and inflammatory type of reactions in the body almost all of them have an element of the entrance of these substances which are technically called lps's lps stands for lipo polysaccharide lps lipo means fat polysaccharide means uh sugar or it's a long sugar a complex sugar and these lipopoly saccharides we'll call them lpss that are entering into the bloodstream are also known as endotoxins and don't mean psi toxins obviously means toxins so these lps function as endotoxins and they are a huge huge health problem and i would venture to say everything from parkinson's disease to autoimmunity to cancer all have an element of lps infiltration into the blood and subsequent immune response so these endotoxins the lps's are really parts of your good bacteria or parts of the bacteria that live in the gut they're bacterial remnants and they get inside the bloodstream now once they get into the inside the bloodstream anything's possible including on the skin rosacea eczema psoriasis acne pretty much every single skin condition you can name probably even dry skin and melasma have some element of this lps infiltration this endotoxemia immuno remember means blood in the blood endotoxemia means endotoxins inside the vascular system inside the bloodstream so this is a major major problem and fixing a leaky gut is job number one if you're dealing with any health challenge including rosacea and the reason why this is so important and kind of something you want to pay attention to is because we don't it's not an automatic connection between our skin and our intestine we don't kind of think right away oh i have rosacea i have an intestinal problem it's really important to understand this mechanism if you want to truly address rosacea because there's no way to truly address it topically you can only truly address it via all of addressing all these mechanisms we're talking about here and on top of that once you really understand these mechanisms you can save yourself a lot of headaches down the road health headaches and i'm talking about some serious health challenges that can be associated with this mechanism so how do what how do these does this leaky gut form in the first place well the one of the most important and underappreciated causes of leaky gut in fact one of the most important and underappreciated causes of all disease is our ingestion of crappy fats i'm like crappy fats i'm talking processed fats and fried fats and any really especially fry fats but any highly cooked fat doesn't have to be necessarily fried frying is obviously super highly cooked to fry something you have to leave your your fatty your substance in the fat for long periods of time and at high heat so that's the most egregious culprit is these fried food fried fats deep-fried fats but any really processed fat can cause an inflammatory reaction in the intestine so if you're eating french fries potato chips um deep fried fish right fish at mcdonald's or any kind of deep fried or fried or or heavily processed fat that's heated you are running a major risk for lipopolysaccharides for leaky gut and ultimately for this lipopolysaccharide or lps infiltration i.e endotoxemia lay off the fry fats lay off the processed fats now some people will tell you to lay off any vegetable oils i don't go that far although vegetable isn't a process you want to stay away from but if your vegetable oil is a nutritional oil it's kept in the refrigerator in a dark bottle small amounts are not problematic some people tell you lay off them entirely i say just stay away from the heated and processed kind that's number one then you can use nutrients to protect fats and the most important one is vitamin e vitamin c helps selenium helps something called alpha lipoic acid helps but vitamin e is the superstar of fat protection in fact that's its main role in nature is to in the body is to protect fats in nature in in seeds and that's where it's found mostly is a lot in seeds and grains and nuts and vitamin e and seeds and grains and nuts is there to protect the seed these are all nuts and grains and seeds are all nature's bounty and they're very rich in fats and wherever you find wherever nature puts a lot of fats it'll also put vitamin e because that's vitamins vitamins rolls to protect fat so using vitamin e especially if you're eating a lot of fats and vitamin c and selenium uh and also uh alpha lipoic acid super super important and a very helpful if a little bit expensive nutritional supplement so those are all things you could do to protect fats if you're eating a lot of fats then you can also do things for a leaky gut glutamine is an amino acid and it's like it's like rocket fuel for the cells of your intestine glutamine powder or glutamine capsules that's g-l-u-t-a-m-i-n-e glutamine can be helpful for a lot of things it's really helpful for the immune system it has some blood sugar stabilizing pro properties it's used by bodybuilders in fact it's one of the most important it may be the most abundant i think it's the most abundant amino acid floating around in your blood it's a super super important anabolic well-being defensive amino acid that's extra important for the intestine and any kind of intestinal problems or just if you want to prevent intestinal problems or just if you want to be healthy you want to keep your immune system healthy glutamine is a great supplement to take now there are some physicians and some alternative physicians even who will tell you not to use glutamine i don't buy into that their feeling is that glutamine speeds things up and indeed glutamine is a stimulatory i don't say it's a stimulatory amino acid but it can help your body make stimulatory substances for example glutamate in the brain as an excitatory neurotransmitter i don't i don't totally buy into that glutamine is just so powerful and so important that i think you should be supplementing i personally supplement with five to ten grams of it every day i use a powder glutamine don't buy the capsules or the uh or the tablets they tend to be a little bit more expensive you want to say you want to be more cost effective use the powder put it right in water drink it down doesn't taste like anything i put it in my smoothie and it's just a wonderful nutritional supplement especially for leaky gut either if you have it or if you want to prevent it and then of course staying away from problem foods that's also very important because problem foods can create immune responses in the cells or in the area where the intestinal cells are leading to inflammation leading to a spreading a part of those cells and that's one of the causes of leaky gut of course everybody knows about gluten that's super problematic but there's a lot of other substances in grains and seeds and vegetables that can have this kind of inflammatory response on the uh on the intestinal lining and just because you go gluten-free doesn't mean there's other there's not other compounds in your bread or your flour your beer your your salad whatever it is you're eating they can have that kind of response so gluten-free is not enough although we all know most people know at this point that gluten can create this kind of inflammatory reaction at the level of the intestine now i'm not going to get i don't want to digress too much but i think this is really interesting you have just like you have a barrier to the blood the intestine is a barrier to the blood and that's really what the intestine is it's like a wall that separates the food from the blood you have that same kind of barrier in your brain you have what's called the blood brain barrier and this blood brain barrier keeps stuff in the bloodstream and keeps it from leaking into the brain the only just like the only things that can get into the blood through the intestine are tightly regulated same with the brain when things are floating around in your blood there's there's a kind of a a wall if you will tight cells cells are packed tightly to keep stuff from leaking into the brain from the blood gluten lectins these compounds that are found in vegetables and grains anything that's inflammatory that can cause inflammatory leaky gut or inflammatory related leaky gut can do the same thing in the brain it can cause things like dementia parkinson's disease brain fog all of these kinds of ideas all of these kinds health challenges that are mental and even depression for that matter there's a lot of health challenges in fact i'm not a lot all mental health challenges are now thought to involve some element of inflammation in the brain with the exception of course of you know strictly psychological kinds of issues somebody something happens in your life but even then there's probably some organic and biochemical and biological mechanisms and inflammation is cheap among these mechanisms and this whole leaky gut issue can affect the leaky you have leaky brain syndrome essentially leading to brain inflammation and all kinds of other health challenges that's just a digression i just thought i'd throw that because that's really really helpful marissa says thank you marissa that's that's really cool she says you've helped me tremendously with my eczema years ago never has returned because of your advice it wasn't me marissa it's the biological system all i did was tell you about it you know i don't take credit for any of this everything i'm talking about here and everything i talk about in all our lives and our youtubes these are all biology and biochemistry you cannot dispute what i'm saying here there's no physician or no drug company representative or no standard practitioner medicine they can dispute anything i'm saying here because it's all just biochemistry just biology this is you don't need a study you know i had a guy today asked me where if i had any studies to show something i said studies are silly you don't need studies if you understand biochemistry studies are based on statistics and the science of epidemiology which is barely a science uh and i don't want to get too much into you know digressing here but what i'm trying to say is if you understand biochemistry you can take do a heck of a lot of things without the pharmacomedical model and that's what we're talking about here so i talk about here every week and that's what we're talking about here today is the biochemistry of all this how all this happens and there's no way you can dispute it now back to our story sorry about that digression uh working on a leaky gut so uh glutamine powder eliminating problem foods especially fats uh essential fatty acids uh omega-3 essential fatty acids especially but all of them you guys know i like udo's blend it's a flaxseed oil and flax seed is unbelievably valuable for a lot of things even though it is a seed oil it's incredibly valuable uh nutritional supplements so many so many wonderful reasons why you want to use flax oil it's also anti-inflammatory for the intestine and of course probiotics and they're tricky probiotics are definitely tricky a lot of people say i took probiotics i didn't notice anything i took probiotics my symptoms didn't improve that's because probiotics are tricky to dose with and they're tricky to buy they're tricky to buy because there's all these different formulas and everybody's going to respond to these different formulas differently and they're tricky to dose with because it's hard to know whether you need 10 billion units a day day it's all just experimentation with brand and with dose nonetheless uh the evidence is incontrovertible that you can do dramatic things to heal a leaky gut and to heal digestive health problems even food allergies sometimes and food intolerances sometimes by using probiotics not a day goes by when there's not some study about probiotics in the brain and probiotics and vitamin d and probiotics in the immune system probiotics in the skin and probiotics and cancer and chemotherapy it's just unbelievable the stuff that's coming out about probiotics and i remember when i first started studying probiotics like almost 30 years ago there's hardly any information about these things but again these being a pharmacist has really helped me be ahead of the curve because a lot of the stuff that's mainstream now are things that we learned in pharmacy school and we did learn about gut bacteria in pharmacy school but it didn't really get going until maybe the last 20 years research and company drug companies spending money and nutritional companies spending money on research that didn't really start happening until maybe 2000 the late 1990s so probiotics super important i talked earlier about hydrochloric acid that can help because that activates enzymes by activation of the enzymes all nutrition all uh foods are made more nutritionally available the components in the foods are made more nutritionally available and you can eliminate these toxins these peptides from forming which can be pro-inflammatory so using acidification strategies like apple cider vinegar or hydrochloric acid so you got lots to work with there i'm sure i didn't cover absolutely everything but the main point about it rosacea is that it's not you're not gonna be able to handle it truly topically you gotta go internally now uh as far as uh kendra i'll answer that in a sec as far as topically okay so here's the deal topically with rosacea you cannot really address rosacea topically except by suppressing the immune system pharmacologically and when i say pharmacologically i mean with a drug obviously and the reason you need a drug to suppress the immune system is because the immune system is a good thing we might not like the rosacea we might not like like the inflammation but the immune response is pro-evolutionary it's been selected for we are the ancestors of uh of or we are the descendants of ancestors who had great immune systems whose whose skin uh this whose skin's ability to defend itself to support immunity was was really was top-notch so our just our ancestors were the ones who made it because their immune system was super active and super strong and super powerful it didn't anticipate all the toxicity was gonna have to deal with the year and that's one of the big problems that we have nonetheless to suppress this really powerful biological system and uh process you need drugs to you you have to pharmacological if you really want to suppress the symptoms you gotta have pharmacological intervention that being said there are some nutrients that can strengthen the immune system and sometimes when you strengthen the immune system it's not as jumpy it's better able to handle attacks and assaults and invasions without a full-blown inflammatory response so strengthening the immune system can sometimes help and there's wonderful topical ingredients that will strengthen the immune system of course vitamin c is the ultimate immune booster and you know if you've listened to me talk before you know anything about what i do vitamin c is the king of topical skin ingredients but it has to be fat soluble and fat soluble vitamin c has a wonderful calming effect soothing effect on the skin because it has a an ability to to strengthen and support the immune system so it doesn't have to go into full blown inflammation so topical vitamin c can help also keep in mind that topical vitamin c is not only going to help with the rosacea symptoms the the redness and the blemish formation the healing that takes place post blemish formation vitamin c is also just good for your skin and so taking care of your skin topically should be about more than just addressing the symptoms of rosacea or eczema or any other disease but of taking care of the health of the organ called the skin vitamin c is the single most important daily nutrient your skin can take topically make no mistake about it and if you really want to have healthy beautiful skin you absolutely have to be using fat soluble vitamin c in high concentrations uh on a regular basis like a daily basis or on a multi multiple times a day basis so vitamin c can be very helpful uh topically also this is kind of tricky there are some folks who benefit from things like retinol and salicylic acid retinol i think is actually a pharmacological treatment for rosacea sometimes rosacea is associated with the hyper proliferation of cells that make uh to create a topical situation that looks like acne in fact there's an overlap between rosacea and acne and also sebum production can be associated seborrhea is technically the term uh seborrhea sebum production and blemish formation pimple formation can be associated with rosacea and retinol and salicylic peels can help with those however this is a big however when you have a stimulated a very uh active a dynamic system in the skin salicylic acid retinol can make it more dynamic it can make it be over stimulating so that's why i say you've got to be careful even though both of these are considered to be ways that you can treat both rosacea i'm sorry both rosacea and acne that's salicylic acid and retinol uh and i have seen good results with both so you gotta be but you gotta be a little bit careful um some folks get benefits from vitamin vitamin k plays a role in vasodilation but in k is also a very interesting topical in the sense that it activates proteins in the skin that makes skin cells grow and skin cells divide so topical vitamin k is going to be one of those ingredients that you're going to start to see in the future more and more we use it in our dermal defense serum and there's some very interesting roles that vitamin k can play in calming down vasodilation it's not spectacular especially if you are have all the issues the internal issues the leaky gut and the food allergies etc it's not really going to change your life it's not going to make a super significant difference but it's just a good vitamin that the skin handles very well that has uh broad health giving salubrious uh salute health giving salubrious meaning health giving and beauty benefits that's topical vitamin k uh let's see what else here oh insulin blood sugar elevated insulin elevated blood sugar are both associated with seborrhea as well as with rosacea and a lot of rosacea patients are also dealing with insulin resistance so using insulin resistance strategies can also help uh the b vitamins niacin chromium laying off of sugar more fiber exercise we'll do a talk on blood sugar and insulin here uh in the next few day in the next few weeks because there's so many different things there's also uh testosterone sometimes the testosterone byproduct called dht can accumulate and that can cause a lot of problems oily skin rosacea is associated with dht uh male pattern baldness prostate issues body hair on females can be caused by dht dht inhibition is a pharmacological strategy for helping folks deal with acne and some of you guys know that they'll prescribe something called spironolactone for acne spironolactone has dht inhibiting properties i like using things like zinc in fact zinc is a must-have mineral for the skin nutritional elements for the skin i like zinc picolinate 50 milligrams a day it stabilizes dht keeps it from accumulating it's great for your skin it's a must-have treatment for acne and can also be helpful for rosacea of course essential fatty acids are always important omega-3s particularly for keeping inflammation down and the aforementioned vitamin e can be helpful um let's see what uh pumpkin seed oil and and saw palmetto both have anti-dht properties they may be helpful there's a a fat derivative an omega-6 fat derivative called gla gamma little lenic acid and that one has some nice anti-inflammatory properties that might be helpful too so all that's you know that's a lot of stuff right uh and that's all for dealing with rosacea the good news is if you do it correctly your rosacea will be gone forever forever and uh just like marissa said her eczema was gone forever when you do things correctly when you correct what's going on underneath everything's gone forever all that all your health challenges will be gone forever because you really corrected the problem and there's tons you could do with rosacea so we'll talk about uh we'll talk about um what i say i was going to talk about next time i we're talking about peptides first of all uh and then there was something else that i forgot oh insulin insulin resistance and diabetes we'll talk about that in the coming facebook lives that we do i want to answer a couple questions here that we've got i don't think i have any questions from you guys my 13 viewers here uh let's see okay so i have a whole bunch of questions i've got here uh i'm going to answer a couple of these when to use one percent retinol and when to use five percent retinol one percent retinol is i designed it to be like training wheels so that people can build themselves up to five percent retinol five percent retinol kicks butt it's an amazing way to stimulate uh all the good stuff in the skin from collagen to new cells to moisture factors to hyaluronic acid it's just a wonderful anti-aging uh topical but you have to work yourself up into five percent and the best way to work yourself to five percent is to do one percent and also you can't use your five percent all that regularly you know some people use it every other day i wouldn't use it every day some people use it every other day i personally use mine once a week twice a week kind of thing uh in between doses of your five percent you can use one percent and that will sort of top off your retinol tank without being too aggressive you always want to make sure you have rest periods between big doses of retinol and a one percent in between your five percent doses isn't necessarily going to throw off your rest period also the one percent can be dabbed on more frequently into onto dark spots you could do it twice a twice a day even the one percent you could even do with the five percent but you don't have to be as careful with the one percent so one percent can be dabbed on one percent as training wheels and one percent can be used to kind of top off your tank in the middle of doses but five percent is definitely the way to go if you can handle five percent also if you can't handle five percent uh most people can handle one percent remember retinol is 100 times weaker than retinoic acid the standard dose of retin-a retinoic acid that you get at the dermatologist's office is point zero five percent retinol five percent has that kind of potency point one point zero one percent is what they'll give you retin-a or retinoic acid if you have really sensitive skin or your tender skin thin skin something like that retinol one percent is the equivalent in retinoid power of a retinol retinoic acid point zero one percent remember with our true retinol gels not only you get the same potency as you do with the drug the drug version the retinoic acid but you also get 25 percent fat soluble vitamin c and they work together perfectly all right so let's see uh sometimes some gal wanted to know about retinol melting in the heat and that does happen retinol will melt in the heat or retinol gel i should say will melt in the heat uh stick in the fridge it'll be just as good and you'll see it's just as good just stick in the fridge takes about an hour hour and a half i didn't put any emulsifiers in there i didn't put anything that holds the thing together because i didn't want to have to i don't want a complex product you know that's the whole the whole my whole fat formulating philosophy of truth is i don't like complexity in formulation you look at formulations the standard formulations are incredibly complicated incredibly complex recipes or concoctions they have all kinds of binders and fillers and and liquefiers and solvents and i don't i don't like working with those i don't think you should have to pay for those they don't do anything for your skin so consequently retinol which only has like four ingredients in it it melts in the heat so stick in the fridge an hour later two hours later it's just just as good as new you can even keep it in the fridge if you like uh and then let's see oh this is cute why does my omega look this way omega-6 healing cream is my of all the products i've ever formulated that's my favorite product it is the most multifunctional product it's the best moisturizer you'll ever use the healing properties that stuff are mind blowing and just go on truthreview.com and check out the the reviews on omega-6 healing paint it's really is mind-blowing however it's a bizarre product it's hard to make uh it's just weird and it's idiosyncratic it's there's a reason why there's nothing like that on the market it's just a bizarre weird strange formulation one of the things that happens when we're making it is the way it settles holes develop in the surface and it has to do with the chemistry of some of the ingredients but it's still it looks even though the each jar looks unique like a snowflake like us like all people are unique all jars of omega-6 healing cream are unique it's the most kick-butt topical moisturizer healing product you'll ever use from everything from from cuts on your forehead to diabetic dry heels and feet and everything in between and anywhere in between lips and sunburn and babies diaper rashes all kinds of stuff that you could you could do with omega-6 healing cream so it looks that way because it's just a weird product it's very it is idiosyncratic got a few more of those but we'll say those for another day and see if you guys any questions here dana says she loves her omega-6 doug says how do i feel about powder probiotics versus kefir kefir makes me sick well you know if kefir makes you sick that you know there's bacteria in there and that's it's an active food kefir is an active food all these foods that have bacteria in them are active foods so anytime you have an active food you can do things in the digestive system because you've got a lot of activity in the digestive system you can disturb bacteria for example or if you sometimes digest a stomach issue you're not making enough digestive juices for example you may be irritating something with the acids from the kefir so i can't really explain why that is but if it makes you sick then i would avoid it uh you don't need to have kefir how do you feel about powdered probiotics you know powder probe i don't know a lot about powder probiotics but if you're powering a probiotic that tells me it's going through some processing i would want to see if uh i want to check to be sure that in the processing i still have my live bacteria and that's just my thinking about it uh pot pat isn't it pat says awesome all the things you can do about with the omega-6 healing cream that's what i love about it you could do so many things with it from just being a plain old moisturizer to healing burns in fact i formulated it as a burn cream that's that's uh there's a really interesting story behind that that i won't bore you with here because we've got so long on this um let's see doug says sauerkraut's great fermented vegetables are really great because not only do you get the bacteria but you get the fiber and the enzymes and the acids that are produced by the bacteria break up the the uh the uh veggie nutrients or break up the fibers and release the nutrients so the nutrients are more accessible number one you get acids from your for your digestive system number two you get fiber number three and get probiotics number four and that's with fermented cabbage if you're making sauerkraut fermented beets fermented cucumbers there's a great book called the art of fermentation i highly encourage anybody who even likes to cook a little bit it's very easy to ferment stuff but this book the art of fermentation has great recipes and you don't need to be a great chef but it has great recipes and it also explains fermentation and the importance of fermented vegetables they're just unbelievably valuable you know fermented dairy is okay too but fermented veggies really are the way to go in my opinion wellness against all the odds sherry rogers great thank you robert i i haven't heard that book i've heard i've been reading tired not toxic or toxic not tired for many years uh she's i've been reading toxic not tired by dr sherry rogers probably since the 80s or certainly since the early 90s and i i dig into it all the time unfortunately she doesn't have an index in the book so you got to kind of read through it it's really difficult to find things once you once you read through it the first time you might want to highlight and use use markers because she doesn't index anything doug says is fast and good yes fasting is the point good uh wellness against the odd robert you're awesome robert knows his stuff folks let's see ph strips rob did you call me yes somebody called me the radio show talked about ph strips i wonder if that was you uh let's see yes that was you uh eat greens greens greens greens are amazing yes sir greens are great source of omega fats you wouldn't think that right because it doesn't look fatty but greens are one of nature's best source of sources of omega fats and also greens are great sources of calcium which is another really interesting mineral that people don't understand and it is very very very uh not rated i was going to say overrated but i don't say overrated that's really important but not rated correctly we'll say it's not overrate though it's super important all right that's it i think that's all you guys i always go longer than i want but uh thank you so much for you guys support and i appreciate all of you happy holidays uh we've this will be up on facebook live we'll put this on our facebook page and this will also go on our youtube uh youtube channel and that's it have a awesome beautiful day bye for now
Gut Microbiome Explained- SIBO, Leaky Gut, and IBS #podcast_en (auto-generated)
hello and welcome to friendly pharmacy preet kangura dr prix kangura is a naturopathic physician who practices in victoria british columbia canada at juniper family health clinic his clinical focus is heavily fixated on gastrointestinal and autoimmune conditions dr kangura has become a fixture in the world of sibo diagnosis treatment prevention and education he is also a co-founder and co-owner of sibo diagnostics which is canada's leading sibo and ibs testing laboratory dr kangura has pioneered treatment and prevention protocols for sibo and strives to share his knowledge with other doctors by providing complementary consultations for doctors using sibo diagnostics laboratory as well as his in-depth physician-directed continuing education courses dr kangura obtained his bachelor of science in physics from the university of victoria and his doctor of naturopathic medicine from the boucher institute of naturopathic medicine dr kangara thank you so much for coming on the channel today my pleasure if we could just start out if you could tell us a little bit about your practice i know that a lot of your practice involves gut health and also addressing autoimmune issues so as a naturopath how did you get into this side of of your work and what is your day-to-day look like right now right when it comes to us naturopathic doctors one thing that maybe i'll clear up right from the get-go is because uh different people from different parts of the world will be watching this and a naturopathic doctor kind of means something different depending on where we practice and yeah here here in bc we are fully regulated and we are considered uh primary care physicians just like your gp family doctor is in the sense of um you know we're able to uh do diagnosis we're able to send you to the lab for testing we can prescribe pharmaceutical medications here uh for the most part just the same as your family doctor but of course on top of that we have our naturopathic tools of our trade and that would be herbal medications clinical nutrition and other modalities such as acupuncture even intravenous therapies for certain conditions and so here in bc where i practice i'm able to use all these different tools in my practice and that's the way i look at medicine is very integratively so not this medicine versus this medicine but putting it all together and this in my opinion works great when it comes to gastrointestinal health and autoimmune conditions because there really isn't just one way to go about it um there are multiple ways to come at these uh conditions and illnesses and so to answer the other question about how i kind of got into those niches in my practice um you know i always kind of uh you know give my wife credit for even getting into naturopathic medicine but really actually make my mind always focus on the gut because back when we were dating many many years ago and early 20s she felt very ill with her gastrointestinal system and she was not getting answers from her family doctor going to the er multiple times with significant abdominal pains and everything came back normal so no one really thought anything was wrong and then under the recommendation one of my close friends mothers recommended you know what go take her to see a naturopathic doctor it really helped her daughter you never know and so she did see a naturopathic doctor here in town of victoria and within six months her life was back and early 20s and she was losing her hair joint pains and got digestive symptoms and so it was very worrisome and through looking at the gut specifically and repairing what was happening at that time for her really turned her life around and so some years later when i graduated university was originally going to go into i have a bachelor's in physics i was originally going to do a master's in um medical physics and so like radiation treatments and things like that that was my my kind of my goal but by the time i finished and i saw what happened with my life i really started looking into naturopathic medicine and the schooling for that because of what i've seen with my own two eyes and so that's how i got into naturopathic medical school and then i always focused on the gut because once again that experience and so as soon as i started practice that's where my main focus was and like any any doctor that has a niche where you put your energy towards that's where you're going to do best that's why we call it practice we practice over and over and so gastrointestinal disorders became my bit my big big focus and then autoimmunity which doesn't always have a connection with the gi tract many times does and so that's kind of how that branched out into that oh that's a really interesting story and i can see why you're so passionate about this especially if it came from you know something that your wife originally suffered with and so you you saw this firsthand how it really can affect someone i know that i've seen a lot of patients who have many different kinds of gut issues in general and there's a lot of information and you know research coming out right now about the gut and there's a lot of talk about the microbiome and the floor of the gut and i feel like we're just starting to understand a little bit of how how important this is could you just educate us a little bit the microbiome what does that even mean and where does this bacteria reside in our gut right very good questions because some people here microbiome they have their own idea really what that is and depending who's saying it it really you know might have a different definition but in general when i say the microbiome we're talking about our bacterial communities in our intestinal tract um now of course we don't just have bacteria energy track we can have you know normal levels of certain you know yeast species like candida now when that gets a little bit out of balance that becomes a problem but generally it's bacteria many different species a different bacteria but when it comes to our microbiome communities one thing that a lot of us don't think about is where are they supposed to reside not just what type of bacteria they are of course we want as many beneficial bacteria as possible and what makes some bacteria beneficial is that some bacteria like lactobacillus species bifida species meterococcus species just an example they have a lot of anti-inflammatory effects for our colon they ward off dysbiotic aka you know in a sense bad bacteria and bad yeast from overgrowing they're kind of our first line of defense against these things and so they're beneficial for a few different reasons and some bacteria produce certain micronutrients in our gut as well certain b vitamins and vitamin k and things such as that so that's what makes some bacteria good for us but they it's also very important to know where they're supposed to reside and when it comes to our microbiome we should have at least about 99 of our microbiome living in our colon aka the large intestine okay the small the small intestines which is where we do pretty much all of our digestion and most of our absorption of nutrients and medications and you know a little bit of water absorption there as well we are supposed to have a very minute amount of bacteria even good guys living in the small intestines you know one percent or less and as we talked today about certain things i can have an expertise in uh for very good reason we don't want a lot of bacteria there even if they're beneficial and i see firsthand quite often you know how obvious it is that we need to maintain this balance and a prime example would be someone who's on antibiotics especially women and they suffer from a yeast infection we almost warn them right when we're giving them the antibiotics listen you should be taking a probiotic or you know if you come come down with these signs or symptoms this is something to watch out for and it can it can really affect a person within a matter of days and so there's the use of antibiotics that i know that can affect our our gut but has our western diet or lifestyle choices affected our gut adversely or what do you see in practice because i really feel like a lot of people are dealing with gut issues and it seems like it's almost increasingly so yeah it is and i think a lot of it stems from potentially a lot of the typical western diet so if we focus on that here first now i will say in the last you know 10 maybe even 20 years especially the last 10 15 years there has been a big shift in you know in mainstream uh living to eat healthier and if you look back at the 90s or 80s no i was born in the very early 80s like that really wasn't the big thing like it was very niche to see a health food store talk about fiber intake and things like that it was all you know white flowers and you know easy snacks for kids they can microwave and all those things and in the most recent years right and things are better and the fiber aspect for example fiber feeds bacteria now we want the fiber to feed or beneficial bacteria but unfortunately even dysbiotic bacteria that live in the human gut will feed on fiber too so sometimes we're not feeding the right guys all the time but essentially the western diet probably for the most part at least i can speak for canada you know probably has more fiber in the diet even for younger people than it did let's say 20 years ago so i think from that stance things are probably getting a little bit better however not everyone eats that way not everyone focuses on that you know but especially when i see my practices a lot of my patients i have that had chronic digestive issues most of them were you know born in the 80s 70s maybe growing up and for early adulthood their diet wasn't really focused on healthy foods and so i think from a western standpoint um there probably was some detriment and maybe definitely still today i mean you know like you know there's fast food everywhere and you know skip the dishes and all these apps it's just so much easier to get this stuff and it's not going to be that conducive to great microbiome but the other thing we have to think about too is and you know i was one of these children growing up in the 80s i had antibiotics all the time all the time growing up and so many of my patients around my age same story and and for me it was for good reason i used to always have um significant tonsillitis and that caused actual breathing issues and things like that but also because of that back then and less was really known about the detriment of antibiotics that aren't needed i was given antibodies anytime i had the first son of a cold you know and my parents were worried because i had this issues with breathing with my tonsils would enlarge and so i definitely got a lot of unneeded antibiotics and that does a you know that causes a big shift in the microbiome because of course antibiotics are needed for certain infections but if you take too much or certain types you're going to wipe out some good beneficial bacteria in the colon and that's going to allow potentially dysbiotic bacteria to overgrow or even yeast and things such as that and that especially if as a child where you're you're building your microbiome the diversity that can really alter it for you know going into adulthood and i know there's a lot of work that's been done on um the use of antimicrobials and only to use them when needed but but yeah i i can definitely empathize with with your experience growing up in the 80s as well you mentioned something there dysbiotic bacteria so i know that in some of your practice you you do see something called dysbiosis can you explain to us what is dysbiosis and what what is dysbiotic bacteria yeah so kind of maybe two different things depending exactly what you're talking about this is a good distinction to make so dysbiotic bacteria can be looked at as bacteria you know bad bacteria bacteria that's not great for our health not just intestinal health there's some dysbiotic bacteria that have been correlated with developing certain autoimmune conditions if you harbor them in the gut for an extended period of time at high growth levels so these would be bacteria that can cause you know inflammation of the intestinal tract they can create an increase in inflammatory cytokines not just in the gut but systemically create autoimmune cross reactions to occur one good example that i look out for in patients that have rheumatoid arthritis which is an autoimmune arthritis is that in this research dates back decades now that um many people rheumatoid arthritis they found had a high level of proteus species of bacteria living in their gut proteus when growing out of control high amounts in the gut can cause gastrointestinal inflammation diarrhea excessive gas abdominal pains but what seems to happen in some patients is that the systemic immune system will start to react to the proteus that is in the gi tract and cross-react and actually uh create um rheumatoid factor antibodies by accident not just not just the proteus antibodies and so in some rheumatoid arthritis patients there may be a connection with a certain disc by autobacteria living in their gi tract now that's not the truth for every ra patient of course but there is a potential there so that's just one simple example of how the gut can affect um our immune system and uh how it can affect inflammation systemically so that would be like a dysbiotic bacteria now a dysbiosis when i use that term in practice it could mean too much of that bacteria living in the colon because that would be an imbalance and so that's why i look at the term dysbiosis an imbalance in our gut microbiome so that could be too much of a bad guy living in the colon or it could be and this is what i do a ton in practice a dysbiosis that is called small intestinal bacterial overgrowth or s-i-b-o for short sibo that is the dysbiosis in the sense of too many gut bacteria are being allowed to pool and live in the small intestine so a little bit more than that one percent that should be there ends up remaining there and it could even be good guys so in that sense it's not always dysbiotic or bad bacteria overgrowing in the wrong place a lot of times there's actually too many good bacteria living in the small intestines but as we'll get into it that can lead to a lot of chronic digestive issues and you mentioned excuse me you mentioned sibo there and i know that you have a laboratory that uh diagnoses sibo right i think it's called sibo diagnostics and uh can you explain it explain to us a little bit about uh how you how you diagnose sibo through this this laboratory right so uh ac so maybe i'll say a little bit more about sibo then this will make more sense so with sibo small intestinal bacterial overgrowth it's kind of right in the name it's bacterial overgrowth in the small intestines and like i just mentioned it could be too many good bacteria with commensal bacteria or it might even be some bad dysbiotic bacteria overgrowing along with some good bacteria but this is a problem because when we have and this is one reason why we're not supposed to have any bacteria or small intestines is that bacteria are gas producers so when you know a person is very flatulent passing a lot of gas that's actually our gut bacteria producing that gas not so much us at all and burping and belting is usually back bacterial fermentation uh coming up now sometimes carbonation and things like that we um you know will burp up but a lot of times it's bacterial fermentation most of the time it is and so our small intestines are not supposed to have a very heavy count a colony count of bacteria because they're they're called small not because they're short in length but because of a very small diameter and they don't have space for bacterial gases our large intestine which is actually much shorter than our small intestines when we stretch them out has a very large diameter so it has a housing unit for all those bacterial gases that can occur so our small intestines don't so if we develop sibo what ends up happening is the food we eat if it contains bacteria food which is fiber and certain fermentable sugars the sibo will feed on those constituents at an extensive rate in our small intestines and fill up our small intestines with their gases either hydrogen gas methane gas or hydrogen sulfide gas or maybe all three or two of the three and this causes our small intestines to balloon out they have to expand out to fill up with these gases and this is what uh while and so this is what causes the abdominal distension and bloating seen in a lot of ibs patients and of course this is either going to stay as trapped gas maybe cause gas pains or it's going to release easily and they're going to get a lot of belching or flatulence or both it can cause heartburn um it can even some simple cases lead to nausea and it can alter bowel movements diarrhea constipation depending on the the type of sibo that's growing and the type is based on the gas and so one thing i should mention which i forgot to do a few minutes ago is sibo is one of the most common causes behind ibs and ibs for people that don't know stands for irritable bowel syndrome and really what it is is a label to describe your symptoms but there has to be a root cause and sibo's not always the root cause but it is one of the most common causes behind ibs because of this mechanism of bacterial fermentation that i just spoke about now there are certain definitions of what ibs is like rom-4 criteria and things like that but that's also not a great way to look at a lot of doctors they've done surveys don't use the wrong criteria because it doesn't actually have all of the digestive symptoms included in it so the term ibs gets thrown out a lot but sibo's one of those common causes of it so what our lab does is to diagnose sibo it's actually a breath test and there's a couple different breath tests we offer we offer the standard three hour lactulose quintron test and now the brand new two hour trio smart lactolouse breath test which has been in the united states for the last year and a half and we finally have it available here wow both right and so the quintron test the one's been around for quite a bit continues for two of the three forms of sibo intestinal hydrogen and methane producing sibo and the new one trio smart can actually test the third gas hydrogen sulfide as well which the quintron cannot and that one can that test is complete you can test hydrogen methane and hydrogen sulfide sibo there is a pretty big diff price difference between the two tests unfortunately so not everyone can afford the new test but um you know when i educate doctors on my courses and everything i teach how to assess for hydrogen self-plexible if you can't do the expensive test there are hallmarks to load for in the patient case but essentially uh we provide these these breath tests to doctors across canada uh to give to the patients to test for the two different forms sorry potentially three different forms of sibo and we're also the only canadian lab provider of the test called ibs smart it's a blood test and this test this gets into deeper why we develop sibo um but this uh this test can uh determine if you develop placebo and ibs because of an autoimmune cross reaction that happened after a case of food poisoning wow okay um and so i want to make the point that we are not diagnosing anyone here and if you're listening to this and you think that you might have sibo then that's fine but you should seek out some some medical advice for that but i did want to i did want to ask you are there any red flags or classic symptoms i know you mentioned flatulence bloating that a person could have sibo or even experiences they might have had like i think maybe gi upset or something like that that can leave people more predisposed to to this right so they answer that question first the number one reason why most of us develop sibo is just one case the food poisoning or traveler's diarrhea which are both the same thing we just give them a different label but it's bacterial gastroenteritis bacterial infection of the gi tract you know potentially salmonella or campylobacter junior or you know the food poisoning e coli something like that and this is what the ibs smart blood test can make the connection with but i won't get into great detail here about it but essentially um about one in nine of us when we get a case of food poisoning will develop ibs within three to six months afterwards and these studies have been around for quite some time and the mayo clinic finally just kind of you know did a meta-analysis of all of them and they found yeah it's about one because some showed one in five some show about one in ten it sounds like concession consensus is about one in nine and we pretty much know why that is about one in nine of us will have an autoimmune cross reaction that occurs in our gi tract that damages a mechanism in our gi tract called the migrating motor complex and that mechanism is essentially how we do not develop sibo it prevents sibo and when it becomes damaged and weakened we have a much higher chance of developing sibo so just because someone's had food poisoning travels diarrhea the higher chances is not going to happen but about one and nine depending what study even one in five this may happen they may develop sibo so someone with the case of food poisoning travels diarrhea it potentially could lead to this but there's other causes of developing sibo but then hallmark signs and symptoms are a lot of the digestive symptoms i've already mentioned such as abdominal bloating after eating potentially abdominal pain but also excessive gas or trapped gas and potentially diarrhea and or constipation in some cases even nausea and heartburn and things like that so kind of the prototypical you know ibs or what we think of as ibs symptoms but another key hallmark is and it sounds funny but i'll explain in a second the healthier we eat the more symptoms we get that is a hallmark of sibo because the healthier we eat typically means eating more healthy fibrous veggies fibrous nuts and seeds and beans fibrous fruits fibrous grains so white flour grains and this the reason why this uh this there's this connection with eating healthy and having more of those ibs symptoms and sibo patients is because when you eat healthy you're eating more of the bacteria food which is the fiber so if you have this overgrowth in small intestines you're actually feeding the overgrowth more of its food and it's filling up your intestines with more of their gases okay so if say someone has a severe case of traveler's diarrhea is there anything they can do to avoid sibo yeah so one thing that you can do to well not so much you can do to prevent so if or just manage it better to manage it right so the biggest thing is knowing this connection because if you're one of those patients where the autoimmune cross reaction um occurs where you produce an antibody called antivinculin if that if you're one of those 199 people that damage and that autoimmune damage to your migraine motor complex is going to happen very soon after the food poisoning travels diabetes you can't really stop it from happening but if you know this information now going forward you can then do some preventative or i shouldn't say preventative um early steps into you know getting this dealt with in case you are one of those patients and you might develop sibo because so many of my patients when i do speak with them they've had their digestive symptoms from their sibo for 20 30 years and they've always just been told it's ibs and they have to deal with it there's ups and downs or just gets worse over time and for some of those patients it actually was due to sibo and if you treat sibo you can see that ibs picture go away so if that type of patient or even if they've had it for five years knew about this potential connection much earlier in the game they could have had that diagnosis much earlier which means it's always easier to treat early on than it is 10 20 30 years later so the biggest thing would be knowing that connection and if you do start to develop chronic ibs symptoms at the first sign of those daily chronic symptoms to go get assessed by someone that you know maybe treat sibo knows about it that'd be my biggest advice i mean if those symptoms don't arise then you're likely okay no that's really that's really good sometimes the practical things that we can just watch for and and know where to look right if they if they do happen um another interesting thing i was listening to one of your talks recently and you mentioned a link between rosacea and sibo could you tell us a little bit about that that was the first i'd heard about about that possible connection right so especially in naturopathic medicine we do you know uh look at the connections between the skin and the gut very much not just rosacea but things like eczema and psoriasis and even you know cystic acne and things like that potentially as a connection to the gut but rosacea and sibo have a very big connection um there have been studies that showing that there is quite a high percentage of rosacea patients that have sibo upon testing compared to non-rosacea patients so that's where it all started um and it's uh it's something i do see in practice quite often patients with rosacea do have a much higher chance of having chronic ibs symptoms and potentially do with sibo and and for people who don't know what rosacea is it's an inflammatory skin condition usually affects the face of the cheeks and bridge of the nose sometimes forehead sometimes the eyes are the way the eyes can go red but usually it's the cheeks that are very inflamed sometimes itchy sometimes burning sometimes it can affect the chest as well and a lot of the patients of rosacea do feel like there's a connection with their gut because though certain days they'll eat something it's very soon after eating they feel like the rosacea may flare but it's really hard for them to pinpoint exactly what's doing it and the reason why sibo is the the theory on why sibo uh may lead to rosacea because we see the correlation but nothing's been proven on the causation of why sibo leads to it the theory is that it's connected through intestinal permeability aka leaky gut syndrome and leaky gut syndrome that term is thrown out there a lot and sibo is a one of the primary causes of potentially developing intestinal permeability of the small intestines because this dysbiosis sibo that's in small intestines is not supposed to be there and the gut's immune system and systemic immune system will try to react to the bacteria that shouldn't be there and this can lead to changes in the intestinal lining that can allow intestinal permeability to occur from a few different mechanisms one of them from zonulin potentially increasing but there's a few mechanisms and when we develop intestinal permeability leaky gut um at the microscopic level certain things we're going to start to absorb that we shouldn't and certain proteins before they're broken down to amino acids may start to absorb still as polypeptides and this can create an immune response to things that are leaking through so one theory is that rosacea being inflammatory response is actually a potential uh immune system inflammatory response that's showing up as rosacea in patients with intestinal permeability that may be stemming from sibo and so is there evidence that treating someone for sibo can possibly in some cases improve rosacea there's some small evidence they haven't done any large studies on tree and sibo will rosacea improve there is one or two small studies that did show some good changes and some good benefits to rosacea patients so but it's not large enough um to hang her hat on so clinically anecdotally i i do see my practice i'd say about try to give a number roughly about fifty percent of my rosacea and sibo so patients have both conditions sibo and rosacea about 50 percent of them their rosacea will start to improve as we get rid of the sibo and digestion improves some patients this minor improvements in rosacea some patients are significant or anywhere in between then about 25 percent of my patients their digestion gets better first and then in the next three to six months the rosacea starts to improve as probably the gut starts to have the ability to heal again um and once again minor improvements to significant and then i say about a quarter of my rotation sibo patients we can if we do deal with the gi tract and digestion improves the rosacea does not tend to improve as time goes by so in those cases maybe there's still connection the gut just didn't heal well enough or maybe in that case there was no connection that's very interesting and uh what about anemia do you do you see uh how does how does the interplay between the gut and anemia this is a big one um because it gets overlooked as a cause of chronic anemia iron deficiency and sometimes it's not just full-blown anemia it could just be you know very low ferritin but hemoglobin's still okay and then rbc is okay but sibo can be a cause of iron deficiency or make iron deficiency worse and the reason being is that bacteria use iron for their own vitamin c just like we do and if you now have bacteria overgrowing in your small intestines where you're supposed to absorb your iron from this bacteria can now use a lot of iron that's coming in through your food or supplementation before you have a chance to absorb it so you think you're getting certain levels of iron through eating certain foods or taking your iron supplement but the sibo the bacteria may be using some of that iron and not allowing you to absorb it like you normally would and this can actually lead to anemia in some patients or it can make it worse faster and so there is definitely connection between sibo and potentially iron deficiency and also sibo and b12 deficiency because bacteria also be used b12 and um and so they can also use some b12 that comes in through the oil route um before you have a chance to absorb it and so many people do suffer from anemia and sometimes we know why and it's good to investigate why but sometimes there's really no reason and i see especially a lot of women who suffer and also it's true people can take supplements for quite some time and not not see very much of a response so i guess that would a red flag if you're taking iron and it's you're not seeing any improvement it's good to look further into into what could be the cause especially if that patient also has chronic digestive issues because then if they're okay there's more reason to think something at the gut level maybe has something to do with the iron malabsorption uh and it's not just sibo celiac disease you know very significant artificially occur because of the flattening of the villi in small intestines so for a different reason but even if it's not celiac because that's one thing a lot of doctors will rule out someone's unexplained iron deficiency is those testosterone celiac and then they test that and it's like okay patients want celiac and then they kind of stop looking at the gut but if those digestive symptoms are there definitely um you want to look at things potentially as see such a sibo for you know unresolving anemia and something else i wanted to ask you about was the subject of biofilms so i've heard of biofilms before uh when we talk about like a medical prosthetic and then a biofilm developing over that and then that being treated uh maybe with antibiotics but i know and i've read that there is more information coming out about biofilms in our in our gut and bacteria forming these biofilms so could you could you tell us a little about a bit about what is a biofilm how does this form i i heard that you need more than one type of bacteria for a biofilm or something um right and how can how can this affect uh treatment right so bacterial biofilm production is probably the biggest roadblock behind successful sibo treatments and can even be a roadblock behind uh treating infections like actual and that's one thing i should maybe clear up too because people here bacteria in sibo sibo's not an infection it's more of an imbalance a dysbiosis now you can you still use antimicrobials and potentially antibiotics get rid of it but it's not an infection but even chronic infections can be held back from resolving if there's a biofilm being produced by the bacterial colonies but biofilm is is just natural it's a natural thing that bacteria do when they cohabitate so you mentioned that you need more one bacteria and that's true but and so that's why some infections biofilm is not a big problem because it might just be a single bacteria causing that infection but when it comes to the gut and sibo when someone develops sibo it is never just one species of bacteria overgrowing it's always multiple species so biofilm will be produced they cohabitate and they start to produce this this microscopic film that is held together by metalloid links which are metal-like constituents and it holds the biofilm together and they produce this to adhere their colonies to a surface so potentially you know for example intestinal lining and then it's to protect themselves from the environment your guts immune system or antimicrobials antibiotics and also if you you know if you google image back to above and you see these kind of little animations where they show the biofilm build up and then the biofilm kind of disperses out so the colony can go attached somewhere else and so it's a way to propagate their communities and so maybe throughout the small intestinal tract in the sibo case and so it can inhibit treatments from working well because what happens is if someone has biofilm being produced in their intestinal tract and you're you know and they have sibo and you give the patient antimicrobials some of the bacteria is going to come out of the biofilm to feed when that patient feeds so only some of the sibo is going to be exposed to the antimicrobial but the rest will not be and so you need something that can open up the biofilm you know biofilm destructors and things like that now not all simple cases need anything significant like that some need significant biofilm disruption for the treatment to work um now a good example of everyday biofilm too because a lot of this does sound kind of strange to people but when you think about this way it's like oh yeah that makes sense is that if you don't brush your teeth for 24 hours you get that film on your teeth right and that's back that's bacterial biofilm we call it plaque but it is bacterial biofilm production it does not take long for you to feel it after stopping uh the brushing of your teeth so you can see how quick it forms and so just imagine the gut where it continues to build and build as the colonies build and grow and we're not actively brushing that biofilm off in the gut and so it's something that uh is very important not just with sibo cases but even other you know other type of infections but it's something that uh definitely needs to be focused on and one reason why a lot of people their sibo is tough to treat or is not resolving when it could be if that's being dealt with okay i should have warned you all to take notes because dr kangaroo is full of so much information right i i sometimes can't stop myself no it's excellent it's excellent it's really good information you mentioned earlier zonulin and i did want to touch on that uh could you tell us i know zonulin is something a lot of people are talking about right now what is zonulin what is the the role of zonulin in in the picture of our of our gut here right so zonulin is a inflammatory kind of modulator of the gut and essentially what it is is it's a gatekeeper molecule for the intestinal lining so our intestinal line is very thin at the microscopic level but it's held together each intestinal cell very tightly by tight junctions that would be right here holding those intestinal cells together and when our intestinal tract or small intestinal tract is nice and healthy and those tight junctions are nice and tight only things that are supposed to absorb into our bloodstream will like protein broken down to amino acids those amino acids now can absorb for example so zonulin if it's increased what happens is that tells us tight junctions to open up and it's like a door that opens so it's not so much the intestinal tract kind of like you know actually opening up like this yeah um becoming like porous you know and if we visualize visualize that it's more like a little door that just kind of opens and when it opens what happens is things can leak through into our systemic um system and so that's where uh you know undigested proteins can leak through certain toxic waste from bacteria whatever it is or certain things we're eating that normally wouldn't leak through would leak through and this is intestinal permeability so zonulin increasing is a very common cause of leaky gut syndrome in celiac patients zonulin is shown to be extremely high and so that's one reason why celiac patients want before they realize their celiac under eating gluten have very inflamed intestinal tracts very in sometimes very serious uh you know skin conditions they're linked to um celiac disease because of the significant leaky gut because zonulin is very high in celiac patients um when you take the gluten out the design will come down and the gut can hopefully heal but even things like dysbiosis like sibo or you know fungal growth and things like that can increase zonula not the same level of celiac but it can do it and it can start to open up those tight junctions and you start to get you know leaky gut syndrome and the one reason why this our bodies does this like why would our body do this like why do we produce zonulin like if it just hurts us um the biggest reason is that the body thinks it needs to send troops systemic immune system cells into the gut so it starts to open up the tight junctions to send like white blood cells in and that could be because sibo's there and the back the gut's immune system is not dealing with it so it's starting to increase zonulin to try to get the systemic immune system components there in celiac disease it's a big part of the autoimmune response that happens in the presence of gluten the body uh thinks it needs to go and kill gluten right away in that gut because of an autoimmune reaction to it um and so that's why zion was very much increased there so it's it's kind of a it's a uh in a sense uh poor decision by the body to do it um but that that's why it happens in some people very interesting and i also want to ask you about stomach acid so i know that there are so many people that are prescribed acid reducers and sometimes long term and this can be for good reason this can be for all sorts of different different issues but the stomach acid stomach acid is very important for digestion and so my concern is maybe the overprescribing of these medications but don't make any changes to your medications i just wanted to know from your standpoint what do you see in your patients as to people who might have low stomach acid and have had stomach acid for quite a while could this leave them predisposed to intestinal issues right so low stomach acid definitely can lead to some just direct digestive issues especially with proteins so most of our food is broken down in our small intestines by enzymes that are released by the pancreas including proteins but the first step to protein digestion happens in stomach acid so we need sufficient amount of stomach acid to unfold protein at the microscopic level one time therefore when it enters the small intestines it'll be broken down properly so a lot of patients with low stomach acid they'll notice that eating heavy amounts of protein causes the issue or causing digestive issues and that could be potentially one sign of it and then also you may not break down your protein properly then and you know and maybe not get the amount of amino acids or protein you think you're getting and so just from a protein digestion standpoint it can be an issue but for many people what chronically low stomach acid can lead to is actually um you know acid reflux and heartburn gerd in general a lot of people heard this like you know low stomach acid can lead to heartburn but it doesn't make sense right in some people's minds because low stomach acid but harper makes no sense um well one reason um you know why people believe that low stomach acid can lead to chronic heartburn in the need of things like ppi medications or over-the-counter antacids is because when stomach acid becomes too low when someone eats the stomach acid rises but it never rises now to the threshold to tell the lower esophageal sphincter to close properly and that sphincter is supposed to close to protect our esophagus from acid and so if it never reaches that threshold then it doesn't close well or does it stay closed very well and so as the stomach starts to churn even though there's lower stomach acid the acid can start to actually still come up and so you can actually develop chronic um you know gerd and reflux and so that's one detriment long term and then of course all those patients end up going on ppis and antacids because you've got to protect the esophagus there's a time and place for doing this and so it definitely makes sense but there are there are a couple of things um that can actually help restrengthen that lower sufficient sphincter because it becomes weak over time as well so when the stomach acid stays low long-term that sphincter stops getting exercise of opening and closing so when stomach acid does get really high and it does reach the threshold it still doesn't close well a lot of people so they really need to stay on antacids but there are a couple things that have been proven to help re-strengthen less so that's what i typically do in practice is work on that as opposed to just suppressing acid forever time and place for that though but once we get that leds hopefully we're getting better we can hopefully maybe then be the patient off the antacids if possible um but now when it comes to sibo a lot of people read about although stomach acid can lead to sibo because it's more bacteria than supervised like bacteria goes with an oral leak and that's what i was wondering about yeah yeah and now the thing with that is it's never going to be the number one cause of cbo because if even if too much bacteria irregular bacteria gets into the small intestines if that patient's migrating motor complex that thing i mentioned a few minutes ago they can get damaged from food poisoning that's the sweeping action for small intestines that kicks in every three hours it sweeps excess bacteria out of our small intestines into a large intestine every three hours so even if extra bacteria get in or we take probiotics that are a bunch of extra bacteria the reason why they're not they're not going to stain the small intestines is the mmc kicks in and sweeps them into large intestine where it's supposed to go so long as that mechanism is working properly low stomach acid should never lead to sibo but if someone has sibo is developing sibo because that mmc is weak and bacteria doesn't get flushed out very well then low stomach acid theoretically may allow more bacteria into small intestines and it may help speed up the process of developing sibo um but it's not as important as maybe some people put out there as low stomach acid means you're going to develop placebo that definitely i don't agree with that yeah no that's interesting i'm glad i asked that because i was wondering about about that because we do see a lot of people on these proton pump inhibitors different acid reducers and um and whether there was there was a link there so it's good to it's good to hear that about that from you uh you did mention probiotics there as well for eating there are so many probiotics out there and people are taking them like i don't know it you know even for myself it it's hard to know you know we we look for a high potency probiotic we know that it's good for someone who's been on antibiotics to be on a probiotic i always recommend it are all probiotics the same or are there any red flags like if someone is taking a probiotic and they notice that you know maybe they're having trouble with it or can you shed some light on this i know this is a huge topic um but a few key points maybe for us right yeah so a couple of me i'll keep the key points to maybe related to sibo ibs and and that probiotics um you know like you said there's a million of them out there what's what and what's the important thing to know about it so if we just ignore sibo an ibs first standpoint for a second here and we just look at what type of probiotics should we take if we decide to take a probiotic well um we want to make sure the probiotic we're taking are hmf forms of bacteria so hml stands for human microflora so uh not just that they're lactobacillus species or bifido species but they're ones actually meant to reside in the the human gi tract um because those are the ones that have the higher chance of potentially seeding in our colon and flourishing from there now they don't always and there's been a lot of research that's come out showing probiotics maybe don't do as much as we think they do yeah and or you're taking probiotics with antibiotics does it prevent things like c deaf um infections or you know yeast infections and there's not a lot of great evidence showing that it does a good job of that now that could be for various reasons like maybe it's not the right type of probiotic maybe if patients were taking high dose of hmf lines it would you know start to prevent these things and maybe they got to do studies specifically with those strains because there definitely are good hmf type of probiotics out there that can really help with certain conditions and and help with gut health but so that's one thing to think about but the other thing to think about is if for a sibo patient is if they've developed sibo that means usually means their migraine motor complex the sweeping action of the small intestines is not sweeping bacteria out of their small intestines as well as it should so if you put a bunch of bacteria in orally even if they're good guys they're still gas producers and if those bacteria put in are not all forced into large intestine then they can actually pool in the small intestine and actually create placebo so one thing i see in practice a lot a lot of other doctors do as well is sibo patients don't do do not do well with probiotics and so before the patient even knows what the word sibo is i've never brought it up never heard about it i'll always ask the question have you tried probiotics for your digestive issues and how'd it go a lot of these patients will actually state i feel much worse when i take a probiotic and now it doesn't guarantee they have sibo because it can be feeling worse for a few reasons um but it's it makes sense why a single patient by taking probiotics can actually make them feel worse or i'll ask them you know probiotic fermented foods like sauerkraut kombucha kefir those four especially um what happens if you eat those and same answer for a lot of sibo patients is i do not do well when i eat those i get more gas more bloating or if i do for a week i'm way worse the week after um and so and a lot of patients they say i take a probiotic and i felt no different because probiotics if someone's developed ibs um even if it's not due to sibo but especially if it's due to sibo um probiotics aren't really going to fix the ibs in most cases and so but there's a time and place like patients have to do very broad spectrum heavy dose antibiotics um and you want to do probiotics at least afterwards in case you can replenish those good bacteria even if the antibiotics didn't lead to an opportunistic infection um it's still probably a good idea to do it's just uh certain patients products may be a good thing may not be and when i say not a good thing it's not not detrimental in in most cases nothing serious it's just they might notice things like digestive symptoms may get worse no and that's good to have those insights because it's uh it's a big world of probiotics out there and i know that you mentioned there's there's a lot of new information coming out about probiotics and there's actually someone coming on the channel who's a pharmacist doing research in this and uh because it's we really need some guidance on on this and because they're also expensive right people are well they they are and and i don't want to downplay the importance of progress i kind of don't know but because they are extreme good bacteria there's a reason why we have them they're extremely important for holding health it's just taking pill versions are they really going to make a clinical difference and that's the key now and maybe this person you're having on maybe it's going to dive into this or maybe not but you know certain fmt treatments that have been you know fecal transplant treatments have shown really great benefit for certain people now here in canada it's only approved for very uh specific things but in other parts of the world they're using fnt fmt treatments for many other issues and and uh you know intestinal issues including ibd inflammatory bowel disease and so not just to treat maybe c diff um things like that but so and that's a different you know those are true human microflora bacteria because it's fmt it's fecal transplant so that's that's a little bit evidence right there you need the right type of lactobacillus you need the right type of pivotal species and then within those realms of species there's many different types and so it is very complicated and that the doctors and the researchers that are doing like the fmt trials and research they'll be the first to admit that we're just scratching the surface on what each bacteria may or may not do and how we can deliver it to the colon no i'm glad that you pointed that out that's that's important um and just in closing dr kangura uh you would mention leaky gut and leaky gut is kind of like this thing that everyone's talking about these days and you know there's thousand remedies repair your leaky gut and you know a lot of them i don't think are evidence-based um but do you have any advice for us so if someone wants to just try to maintain a healthy gut in general if they don't feel like they really have any issues but are there any things any guidance lifestyle choices or anything like that that you would that you would recommend yeah so you know just for the general person whose digestion is going to be fine but yeah they want to do more preventative stuff and they just want to keep their gut as healthy as possible because the gut everything connection is very much there um there are some yeah there's some things you can do so you know food is medicine this is a great way to look at keeping the gut healthy there are certain foods that are pro-inflammatory there's certain foods that are anti-inflammatory so if we want to keep the gut as healthy as possible we want to keep gut inflammation as low as possible just like we want you know systemic inflammation as low as possible and you can do this through you know certain diet changes so there are certain anti-inflammatory type of diets patients can do and definitely under the you know guidance of a practitioner that can help them through it but there's different there's different levels of this but you know there are certain anti-inflammatory diets that i've seen make a big difference in people's health um you know when it comes to potentially leaky gut connected illnesses or conditions like skin conditions or you know brain fog quote-unquote or sleep issues or joint inflammation whatever it may be and so food is medicine is the one way to look at it is just keeping the inflammation in the gut as well as possible by not putting pro-inflammatory things in and that that be through you know certain it doesn't mean you have to be eating 100 anti-inflammatory that's very very hard and difficult to do but if you are right now eating 70 percent proflamatory foods 30 anti-inflammatory if you swap that that's a huge difference or even if you bring that to difference that's the first step and then maybe get it to 60 40. then you're gonna you know probably do your gut some good um and and so watching other things too that you intake like there's you know certain um preservatives and foods and and we're learning more about these type of things and what can potentially cause gut damage and uh and all that but looking at the diet i think is the simplest way and then these other therapies for certain conditions can come in if those conditions develop and probably generally i would guess getting away from manufactured foods eating whole foods right yeah that kind of thing exactly well you have given us an incredible amount of information i'm sure some people have to watch this more than once to really absorb all of this but thank you dr kangaroo so much for for joining us today and for giving us a little bit of your knowledge and talking to us about sibo and i'll put all of the links to dr kangura's work and his lab in the description of this video if you would like any more information so thank you so much dr kangara take care no problem thank you well i hope you found that helpful dr kangara certainly has a lot of incredible insights and experience in this area let me know in the comments what you thought of the interview and if you have any questions about gut health maybe we'll have dr kangaroo on the show again sometime soon i hope this helped take care and stay healthy bye [Music] you
HISTAMINE INTOLERANCE- Symptoms, Root Causes in the Gut Microbiome, and Treatment_en (auto-generated)
Welcome Friends I'm Dr rajr and buad and today's video is all about histamine intolerance now I'm sure most of you are already familiar with lactose intolerance which is where a person avoids dairy products like cheese and gluten intolerance which is when a person reacts to the protein gluten that's present in traditional wheat bread but a lot of people are not familiar with histamine intolerance which is what inspired me to make this video in histamine intolerance unfortunately a person can feel like they react to everything awareness of histamine intolerance has grown in the last couple years but it's still very possible that your doctor has not even heard of this condition sadly in histamine intolerance a person will react to a lot of foods that are typically considered healthy like fermented drinks like kombucha or fermented foods like sauerkraut which are loaded in probiotics they'll even react to avocados which are known to be a healthy source of good monounsaturated fats so what are histamines histamines are compounds made by our immune system specifically mass cells and basophils which are types of white blood cells these cells are armed and ready for battle at all times because they're packed with granules when they get triggered they release these granules which are full of inflammatory mediators one of which is histamine so normally histamine is actually an important part of your immune system but too much histamine can cause symptoms in histamine intolerance the body can't process histamines properly there's a combination of increased production and decreased breakdown of histamines which causes it to accumulate High histamine can cause a wide range of symptoms and that's because there's four different types of histamine receptors and they're located in organs throughout our body in our brain histamine acts as a neurotransmitter and it influences our sleep wake cycle too much his can cause insomnia anxiety headaches dizziness and tentis which is ringing in the ear in our stomach histamine triggers the release of gastric acid too much histamine can cause acid reflux or heartburn in our nose histamines can cause sneezing nasal and sinus congestion on our skin histamines can cause itching as well as rashes like hives or eczema histamines cause blood vessels to swell so it can cause flushing or swelling anywhere in your body in the lungs histamines cause constriction of the Airways which can cause wheezing or difficulty breathing in the heart histamines can cause palpitations rapid heart rate and even high blood pressure once again histamines can act as a brain neurotransmitter that's why too much histamine can trigger anxiety and insomnia and they're also a big trigger for migraine headaches antihistamines are histamine one receptor blockers and that's why they often cause drowsiness as a side effect in the stomach histamine triggers the production of gastric acid which is why too much histamine can cause acid reflux or heartburn acid suppressive medications like flodine or pepid work by blocking the histamine 2 receptors on the stomach once again histamines can cause a wide range of symptoms ranging from nasal congestion to skin rashes you might be thinking histamine symptoms sound a lot like allergies well yes it does it turns out that the symptoms of histamine intolerance and allergies are actually very similar but the mechanism is different and therefore the treatment is different in allergies your body is reacting to a specific food or environmental item for example when a person with a peanut allergy eats a peanut this causes their immune cells to produce IG e antibodies that are specific to the peanut proteins these IG antibodies then bind to the mass cell along with fragments of the peanut allergen and this triggers the mass cell to release its granules this process is called degranulation and remember these granules are loaded in histamine anaphylaxis is a life-threatening allergic response where a person has an extremely high IG mediated response toward a specific food or environment m al allergen in this example a person with a severe peanut allergy accidentally consumes a peanut this causes the mass cells to go crazy and explode and release large amounts of histamines and other inflammatory mediators this can trigger Airway constriction that can be life-threatening this is why it's so important that patients with anaphylaxis always carry an EpiPen because of the similarity in the symptoms it's helpful to rule out allergies before diagnosing histamine and tolerance you can do this through a blood test that checks the IG antibodies that are specific to common food and environmental allergens the most common food allergies include wheat dairy products from cow's milk soy eggs peanuts fish tree nuts and shellfish now let's get into the mechanism of histamine intolerance histamine is broken down by two important enzymes the first is called Dow which stands for diamine oxidase and it's found in the lining of your intestines the second enzyme is called hnmt which stands for histamine and methyl transferase and it's found inside the cells of many organs throughout your body in histamine intolerance there's significant reduction in the dowo enzyme and this is caused by inflammation and disruption in the gut microbiome this is what causes the histamines to accumulate now let's talk about the production of histamines histamine is made from the essential amino acid histadine by an enzyme called histadine decarboxylase this enzyme is made by the bacteria that are present in food as well as the bacteria in our gut microbiome people with histamine intolerance have increased production of histamines by bad bacteria in their gut microbiome which I'm going to get into more detail later because of the microbes that are present in food aged and fermented foods have higher levels of histamines this includes foods like sauerkraut aged cheeses aged vinegars soy sauce and even bone broth once again it's the bacteria in these foods that are producing the histamine another category of food high in histamines is fish especially canned or smoked fish like tuna or sardines in fact there's a type of food poisoning called scoid poisoning which is caused by fish that has not been stored properly and has an excessively high level of histamine scoid poisoning can cause symptoms like nausea vomiting diarrhea abdominal pain headaches dizziness and rashes but the good news is it's usually self-limited within 24 hours and it's treatable with anti-histamines histamines are also the reason why some people get a mahi mahi flush interestingly fish are not only high in histamines they also have Inhibitors of the Dow enzyme just remember the fresher the fish the less histamine it'll have next we have foods that cause increased histamine release by your immune cells this includes citrus fruits like oranges and lemons as well as strawberries although these foods do not contain High histamines they cause your mass cells to release more histamines now let's talk about alcohol most alcohol are high in histamines because they're made through a fermentation process alcohol also reduces the activity of the Dow enzyme in the lining of your intestines finally alcohol and histamines compete for the same enzyme called alahh dehydrogenase which is involved in the breakdown of histamines as you can see there are multiple reasons why a person with histamine intolerance would not tolerate any alcohol the bad news is that there are some produce items that are unsuspectingly high in histamines this includes spinach eggplant avocados and tomatoes now let's review the three mechanisms in how foods can symptoms in histamine intolerance first some foods are naturally high in histamine like fermented foods like soy sauce second some foods inhibit the dowo enzyme like alcohol finally some foods cause your body to release more histamines from the immune cells like citrus fruits next it's also important to be clear that there are three sources of histamines there's food your immune cells and finally your gut microbiome coming up we're going to do a deep dive on why a disrupted gut microbiome can be a big root cause of histamine intolerance most people with histamine intolerance acquire this problem at some point in their lives so what causes them to become histamine intolerant one of the big root causes of histamine intolerance is disruption of the gut microbiome if there's an overgrowth of bad bacteria in the microbiome these bacteria can end up eating the dowo enzyme and increasing production of histamines interestingly the number one most common symptom seen in histamine intolerance is bloating that's because small intestine bacterial overgrowth also known as sibo is a common root cause of histamine intolerance so what is sibo normally your small intestine does not have a lot of bacteria and the primary role of the small intestine is to absorb nutrients from your food most of the bacteria are located in the large intestine or colon but if the bacteria from the large intestine back up into the small intestine these bacteria are now in the wrong place and they can cause a lot of bloating and discomfort the good news is sibo is a treatable condition and I have a whole video dedicated to sibo which I'll link below sibo causes histamine intolerance by damaging the enzymes that are located on the lining of our small intestine these tiny finger-like projections are microvilli on a cell in the lining of our small intestine at the edge of these cells is something called the glycocalix this is a protective glycoprotein layer with enzymes that normally help with food digestion unfortunately in sibo the bacteria end up eating the glycocalix and they also end up eating up the dowo enzyme which is stored in the cells lining the microvilli this this is why sibo can be a big root cause of histamine intolerance next we have disbiosis disbiosis means there's an overgrowth of a bad bacteria and it doesn't necessarily have to be in the small intestine so it could be in the colon research shows that certain species of morganella haia Proteus enactor enus citrobacter pomonis and lactobacillus serum ner can produce higher levels of histamine from your gut that's because these bacteria produce higher levels of that enzyme histadine decarboxylase so they convert the amino acid histadine into histamine once again this is why a disrupted gut microbiome can be a big root cause of histamine intolerance you could also have disbiosis with a fungal overgrowth like candida to learn more about candida as well as small intestine fungal overgrowth I have a whole video dedicated to this topic which I'll link below another root cause of histamine intolerance is leaky gut also known as abnormal intestinal permeability normally the lining of your intestines is only a single layer thick and the cells are bound together by tight junctions these are the cells that carry the dowo enzyme and they normally break down histamines before they enter your bloodstream in leaky gut there's disruption in the tight junctions between the cells so histamine can go straight from your food into your bloodstream on top of that food particles and bacteria can enter your bloodstream triggering immune disregulation which can cause autoimmune disease and it causes your mass cells to release more histamines to learn more about leaky gut please check out my video and I'll share the link below next inflammatory bowel disease which consists of Crohn's Disease and ulcerative colitis is also associated with histamine intolerance these are autoimmune diseases affecting the intestines and they are strongly linked to disbiosis and inflammation which can impact the Dow enzyme as well as the production of histamines by the microbiome histamine intolerance is also associated with irritable bowel syndrome or IBS what's fascinating is research shows that the histamine levels correlate with the severity of the abdominal pain IBS is just a label for the symptoms but it turns out that sibo is a big root cause of up to 70% of IB s remember sibo bacteria can eat up the Dow enzyme on the lining of the intestines next we have gluten sensitivity about 8% of the US population is Gluten Sensitive meaning they feel better when they avoid gluten from their diet research shows that non-celiac gluten sensitivity is associated with a dow deficiency and hence can be associated with histamine in tolerance as well before we move on I want to emphasize that a big root cause of histamine intolerance is a damaged gut microbiome that's because the bad bacteria can reduce the activity of the dowo enzyme and increased production of histamines there are also genetic causes of Dow deficiency in fact over 50 Snips which are genetic mutations in the Dow Gene have been identified now let's Circle back to the symptoms of histamine intolerance people with histamine intolerance often get symptoms right after eating foods that are high in histamines if you're noticing that certain foods give you a runny nose or make you anxious these could be symptoms of histamine intolerance so how do we make the diagnosis of histamine intolerance the first step is to rule out allergies you can do this through a blood test that measures the IG antibody level specific to all the food and environmental allergens unfortunately at this time there's no accurate blood test stool test or urine test to diagnose nose histamine intolerance intestinal biopsies to measure the Dow enzyme activity which can be done during an endoscopy or colonoscopy is still in research phases the gold standard of diagnosis is a lwh histamine diet if you follow this diet for 2 weeks and your symptoms improve then we can make the diagnosis of histamine intolerance let's review the foods that you have to avoid on a lwh histamine diet first we have aged and fermented foods like sauerkraut soy sauce aged vinegars cheese alcohol as well as processed or cured meats you also want to avoid canned or smoked fish produce items high in histamines include spinach tomatoes eggplant avocados bananas pineapple as well as mushrooms histamines are also found in legumes like soybeans lentils and peanuts you also want to avoid strawberries as well as citrus fruits like oranges because these fruits can increase your release of histamines finally coffee black tea as well as chocolate could also be a problem for many people with histamine intolerance interestingly apple cider vinegar seems to be tolerated in histamine intolerance even though other aged vinegars are not tolerated being on a restricted lwh histamine diet is hard and some people get overwhelmed not knowing what to eat the good news is the lwh histamine diet is just to make the diagnosis of histamine intolerance and to manage your symptoms but ultimately it's not the treatment for the condition ultimately the treatment is to address the root cause which is often a damaged gut microbiome let's go over a couple more tips for the low histamine diet because histamine is made by the microbes that are present in food as it ages you want to eat fresh or Frozen only this is why you want to avoid leftovers that have been kept in the refrigerator if your meal prepping the best thing to do is to freeze your food as far as cooking methods you want to avoid slow cookers as well as frying or grilling because these methods could increase the histamines in the foods the good news is that boiling or pressure cooking seem to be fine and do not increase histamine levels another helpful tip is if you have a flare up of your his symptoms you can often feel better quickly by doing a short period of fasting where you just drink water this gives your digestive tract a break and allows your body to focus on clearing out the histamines if you feel so much better on a lwh histamine diet this confirms the diagnosis of histamine intolerance the next step is to address the root cause and heal your gut the good news is we can run some tests to figure out exactly what's going on in your gut microbiome if you're having a lot of bloating we can diagnose sibo with a sibo breath test there's also a stool microbiome test that can tell us if you have inflammation leaky gut dispos candida overgrowth parasites or an infection with hpylori the good news is we can use Herbal antimicrobials to clean up the microbiome this includes berberine which comes from the root of the berberine plant oregano oil which comes from the Mediterranean herb and alidon which has the antimicrobial compounds from garlic these herbal antimicrobials have anti-inflammatory benefits and they work for a wide variety of gut issues including sibo SEO which is small intestine fungal overgrowth disbiosis as well as candida overgrowth to heal leaky gut we use the amino acid powder called el glutamine which is food for the cells lining your intestines which are called ocytes we can also use a supplement called IGG guard which is dairyfree imunoglobulin derived from bovine serum to help rapidly heal inflammation in the gut in leaky gut it's also important that you clean up your diet this means cutting out refined sugar gluten dairy alcohol and vegetable oils it's also important to avoid non-steroidal anti inflammatory drugs like ibuprofen which can often worsen leaky gut and to manage your stress to help promote gut healing now what about the use of antihistamines well that's a great question let's dive into it the great news is we carry a natural antihistamine called histamine support which has natural ingredients like coratin vitamin C stinging nettle bromelin and NAC these ingredients help to stabilize mass cells and reduce histamine release it's best taken at a dose of two capsules twice a day if needed over-the-counter antihistamines can also be used shortterm this includes histamine one blockers like Loratadine which is Claritin or curine which is zertek histamine 2 blockers like flodine which is pepid reduces the production of stomach acid so it can be used to treat heartburn or acid reflux it's best to avoid using these medications longterm because otherwise when you stop them you may get a rebound increase in histamine production digestive enzymes can also make a big difference in histamine intolerance our digestive enzyme Pro helps to Target the breakdown of proteins fats and carbohydrates this can help to prevent bloating as well as to reduce inflammation in the gut we also carry vegetarian digestive enzymes you can also supplement with the dowo enzyme it's typically made from porcine kidneys and I'm excited to announce that I'll be carrying it soon in my supplement store what's fascinating is there's a natural food source of the Dow enzyme and it comes from sprouted legumes keep in mind that not everyone can digest legumes but if you can then sprouting peas or legumes especially in the darkness is a great way to get a natural food source of the dowo enzyme it's also helpful to give your body some of the co-actors for the dowo enzyme this includes vitamin C B6 which is found in our methyl B complex magnesium as well as zinc and copper which are found in our multivitamin next we have vitamin D which is very important for immune regulation so you want to supplement with vitamin D3 with K2 either in capsule or liquid drop form to get your blood level optimized to a goal of 60 to probiotics great question let's go over it research shows that there are higher levels of a good bacteria called bifidobacterium in normal people compared to those suffering from histamine intolerance there's also a good probiotic yeast called sacy bardi or ES bardi which has been shown to improve the activity of the Dow enzyme our probiotic 20 billion as well as our probiotic 100 billion has bivo bacterium as well as multiple good strains of lactobacillus to help with disbiosis in the gut you can also try espi just by itself and our probiotic 20 billion also contains espi as well there's a lot of literature showing that espi can help with IBS symptoms and it also helps to prevent the growth of other bad yeast like candida in the microbiome the good news is as your gut gets healthier the cells lining your intestine will produce more d enzyme which will lead to better histamine tolerance this is when you can gradually start reintroducing histamine containing foods and hopefully now you'll be able to tolerate them much better you also want to avoid Dow blockers which include many common medications Believe It or Not ibuprofen and other common non-steroidal anti-inflammatory drugs as well as common antibiotics like Augmentin can block the Dow enzyme in the description below I'm going to link a review article that has a table listing the many other medications that can also block the dowo enzyme now let's talk about histamines in women for you men out there please stick around you may find this information interesting high levels of histamines can actually cause bad menstrual cramps unfortunately this is an additional symptom that women with histamine intolerance can experience if this is the case taking an antihistamine at the start of the period can help reduce the cramps this is a graph showing the hormones in the menstrual cycle what's fascinating is histamine levels correlate with estrogen levels estrogen is more dominant in the first half of the month called a follicular phase so this is when women experience more histamine symptoms close to ovulation there's a peak in both the estrogen levels as well as the histamine levels and this can trigger migraines in some women in the second half of the menstrual cycle called the ludal phase we see a rise in progesterone which correlates with a rise in the dowo enzyme so women with histamine intolerance will typically have less symptoms in the ludal phase of their cycle unfortunately because progesterone levels drop right before the menstrual period this can cause a rise in the histamines which can cause the bad menstrual cramps what's really amazing is that histamine intolerance improves during pregnancy this is because pregnancy is a high progesterone state but also because the Dow enzyme is actually made by the placenta in fact Dow levels can be up to pregnancy another cool fact that I wanted to point out here is this pregnant lady is holding an apple and apples are a great source of coratin which is a natural anti-histamine histamine levels also vary along with our circadian rhythm which which is our sleep wake cycle typically histamine levels are higher during the evening and night time so you may notice that certain foods affect you more when you have them for dinner as opposed to breakfast now I want to introduce you to two other conditions that are similar to histamine intolerance but a bit more severe the first condition is called Mass Cell Activation Syndrome it has symptoms very similar to histamine intolerance but often more severe episodic and not always connected to food it's thought to be caused by a hyperreactive immune system that's been triggered by an infection or toxin exposure possible root causes include many of the gut conditions we talked about such as sibo or disbiosis but it can have other triggers as well such as Lyme disease and viral infections like Epstein bar virus cytomegalo virus herpes viruses vericella even on Co it can also be triggered by exposure to heavy metals and molds what's fascinating is research even shows that exposure to EMF which is electromagnetic fields can activate mass cells in sensitive individuals to diagnose Mass Cell Activation Syndrome you want to measure the blood levels of an enzyme called tryptase which is often elevated during a flare the treatment for massell Activation Syndrome is similar to the treatment for histamine intolerance in that you want to address the root cause which often involves healing the gut or addressing any chronic infections next there's a condition called systemic mastocytosis this is a more serious hematologic condition where mass cells start multiplying and can infiltrate your bone marrow it can also cause enlargement of your spleen lymph nodes and liver in systemic mastocytosis the blood level of tryptase is elevated all the time regardless of symptoms this is a condition that needs to be treated by a hematologist which is a blood specialist now returning to histamine intolerance I want to emphasize the good news histamine intolerance is a treatable condition and healing the gut is the key to restoring your Dow enzyme now I want to introduce you to one of my patients named Tony when Tony first came to see me he was having a lot of symptoms including food and intolerances anxiety insomnia rashes headaches and sinus pressure interestingly all these symptoms began in October of 2021 when he also noticed a shift in his gut health that's when he started having constipation occasional episodes of diarrhea as well as bloating when I tested his gut I found that he had both sibo and leaky gut over the next couple months we worked on treating his sibo and healing his leaky gut Tony was extremely committed to his health and did a wonderful job in following all the protocols the amazing news is as his gut healed all his other symptoms went away so Tony had a classic case of histamine intolerance that was causing this wide range of symptoms and it was all due to a damaged gut that was affecting his Dow enzyme many of the supplements like histamine support as well as the co-actors for the enzyme improved his symptoms but ultimately it was healing his gut that improved his quality of life dramatically the best part is he was able to go back to eating all his favorite foods like spinach salad pizza coffee and even an occasional alcoholic beverage thank you Tony for inspiring me to make this video and for allowing me to share your story so here are the key points histamine intolerance can cause a wide range of symptoms histamine is found in many foods but especially aged and fermented foods having lower levels of the dowo enzyme due to a damaged gut is a big root cause of histamine intolerance the gold standard of diagnosing histamine intolerance is if your symptoms improve on a lwh histamine diet But ultimately the treatment is to heal your gut so that you can restore your dowo enzyme and reintroduce Foods thanks so much for watching this video If you enjoyed it please give it a thumbs up and subscribe to my Channel please leave all your questions and comments below I look forward to hearing from you thank you again and have a wonderful day [Music]
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
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.
Psoriasis and Rosacea, are these disorders stemming from the gut-_en (auto-generated)
hi I'm Dr Martin ruford I am a chiropractor since 1979 more importantly to this presentation I am a certified functional medicine practitioner of several years Dr Randall Gates board certified Chiropractic neurologist also a chiropractor today we're going to talk about psoriasis and rosacea is the connection in the gut and that's going to lead us to a lot of other things relative to potentials of diet and different types of supplements that you may not be aware of could have something to do with this um Dr Gates is a board-certified functional Chiropractic neurologist I am a functional medicine doctor and we put our disciplines together in an effort to evaluate and treat chronic pain over a period of years we have been together for about five and a half years and we have started we've treated fibromyalgia ultimately fibromyalgia all have chronic fatigue we've treated chronic fatigue a lot of those people have perip neopath we we've learned how to treat periph opathy those people have restless like syndrome so you know we've gone on the restation went on and on and on and on we treat uh mostly neurological issues but we treat but to treat all these issues what we found was there are a handful of critical areas that someone needs to know to be able to stop their progression in these in these conditions and reverse it reverse it usually quite substantially to the point where it almost is like normal and then maintain it and those areas um are one area is chronic stress a chronic fight-flight syndrome in your brain that uh that creates a lot of bad chemistry in your body another area is the immune system we've had to really understand the immune system quite Thor thly to be able to apply principles in an organized fashion to conditions that have not yet been embraced as an immune problem or or are treated in a way that maybe isn't the best way um we've had to embrace the thyroid the thyroid I I've said to Dr Gates many times I can't I I don't know if we've had a fibromy patient ever come in here who has not had Hashimoto thyroiditis and if you've never heard of that a chronic problem look at our website and look up Hashimoto and then um the the one that we seem to talk about most online is the digestive bow system these seem to be the four key areas that pretty much everybody who comes in here has some combination of those problems some combination of them being misdiagnosed not diagnosed mismanaged um managed in a model of care that really has no chance of creating a an effect of stopping the condition or reversing the condition and so that's what we're going to talk about today we're going to talk about psoriasis and rosacea and there is the connection in the gut and that's going to lead to I think a number of other areas that you're going to find of great interest especially if you have this because we've treated a lot of patients with psoriasis over over the years none of them have come here for psoriasis they all came here with fibromyalgia or something or gut problems or gut problems lose weight or gut problems lose weight or thyroid or something like that and invariably I was reviewing with Dr Gates I just said how many how many patients have we have because I I I'm not doing the treatment anymore but I but I do interviews and I do reports and I do a lot of different things the way we have things set up and I get to talk to the patients after they've been through different chunks of their treatment say and my skin problems are going away and we're not using uh the types of drugs that we're probably going to talk about later on and and so the research backs us up on that Dr Gates has done an enormous amount of research on this and he's going to share uh with you some of the most pertinent research that he has done today and so let's talk about psoriasis the incidents of it U what is it I think what is it probably would would go first how frequ how how how frequent it is and absolutely so psoriasis psoriasis is a skin condition many of you know it can have varying manifestations frequently in medical schools it's taught as you know scaly lesions over the extensor surfaces of the body as we term it so like the elbows over the knees but there can be other forms of it and it really requires a dermatologist to diagnose it most medical doctors chiropractors dos will say relative to the skin um if you have what appears to be a rash go see a dermatologist because that's their entire world with that being said once you're diagnosed you need to know that about two to 5% of the world population has psorisis so it's actually more common the rheumatoid arthritis which is pretty interesting so it's a we probably tell them to go to an internist or go to us yeah exactly you'll get that later on so that's those are the general statistics with psoriasis but as Dr was saying relative to kind of our flow on on treating these varying illnesses and now we seem to be a clinic of neurological issues and autoimmune disease basically uh we have seen a great connection between the gastrointestinal tract and several autoimmune disorders and that's why we're doing these broadcasts we're also doing these broadcasts because there's a there's a the beginning there's the glimmer of an awareness regarding food diet and autoimmune disease and that really started with gluten which is a good first step however it's really just the first step on a very complicated Journey that we have come across to really help these differing autoimmune diseases there are nuances between all of them that are important diets May differ for rheumato arthritis patient in our Clinic versus a hashimotos thyroiditis patient which is where the immune system kills the thyroid So today we're going to go into to all of that in terms of psoriasis and what it's like to live with it it is a miserable condition I read an article and obviously patients are going to have issues with their skin and itching and flaking and symptoms of that nature but they really talked about the emotional burden of psoriasis because uh they want to go to the beach we're vain culture and so people are afraid of what it looks like and I even remember when we were studying Dermatology in school I thought wow what a what a significant illness that is to be afflicted that class cuz it was too ugly to look at we shouldn't laugh we're going to get some sensitive we're not laughing at you we're that goes back to a long joke where uh Dermatology is not just the most exciting class when going through school no they show you they basically show you slide after slide after slide I guess slide that tells you when I went to school and usually the worst Cas the worst cases that you can possibly imagine and my class was at 7 o'clock in the morning right so it was uh it was I was not prepared for that so that is why we laugh because Dr joked about it in the past it is laughing but it's uh um yeah it's it's very emotional kids wonder if they're going to be able to have spouses or I mean if they're not already you know in some sort of relationship and and I mean people probably get to the point where they consider suicide over if it gets bad enough it's because it doesn't go away supposedly and and it can be controlled but it doesn't go away and the emotions are are a very big thing and to go back to the part that you said about gluten you know just being the glimmer we used to when we as this has evolved our our office has been an evolving situation as we were able to see different things that made a positive uh uh change in a person's clinical picture um we would Implement that and then we would see other things and we used to just say get off gluten and then we found that gluten was just the tip of the iceberg relative to diet and to to say a little bit more about the diet for one condition might be different than the next frankly the diet for one patient with the same condition might be different than the next so diet is like anything else we want to we want to make everything a one- siiz fits all um today and we want the paleo diet which is a great diet and we want the specific carbohydrate diet or whatever diet and and and we want to try that one and we want to try this one but it worked for that person at sasis we it didn't work for this one you're about to find out why that is the case and uh and there are a lot of different factors to that so there's there's never going to be based on our observation the standard diet for the autoimmune patient whether it be the psoriasis patient or or the rheumatory arthritis patient there there are common elements but we'll talk about everything that um that actually affects that that actually affects the psoriasis and the diet so um I guess we should just go into treatments go into like okay you know you have cicis most people or now we did talk about some of you may have eczema that has been diagnosed with psoriasis but we won't get into that real heavily but most of you at least think you have psoriasis or definitely have psoriasis so we won't get into all the clinical diagnosis of that let's talk about how it's treated so the current treatments right now are uh the bi bi ologic therapies you've probably heard of them biologic drugs commonly used for psoriasis are enil another one is Remicade there are a variety of them and there are now this new class called the biosimilars which are a little cheaper and that brings us to our next point we went to a lecture in 2013 By a rheumatologist and he was talking about the effects of cost on the with these medications for a lot of people now at that time a significant percentage of the population did not have health insurance and he was detailing some statistics about how a lot of psoriasis patients go bankrupt medically because they just can't afford the medications anymore and it was pretty staggering I think he was saying like within five years was were the statistics he was quoting so we're not saying that applies to you but just know that these medications are not cheap they can range from 12,000 to 30,000 a year on average I'm not saying specifically embil or Remicade but generally these biologics are pretty expensive and we discussed last week because we're kind of doing this as part of a series regarding autoimmune diseases and infections uh that it's anticipated that these biologic therapies are going to cost a trillion dollars over the next decade for a healthare system for autoimmune diseases and to a certain degree cancer so obviously the I shouldn't say Obviously Dr ruford is working with me on that sometimes things are obvious in my obvious they wouldn't be watching us exactly forgive me for saying that from that it becomes apparent that we have a an issue here where we have expensive therapies that are effective most psoriasis patients are pretty happy with the biologic therapies uh right now again know that biologic therapies are relatively new so the long-term implications and Effectiveness are not completely known yet we talked about that last week and that's kind of the skinny on the current treatment for psoriasis yeah and there are a lot of other things that people do I remember my father-in-law had exen he would come up to our house up there in tyru we live not far from Lake Tahoe and and there's a lot of sun here in Reno this is called Big Sky kind you look up and all you see is blue sky as far as the I can see and he he had eczema he would sit outside in the sun and by the time he would be here for three weeks and by the time he went home his his eczema would pretty much be be gone interesting um they talk about UV light stuff and they talk about laser stuff and the point I want to make about that for those of you might have said they're even doing D3 injections now I think and there's I think that might be interesting to discuss but um but the point being that still these really aren't getting to even that and that's way better than taking drugs no question about it we're we're all over that but even that we're we're kind of a you know I've I've been in man I've been Alternative Care Now for get to the cause of the problem we get to Thea cause of the problem but yet frequently we weren't getting to the cause of the problem but we were doing a less uh offensive job of getting the problem calmed down or under control and so I'm a chiropractor I don't know how many chiropractors are watching out there but early on it struck me that having to adjust somebody every week or two for the rest of their life probably meant that I wasn't getting to the cause of the problem so I'm gonna get a lot back on that okay but so we started looking at other things muscular skel do they have a short leg do they have a pu foris problem do they have a SE problem long before anybody even was talking about this stuff because chiropractors were not to look into muscles or anything like that and sometimes sticking a lift in the guy's foot or giving them an orthotic or whatever or sending them to a massage therapist got to the cause of the problem um and I I've had a lot of folks come in through the years who've been on these oh I go through and I sit out in the sun and I take UV and that's way better than than than the drugs and the immunosuppressants and things of that nature but it's still not getting to the cause of the problem and we're going to tell you we think that the research is pointing out that we we can get to the cause of the problem and it may not be curable okay but it definitely can be stopped and reversed and controlled and at that point this is closer you're going to get to the cost I mean of the problem would that be correct I think that'd be correct based on the current data okay for sure so let's do the current data let's do the current data on the gut relationship with psorasis okay and they're all dat guy and I'm gonna take one step to the side and then we're gonna hit that okay I don't know that we've really specifically mentioned this thus far psorasis is an autoimmune disease so your immune system isn't in essence attacking your skin we are never supposed to have autoimmune diseases our immune system is designed to prevent our immune cells and chemicals from attacking us so those checks and balances have broken down in you what the enil is doing what the Remicade is doing what these biologic therapies are doing is that they're basically immune cells killing our immune cells so that they don't kill you if that makes sense and that's why they can work because there's so much immune inflammation going on in your body resulting in psoriasis they have done studies where they have shown in cases of psoriasis chronic fatigue syndrome ulcer of colitis that these inflammatory markers are very elevated like tumor necrosis Factor Alpha that's one you should kind of be aware of you hear tnf Alpha Inhibitors it's just an inflammatory General in the immune system if you want to think of it that way another one that we look at as an inflamatory marker is C reacor protein and so these go up in the thought process process is that they're going up because there is imbalance in the gastrointestinal tract you well how does that work well 70% of your immune system is right here in the GI track thank you to eron Andrews and her align probiotic commercials uh that awareness spreading but it is complicated it's a very complicated environment in your gastrointestinal tract we're talking about trillions of microorganisms pounds pounds of bacteria pounds of bacteria in your gut a variety of different species that are actually semi hard to classify because they grow in an anerobic environment so it's not like we can just take a stool sample and culture it out and say oh Jerry you have these bacteria and Linda you have these ones because they die once you get them out of there so now they have to use genetic analysis for a lot of these bacteria which we used to use until uh the lab was sold but now we're looking at going back to that but it's kind of interesting so genetic analysis of the bacteria of psor psoriasis patients is now being used and what they found is that there's really a lack of diversity in psoriasis patients versus normal control so normal people have good they have a forest with lots of trees whereas your forest and your GI track is uh one kind of tree exactly or just a few types of trees all pine trees we live near Lake Tahoe where all the pine trees were cut down at one point in time to build Virginia City which had this big silver thing and now they planted all pine trees you go up there it's just it's beautiful but it's just a billion all of the same height I might have that's true it's pretty weird but it's beautiful how funny thought of it that so that's what it is you have you have all the same pine trees in your gut so that has unequivocally been which is not good no it's not good it's not good for generalized immune health and we know that the skin in the gastrointestinal tract seems to have a relationship to skin throughout the rest of the body those Studies have been done relative to eczema it's talked about in the celiac disease lit literature overlap between psoriasis and Celiac or dermatitis or pedoph foris and celiac disease so we know there's this gut connection and it appears that when we only have a few types of bacteria or we have less diversity in the GI tract we get more inflammation throughout the system we also see that psoriasis is highly associated with obesity and those who are obese have a greater degree of psoriasis or it's harder for medical doctors to control if someone's non-obese I know I'm kind of going off the oh no it's cool I was just thinking is that the is that the obese person who just can't lose weight or is that all obese patients and there's a big difference in our clinic in that they just said basically the psoriasis patients who are more difficult to treat are obese okay and have a high and the reason I said that is because we have Bo bees patients come in who can't lose weight and they're usually either going to have an abnormal thyroid problem blood sugar problem gut problem which is why I asked that exactly okay or they're going to be stressed out of their minds or all four and then that creates a chemistry where you're just not losing weight no matter what you do so I would bet that it was more of those guys probably I would bet too those are the ones we've seen those had psorasis those are the ones we see what we know now with obesity diabetes pre-diabetes is that there is a bacterial issue in the gastrointestinal tract we've talked about it at length if you watch our weight loss videos or pre-diabetes in the gut lecture what we know is that obese individuals diabetics they have too many of what we term the wrong type of bacteria pieces of those bacteria not whole bacteria but pieces break off and go into our bloodstream this causes systemic immune activation it also results in insulin resistance and because there systemic immune activation there's inflammation and that's part of the metabolic syndrome that we've talked about as well which is where you're obese you have inflammation in your body your cholesterol is high and you may have pre-diabetes and depends on the criteria you use but those are the generalities so now there's this overlap with obesity and psoriasis and they've looked at um gastric bypass patients and there have been some studies coming out where a psoriasis patient who is obese goes through gastric bypass and as soon as they have the gastric bypass before they start losing weight their psoriasis starts going away which is really interesting and one of the thought processes there is that there's this chemical called glucagon like peptide that goes up 20 times after a gastric bypass and it has been shown to basically calm down the immune system but it's a gut hormone and now they're doing work where they're using medications that are basically they look exactly like glucagon like peptide and they're also seeming to help psoriasis patients so again there's this gastrointestinal tract connection you know in the end I mean most most of the time when people come in here with some sort of skin abnormalities General rashes and all that type of stuff it usually ends up being somewhere in the yeah in the gut like either I mean I could be adrenals but but most of the time it seems like it's it's going to be like liver problems or or small intestinal problems or something like that and think about it your skin is basically an extension I don't know if you know this think about it but your skin is basically an extension of your intestinal tract it's all one continuous this goes in kind of goes in your anus in your mouth it's all one continuous uh uh organ if you will and so uh so if you get skin problems any kind of skin problems start thinking gallbladder liver intestines stuff like that or stress that's such a fascinating analogy it's true I know we use the analogy of the dut basically donut doesn't do it for me but keep using it it has it's for a dut you know the inside of the doughnut is made up of skin which is the same skin that makes up the outside of the doughnut it's probably because I see this big doughnut with all this Puffy Cream probably because you like clat them I can't eat them you don't like the little round ones with the chocolate on top like right and I can't eat them but uh yeah and obese patients are much more difficult to treat with psoriasis than non-obese patients for these reasons for these reasons and one of the interesting studies that I attached to today's broadcast was regarding probiotics now Dr ruford and I sometimes get a little angry regarding the discussion of probiotics because everybody wants I think I get angry because it's a simple solution you know everybody you have this hugely complex Forest of the Gast testal tract you have elements of leaky gut syndrome which we haven't even talked about you have a gazillion food intolerances that may be causing this lack of bacterial diversity which we haven't talked about and then somebody comes out and says oh you need to take a probiotic and when I'm doing the consult and people told me that I said you know that's like peeing on a forest that's how I typ of bacterium called bifido bacteria and it is referred to qually as a good bacteria and they went in and they took sis patient a probiotic yeah they took psorasis ulcerative colitis and chronic fatigue patients they measured their tumor necrosis Factor Alpha they measured their C reactive protein across the board they were elevated inflammatory markers and and immune markers they're elevated signs of inflammation they take a control group they take a a treatment group it's double blinded so the people giving the treatment they don't know if they're giving the uh control group probiotic or Placebo same thing for the treatment group and it comes out the treatment group has these staggering improvements where their tumor necrosis Factor Alpha drops into the tank so it goes way down kind of like you would see if you were taking a biologic medication and then they inflammation their C reactive protein goes way down and I'm going to say just with the supplementation of bifido bacteria and we present this literature because we're seeing things clinically that are not going to appear in the literature for maybe 10 years we saw that we've talked about itens with fibromyalgia as an example we were seeing things and then all a sudden now it's just popping up because clinicians have to see these associations who then talk to researchers who then in engage in a research study that takes years to complete and publish and then you're going to hear about it well we do well we I mean ultimately not the not the promoter it's okay just say the reason that we've been able to do that is because we we started to understand what chronic pain looked like but so we so we crafted an exam that was a pretty that's a it's a pretty standard exam that we put together Dr Gates does a neuro exam from head to toe every aspect of your nervous system and I do the the general systems exams everything else and after you done a hundred fibromyalgia patients you start to see the commonalities among them and as you start taking the histories I know for the fibromyalgia patients I was totally in shock that every one of most of them most of them were sexually physically verbally abused but that all of them had some sort of a stress component that put them in like almost like a a post-traumatic stress syndrome 24 hours a day that was one aspect that was that's what doct Gates is saying so we can see that well we're clinicians we can look at that and say man we got to do something about that we do something about it and they've suddenly improve well we don't have to do a 10-year study and submit it to uh the Journal of the American Medical Association so that they can reject it or say oh it's okay now you got to do another fiveyear study and oh by the way we need to make a drug for it and all those types of things so so we have we do see things way ahead of time way ahead of time it because of because of the way that that we go about things and and so that's why we can talk with some confidence on this I think we should talk about it's not you didn't have it down here but but you know I you look on WebMD you look on the Mayo Clinic you look on all these other ones that people think are you know the end last word of it and there's almost no mention of diet almost zero mention of diet um we've seen people get off of gluten and and have it help their psoriasis and their eczema and so on and so for and now there are clinical trials being talked about online in the research database about this okay okay and then once you and then and this kind of dovetails with with what we said about um not only does this abnormal balance of bacteria contribute to uh you getting eczema but it also contributes to you having to figure out which type of dietary recommendations are good for you I the best dietary recommendation I saw was on WebMD and they said just eat a good diet and get exercise and get out in the sun now and then um and so but but what we have found is is that food sensitivities play a big part in this and the food sensitivities frequently are different in in everybody and they can vary now you have again all the things you talked about you have small intestinal bacteria overgrowth if you have something called leaky gut and you have eczema you I'll tell you you have food sensitivities and you'll be shaking your head up and down right now bet you're shaking your head up and down go yeah you know when I eat this thing my Eczema gets worse and or if you even eat other Foods maybe or psoriasis I'm sorry um or or or E there's even some suggestion that other foods you can eat might make you better might you know and you go whoa what's that how come today people don't usually stop and go what did I eat yesterday or something like that so I mean we've seen food to be significant factor absolutely I mean these people come in and they're staggered and they go oh my God my Skin's problems it's not what they came in for they came in for fibromyalgia they came in for for rum to Artis that came in for something like that and and so um I think that the food absolutely should be mentioned thank you I'm glad you brought that up and it's an element of we don't know what's the chicken or the egg right what we what seems to happen because we see a lot of autoimmune patients when we were doing food antibody testing we would see and we're using the best tests that we have found on the market these were the cyrex laboratory tests we'll we'll promote them we get no kickbacks from them we uh they're very reliable they're very specific and sensitive DNA test yeah antibody tests too so with this food testing um with all these allergies we have to ask or intolerances is a better way to say it why is somebody have 20 food intolerances why are they Reed into gluten dairy rice teff soy potatoes eggs and one of the questions or answers becomes is there a problem with the barrier between the foods and our GI tract which should be like a tube and then than the outer surroundings and that's where we get into this concept of leaky gut syndrome where the intestinal cells which are skin as Dr ruford said should be tightly bound together and they start to open up a little bit and then food molecules can start to leak into the bloodstream and the immune system starts attack that food molecule because it looks like a bacteria or it looks like a fungus and that can create this immune activation to the gastroint testal tract so Dr ruford is saying food intolerances are a huge issue because unless you get rid of the food intolerances and once everything has broken down in our experience you're not going to correct the problem maybe you have to keep taking probiotics forever and we have seen the multimodal approach of getting rid of food intolerances so basically figuring out every food intolerance you have and eliminating it from your diet now we have a potential to calm down the inflammation in your gastrointestinal tract from there we can enact strategies to help bacterial diversity or get rid of bad bacteria and you can do that by starving the bad bacteria through diet you can do that by using natural antibiotics and then you can do that by going in and putting in good bacteria like bifido bacteria after that you also want to go in and heal this leaky gut and so there are certain supplements that have definitively been shown in the literature to do this we see it clinically all the time and that is our approach for this issue now you brought up vitamin D which I think we also need to bring up because I've talked to psoriasis patients even before I was doing this work and they say yeah I go to Hawaii and myiasis goes away I don't know what's going on is it a UV light exposure is it a vitamin D issue relative to autoimmune disease studies done back I think it was in the 2000s early 2000s they take a mouse with rheumatoid arthritis they feed that Mouse cartilage in the rtis goes away they've done the same experiments with MS and a mouse model so little mouse with Ms they feed up brain tissue and all a sudden the MS goes away unfortunately those statistics have not panned out in human beings because our immune system is a little more complicated but what we do see or why those studies worked in the mice is because when we eat the cartilage and you have rheumat arthritis it fires up something called the th3 regulatory system vitamin D take a break there so we have two main sides immune system one is called the th1 side it does rough and tough killing of bacteria and viruses th2 side generally does precision killing of bacteria and viruses it remembers infections in autoimmune disease frequently one side is out of balance for you with psoriasis the th1 side generally is acknowledged as being too dominant so when this was discovered researchers and clinici said well maybe if the th1 side is too dominant let's do things to bolster up the th2 side that didn't work because it's just too complicated there's communication between these two sides of the immune system and lots of times when you boost up the th2 side you boost up the th1 side now the autoimmune disease is even worse and you can get sick for months yes you can like I did right the only place it really seems to work is boosting the th uh one side when there's a th2 dominance and things like asthma but we won't go into that for the sake of discussion so no there's this th1 th2 imbalance and then there's this evil dictator guy called th7 which is now being acknowledged with a lot of these autoimmune disorders and it seems to stir the pot of keeping this autoimmune problem continually going and these immune sides of your immune system imbalanced where vitamin D comes in is it fires up the th3 regulatory system which is in the middle which brings these two into balance so that's where vitamin D really seems to work and that's why eating the cartilage with a mouse has room for arthritis also brought the immune system into balance so eczema is an immune problem the cause of it is an immune problem i' I've read articles where it's they're still saying it's genetic there's there seems to be a genetic propensity in about a third of the cases or something like that but it's an it's an autoimmune problem so immune system is attacking and the so the key is to calm the immune system down and some of and and and the key to calming the immune system down is Def finding everything that is causing your immune system to fire up and what we have found in our travails through this has been it you can't get anywhere until you calm down the gut as Dr Gates said what's in the gut do you have H pylori do you have parasites do you have do you have small intestinal bacteria overgrowth do you have leaky gut which leads to food sensitivities you and it has been our observation that in and I'm going to make a global statement here he's probably gonna cringe at but maybe not in pretty much all autoimmune problems and almost all chronic pain you are not getting anywhere until you get that gut under control and it's a little complex but you got to get that gut under control before you can even begin to heal that leaky gut to stop food sensitivities and then you can figure out what your diet should be and and supplement so so the so the reality is for eczema patients if you want to have it under control so it doesn't keep coming back you find out what's exacerbating your immune system you that will stop the progress it'll usually reverse it to a degree your symptoms will generally go away or improve substantially and then you'll be able to control it from there once you know what foods I shouldn't eat stress mechanisms need to be controlled we didn't get into that stress can be a trigger if you're if you really have a or if like those fibro patients I talked about if you're kind of in a little post-traumatic stress C or big posttraumatic stress room that has to be handled and can be handled watch our watch our our presentation on stress and um and why zebras don't get ulcers and it's a great presentation you don't have to be like that your whole life and those are the keys those are the keys yeah right there I mean I I think that's like a general summation of those are the keys to immune problems frankly and you have an immune problem that's what you have no different than rheumatoid arthritis no different than Hashimoto no difference in Celiac by the way people who have who have the psoriasis tend to get um Crohn's like a percentage of the time yeah so there's some overlap with inflammatory and they're showing that people have Celiac may have a propensity towards towards it because it's all together right because these are all autoimmune problems I mean I get one day they're gonna say well you know somebody who's got psoriasis has a propensity to get any type of autoimmune problem there is maybe I don't know but the the point being that you have an autoimmune problem calm down immune system calm down your stress mechanisms that's as close as you're getting to a to to getting the the cause and you can't use the word cure because you're not going to cure it but you you can calm it down you can dampen that immune response and then you can control it forever if you keep doing the right things and control your stress and control the inflammatory processes at that which at that point become mainly mainly food sensitivities food sensitivities yeah and maintaining that bacterial diversity and maintaining a diet that probiotics yeah that promotes the good bacteria to flourish with lots of species yeah yeah and I didn't comment on rosacea for all those watching who watched now we'll talk about rosacea I'll I'll get the uh the Mad comments about it you didn't mention rosacea I'll say fast forward to you know 40 minutes into the broadcast what they're find rosacea H pylori there appears to be an association H pylor is a stomach bacteria which can cause a host of conditions across the body including ulcers gastric ulcers certain types of stomach cancer but it's also associated with rosacea they're also talking about rosacea being associated with small intestinal bacterial overgrowth which is where there's too many bacteria I show the wrong type but too many in the intestines because we've seen rosacea clear up with our treatments I was just going to say so it's the same treatment it's the same exact treatment for those of you who listen to it all um same treatment which is why we put the two of them here with nuances in between yes okay I think that pretty well handles it okay well we hope you enjoyed this H if you want more information you can go to www.paltalk.com you can also go to our Facebook page I hesitated there because we used to say if you have any questions unfortunately at this point because of the popularity of these videos we can no longer handle the questions so if you want more information go to our website um these these pretty much everything we talked about is on we we have probably look up autoimmune you can look small intestinal bacteria overgrowth you can look up leaky gut you can look up the back there's a talk on there you got to is scroll through them until you see that one and boom and and and there will be the data right okay it's all there all right so until next week thank you so much uh you can send us your comments if you want let us know how we're doing that's always nice to know yeah sometimes most of the time so until the next week thanks for watching
Rosacea Healing Workshop Session #3_en (auto-generated)
[Music] hello hello and welcome to our session number three yes we are going there and we are talking today is very exciting because we're talking about god health gut is super important piece of healing journey and i really before we start i really want to celebrate you and i hope you are getting a lot of insights and a lot of value from this from this workshop and from the talk yesterday and before yesterday we talked about inflammation so if you didn't listen to the recordings yesterday uh then listen to it because it really will bring a lot of value you will you learn that how food can create inflammation in the long run and what food can calm inflammation if you have any questions ask me i'm here and it's time to integrate what you what you are learning remember that 25 more likely to happen if you write it down so write it down all your discoveries that you learned today and this week tomorrow we will be talking about habits and strategy that we teach and action planning really how to make the skin healthier and how to find the way to be more healthier and more resilient because that's what we want rosacea is chronic disease and with every chronic disease it's it's as i mentioned yesterday it's very complex and we have to embrace uh you know you have to embrace yourself instead of you know going with the flow you have to have some action action plan and intention and that's why we're here this week because you can put some intention how to um how where you go and how you want to be instead of just be a victim and just say why this happened to me we can do much better and really you can live through transformation and if you put some action planning and if you you can really shift completely um to the person to be in driving seats and really do some healing work because i know it's possible i'm i'm living example that it's possible and many others and so today the topic is a leaky gut before i start i want to remind you to be active because we will give a full scholarship to one person who'll be the most active in this workshop how you can win be all in show up for yourself each day do the daily exercises and enjoy really the support of this lovely community participate in the video comment in the video and comment in other people's posts if there are some and uh just be all in and really be all in that's what it requires we live only one we have just one shot we have only once uh we live only once and every day that we pass it will never come back so i want to really just if you are kind of procrastinator just this is and this is the end of it uh you uh you have to do some work if you're ready to do that and really i'm here to help you so make make sure that you take advantage of this week and that you have some as you can have some support that you really need and of course again this is not i cannot give you any medical advice even i'm a physician this is beyond my medical practice this i i really want to hear help you and support you and give you nutritional information so this is for educational purposes only and i really devote myself to create my sugar stop that's the company that that i created for people to um to support them who needs uh to make this change because i believe that anybody with chronic condition as a rosacea is chronic condition they need support because um you know we will not get support in medical medical office that's why i never i was it's just such a short period of time that's why i created this this this container when people have support they have guidance they have mentorship and they have the compassion that they really can lean and really get better so because i believe that people with with chronic disease they can really improve if they have this support and they can get better and so um you know to to get better often means to to change the life and for some people can be too scary i have many people who joined the program they told me you know i was really scared to join and i understand uh it was scary for me too i i just but i just want to tell you that it is possible i want to inspire you and and i want to give you this hope because i know how changing lifestyle can be difficult but you can do that you are here for a day uh listen to me one hour so you are committed and and it's really important to visualize the outcome i think this is where people struggle they see the face in the morning the red and inflamed and then just they shut down and say why me or um no we have to just uh get out of this circle this you know vicious cycle and really go out and this is all where you will you'll develop this skill um when you will do the work that we're doing and you know i didn't i did uh you don't need to believe hundred percent to take actions i didn't believe 100 when i started visualizing that i can heal my skin it was like impossible i said well this is it now i will really live with this until you know my days are gone that's what we know so i didn't believe a hundred percent i did i didn't believe that i can fully do it but i did believe only a little bit more that i didn't and this 51 the tiny bit gets you past that no and that gets you uh to do the first action step to help you to do the scary step that you need to take because that's what is you know the putting one foot uh in front of the other and that's what really will make a huge this is the transformation you just keep walking and walking and before you know it you live different life um and that was with the shopping list as i told you the other day from one of my my my client uh that she was just shocked what what she found in her winter jacket from from previous years how how she was what she was shopping she was just so i'm really excited and that you are here that you were able to join and that i can really offer you this because this is not something that we normally have because this is very controversial um controversial place that we are in uh and this is really not mainstream yet and so i just want to support you here really to to make the scary step that you need to take and when we are treating the skin condition the first reaction because today we're talking about uh all the bacteria and a gut health and the gut uh guts can access you know when we're thinking about the the treating the conditions um the skin conditions uh the first reaction may not be to think about gut health but growing um research indicates that we should be thinking about it that's why i devoted the part of my work is really i never thought and i will talk about poop in my career that's why i kind of change completely how i talk to people and what i what i how we're going forward because it's just such a important um important aspect where we should start and we should really improve it and without really dismissing the importance of topical therapies like sometimes we need to put a cream sometimes we need to put you know some tablets the latest medical literature indicates that health of the gut microbiome is equally essential uh when treating conditions like like rosacea and so um it's that's that's what we will talk about today we will talk about gut health we will talk about leaky gut and gas microbiome and you will connect the dots how is aha so it's like that which we we still don't know everything how it works but the data showing us that this is the though we have to walk this way and so when we think about our skin uh we that we tend to think about the beauty or breakouts but you know it's the larger organ of the human body our skin consists of the beneficial bacteria that serves the physical barrier of outside pathogens making the essential to our overall health so you you hear a lot of time the the the skin barrier and that's really if you have good bacteria on your skin you are fine you have good skin barrier but when when it's broken then it will really affect um and we can have all the issues that we have maybe now on your skin so and our skin is really home to trillions of the microorganisms and their by-product because they live on our skin but they as well producing um the chemicals or the products that we know collecting really uh talk about this as a skin microbiome and similar to those in our guts the skin microbiome really play a major role in managing what comes into your body from outside world and communicating information back to the nervous system to the endocrine system to the immune system so again it's like all connected and it should come as no surprise that gut health and skin health are really linked together and these interactions are referred as a gut health here is a picture here is a picture i want to show you you see so this is on the left side you have skin that is nicely i don't know if you can see that uh there is a there is a nice vasculature and uh there is no inflammation on the right side all these red aria is that something is wrong and this is what i'm what i will be talking today about this is where it's it's linked to leaky gut be saying leaky gut leaky skin i don't want to go much into the research if you want i can share this paper with you just let me know uh if if you don't if nobody will ask me i don't want to bother you because it's just it's too medical but this is something that it's more and more science is telling us that this is the way we have to walk we have to see this as a complex issue and that's why i want to uh tell you more about it today and so more um imbalance your but my your microbiome is this will be more showing as conditions like acne you know psoriasis eczema rosacea all these skin conditions are really linked to to the gut and although these threats are still being studied these links the research suggests that anything damaging your gut whether it's diet lifestyle or environmental factors can also manifest on the skin too so we know that it's a clear link as i told you leaky gut leaky skin there is a clear connection and um we i'm just excited what the recent will will show us in the future because i think we will have some aha moments on the way and so i want to share first what leaky gut is because you might hear it from from before uh somewhere on the internet but i just want to tell you what what the research i want to show you the picture here so uh let's let's show it to you yes so what is um intestinal permeability this is what we what we call uh in the medical literature is industrial permeability otherwise we call it let's call it leaky gut here so uh those are the cells in the in the the layer of the gut it's just one layer of cells you see there is a nice they sitting on the membrane and there is a the nucleus and that's all these is nicely organized they they have tight junctions they they have like really they tied to each other that is how it should be so only tiny molecules can go through but and we have a lot of them it's like uh this this this is intestinal lining and it's covering more than four thousand square feet of surface area so it's a lot of surface area and when this uh these cells working properly they're really creating this tight barrier that controls what gets absorbed to the bloodstream as you can see on the right side where the blue arrow is this is where there's a problem problem that that's where it really some toxins can really go in and and this is the unhealthy gut lining that can have this large cracks or holes allowing partially digested food toxins and bugs the bacteria that normally would be beneficial but we don't want them beneath this layer we want them above uh and so this this cause really the intestinal hyper permeability this is what it sounds like and uh really then the digestive tract is no longer able to ensure that good stays in and that stays out instead this gut tight junctions you know the proteins holding the intestinal walls together are loosened and this uh this various gaps um uh really let the particles go into the bloodstream and this is where the body reacts to this foreign particles in the blood but but by producing immune antibodies and pro inflammatory cells to fight them off so this breeds chronic inflammation food allergies and varied health complications very often i have few actually clients and they had huge allergies for years they did we were doing some work together and this was not planned we we never think that they could uh like diminish their uh their allergies but she is calling me and she said i don't have allergy this year and so it was amazing for me to to to find out that uh actually when we heal the gut the allergies can really subside so so this is something it's it's amazing and so it's good because we we have today much more understanding of the causes so we can really uh to do something about it these days there's so much research going on and it's really booming and the study is showing us that we have um there are modification intestinal bacteria and inflammation there is even some research going on about gut microbiome and the fecal transplant with autism children there is a so they can really improve their gut microbiome with fecal transplant and the the kids they can help with autism there is as well they were able to do that with clostridium difficile this this is the bug that is really harmful for our guts and and as well for diabetes because uh we know that um you know diabetic patients they have as altered microbiome i will talk about it in a minute but so just think really if you just take from this lesson that whatever you eat you always have to sing what's happening in your gut what's happening what goes in what goes what goes in that should not be in and um and leaky gut really can produce problems not only in the gastrointestinal system but as well elsewhere and this is what what we have then problem we have the autoimmune disease problem which is uh you know lupus type chronic fatigue syndrome as well fibromyalgia arthritis allergies asthma acne rosacea as well obesity mental illness it's all linked to and i didn't talk about other issues those are just ones that are just in top of my mind but we know that gut health is absolutely critical and i i feel it was the missing link for years and now we know that you know when i when i connect my dots so i got rosacea 11 years ago and took me 10 months to really improve it 10 months of hard work i i really learned the hard way i experienced i was the guinea pig i was trying everything and i failed so many times but i'm grateful because the failure it was learning for me and uh it took me 10 months to really clear the skin and it was i told you yesterday it was a puzzle for me it was something that i had to really uh put as a priority and i didn't know even i i could do that uh you know i if you tell me that i will heal the skin if i do this this is it doesn't work like this you just have to do the work and see what happens you have to be open-minded and you have to just be able to have a courage because otherwise if expectation you're still in that cycle of uh not not believing and not surrounding the body do the job if we have expectations uh we are not on a good path and so let's go back to the gap so what it means this what you see the permeability this is where several factors really can negatively affect this gut integrity because we need all of the cells looking nice intact and be really tight like nothing goes in and so you can guess what is cause and really has negative effect it's sugar it's all the processed food all these standard american diet exposure to chemicals glyphosate is a big big problem that's why i always eat non-sprayed um non-sprayed food there is a clean 15 and 30 dozen if you need i can drop a link to that if you don't know yet which vegetables and fruits you can eat um organic and which which you don't need to eat organic as well um a chronic infection if you if you uh you know some some of these abstraction biovirus virus and other as well glovecorogluten i will talk about gluten today gluten is big big uh trigger and really affects the integrity of the gut health of the gut and some food allergies you know people who have food allergies and they eat something they immediately uh damage the gut and poorly manage stress it this is so overlooked uh i'm i don't know how i sleep with this maybe there will be link as well as sleep as well it has has connection to this but poorly managed stress is a big trigger for leaky gut so that's what um as well actually the lisa rankin was talking about that she has patients and clients eating kale all day but they were unhappy people and they could never get better and because the the mind was just in the wrong place so um but we talked about it other time so really should we talk about sugar you know what sugar everything now what you need to know we just have to you know we have to find out in your pantry remember what is in your kitchen is your stomach if you have cravings you will go through your pantry and eat what is there so you have to declutter you have to take it all out i teach all that in my programs uh but it's not on topic here i just want to give you really overview what is really important how you can move with with your thing and you can really start the healing so gluten i want to uh focus on gluten today because gluten makes our gut leaky simple as that especially if you have some autoimmune disease it's absolutely necessary to take all the gluten and actually all this all the the grains because sometimes um you know even the other can release this uh release of zonulin and increase the permeability but but gluten does it it triggers the release of zonulin is the molecule that really kind of holds all together and and then the perimeter then really creates the opening in the in the spaces between the cells i told you yesterday it was a harvard professor um a fafasano that showed that the gluten across transient leaky gut in all of us when he said it for salmon that um you know in that conference everybody like having a mouth wide open because that was surprise we didn't know this before so really um the thing with gluten is that if you have gluten once in a while you might not be such a problem but if it's too often this leads to more inflammation and more body confusion and more health complication and so gluten is in many grains such as wheat barley and rye but unfortunately it's really uh found itself into the our food supply is disguised and all the package food featured in most uh pre-prepared dishes sometimes it's even in a salad dressing it's like you just have to read labels and sometimes i feel i have to have phd to read the labels well because we are really suffering from this uh you know a lot of gluten energy allergy sensitivities and intolerances really became the buzzword in the health community so it's a lot of gluten-free things on the market but again especially if you have autoimmune disease you don't want to have gluten and no other other grains you don't want to go from uh the wheat cracker to the rice cracker this is not the way forward you want to go from uh wheat cracker to carrot or celery stick that's the point or a piece of egg a piece of meat or something so really the gluten is is a major component of licking cycle and is really damaging condition and it should be it should not be taken lightly but the thing is that um you know as i said the the gluten on in many food and such as dairy and other can mimic gluten and those are all grains that's why i said um that's often common mistakes that people they do following gluten-free diet and they're using other other grains and they're not so well so this is something i would i would love to uh mention that you really take it home because especially if you want to really improve your skin this is something is super super important and really gluten is still the worst oats are fine sometimes i mean i love oats and i ate oats all the time uh when i was as well healing my skin so sometimes oats are fine but even if you're seeing the odds are problem you have to see and see for yourself that's what i'm um that's when i'm again saying that we have to have a personalized approach this is how we have to go forward and um you know very often the people who have gluten they very often they go uh without noticing anything at this point they're likely to see just little symptoms or no symptoms at all but then um you know this is where people most uh will assume that gluten won't hurt them and therefore they can eat no problem but unfortunately the lack of symptoms does not mean that gluten doesn't hurt your gut and very often you will live your life you he you eat gluten here and there and then you stopped eating gluten and you suddenly feel oh i feel actually much better and this is just gluten imagine if you stop all these harsh chemicals and food now that really creating inflammation and leaky gut this you will be just another level and so um really it's it's just because if it's it's fact that uh in fact it takes um exposure over time and accumulation of damage before leaky gut really will be noticeable um so um this is something that you have to always think this is not something that they created one day and often one thing that will be noticed is increased food and environmental allergies that's what i was telling you before when the lady she was able to heal leaky gut or make it less leaky she was able to get rid of the allergies which is which is amazing so i hope i change your view on gluten if you want to stop gluten you will need to have it at least uh one month away because uh this will uh this will you will not see any any really any um any changes and uh it needs the the gut needs to regenerate and it it usually takes a few weeks and you know gluten aside from contributing to licking out actually an inflammation as actually it's really um alters as well our gut microbiome which which is something that i will talk now so um you know we have this gut microbes everywhere in the body and we the majority of the gut bugs we have in our guts and this that's that is where where we have like four four pounds of them and we carry a lot of bacteria in our gut guts and we have to really take care of them because they are responsible for our digestion they have really very important functions they have immune response function they help us to absorb some nutrient they help us to vitamin production and they helps us detoxify they are affecting our mood can you believe it they're affecting our mood and and much more and so that's what gut microbiome is it's basically the bacteria that lives in um so microbiome and not gut by microbiome it's the bacteria that lives everywhere on our skin our nose our eyes our ears everywhere uh and majority lives really in the back uh in the gas gastroenter intestinal tract we this is sibo it's about sibo c4 and all these it's above these lectures but a lot of patients with rosacea has sibo a lot of so if you are bloated you have to change your diet from the scratch um because then it's something can go go on and you have what we call gut dysbiosis so not only that it can be the good bacteria and bad bacteria can be in bed ratio but as well it can be in different location that's what sibo is uh but these gut gap dysbiosis is really can be source of inflammation in the gut and as well in the whole body um and this can really increase the risk of developing chronic illness and it can give you the flare that you have in the skin so this happens when we eat the sugar the gluten the soda the fried food oh my gosh fried food completely this is like no go i would rather have cake i would have candy but i wouldn't i would not have fried food because this is with the bat oil as i told you in session one they're using this all these inflammatory oils and it's just so just so bad for your health and so we want to create this gut symbiosis this is the right balance of good and bad bacteria i don't tell you this species is no it's pointless uh you can have a test for that um now it's really available i will be doing testing from september if anybody is is interested but it's not for the agenda today i just want to tell you that really if you eat diet rich in whole foods a lot of fruits vegetables all the function will be will be healthy your immune system as well will be working better so for example if my kids are sick if they have a flu or if it's like flu season i don't give them any sweets because we know that sugar will really damage the immune system like immediately so it's something that we have to always think about um not only rosacea but just overall health because we want all we want to thrive right we want to have vitality and we want to just be healthy with lovely looking skin so i want this for you and you know we have some examples and from from experience of from um from the experiments on the mice so they were this they they did this on a lean mouse and obese and they were able to manipulate the mice to be obese or lean by transplanting the bacteria into the mice so from the from the obese human they took their poop and they put it into the lean my mice and they they were born in sanitized world and these mice uh mouths uh get fatter because they had depending on what microbiome it got so this is amazing uh so i i hope that you are slowly understanding what you should be removing from your daily life and implement these changes and really this you will start repairing the damage that has previously done i can guarantee that it's a journey as i said the healthy the health health and healing it's not destination is a journey but if you have what it takes and you want to walk again the one foot in front of the other you will get there i have no doubt and so you know this is again we go back to the inflammation this is done by uh you know if you eat good food you will calm the inflammation and we really uh when you introduce the nourishing food probiotics essential fiber vitamins and minerals that's what i see how people make mistake because they they say oh i got sugar i got gluten nothing happened yes because they they didn't put the healing compounds back in and it it's again if you have sibo and you have some probiotics you will just you will be like balloon it's not we have to try it again personalize it's very important to realize but nutrients must be replaced for effective healing period we cannot just take out take out eliminate eliminate yes that's what we do in the beginning we eliminate but then we have to really replace and rebalance what was wrong in the body because that's that's why we're doing this work we need to put the body back in the balance and uh while everyone needs is it's really highly individualized we have some common ground when we know that this is what we have to be doing when and and it's helpful when we want to uh help the gut healing processes so that's the probiotics that prebiotics prebiotics is the fiber all the vegetables that the probiotics feed on so we have the bacteria that eat the the fiber those are the probiotics prebiotics then we have symbiotics those are the the you know as well the metabolites the digestive enzymes are great as well so all the fiber from vegetables the collagen or i'm really not so keen i always prefer to do a broth or meat stock this is something i i'm so passionate everybody who will be working with me will have to learn how to make a proper chicken soup or chicken property the broth because it's something that we we all need to learn because it's so simple and it's so so uh important and delicious nutritious turmeric is another one anti-healing compo compound l-glutamine is in a functional medicine um a prescription quercetin anything that's broccoli that is will be fantastic so and when you heal your gut you will improve your health and you will improve your skin i can guarantee that it's 100 it always goes this way and and as as far as you want to go the healing will appear and so this is emerging signs this is you will not hear this from the doctor's office i think i would not be here if i didn't have rosacea i'm so grateful i have this skin condition i had this a chronic disease because um i can hear i can i was able to learn all that and really now share with you and and i'm so happy uh because it's it's our goal is really to be able to sustain wellness and really to to just be with with with ourselves as we are our best ourselves and that's we have to nourish because again it's health really is is that it's not it's journey and um it's something that i know that people need guidance they need mentorship and they need network as i told you yesterday i saw it so many times every single client patient who succeed had had the guidance had the support and had the mentorship had the uh you know if they didn't if they didn't have the community support they have a spouse and really uh support them and really saw them as they are and this is so so important so you know i learned the hard way and so i would just summarize and to do five steps that you will have to really master if you want to do this healing and you know of course we are focusing on the biology we're focusing on what to eat what not to eat what to drink you know the exercise the sleep all that but if i put it in like a five really buckets and look from perspective the first one really important is the mindset the belief it's super important that you if you cannot believe you can heal like it's no way that you will ever succeed you have to surrender you have to let the body to do the work and you have to uh believe that the healing is possible for you you have to create a space um you know like in anything if you are doing some work you know if you want to learn skiing you imagine yourself that you are you know skiing on that mountain because you're imagining that you are already skiing same is with this you imagining that your skin is is clear because you were not born with rosacea so you can make you may as well to improve it and sometimes even reverse it it's really possible um it's we can reverse today so many diseases so i don't see why not we can't do this sometimes a little bit more work because we have to do some testing when people did all this work and they didn't heal 100 i can tell you that if you do this work what we teach you will get like 80 i don't want to say number but ev like a lot of things will improve because that's how we you know that's why we came to the world we were designed for health and then that on the way we just got sick and so we know that we can do better and really the the heal to heal chronic condition you have to really start believing um and not to be in this victim uh position and really complain all the time why me you have to step into power and say no it's it's me it's my skin i love myself it's how it's it's okay it's okay high five you can do that every morning high five and say i love you in the mirror say it loud i never think that i would ever teach this or i will talk about this but it's it's just so true and it was true for me i was unable to do that and so how could i if if i if i really hated my skin how the skin can go go get better it just doesn't make sense so that's why we talk about it today so mindset is absolutely critical the belief the surrounding is the surrounding second is the is the importance of habits and we talk about that tomorrow and how much it's really like it's so important skill a skill set that you the healthy person will have because healthy person will have certain habits that the person with disease won't have so i want to arm you with all these um that you master everything and that you need to really uh you know improve improve your health from from uh from the from the ground and so we talk about it tomorrow as well and not only it's from the way you eat the way you think how you take care of the body and you know mine is everything so we we do that as well um and so number three is really um there is um you know without strategy and with your action plan there and the ro you need the roadmap to to uh to go the where the path is without this if you're just floating in the with a floating in the life and you know you might ended up having rosacea 30 years because like you have to put some some planning and you have to put some action plan to really uh just know what you're doing because otherwise we will just really go from one another day without um any any success because we if we want to be successful in this journey you have to have some um pattern and some some action plan that you walk and so that's the strategy and action plan and the number four is really to um to have a circle of support and community it's just so important um i can't i can't tell you how important this is uh because all the all the success that i've seen i was uh the people who really are and are inspired by others they get support because sometimes on this health journey we are vulnerable and we need people who understand us who have similar conditions that's why these facebook groups you know and if they are so so powerful because um i remember some of my clients they said oh yeah i was talking about this on facebook they are so powerful because people having a same thing and they just sharing their uh experience and um so the best is as well if you have a mentor or someone who did the journey and so that's why i'm here this week for you and uh so so you can improve your your condition and really i want to give you support and really i it's this this is just i i really i'm so happy i'm doing this you cannot imagine i'm so happy and so the fifth um the fifth is really putting it all together connecting the dots between the gut microbiome listening to your body uh really connecting the sleep the stress all this the gut microbiome what the feel immediately what feels good for doesn't feel good in your life and the communication with people healing all trauma all this you can just be in different place and the thing i want to share with you today is something that i am a bit nervous but i am so so excited because um i'm going i'm going to teach you all of this and i was waiting 10 years i was waiting 10 years to open this special place this special container of everything that i learned for people like you and that i experiment and i learned the hard way because i was alone in this and it took me really it took me a long time and i just want um to be there for you and help you if you are ready to do the work this is not for someone who is looking for a quick fix or for uh some you know some more products this is for people who are ready to to do to walk this journey and to really learn what is there because as i said we have just one life and i want for you that you look at the mirror and just start loving yourself as you did before because this rosacea i don't want that this thing uh takes any off more anymore day from your life to to being miserable to being angry or just um you know being unhappy because you deserve to live a healthy life and happy life and i just want to share with you everything so i created this is the first time ever i never did this before you will be the first one i i did this before i helped one to one but i never i never open uh like this um this it will be 52 lessons that we will go through it will be one hour a week with me on zoom and we will just go in this one hour indeed it will be um it will be really i will be your mentor i will be your guide i will be your support you always can come back to me and i'll answer everything that i know and if i don't know i will have a look or if i will invite people who are maybe mold specialists who are you know i have already my team that will do it we do it together i have yogi i have um someone a girl that does um the uh the tapping technique so and it will be more so it's something i really want to create something that will be like we fill all the the holes and it will be like this holistic approach to the whole thing and really i want as well to be that you are in a place where the positive energy is contagious and uh you will just know what to do and um i'm just so happy that again i want to cry because i know how much i suffered luckily i have this disease of how how long four years and it was suffering i really i couldn't go things because people like looking at me like what is in your skin like my dad oh you're looking awful it's like help me so you know someone came to the house i have to quickly put at least makeup because otherwise they they were just like they would just be shocked like how i look and so i know how hard it is and i know that we don't you know we medical doctors we don't teach that it's above our this is not our job our job is prescribed your doctor's job is doing great job please don't spit on any doctor because they're doing the great job they should prescribe medicine and you should prescribe creams they just didn't have rosacea as as i did so i'm in this sweet spot where i'm a doctor and i'm patient so i know the both ways and that's why i became a coach to to to help you to uh to do this and i'm so happy to to offer you this it's really the the the price for this program it's a really so it's no brainer it's 900 um so sorry 179 a month so it's like it's it's really no-brainer i just wanted to put a price that everybody can afford but it will be commitment for you that you really um just do the work uh and it's it's for one year so it's 52 lessons that we will go through everything so and the end of it you will just have different life and i did similar programs before so i know it works but i never did with rosacea and so that's why i am happy that i can offer this to you and so if you have any question about that i will post a link below this video you can have a look it's not much on a sales page but um i just want to help you and that's why opening this because i believe you can heal and i believe that you have the power to really improve your skin and look at this mirror every morning and see oh my my gosh look what i did i i did this work and now i am so happy about myself so that's why uh i created this so uh tomorrow so i hope it was helpful today uh we we learn a lot we learn a lot about the gut health it's super important there is as well sleep is is related to god and everything is right to god whatever you do when you smile you're is related to god when you cry you are you either making your gut happy or making you get sad uh and so um this was from today i'm so excited that you are here with me uh we are running we carry on we continue with this tomorrow we're talking about habits it's very important that you show up uh be talking about habits and please be active because one of you will join me for this program for free which is the value is over two thousand so uh you know it's it's it's a good value and i i really want uh be here for you uh to help you to go out this suffering but any anyhow tomorrow i want to see you here again at one o'clock we're talking about habits uh how you can really with your habits improve your skin and friday and and uh yeah and the saturday actually saturday we'll talk about rosacea and you will connect those even more and then we will have some bonus sessions it's we have a lot of our play just keep keep going you're doing great job and if you have any questions please please ask me i'm here to support you i'm here to guide you i i'm really so grateful that you are here with me that you sign up i i cannot really i'm i'm really expressing great gratitude because um i i know i know how it feels to be in that place and um i'm just happy to help all right then so see you tomorrow and i have a
Rosacea, Stress and Mental Health - Part 1 - Rosy JulieBC_en (auto-generated)
[Music] [Applause] [Music] hi Rosie friends its Julie I'm back and I'm making videos again and I couldn't be happier I have missed this so much I have been working on the third book for my novel series and it's out on Halloween so it is really French time right now and I have been really busy but it's a good busy so it's been worth it but it has meant that I have not made a video in quite some time thank you very much for sticking with me and for your patience that's it it has had me thinking about a topic that I've wanted to discuss for some time now it's one that I haven't really known how I want to approach it I've kind of been having a hard time getting my mind around it so to speak as you can see from the video title I am finally covering the topic of rosacea stress and mental health and when I say mental health I mean all sorts of different kinds of issues not just the ones that I currently experience there is a huge amount to unpack here so I thought instead of trying to make one unbelievably long and horribly inadequate video I would try and break it down into a multi-part series I'm thinking it's probably gonna be three parts long at the moment but I am going to ask for your help here if you have any subjects in terms of rosacea and mental health rosacea and stress anxiety depression any of that kind of thing I would love it if you would leave a comment I will see what I can do if I know anything about it or have experienced it myself then I will be happy to talk about it that said I do think that it's really important to point out here that I am not a doctor I'm not a counselor I'm not a psychologist or a psychiatrist or any of those things when I mean talk about it I just mean as a discussion in terms of what I know what I've experienced and what I've read about on various sites that I trust like rosacea or the National rosacea Society and the Mayo Clinic and and other really well reputed sites in addition to actual studies that I've read too because I like to read medical studies because who doesn't like that well that being said I'm not here to diagnose you I'm not here to give you recommendations as to what you should do if you think that you have rosacea or that you know that you have rosacea or you think or know that you have some sort of mental health or physical health issue and you are looking for diagnoses or advice I really strongly recommend that you speak with a doctor they are the ones who can actually help you out I'm just a patient myself just like you I may look up a lot of stuff and ask a lot of questions to various experts and doctors and things but that does not make me an expert myself for this first video what I'm going to talk about is basically sharing a little bit of my own experience and a few basics in terms of some of the concepts that I'm gonna be discussing things like that I just want to get into why I'm interested in this particular subject and how it affects me and then we can expand on it in parts two and three in terms of how it kind of affects all of us who have rosacea and who are affected by things like stress and anxiety as a trigger and as a symptom of our condition okay so to get started I wanted to actually talk about stress itself and what I'm going to mean by stress because stress can come in good and bad forms not all stress is bad some stress is actually necessary and is healthy that said a lot of kinds of stress good and bad can affect our rosacea so I thought I would actually discuss stress as a concept at its very most basic level just so that we'd know when we're talking about stress in later videos what I'm actually referring to so the first kind of stress is the most basic ground-level kind of stress and that would be the type where you feel that you are in immediate usually physical danger this is the stress is the one that you get from your reptilian brain it's the one that is the fight-or-flight response it is built indoor very physical very primal they're part of the original part of our brain that has ever developed and it is what gives us the ability to respond quickly and to think quickly and to be suddenly more alert and to have a physical boost so that we can either fight to save our lives or run to get away if you've ever yourself or if you've seen a video or anything like that of somebody who has almost been hit by a car and they've left right over of the hood or they've seen something happen and have suddenly had this almost superpower to lift something they wouldn't normally be able to lift then that's usually because of this response your body suddenly is flooded with adrenaline and that just pumps you full of energy so that you can give yourself the best chance at getting away and living to see another day so that is really unscientific but that is the most sort of basic level of what that one's all about so the first type of stress is just that fight-or-flight you feel you're an immediate physical danger and this is what helps you get away the next type of stress is the one where you want to perform at your very best you have a job interview you have an important presentation you are playing on a sports team and this is the game something else that is just life defining and you need to make a good impression or perform at your very best this stress is the one that can help you again to have better mental and physical capacity so that you can push through and perform at your very best interestingly this dress is actually based on that same original stress the one that you felt from in the previous kind where your life was in danger it is still the fight-or-flight response it just happens to be because you think that this particular goal is so important that you're having the same reaction it is a it is life or death that's how important this is to you so your body and your stress respond in the same way in those first two situations stress that you feel might not be comfortable you get that you know bracing heart you were breathing fast or your hands might be shaky that kind of thing but at the same time it's helpful it helps you to get away from a dangerous situation and it helps you to perform at your best in a situation that you feel it's really really important but there are also forms of stress that are not helpful and that is normally a chronic type of stress so you live a very very stressful lifestyle a job that has you on-call 24 hours and you just never know exactly how something very important is going to work out there could be you could have just received medical news that is long term that is something that you didn't want to hear it could be that you're going through a very uncomfortable transition in your life or a positive transition one that you're just really unsure about the income and you have a lot of worries that kind of thing when you have that kind of chronic stress that type of thing can be damaging because when stress is just constantly there day and night and it never goes away it doesn't give your body the chance to come down from that really excited state so it doesn't have the chance to relax and it doesn't have the chance to recover as well as it can there are a lot of processes that go on that are very very hard on the body and on the mind for that matter and finally there's kind of a positive type of stress if you want to call it that and that's the type of stress that you feel that's actually a very good but powerful sensation it's an excitement you've won a prize you got the job or the promotion you wanted you got really great news of some kind as much as those are all very very positive things they all actually create this very similar type of response in the body you know something really fantastic happens you still you get the increased heart rate you get the increased respiratory rate your hands might still shake you know if you if you learn something absolutely fantastic it still can give you that same rush if you experience stress as a trigger like I experience stress is a trigger absolutely any one of those kinds of stress can actually create a rosacea response whether good or bad whether I am upset and blushing because I've been embarrassed or I've just been scared or I've I'm going through something traumatic or I just had something really fantastic happen one of my risk first responses to have a flushed face and that could last for a few minutes or it could last for quite a long time in my case I know that things are exaggerated I do have a number of mental disorders if you have been watching my videos for a while then you know that I suffer from several different kinds of mental health condition and each of those can actually contribute to worsening my rosacea symptoms as well at the same time rosacea can also play a role in worsening my mental health conditions depending on how well my skin is doing it and how comfortable it is at a certain given time for those of you who haven't been watching my channel for a while I suffer from social anxiety disorder generalized anxiety disorder panic disorder obsessive thoughts and I am also prone to periods of depression so it's a lot of fun being me and it's a lot of fun being around me at the same time I was first diagnosed when I was 19 years old with my first condition which was social anxiety disorder as it turns out I've probably had that since my early childhood but that was the first diagnosis that I actually received and that was the first time that I started receiving any kind of treatment I hadn't even heard of social anxiety disorder before that point my sister just happened to hear a show about it on the radio and came home and told me that I sounded exactly like that and I went to see the doctor and it turned out he agreed over the years to try to manage this I have taken a lot of different kinds of medication and have tried lots of different kinds of therapies I've taken antidepressants including zoloft which was a little yellow and white capsule I've taken paxil which is this little pink eye here I have taken beta blockers which look like this and they are what I was given along I think I was given that one along with zoloft because their zoloft didn't control my racing heart and it felt like I was having a heart attack and I was fainting from that so I got those pills for that one and then later on when that wasn't enough I got these really tiny little things here and those are ativan and those are something that I would stick under my tongue wait for it to dissolve and that would clear up a panic attack these are all very old pills and I didn't even know that I had them but I discovered them the other day and I am returning those as well as some expired anti lrg pills and my old contact lenses that I don't wear anymore to the pharmacist so don't worry I am NOT hanging on to these for any disease and to get rid of them at the pharmacist properly I said I did break them out just cuz I thought it might provide a cool visual to show that yes I have been on a lot of medications to try to control all of my everything going on in my head I took these in various dosages and combinations over the years throughout the time that I was on these different medications I worked really hard to be able to try to control the symptoms on my own until I finally was ready to wean myself off of them and I do mean weaning myself off these drugs because they are highly addictive and I was definitely stuck on them when I was trying to even when I was just gradually reducing the dose according to my doctor's instructions I was getting withdrawal symptoms like electric shocks in my teeth and hand so that was not fun nor was the feeling of having like a nail pounded into the top of my head during the night so these are definitely very serious medications they definitely helped me but they should not be taken lightly I'm not taking anything now I'm feeling very proud of that I don't think that anybody who is taking these types of assistance to get through their struggles should think less of themselves I took them for nine years and I don't know how it would have gotten through that time without the added help the symptoms that I was experiencing were very very strong and I don't know how I wouldn't have ended up basically as a shut-in if I hadn't had that extra help so that would reduce my symptoms while I was learning to cope with them on my own that's it I have far from mastered doping I have improved it definitely I am still trying different things all I can do is try to be very very aware of my symptoms and to my responses to my symptoms to try to make sure that I'm always having the healthiest reaction that I can manage I still have a lot of triggers for my anxiety and especially for the panic the main ones are things like talking on the phone I do have a phone but I do not have a ringtone for the voice calls because I won't answer it anyway I'm just not quite there yet I am trying to build up to phone calls but there are about four people in the world that I'm comfortable talking on the phone with the top challenge is with invasive thoughts well I am able to leave my home and go to the store and go shopping and meet people and I even do attend events with my co-author promote my book I still know that when I do a lot of these things and I have appointments and things like that I probably won't sleep the night before and I may or may not sleep the night afterward because my thoughts are stopping me they're constantly telling me things like shouldn't have said something or I've probably offended somebody they don't like me anymore because of that and I've hurt somebody's feelings that I set a joke that just wasn't funny and now they think they don't respect me anymore I know that these thoughts are ridiculous consciously rationally I know that no single thing that I say in passing that small and light is going to be taken that seriously nobody thinks that the things that I say are that important but that doesn't seem to stop my brain at all and that stops me from sleeping insomnia goes hand-in-hand with that and then when I don't sleep both my rosacea and my invasive thoughts get worse if you want me to talk any more about any of the topics those topics my triggers my anxiety my individual conditions any of that kind of stuff I will happily do that in another video please request that in the comments but I know that I'm digressing right now from the rosacea a little bit and I'd kind of like to stay on track for the series I will be much more focused in parts two and three I'm just trying to create a foundation so you'll understand where I'm coming from though the whole point to all this is that stress and anxiety and depression and rosacea are all linked in a lot of ways fortunately they do create a kind of vicious cycle among a lot of us I know that this is how I experience it I know that I have been talking to a lot of you over email and over direct messages over to my different social media accounts and you've talked about this quite a lot about the anxiety that you feel from your rosacea and that it's making your fascia worse or the other way around that you feel anxiety and then it brings out your rosacea I feel at least in my case that it goes both ways one of them just feeds off the other and it gets worse and worse and worse and it's easy to get caught up in it this a common way for one of the cycles to start up for me is that I will have a flare-up from whatever it might be I've eaten something funny I've had something embarrassing happen and I blush and it just triggers the whole thing I went out in the Sun and didn't realize I would be out there for so long and it sets it off whatever it happens to be I end up with a flare-up that brings with it redness stinging burning itching bumps and all those fun symptoms that we tend to go through because of that I feel more stressed I'm uncomfortable I feel ugly I feel like other people can see it happening and especially because when I blush I blush when I'm embarrassed but then it doesn't go away so people think that I'm still upset even if I'm not and I blush a really easily it doesn't take a lot of embarrassment it just takes like and that's it then my face will flare up so as soon as I start to feel even the slightest bit stressed or embarrassed then I flush even more so any of those original symptoms will get worse and as those symptoms get worse I'm aware of them I'm more uncomfortable and I feel more stress and that just keeps building and then I become uncomfortable enough that I don't sleep very well at night I end up lying awake listening to my invasive thoughts the next day I'm less capable of coping with stress because I'm not well rested and I've been torturing myself for the last 10 hours or whatever however long I wasn't lying in bed trying to sleep and because of that it just gets worse my symptoms get worse my face keeps flushing it keeps being itchy and uncomfortable I feel ugly and so on and so on and so on so as you can see once you get into the cycle of bouncing your rosacea symptoms and your stress or anxiety off each other it's really difficult to crack your way out and it sounds like it should be easy it sounds like you should tell yourself to just calm down get over it it's not that bad it'll pass all of those things but when you're in it it's not that easy if you've ever been really upset about something you can't just tell yourself not to be sad anymore or not to be afraid and the same thing goes with stress you can't just say well I'm not gonna be stressed anymore and then it's gone because you can't lift just lift that away super easily get the the rosacea symptoms tend to stick around um as a side note I recently read a book called Turtles all the way down by John Green he's a fantastic author he is a fantastic youtuber I really have a lot of respect for him it's a fiction novel and the main character has absolutely nothing in common with me except that she has invasive thoughts and her invasive thoughts are nothing like my invasive thoughts but he has absolutely nailed the description on what it feels like to constantly be arguing with your brain you feel like you're actually under attack by somebody else who just happens to also be you and so if you are ever if you experience this and you'd love to read about that experience or if you know somebody else and you would like to know what they're going through he has done a fantastic job it's a really good book all by itself but he has also done a wonderful job at describing the experience of being in the head of somebody who has all of these constantly invading obsessive thoughts sidenote over whether you have a mental disorder or not stress in all of its forms can have an effect on rosacea and rosacea can have an effect on your stress so whether it's because you have an anxiety disorder you're suffering from depression or there's just stuff going on in your life that makes you feel stressed for a moment or for a day or for a few days they can all play off of each other and nothing gives me a flare-up faster then Sun is definitely my top trigger I find that way easier to control those sun exposure is way easier to control then stress and anxiety and things like that and I can feel stressed and instantly flare up for that reason a major part of the Rosi lifestyle that I've been building to try and keep my rosacea symptoms under control has to do with actually controlling my stress which is good for me anyway since I do have anxiety disorder some panic disorders we have already talked for a lot longer than I'd meant to I kind of got a few babbles there but I really did want to set a foundation to let you know sort of where I'm coming from in terms of talking about stress and rosacea art how rosacea is actually a trigger for various mental health conditions how it can cause more stress in a person's life and how it can actually increase the risk of mental health conditions I have been finding a lot of studies that I will be discussing in the next video and I will cite everything in the video description when that one comes out part three is going to be about how stress and anxiety and other mental health conditions can make rosacea symptoms worse so it's the other way around and I'm hoping to get into some coping techniques and things that have worked for me I don't know what worked for you but I'm hoping that by sharing what I'm going through it will give you something to discuss with your doctor or something to try out for yourself if you feel that it is appropriate for your condition either mentally or in terms of your rosacea because I feel that this is something that is affecting an awful of us and it hasn't been discussed enough this link which is very powerful and has been shown time and time again in research and has talked about in a lot of places that are specific to rosacea is not it's not getting out there quite as much we're talking more about foods and skincare products and the Sun and that kind of thing but our mental health isn't getting the attention that it probably should because it is affecting our lives and our rosacea symptoms for that matter so because of that I just wanted you to know that you are not the only one who is struggling with this kind of thing if you are struggling with it you are not alone and there are a lot of things that we can do to cope with our anxiety our stress and therefore a lot of the triggers that are making our rosacea symptoms worse so I hope you like this video I hope it was informative to you and helpful and entertaining in some way again if you do have any requests specific to stress and rosacea that you'd like me to cover in one of the future videos in this series then I hope you will make a comment and let me know what they are I will try to accommodate if I can if you did like this video I hope you will give me a big thumbs up that way I will know I do pay attention to the number of little thumbs ups that I get for a given video because that lets me know that that is a video that you enjoyed and that you would like to see you would like to see more of that type of thing in the future and if you do want to see more stuff like this then I hope you'll subscribe to my channel and click the little bell if you want to be notified every time I put out a new video I try to put them out every Sunday and sometimes I have one I would on Thursdays as well and everything and I will see you next time [Music] you
SIBO and skin issues with Dr Michael Traub - Ep 53_en (auto-generated)
[Music] welcome to the healthy gut podcast with Rebecca Coombs the place where you can learn how to achieve a happy healthy gut here's what's coming up on today's show welcome to episode 53 of the healthy gut podcast today we're joined by dr. Michael Traub dr. Traub graduated from National College of naturopathic medicine in 1981 he was board-certified in 2007 by the American Board of naturopathic oncology and is medical director of La Caille Health Center and Hawaii integrative oncology in kahla Kona Hawaii dr. Taub served as president of the American Association of naturopathic physicians from 2001 to physician of the Year award he is the author of essentials of dermatological assess and integrated with therapeutics he is an avid amateur triathlete and has practiced meditation and non-duality for over 40 years today we're talking about the impact that the health of your gut can have on your skin we talk about the gut skin access and why common conditions like acne rosacea psoriasis eczema and skin cancer can be a sign that you have SIBO or another underlying gut issue we also talked about what we should be treating first the skin or the gut or SIBO if you have it as someone that suffered terribly from a horrific acne for so many years in my teens I really am very passionate about this topic because I know it firsthand what impact poor skin or skin that makes you feel less than your best can have on you so I hope you enjoy today's episode with dr. Michael Rob welcome to the healthy gut podcast dr. Michael tribe it's wonderful to have you on the show today thank you about Rebecca it's beautiful to be here with you and we're going to be talking all about SIBO and skin and something that I have personally lived with for many many years skin issues and I'm so fascinated about how the health of our gut can often be displayed on our skin but before we get sort of started on that topic I'd love to talk about how you got into naturopathic medicine and and how you find yourself to be we know working in beautiful Hawaii today and and really helping people with digestive issues well my father was a dermatologist my mother was a nurse so I grew up wanting to be a doctor and unfortunately I grew up in Southern California and I had a very standard American diet and I developed really severe acne as a teenager and it really affected me it made me very kind of inhibited and self-conscious and it was very ironic because my father was a dermatologist and he sent me to his partner who basically used every treatment available at that time to try to help including giving me tetracycline that which caused my teeth to get discolored and giving me x-ray therapy which led to many skin cancers later in life and none of it really helped but the good thing was that in my last year of high school I fell in love really for the first time and just the beauty of having somebody who cared for me and who I love deeply really seemed to help me and my skin cleared up and so I credit her with the cure to my hat so Wow then we went off to college to different colleges and our relationship ended because we were apart and in my first year at university I was premed I got involved with a group of people who were trying to go to anti-war protests to the you know for the vietnam war was still going on then and and keep them from getting violent you know it was kind of ironic when peace protests would get violent so i kind of jumped in with them and did that and then we plan to do an act of civil disobedience to protest the war and got arrested on purpose and that in ultimately affected my ability to get into medical school as I had to explain you know any convictions on my record and at the time I didn't think it was going to hurt me because I thought it was a evidence of my humanitarian values and so forth but I was very naive and the medical school applications didn't see that that way so the friend my friends were many of them were vegetarians and eating pretty healthy and so at that time my my diet began to change and ultimately I found out about naturopathic medical school and decided to go there and when I first started there was this common concept that food combining was very important and that have you ate this with that it wasn't gonna digest well and I got it kind of got caught up in being concerned about that to the to the extent that it began to affect my digestion and I began to have you know symptoms of what we would call irritable bowel syndrome where I would have discomfort and bloating and it affected my bowel movements and so that was kind of my introduction to having gut issues and finally it didn't take me too long but I figured out that the problem was not what I was eating what foods I was combining really wasn't the issue it was how I was feeling I'm you know about my food when I sat down to eat it and the worry that was affecting my gut so I let that idea go and started just sitting down and blessing my food and being relaxed and meditating for a few minutes and I could eat whatever I wanted again and I was fine so that actually you know was a real lesson for me about how much our psyche illogical state can affect our digestion and from then on you know i-i-i I was beginning to meditate and practice yoga which I've continued to do all my life and I really haven't had any significant gut issues from that time so I'd like many people who have an interest in SIBO or digestive disorders I'm you know that's that's the extent of my experience and but as a doctor of course I've seen many many people who have suffered from what I used to think was irritable bowel syndrome and I knew it was stress-related and I would work with them with their diet that we didn't always get the kind of results that you know one would want and so about four years ago I started hearing about this condition and it got caught my interest I was very impressed with the people I was learning from like dr. C Becker and dr. Sandberg Lewis in Portland and it made sense that there was this underlying you know imbalance in the flora of the small intestine that was causing these GI symptoms and so I started recognizing this in my patients and my initial experience with treating people was phenomenal I mean these were people who had you know long-standing gut issues and by testing them diagnosing them with SIBO and treating them you know they felt better than they had in many many years and so that was very rewarding for me and my patients and unfortunately it kind of gave me a overly optimistic perspective on treating this condition because I've subsequently found down that found out that it's not only common but and and underlies the majority of irritable bowel syndrome cases but it's it's a chronic condition and it takes time with most people to manage the symptoms to the point where they are no longer a problem and I know that in your own history I think you are fortunate to be able to recover relatively quickly and so I think however that in my experience with patients that's the that's the minority and that in general requires multiple courses of treatment and and working with the diet and you know the other aspects of care that are needed in order to really get a full recovery so that's kind of my story and my experience with treating see both my my focus in my practice is actually oncology I still have a primary care practice and I'm very interested in dermatology as a result of my you know father's career but because of my expertise in dermatology I've focused to a certain extent on the this connection between the gut and the skin and that's I think primarily what we're here to talk about today it is and something that I lived with a lot of skin issues in my younger years and I now can see that there was a very strong correlation between what was happening in my gut and what was happening on my skin so can we can we just sort of talk about how that occurs like is the health of our gut mirrored on our skin it is I don't think that it's necessarily as simple as that because the underlying immune dysfunction of many of these skin conditions that have a connection with SIBO is complicated it's not it's not just straightforward it's it's complex so I think that to go back a little bit it was almost a hundred years ago but back in the 1930s that there were two well-known dermatologists their name was were John Stokes and Donald Pillsbury and they actually proposed a gastrointestinal mechanism for the overlap between psychological states like depression and anxiety and skin condition conditions such as acne and they they thought that emotional states might alter the normal intestinal flora what we now call the microbiota and that it might increase the permeability of the intestine you know what we commonly called leaky gut and that this could contribute contribute to systemic inflammation and now many aspects of this gut-brain skin unifying theory have been validated and the role of the intestinal microbiome and oral probiotics to to mediate the systemic inflammation and oxidative stress and blood sugar control and the content of fats in tissues and even mood have really important implications in acne and in other skin conditions just taking acne as an example there's a kind of a vicious cycle that can be established between psychological distress whether it be worry or depression in combination with a high-fat diet and processed foods that don't have much fiber that can cause alterations to the gut motility and to the profile of the bacteria in the gut and this can lead to a loss of the normal biofilm sometimes that can then cause the intestinal permeability and allow toxins to get access to the blood the blood and that can increase the burden of inflammation and oxidative stress and in those who are genetically susceptible to acne this kind of cascade of events can increase the likelihood of then having the excess oil in the oil glands produced and making acne worse and causing additional psychological distress so it becomes a vicious cycle and so we we know that probiotics and antimicrobial agents can play a role in cutting cutting off this cycle at the gut level and that way we can address acne by treating this disruption of the gut mm I wish doctors had known about that when I was going through this I'd developed acne at 11 and probably by the time I turned 12 I had terrible acne it was all over my face neck chest arms and all over my back so you know literally half my body was covered in very cystic acne and the very common treatment and it still seems to be today that I was put on multiple rounds of antibiotics by the doctors and nothing worked and like you say there was the enormous amount of psychological stress that goes with it I was at an all-girls school here in Melbourne Australia and you know anything that sets you apart is great cause for bullying so I was bullied just horrendously because of my skin which makes it worse and then I would you know eat junk food because I felt so bad about myself and I'd gone eat the junk food and then I'd feel worse and I was a really really horrible cycle that lasted for many years until I went on to Roaccutane which is a very powerful drug which did clear up the acne but you know I often wonder what did that do to me after you know basically putting a nuclear bomb inside my body and I and I do hear from people in the SIBO world lots of SIBO patients who often talk about how their acne has really flared up with their SIBO progressing or getting worse or that the SIBO isn't under control and that they're really saying this this flare occurring on their skin so if somebody is in active treatment for SIBO and their acne has really flared up and they don't feel that it is actually improving with their treatment do you know what how would you would suggest that they approach it well I think it's important when you have both the gut issue and a skin issue coexisting and probably contributing to each other that you address both at the same time and that you know the vitamin a derivative that you took for your acne that was effective in is really a wonder drug and is probably the most important drug that's ever been invented for Dermatology because it was it's so effective but it does have potential side effects and it the the main one being that it can cause birth defects and so if young women take it like you and become pregnant the risk of having a baby with congenital problems is really high and so it has to be very carefully prescribed and a woman of childbearing years has to be on two methods of birth control while she's taking it and so it's you know it's a very very effective drug for cystic acne but it's also a very dangerous one so it turns out that before that drug was invented dermatologists were just using high doses of vitamin A and then they found out that you know not only was that effective but if they tweaked it and made a synthetic version of vitamin A that they could patent it as a drug and it was you know be sold as a prescription and make money for the drug company and so that's what happened but when I have somebody who has severe acne I used high-dose vitamin A therapy and it works very well and if it is a woman of childbearing years then I you know make sure that she knows that she cannot under any circumstances become pregnant while she's taking the high-dose vitamin A but it works just as well as the drug and it doesn't seem to have any side effects I've used this safely for many years and so that's my first line therapy for severe acne we've learned is that I'm topical or is that tanco is that indicated it's an it's taken internally yeah and we've learned you know in the last 15 years or so that diet does play a huge role in the causation of acne and we know that milk products are probably the primary driver of acne and that sugar simple carbohydrates are also a very important driver of the underline hormonal and inflammatory disturbances that are going on with acne so you know the diet definitely needs to be addressed too and it you know if a person has SIBO they're already avoiding you know formidable carbohydrates so that helps mmm definitely and it's so interesting you say that because I was following that very standard Western diet of low-fat high-carb I had a very sweet tooth in those years so lots of sugar and you know I was I didn't really like meat so I was you know I didn't eat a lot of meat we ate a reasonable amount of vegetables but way too many carbs and sugar for my system and no wonder no wonder I had such terrible acne and at the time I mean this is gosh 30 years ago doctors were saying that diet had no correlation to what was happening on my skin right and all I could do was was do antibiotics so we didn't know in those days that changing my diet would have had such a significant impact whereas I think that these days you know people are more up to speed with the importance that diet plays it's interesting I had a lady you know I put always put a call out for questions and whenever I'm interviewing somebody and a lady wrote to me saying that her daughter was having a lot of skin issues but she had she just could not kick the sugar so if someone's sort of listening and they're thinking oh my gosh that it's the you know sugar okay but they feel like they just can't kick it do you have any advice on how to move away from the evil white stuff have you ever had a relationship with somebody who you really love but it was not a healthy relationship yes oh I talked to my patients about breaking up with sugar you know it there's there's some really nice things about sugar but there's some really nice things about sugar and it's it's almost like breaking up you know it's almost like leaving our relationship that in some ways has been wonderful and in other ways is not so wonderful and so it's it when you and when you break up with somebody usually it's best to just kind of you know completely break loose for a while and have have no no contact and kind of get used to who you are without them and and have a have a you know a cool-down period you know rather than jumping into another relationship and I think that the same thing is true with sugar is that it's best to just really a hundred percent avoid it for a period of time and let your body get used to that and not try to continue to feed the desire for sweet things by using things like stevia and and just you know learn to love the natural sweetness of Whole Foods rather than foods that have been had sweeteners added to them I really love that analogy Michael and it it really sings true for me having had a sweet tooth for you know so much of my life and and in fact coming off the back of my month in the states in Canada where just by virtue of being out of the hot out of my home my kitchen I ate way more carbohydrates and therefore added sugar than I would normally eat and I got back to us Australia feeling pretty ordinary just from having so much processed food because I was constantly flying all over the place so I've gone I'm I am an all-or-nothing person so I'm back into a very strict low carb high fat way of eating and is strictly no sugar because I could see that the sugar it was becoming an issue for me again and I the first few days it's it's really like a relationship breakup I my body was mourning the sugar I was having intense cravings from it someone I live in an apartment complex someone was baking something sweet and I was nearly licking their front door I would smell it like oh my gosh where is that sweetness coming from but the first few days are just the first few days and I knew it was going to I was probably going to have some cravings and I'd just get up and I'd go for a walk and I'd go and drink a glass of water and I'd put a song on and sing really loudly to just distract myself and now that I'm through the worst of that I was chopping up some vegetables the other morning I loved to make a big vegetable stir-fry with some some form of protein in the morning and I bit into one of my pieces of carrot and I was thinking ah how gorgeous and sweet is this carrot and when all of that artificial or processed sugar is out of your diet you know some it's amazing how sweet real food actually can taste yeah and the carrot to me tasted almost like you know a sugary thing because it was so fresh and sweet it was organic it was gorgeous and I'm they're going mmm amazing carrot but I wouldn't I wouldn't taste that if I was still having the sugar in my diet yeah I'd like to I think in my experience when I've broken a habit whether it's sweets or coffee you know it's like many other habits even exercise if you're trying to establish a new habit of exercising regularly it usually takes about three weeks to you know either break a bad habit or start a new one and kind of get free of a bad habit and or have a new habit that's healthy alike exercise be something that it becomes automatic and you know it's not such a struggle to kind of push yourself to to whatever you doing mmm and I'm few weeks into my more rigid way of eating and I it's now just par for the course for me I'm not thinking about sugar I'm not interested in it at all it's not it's not I'm not getting the cravings and it definitely becomes a lot easier and I have a great system that keeps me on track and I tick I like I really need to game a five things for myself and so I have a daily chart and I'd tick it off and that really helps me psychologically to see that I'm taking a step forward every day and so I think finding the thing that works for you if you need if you feel that you need that extra motivation you know ticking off a list or I've got star stickers that I stick on my I've got a big poster that I've put up in my wardrobe so I see it every day and it's literally you know yes you were achieving all of the things you want to do that will keep you moving towards health and that I find very motivational because it's all lit lots of little things rather than one giant thing it's all the little things you do every day that keep you staying healthy or healthier then if you don't do lots of visual things I feel so I tick them off and oh it's like being a school child I give myself a star sticker for good work but it works for me and and I think finding what works for you is a really great way to make a little plug for your your cookbook the first recipe that I made was the one that where you'd use coconut flour to make these little like pancakes mm-hmm and I loved them they were they were they'd had just a faint little sweet flavour I think I used just the tiniest bit of honey but they were they were wonderful and it really doesn't take you know much sweetness to be able to enjoy something like that and not not such yourself back in any way exactly I'd like to talk about some of the other skin conditions and diseases that one might see appear that may also be correlated to compromised gut health so I've talked about acne what are some other things that people may experience well probably the condition that I have clinically seen the most benefit from treating SIBO is rosacea and it used to be that rosacea was called acne rosacea but rosacea really is a totally different conditioned and acne and it should not be confused with no you know acne itself we're not exactly sure what the connection is between SIBO and rosacea but the connection is is is really robust evidence from studies in Europe suggests that SIBO may be present in about 50% of patients who have rosacea and for those listeners who don't know about rosacea it's that condition where patients have really rosy red flushed blushed cheeks and sometimes it affects the nose as well it's mostly affects people who have some Celtic ancestry so there's definitely a genetic predisposition to this and basically the little blood vessels under the skin the capillaries are hyperactive and really prone to dilating when that person is exposed to heat or when they eat hot foods or spicy foods and you know these people often will really flush and blush when they get overheated or even mildly heated or when they eat hot food and so there have actually been some randomized studies that have suggested that the main prescription antibiotic that we use to treat Seba or a fax Imman really leads to significant improvement in over SIBO and these these kinds of results in that study are also supported by other studies of patients with rosacea who were treated for SIBO so that is very very impressive it but unfortunately we don't have a really you know clear understanding of what the connection is between those two conditions another kind of common skin condition is psoriasis and again in one study about ten years ago it showed that 60% of patients with psoriasis had malabsorption versus less than 5% of patients without psoriasis based on a test of malabsorption called the d xylose test and those 60% of patients who had psoriasis were then tested for SIBO with breath tests and 21% of those tested positive and when they were treated with ant refax Imman or another antibiotic it normalized their absorption and it also improved their skin condition so psoriasis is another condition that seems to benefit from treatment of SIBO if that's coexisting gluten free diet also benefits many patients with psoriasis and there is a connection between psoriasis and celiac disease in a small percentage of patients eczema is a you know after acne is probably you know the most common other skin condition that we see between you know besides skin cancers which I'll get to also but with eczema it often starts in infancy and in childhood and it may be that an imbalance of the intestinal microbiota in infancy from antibiotics or from actually paradoxically to clean of an environment where the immune system develops in a particular way because it's not being exposed enough to microorganisms that can that's recognized risk factor for eczema and staph infection also frequently complicates eczema which you know as a bacteria is a normal component of our skin microbiome in small amounts but people who have eczema tend to have overgrowth of staph and it causes secondary infection and then there's a couple other conditions one is verdict area which we commonly refer to as hives and again their percentage of patients with chronic hives have SIBO and improve when that sibylla's test is treated and lastly there is a condition that used to be called scleroderma but now it's referred to as systemic sclerosis this is a very serious systemic condition that causes fibrosis and scarring of multiple organs including the skin and the digestive tract and it leads to malabsorption and it can lead to kind of a pseudo obstruction of the of the intestines and so this results in malnutrition in these patients and it's one of the most common causes of death from this condition in fact people with systemic sclerosis have a 50% mortality rate after eight and a half years if they have malabsorption just from you know being malnourished so these type these patients with systemic sclerosis who have had SIBO diagnosed actually about 50% of these patients have SIBO - so the eradication of z-bo in these patients has also led to significant improvement in their GI symptoms hey guys do you feel completely overwhelmed when it comes to figuring out what you can eat that's suitable for a SIBO diet I know that I felt so overwhelmed at the start of my cebra journey and let's be honest eating for SIBO it can be challenging it can downright suck at points you've already got so much going on you've got your treatments you're trying to remember to take all your medications and your supplements and not to mention all of the daily symptoms that you have to experience the pain the bloating the constipation or diarrhea or both and the brain fog and exhaustion the list just goes on having someone else take that hassle away from you for planning your food can make your day just that little bit easier and this is where I've come to your rescue I've developed Zeebo meal plans just for you they take all of the stress away from planning your SIBO daily food intake they're based on the SIBO biphasic diet by dr. neurologic OB and each meal plan is just for the specific phase it relates to so you may be on phase 1 restricted or phase 1 semi restricted or phase 2 reduce and repair and there is a meal plan just for you we've got 14 days of SIBO friendly meals and recipes included there's weekly shopping lists there's handy hints and tips to make cooking easier and every recipe is 100% gluten-free the recipes are low grain we only use a little bit of rice or quinoa in the recipes depending on what phase you're following of course all the recipes a low carbohydrate very low dairy low sugar and there are low fodmap options included the great news is that you can download it instantly and you can get cooking today if you'd like to know more about the SIBO meal plans head to the healthy gut co /c bo - meal - plans or head to the show notes from today's episode and just click on the link there I hope you enjoy the meal plans guys I know it's going to save you so much time energy and effort and help you be compliant to your SIBO diet as you go through your treatment now let's get back to the show [Music] hmm it's fascinating and just talking about hives hives was something that were part and parcel of my daily life for many years and as soon as I started my SIBO treatment I noticed a huge reduction in hives and to the point where it's incredibly rare for me to have a breakout of hives these days which is great because I used to be covered in them I was always being put in a pine tassel bath or having chamomile lotion put on my skin for my mom trying to calm the red flaming itchiness that I was experiencing I've had some again because I put a call out for questions I had people ask me about Lich and sclerosis and also Lich and planned lachen like how do I say that like an mm sclerosis and also lichen planus and their connection with SIBO do you know much about those two you know it hasn't been reported in the literature lichen planus is a condition that has some similarities to psoriasis just because of the nature of the changes in the skin that happened with it they're both categorized as populo squamous disorders and you know I think my my belief in these connections between SIBO and the skin can and skin conditions is it I think in most cases it has to do with some common dysfunction of the immune system and you know so much of our immune system comes from our gut and I think that when our gut is disturbed it alters you know our immune system and makes us more susceptible to skin conditions and we don't have this all figured out yet but that's that's my that's my theory about this connection lichen sclerosis is a condition that in some ways is like scleroderma or systemic sclerosis because it causes fibrosis of the skin and I wouldn't be surprised just because of that common Meccan abnormality and the skin being sclerosis or scarring fibrosis that lichen sclerosis could have some of the same improvements with treatment for SIBO that systemic sclerosis has but it hasn't been reported not even any case study as you know because I've thoroughly scoured the published medical literature to see of any associations with other skin conditions and SIBO what about skin cancers today have a connection with gut health well they do the skin to the flora the microbiota of the skin impacts skin cancer we know that there's a strain of staphylococcus on the skin there's a that is associated with a type of skin cancer called cutaneous t-cell lymphoma it's not a real common skin cancer but it is definitely has this association with Staphylococcus on the skin we also know that beneficial skin bacteria particularly lactobacillus strains reduced inflammation in the skin and they enhance what we call immuno surveillance which is kind of like the the immune cells in our skin that circulate there and look for damage to the skin particularly from ultraviolet which is the main causative agent for skin cancer and when your immune system notices ultraviolet damage healthy skin can repair the damage to the DNA in the skin and not allow skin cancers to grow but if you have a deficiency of lactobacillus species in the skin then you're more likely to develop skin cancer so in this case we're talking about the microbiota of the skin rather than the guy mmm fascinating and what what comes first is it that the skin is that there are perhaps in an immune system that's not working properly that can lead to skin issues and SIBO or is there SIBO presence that then leads to the skin issues do is there a clear picture on you know whether you know is it chicken in the egg what what came first she calls this disruption well there's a there's a theory in medicine that's called the hygiene hypothesis and I referred to this when I was talking about eczema and the hygiene hypothesis basically says that a lack of early childhood exposure to infectious agents and to symbiotic bacteria like a less diversity of intestinal bacteria and also parasites can increase the susceptibility to immune dysfunction by suppressing the development of the immune system the part of the immune system that is supposed to help protect us from these types of immunological changes and that I think is really probably the what the you know it comes first is that there's disruption to the intestinal microbiota that interferes with a healthy development of the immune system and this hygiene hypothesis was originally presented in 1989 by a British epidemiologist named Strachan and since that time there have been many studies that have supported this theory and so I think and for example in the last decades as the incidence of eczema has increased particularly in young children and in low-income countries like Africa and East Asia and in urban environments we've seen that the westernization and the industrialization and changing the diet of indigenous people and there they're less them and and them having less exposure to microorganisms and they did historically has made you know children were susceptible to developing eczema so that's the way that I look at it and I think that you know there's a more work that needs to be done to kind of substantiate that theory but I think that it's basically lifestyle and environmental factors that have changed the way that our immune system develops when we're young that make us susceptible to these problems if somebody who's listening to today's interview has a young child or a baby with eczema what should they be doing about it to try and help with their child there are two things that are well substantiated in the literature one is to supplement the baby with probiotics and we don't really know yet which strains of probiotics organisms are best so I can't give any more specifics on that but the other thing is that omega-3 supplementation will reduce the risk and severity of eczema in children as well and in moms who may have a family history of eczema hay fever or asthma because they're all kind of part of the same immune dysfunction they can supplement these other probiotics and omega-3 supplements during pregnancy and reduce their child's risk of developing eczema and these other allergic conditions as well mmm that's interesting I was actually I've just been away with a group of friends and one of the women there has a five month old baby who the poor little thing is covered in eczema and I was talking to her about it and he was very disturbed his face was on fire the poor little thing and she was saying to me oh I used to have terrible eczema as a kid and I was thinking well that isn't that interesting there's you know it's a connection between her and her baby and you know she's talking about how she experienced it suffered it for years and now her little boy has it as well and and she was saying that she her doctor had put her onto a probiotic and she's breastfeeding and so their probiotic had helped his expert to an extent so that was it was really interesting another thing that parents can do is that they can try to expose their their babies to more microorganisms you know like taking them to visit aunt and uncle who live on a farm and let them be in the you know and in the barn with the cows and the pigs and the dogs and the sheep because there's lots of research that suggests that early childhood exposure to the back.the bacteria that are found in these farm animals is actually beneficial for the healthy development of the immune system and I think this is one of the the challenges of a more modern society if we live in big cities we often don't have any access to anyone on a farm and we're living in these very sterile houses and environments and I know I grew up with a mom who you know she doesn't particularly like dirt and I didn't like - and so we had a very sterile house and I didn't even really like going outside to play because it was too dirty help here now that would have been the best thing I could have done for my poor little immune system but um I was inside playing with Barbie weave if people don't have you know easy access to going to a farm is there anything else that we could be doing to help build that diversity in exposure to microorganisms well it's it sounds kind of strange but there is a school of thought in medicine that exposing not just children but even adults to various parasites like hook worms that can help the immune system either develop more normally or recover balance if it's all out of balance and so that that's kind of a way out their idea but there is there is research suggesting that that can be helpful obviously you know not using antibiotics unless they're absolutely necessary can be another major factor that we all run into throughout the course of our life a question I had from somebody around the use of antibiotics they were wondering whether their use of long term antibiotics for their acne treatment had caused their SIBO because they felt that they had not had any SIBO type symptoms present prior to the antibiotic treatment have you seen it that it that SIBO can then result after after antibiotic use for acne absolutely it's one of the well-established risk factors for SIBO as people who have had multiple courses of antibiotics and you know in some ways it's strange we were talking about acne and taking antibiotics for our acne the thing is that the antibiotics that are prescribed for acne are not the ones that are effective in treating SIBO so they actually just disrupt the balance of the gut bacteria and probably make us more prone to acne and tseebo because the the tetracycline antibiotics and others that are used in acne don't don't work for SIBO mmm and when you're like someone like me who spent four or so years on on those antibiotics just cycling through them one after the other you know you can spend a long time taking antibiotics that are just causing great disruption and people want to know what they can do if there's anything they can do topically to help relieve the burn or the itch or the dry flakiness that they might experience from some of these skin conditions do you have any topical treatments that you work with your patients with absolutely it's a really good question because you know the idea with treating skin disease is that it needs to be treated both from the inside out and the outside in to really get good results for dry skin one of the most important things is to restore the lack of of factors in the skin that maintain the water content and the main thing that does that are compounds in the skin called ceramides and so moisturizing creams and lotions that can contain ceramides are much more effective than older ones that don't have ceramides in them so that would be one thing another is that taking omega-3 supplementation orally will help to hydrate the skin as well by providing more fat to the skin that will make it more likely to be able to maintain again the water content of the skin there are therapeutic products available to that I use for these skin conditions that are typically herbal based I don't know I guess this isn't really I'm not bound by any restrictions about naming products on this podcast oh you're not she can name away out of full disclosure I will I will disclose that I do consult for this company that is an Israeli company called Co Metis kam EDIS and they have a line of products that are actually therapeutic for eczema another one for psoriasis they have a products for acne and also for seborrhoeic dermatitis which is what commonly causes dandruff and their products are herbal based they have ceramides in them and they work really really effectively in some cases more effectively than you know something like a topical corticosteroid so for the last four or five years I've been using these products and getting great results and they can be purchased if you're a practitioner through a distributor like here in the US we have a couple distributors Emerson objects and natural partners and for consumers there's a website that people can go to that is Co Metis I think it's dot or - us a.com let me just check and we'll put that link in the show notes so people can head to that that is the website yeah what about things like animal based topical creams like tallow based skin creams can they be beneficial they can be I don't have much experience using products like that but you know tallow lanolin you know other animal based fats can be nourishing and definitely help prevent dryness of the skin it's interesting I having had very oily skin for my whole life I was always looking at how to strip all of this excess oil off my face because I felt like an oil slick and a few years ago I started using an Australian brand called ecology skin care it's a tallow based skin cream it's beautiful and I'm first few weeks my skin felt really oily as my skin got used to having something that was a lot more natural rather than all of these harsh chemicals that I used to put on my face and it's interesting that the you know I guess with the combination of my gut health improving my diet improving what I put on my skin improving it has all all of it has really helped to see my skin really calm down and whilst I still definitely sit on the more oily side I can put a much sort of richer product on my face now without looking like I've just smeared oil all over and we were an adolescent because of our sexual maturation what we have is overabundance of the Hendersons like tests from that really stimulate the oil production in our oil glands and that's why we tend to have really oily skin when we're a teenager but as we get older our body addre just these higher levels of androgens then it doesn't it doesn't cause the overproduction of oil like a dozen or teenagers mm-hmm that's good to know but it's it's not fun when you're the teenager with the very oily face it feels quite miserable another question I was asked by somebody was with a sulphur plays a part in skin issues that's a really great great question because I think sulfur plays more of a role in our health and illness than most of us know and sulfur has been used in the past as a treatment for acne and also for other skin conditions like psoriasis but it's not something that I use at this time in my practice so I'm afraid I don't have much more to say sure now we we talked about I asked the question around you know what should we treat first the SIBO or the skin issues in you and you said you know treating them both but what's the risk if we don't treat one or the other the risk is unsuccessful treatment can it lead to more complications or more conditions appearing if we don't work on our health or the health of our skin well I think it certainly can if we don't work on our gut health I don't think that you get complications from not working on your skin health so much you just get persistence and worsening of the problem and quite often I think increase in negative emotions such as anxiety and depression over what you physically look like on the outside because that can be very stressful when people are looking at your skin and not really paying attention to you yeah I know that one well yeah me too and I think from my own personal experience you know when I was a teenager and I had your acne I would look in the mirror and that's all I would see you know I wasn't I wasn't really seeing me the person and I would feel that that's all anybody else would see when they looked at me but that that's and that's not true most people especially people who you who you know are really good friends they see the person they don't see you know the skin problem and that's I think that that's something that is important for people with skin conditions to to remember that you know there's more to them you know as far as other people's perception of them than just their skin condition mmm it can make you feel like you are a walking leopard owned and absolutely I know when I was I actually have this written down in a diary from from back when I was 15 and my wish was all I want is to have clear skin that's all I wanted in the world because I was just so covered in acne and I would love to go back to that 15 year old me and say look you get it it comes so stop worrying about your skin so much it it will calm down but it you know it was awful at the time there was actually a psychotherapeutic strategy to do that you know once you have seen that something that was really troubling you in the past has has resolved to go back to that younger you and you know and to talk to them and let them know because like I'm sure that I still carry some of the trauma that I experienced as a teenager where I was you know so affected by my acne that it made me feel very insecure and and it was not a happy time in my life and I think it was extremely traumatic for me mmm I've talked about my own experience with quite a lot of trauma I'm on previous podcasts and one of the things that I have done with the psychologists that I've done some work with is go back like you say to that younger the younger versions of myself at key points where trauma was occurring in my life and you know really talking to that younger me and being you know I guess so a role model as the adult self now and really making peace with a lot of the demons that I have been carrying and that's been very supportive therapy for me and it's really helped me to release a lot of the burden that I've carried for many years with you know multiple things that happen to me and I really do think that seeking the services of someone that can help with you know psychological treatment can be so beneficial and I didn't realize just how much of my psychological trauma was all sitting in my gut and how much anxiety was still sitting in there because it was everyday for me so I just didn't really notice it because that was my norm and then when I started to deal with it and it stopped being my norm I was like oh gosh I didn't realize how bad that was whereas now if I ever you know things still flare up and I will take that practice and I will go back to the younger me and we you know I'll kind of do that practice just quietly by myself and if I have found that very restorative and incredibly powerful to help me continue with this this long journey of healing that I'm currently on I think that you you must have gone through a similar transformation as me when I was you know a teenager my skin condition made me very shy and inhibited and insecure and as it cleared up and as I began to you know get into my 20s and and you know continue to evolve from then you know I've actually been caught you know come from being this kind of very turned inward introverted person to really like liking to be around people and being you know there's a definitely an extroverted part of me now too that wasn't there at all before I know if anyone saw me if I was able to just plonk my earlier self next to my current self it I really out would be chalk and cheese people would be amazed at you know who I was then to who I am today and that's a you know I'm really glad that I've had the opportunity to have the transfer as I'm sure you are as well dr. Michael Roberts been a pleasure to have you on the healthy gut podcast today if people would like to connect with you what's the best way for them to do so well they can go to my website Michael tribe and D as in naturopathic doctor comm and my email address is on there it's relatively simple also it's M tribe and D at me calm wonderful and all of those links are in the show notes so thank you so much for coming on the show I know you've answered so many of the questions that my listeners put forward so thank you for your time and it's just been an honor to have you sharing your knowledge on all things gut health and skin diseases though thanks for coming on the show Thank You Rebecca it's been a pleasure it's been nice to get to know each other better this way it has thank you I hope you enjoyed that episode with dr. Michael Traub it's really interesting for me to see how much of the conditions that I experienced throughout my life were actually interconnected to what was happening with my gut so as you've listened to this podcast if there's somebody you know who is really suffering from skin issues be it acne or rosacea or psoriasis or eczema anything that you know particularly if it's causing them to feel uncomfortable or depressed or anxious and I know I felt all of those things I'd love for you to share this with them because it may just be that guiding light that they need to take some action and to figure out what might be the underlying cause of what's happening in their skin if you would like to get the show notes from today or any of the downloads make sure you head to the healthy gut dot Co forward slash skin and if you have enjoyed today's episode don't forget you can head to that page the healthy gut dot to Co forward slash skin to leave your feedback I absolutely love seeing it there or you can leave it in iTunes or the app you use to listen to this podcast it's great when you leave a rating and review it really does help others to know that this is the right podcast for them and make sure you head over to our Facebook Instagram Pinterest YouTube Twitter and Google+ channels where active on all of them and we love seeing you there we're always sharing new content new information and it's great connecting with you there so come say hi just look for us under the healthy gut on next week's show it's a great topic one again I experienced personally and that is constipation so many of us see Boers you know to have to deal with just the pain and the suffering and the uncomfort of being constipated all the time next week's episode we're talking all about constipation with the lovely Linda gripper rich and she talks about how you can do some things to help alleviate constipation and what she does with her patients to support their bowel movements so not to be missed guys I really look forward to sharing that episode with you next week see you then you've been listening to the healthy gut podcast with your host Rebecca Coombs to learn more about the healthy gut or our podcast head to the healthy gut dot Co forward slash podcast and as we are fully funding this podcast if you would like to help support the continuation of this podcast so that we can continue to bring you future episodes all you need to do is make a contribution at the healthy gut dot Co forward slash podcast we would like to thank Belinda combs for the production editing and original music score of this podcast to hear more of Belinda's music head to soundcloud.com forward slash Belinda Coombs the healthy gut podcast is a production of the healthy gut thanks for listening you
SIBO Restless Leg Syndrome and Rosacea with Dr Leonard Weinstock - Ep 7_en (auto-generated)
[Music] welcome to the healthy gut podcast the place where you can learn how to achieve a happy healthy gut with your host rebecca coombs on today's episode of the healthy gut podcast episode dr weinstock is board certified in gastroenterology and internal medicine he is president of specialists in gastroenterology and the advanced endoscopy center he teaches at barnes jewish hospital and is an associate professor of clinical medicine and surgery at washington university school of medicine dr weinstock is an active lecturer and has published more than book chapters he is an investigator at the sundance research center and has participated in over researching the role and treatment of small intestinal bacterial overgrowth in restless leg syndrome irritable bowel syndrome and rosacea and he joins me on the show today to talk about restless leg syndrome and rosacea particularly in correlation to sibo i myself suffered from restless leg syndrome for years and didn't realize it was all to do with my gut so i hope you enjoy today's show episode dr leonard weinstock welcome to the healthy gut podcast thank you so much becker it's great to have you here i first met you at the sibo symposium this june in portland oregon which was wonderful to hear you speak at the symposium and i was uh really lucky to be able to spend a few minutes chatting to you and also gift you one of my cookbooks which was great and i enjoyed that yeah it's a beautiful cookbook thank you i'd love to to start with your story how did you end up in uh with an interest in gastroenterology um and why you're interested in um sibo in particular well my flight towards gastroenterology started with a strong background in internal medicine i felt that internal medicine just gave somebody a viewpoint of the person as a whole like no other whereas surgery was very limited and pediatrics was their own little thing and gyn was their own thing but internal medicine just covered so much and often brought into these interesting differential diagnosis of patients who have been suffering with conditions for a long time and that's what i found with that there were many people who had unusual disorders and so many of the gastrointestinal disorders were called syndromes and that just really intrigued me because i thought when i went to med school oh everything is a textbook and it's all going to be spelled out well when it comes down to things so many things in gastroenterology are syndromes and they're real mysteries so i like to think of myself as trying to solve mysteries because i've enjoyed uh detective shows and so forth and that was one thing and then the other aspect is you know you do things you do surgical techniques as well so if there's a gastrointestinal bleeding you're not just ordering the test you're actually doing the test so for me that is a combination of the both thinking skills of medicine and the surgical techniques that makes it all happen and i think that anyone that has suffered from gastrointestinal issues can appreciate the detective mode in that often one has to play real detective with uncovering what is going on with them it's so true yeah and talk to me a little bit about what why you uh then also got interested in sibo well sibo uh was fascinating because for years i've been talking to patients about irritable bowel syndrome and so fascinating to me that there could possibly be a condition that really know exactly what's causing it so for the first uh half of my career from 1985 to 2000 it was just a matter of waving my hands and saying oh we think it's a you know reaction to food and your gut is hypersensitive and the nerves therefore are abnormal and there could be stress and all this kind of hand holding and hand waving if you will and then um during that latter part of those 15 years i became interested uh really in motility and irritable bowel syndrome and was asked to be on a support group on an internet support group for irritable bowel syndrome and so i was the pharmacology expert and would give input on that and um on new new new treatments and so forth and somebody asked me well what about the article that came out in 2000 for bacterial overgrowth and the treatment with neomycin and getting better from irritable bowel syndrome and i actually had the american journal gastro on my desk ready to read and i hadn't gotten to it so i immediately turned to the article i said now that is interesting that you could actually get rid of um irritable bowel syndrome with an antibiotic and by doing so it was a real remarkable thought and so i started treating empirically patients for with the antibiotic and seeing some good responses and then there's some written information around that time about doing a breath test and i didn't have access to one but in my office but there was a little hospital that had been doing breath tests for quite some time so i started ordering them and that put some science to what i was doing and so i started treating with neomycin and then later ciprofloxacin and metronidazole and some patients would get a dramatic response nothing else had worked before they'd get a dramatic response they'd relapse they'd retreat them and then they'd wean off their responses and would not uh have the marked improvement that they once did before and so um my interest waned a little bit um but then it was peaked dramatically when uh sofaxin or rifaximin was introduced into our country and then i went to a educational meeting about that and learned about how this drug was not absorbed from the gi tract and it was working mainly on the gut bacteria in the small intestine because of its properties being able to work through bile where the small intestine had bile on the surface and you could get through this bile layer with the antibiotic and it treated many different kinds of bacteria and that the cool thing about it is that it didn't have a resistance factor like other antibiotics it operated in a different way so that was exciting and then at the meeting it was also discussed that it had a role in another condition called fibromyalgia which i think many of your listeners know about or have and that the breath test abnormalities were even greater in the patients with fibromyalgia and so at that time i was taking care of a relative who had post-infectious irritable bowel syndrome and restless leg syndrome and this whole concept of post-infectious uh irritable bowel syndrome came out which we'll talk about later and i asked my cousin whether he had acquired the restless leg syndrome after the irritable bowel started and he did and then i started reading about fibromyalgia and syndrome which is much more than the general population so i started thinking well was there a relationship here could uh if fibro patients had small intestinal bacterial overgrowth or sibo could the um patients with restless leg syndrome have the same and i treated him and he had a dramatic improvement in the restless leg syndrome using the sefaxin and that started my interest in looking at things outside the gut and basically getting back to internal medicine where i had interest in looking at how the body is affected and where does this stimuli come from and so that's that's how i got it got started so um i'm interested to know i think it's fascinating that your journey and interest and and you know what's really interesting is that it's looking at the whole body and and realizing that there are connections between one condition and potentially another i'd love to know what you commonly see in your practice and who are the types of people that you're regularly treating well on the office side of things a gastroenterologist will often treat irritable bowel syndrome and acid reflux disease and crohn's disease and ulcerative colitis those are the top four um causes for unknown causes for pain and bloating that brings things up as well and nausea is a big category of illness and in the morning most cancer neurologists are doing procedures and uh doing colonoscopy and uh looking for polyps and and causes for diarrhea so these are some of the things that a gastro does with respect to who comes in with irritable bowel and what they are like i see more and more of second and third opinions because they're often dismissed and this is one of the things about syndromes and patients that bother me in our society and in the doctor's approaches is that many patients you know come in their condition isn't easily understood it's not like hypertension where you can try one drug or another and you can do one test or another to say which kind of hypertension they have in uh up until recently with both breath testing and a special blood test we haven't been able to dissect uh the patients out from this big pie of irritable bowel syndrome into different spits specific pieces so for instance if i can take a syndrome like irritable bowel syndrome and view it like a pie and slice out a portion who have it due to sibo then i feel okay i can treat these people very specifically if it's gluten sensitivity take out a portion put it aside and work on that with diet and so forth until you get to this idiopathic or conditions of unknown where the same set of symptoms are dealt with by all these people in the syndrome but if we can get out of our global view of irritable bowel syndrome as one unknown and and stop treating them as if there's you know nothing you know specifically wrong with them then we can start getting um ahead in how we treat our patients and i just think that's music to my ears i was one of those patients for years going backwards and forwards to doctors uh complaining of digestive complaints and being diagnosed with you know that that broad sweeping term you have ibs and there's nothing we can do about it just deal with it stop being stressed and be careful with what you eat uh so you know it's it's something i lament on as well that that people unfortunately still today are being given a sweeping diagnosis with not much assistance on what they can do about it i'm really interested to know if there are any figures around you know this this piece of pie whether we there are stats on uh you know how many people with ibs are due to sibo and how many are due to gluten sensitivity or other conditions is there any research around that we can kind of classify that piece of pie yes so if you look at the data for um this new antibody test um because work has been done recently showing that there's an antibody in quite a number of patients with irritable bowel syndrome and co and diarrhea that it is looking like up to 60 of patients with ibs d irritable bowel syndrome with diarrhea have an antibody and this goes back to this whole idea that some of our patients in fact perhaps many of them have post-infectious irritable bowel syndrome so just to put that concept into uh facts it's a seven to thirty percent chance that when you get an infection with a bad bacteria that you'll get post infectious irritable bowel syndrome never had ibs before but then sometime after usually three months or more you'll get irritable bowel syndrome and so um with this antibody testing antivinculin in anti cbt4 there's evidence that these antibodies destroy the myenteric plexus nerves the nerves that are running alongside and into involving the small intestine and if you lose those nerves then you're losing the contractions at night that keep our small bowel clean so if we damage the cells interstitial cells of cahal with this antibody you lose the migrating motor complex the sweeper wave that keeps the small bowel free of bacteria and then you're at risk for getting bacterial overgrowth so studies have been done suggesting by statistics and projection that up to 60 percent of patients have ibs due to this autoimmune condition which is interesting because if you look back at breath test results between 40 and 60 of breath tests were positive in patients with ibs d and so that is sort of a one-to-one correlation there that now makes sense we just had to deal however with the problems of the breath test that it's not very specific and there's a lot of non-believers in the medical profession in the research community because of certain aspects to uh how sensitive it is that it just seems to be too non-specific but with a blood test looking at an antibody that gets to hard data that can be really looked at very clearly um definitely and it's such a shame that here in australia we don't have access to that test yet so hopefully one day soon we are able to to do that test here as well but it is available in america and i i don't know if it's available anywhere else in the world do you know if it's available in any other countries not to my knowledge um in terms of other pieces of that ibs pie um who else makes that pie up what other conditions can cause that yeah so okay so certainly food sensitivities um whether it be specific or non-specific certainly um there are some celiac disease patients that can be uh labeled incorrectly as irritable bowel syndrome because the symptoms are um similar many times but hopefully we've taken them out of that idiopathic pie gluten sensitivity i think fits in it because most in general we don't have any biopsy proof that gluten sensitivity clearly exists now there's some i've seen some electron microscopy where people have gluten sensitivity they don't have celiac disease and yet if you look under this extremely high-powered microscope where you're really only looking at a couple cells at a time it's so high-powered you can see these little vacuoles or little balloons near the lining suggesting that gluten sensitivity is a real disease but at this point i would say two percent of the population has gluten sensitivity and there can be other symptoms that go along with it including headaches and fatigue as well other aspects well i think that the the nerves are abnormal in many patients who have irritable bowel syndrome we do see mast cells mast cells that are deposited in the lining of patients with irritable bowel syndrome and we see other inflammatory cells that come in to the lining so i think there's an inflammatory type irritable bowel syndrome which is where i think some of my patients who have failed many things get better with low dose naltrexone because it reduces inflammation in particular lymphocytes so mast cells i don't think have deserved have received the attention they deserve and there are some nice studies showing that the closer the mast cells to the nerves the more pain a patient would have with irritable bowel syndrome and mast cells release a variety of chemicals like histamine and tyrosine which activate the pain sensory fibers so that may be some of the reasons why we're we have specific food sensitivities especially in irritable bowel syndrome food obviously in your book is well demonstrated plays a big role in sibo in terms of what we're feeding our bacteria okay so if you feed your bacteria that you've gotten excess too much carbohydrates and undigestable sugars they're going to have a feast and cause bloating and gas they are and uncomfort uncomfortable symptoms as well right now uh finally you know i think there are patients where they have these abnormal nerves now are they inflam inflamed or or just abnormal for some other reason perhaps some tract when the grain in the brain gut tract is off off kilter but we have this visceral hypersensitivity at the heart of many patients with irritable bowel syndrome such that you stretch the colon you stretch the small intestine and then you're going to cause problems with pain again that could be going on at the same time bacterial overgrowth is going on so you you increase your gas production you stretch out the small intestine before the gas is able to travel to the colon to be expelled and it takes longer to get absorption of the gas in the small intestine so it stretches out and those nerves get activated and cause problems so it's really a bit like a vicious cycle in that if the gas continues the nerve damage can continue which can lead to more motility issues which kind of keeps going around in circles by the sounds of things yes yes and then of course we step towards well what else do bacteria do and um they cling on to the small intestine lining the small bowel doesn't like it's not used to having bacteria there so it really is not used to have these toxic bacteria clinging on and then a lot of these cells bacterial cells cause damage to the lining of the intestine and increase intestinal permeability so called leaky gut and when that happens then other chemicals food antigens or bacterial byproducts get in there and that stimulates the lymphocytes to ultimately produce inflammatory proteins called cytokines and draw in other inflammatory cells causing inflammation and then that damages the lining of the intestine which then has a vicious cycle of its own becomes leakier more gut toxicity comes in and more inflammation starts and this is where i think the gut starts reaching out to other parts of the body and it may be a lot of what you're going to get is what your biological makeup is so if you've got a certain genetic makeup or phenotype um you're more likely to get one disorder versus another but but i've seen but i've seen you know one of my first patients who came in you know had all the symptoms you know was one after another you know post-infectious irritable bowel syndrome then then restless leg syndrome then fibromyalgia then interstitial cystitis and it's just one after another every two years she got a new syndrome and she actually was able to we were able to reverse virtually all of our problems with antibiotic therapy and then ultimately with naltrexone settling down the inflammation wow that's that's fascinating and so what what is your approach when it comes to when a patient presents for the first time in clinic and they're in a in a bad way um you know what what do you commonly see from someone that is complaining of um irritable bowel syndrome and then how do you approach their treatment so ibs is generally defined as abdominal discomfort three months or more per year with associated changes in the bowel frequency and form and with partial relief of symptoms with elimination and i say that partially because that doesn't really account for all the patients with small bowel symptomatology because those patients are having issues with distension and bloating and ultimately if there's enough acidity that is created by the bacteria it may cause contractions and increase output of fluid and then they get diarrhea or as we've gotten to know over the last making methane they get not only get bloating but they get constipation so my history taking is really important in terms of defining their syndrome seeing how bad their bloating is seeing as if it's visible bloating as opposed to just feeling distended because um if they're not visibly bloated um that somewhat decreases the likelihood of sibo but not entirely and on the vice versa aspect to that abdominal bloating can occur without sibo just because it's a relaxation of the lower abdominal muscles in response to pain and so you relax the muscles that helps alleviate some of the discomfort in general so there's a couple different mechanisms for bloating asking about the type of gas that they have how oatmeal odorous is it are they having any uh passage of the gas chemicals into their mouth with bad breath or chemicals that are actually coming out into the urine those are important questions too then the workup i do is perhaps not you know what everybody does i would say uh we actually do quite a bit of breath testing to get a feel of how severe the abnormality is um if um if we've got a very high peak on the hydrogen those patients can be tough to treat we know that they may need um several courses of therapy or drawn out courses of therapy motility may be a big issue and that's where i'm getting the um the blood test could be helpful that ibs checked the antivan cooling could be helpful although i find that actually to be even more helpful when i've had patients who have been relapses frequent relapses for what i think should have worked to say okay maybe it's not this post-infectious autoimmune disease if it's not what is it so do they have some other disease that is associated with small intestinal bacterial overgrowth such as scleroderma or pseudo obstruction or adhesive disease i'm quite interested the comment you made about that bloating doesn't necessarily mean it's sibo and something that i hear from people quite frequently is that they've they've treated their sibo they've received a negative breath test but they're still bloating and they're and i'm feeling particularly uncomfortable and embarrassed about that because no one wants to look pregnant when they're not man or woman um so what what would be your advice uh to somebody that's listening to this podcast that is still bloating even though they have successfully at this point in time treated sibo well there are there are other causes for it okay um so that's you know something that you need to be uh to think about air swallowing uh gastric outlet obstruction um small bowel adhesions um diseases like pseudo-obstruction although those that is often associated with bacterial overgrowth air swallowing can be a tough one i mean there are people who have nervous habits of taking gulps drinking out of the bottle water and gulping down water with it so that air which is you know a typical atmospheric air does not get absorbed very well by the small intestine so that that's an aspect and then finally irritable bowel syndrome without bacterial overgrowth can be associated with pain and again it could be uh just relaxation of the gut wall to deal with pain it's kind of like undoing your belt buckle when you're uncomfortable it makes a difference it gives more room for the organs to move around hmm definitely and and i'm i'm really interested in this this uh sort of gulping air or drinking from a bottle is that just literally when you're drinking from a water bottle that you can be taking in air or is there something that people are doing specifically when they're drinking that that causes air to uh go in well it's the glug glug when you hear the glove glug glug sound that means air is going in and if it doesn't come out as a belch then it's going to stay in your gut ah okay interesting wow that's that's really interesting and it's something you know i've at times have been known to you know gulp down drinks uh but my mom uh can't she just takes sips and we've always teased her about that but now now i think that's probably a good thing that she's just sipping her her liquid so it's yeah she's prim and proper and and taking sibs and now running around sure it's good and also not potentially swallowing air which is good for her um are digestive disorders and and discomfort on the rise or is it that we're just getting more aware of them i think there are two main factors um number one a lot of people who are sitting at home just dealing with this on their own are becoming aware that there's more reasons to complain they may have better access to health care and so they're bringing to attention to their doctors now [Music] and there's a whole you know series of studies showing that there are many people who have yet undiagnosed untreated irritable bowel syndrome with respect to causality and could there be an increased causation for irritable bowel syndrome if we just take the case of post irritable bowel syndrome there i think are a couple of things number one people are traveling more and they may go to underdeveloped countries or countries where cleanliness and safe water supplies are not at hand and then on the flip side if we're getting more fruits and vegetables from foreign countries then it puts it as us at risk for getting infections um because they're coming in and we're not washing our food as well as we should and i'm interested to know whether once uh once you get some uh food poisoning or or infection from a contaminated food whether that makes you more susceptible to it because i've i've found personally that i've traveled quite extensively as an australian it's almost a rite of passage we leave our country and we go off wandering and so i've traveled through asia south america i lived in the uk for seven years so i traveled throughout europe and and i've been into northern africa i went to egypt and it felt to me that every time i went away from the first time i left australia i would get food poisoning i would always end up with food poisoning and i've picked up parasite infections as well i've done that a couple of times and it and it feels to me that i'm susceptible because nobody else that i'm traveling with seems to get sick like i so is it to have am i now more susceptible because of the infections i've received in the past well perhaps your gut is not yet healed completely it's one possibility that um if you're you don't have an intact bile layer protecting your small intestine and or let's say the mix of bacteria in the colon have been altered by antibiotics or by bacteria shifting things you may not have the protective balance in the small in the colon that you once did putting you at risk for other bacteria coming in and so your immunity may be altered in the setting of sibo said to you know you're at risk for other insults definitely and and i know that i've done all of that travel i've talked about was prior to me discovering i had sibo and then working on healing my gut i haven't left australia since so it will be interesting to see what happens next time i travel after taking a lot of effort to heal the lighting of my gut let's talk about restless leg syndrome i know when i first heard about sibo and i heard that restless leg syndrome was a common symptom i i felt like a hallelujah moment after years of having very annoying restless legs i now had an answer for what had happened and i no longer suffer from it now that i've treated sibo can you talk a little bit about why that occurs and what restless leg syndrome actually is well it's the restless like syndrome is defined as the compelling urge to move your legs while you're awake in the evening getting worse at bedtime with usually in a disagreeable sensation so it could be a creepy crawly feeling a tingling uh an aching and um with that urge to move you'll get temporary relief or if you're walking you get up and walk you can get relief so it makes it difficult for people to get to bed now it may be associated with kicking and jerking in the evening while you're actually sleeping that's periodic motor limb distort disorder so it runs in parallel with it but it doesn't necessarily mean that if you just kick your legs while you're sleeping that means you have restless leg syndrome restless leg syndrome again is dr you're conscious you know people could be on long trips in the car or plane and they just have that itsy feeling they got to get up and walk they just can't keep their legs still so it's very bothersome and it uh it is associated with um significant two significant problems hypertension and stroke there's a higher risk so whether that's through a sympathetic increased sympathetic nerve tone we're not sure but it's so it's not just oh it's a bothersome problem it actually interferes getting to sleep and people can wake up and then they get have it and they can't get back to sleep so it's a real problem but what's fascinating to me is when you look at the condition you've got primary or restless leg syndrome with unknown cause you've got familial restless leg syndrome and then you've got secondary restless leg syndrome and there have been 50 conditions that have been reported to be associated with and or contribute to restless leg syndrome and of which 40 are have you know been looked at to have uh comparison to control groups so there's really very specific uh disorders different gi problems five different rheumatological problems six different metabolic problems four five pulmonary disorders that actually are associated with restless leg syndrome for years uh people have thought well there's not enough iron in the brain and there have been studies looking at that because if the dopamine cells don't have enough iron they don't function well and so that gives rise to this this feeling and um and why it occurs at night we're not 100 sure although there is some um thought that influx of iron occurs more at night in normal people and if you're if you have restless leg syndrome that's not happening but of these 40 conditions 15 have been previously tested on their own for small intestinal bacterial overgrowth and all 15 have had positive tests so like people with irritable bowel syndrome chronic liver disease pulmonary pulmonary problems rheumatological conditions like rheumatoid arthritis have been associated with uh small intestinal bacterial overgrowth um so that really made me um exciting to say okay well maybe it's all about the gut and um the problem is when i started looking at drug studies just aimed at treating the gut only for sibo i get good response but not everybody was responding and and there would be a limitation to how good people got but when i started adding naltrexone to it then i had better improvement and what happened was i started looking at the literature and it turns out one of my research partners in vanderbilt had looked at the amount of endorphins in the brain in patients who had restless leg syndrome and there was less endorphins in the brain and the endorphins protected the dopamine cells in the setting of iron deficiency so now what we're doing is we're treating sibo and giving endorphins to increase uh sorry we're giving low-dose naltrexone to increase endorphins to help get into the brain and protect the brain cells and the dopamine functioning so that's part of it and then finally inflammation and or immunological disorders with these 40 conditions is very common and so we're looking at is there abnormality of the t cells and remember i said at least in the gut we can have abnormal cells and conceivably antibodies can be formed by these t cells um and then perhaps those are attacking the endorphin cells in the brain and contributing towards this so a lot could be going on with restless leg syndrome but with what i can have called sequential treatment um i've gotten very good results we treat the sibo first and then we give the therapy with the ldn afterwards and in terms of one study that i looked at with 40 patients and or moderately better response than they did before treatment so and uh some of these patients who are markedly better were went into complete remission which just generally doesn't happen in treating restless psych syndrome with conventional therapy that's so interesting and well i and i'm i'm kind of also living proof that once you start working on the gut uh restless leg syndrome kind of vanishes it was amazing i used get driven crazy at night with my feet feeling like they were just full of ants and uh and the worst place for me to get restless leg syndrome which i always got was on long-haul flights and i used to fly backwards and forwards between australia and the uk every year so 24 hours of travel and by the end of it i felt like i was ready to rip my feet off i was going crazy and i found actually as well for me that my restless leg syndrome got worse when i was tired which obviously you get very tired on long-haul flights so uh the sign for me that i was getting tired of a day or a night uh was my feet would get very uncomfortable but it's interesting fascinating such fascinating stuff the other condition is rosacea and i'd love to hear a little bit more about what that condition is and its connection to the gut well rosacea has different forms it can involve it generally involves the skin and the face the cheeks the chin nose and forehead and it's reddening flushing bumps with papules or pustules or thickening of the skin but it can also involve the eyes and the area of the eyes that are involved are the lids and the glands that produce the uh mucus and the tears the memobian glands and um it should be considered a syndrome too it's funny that they don't call it rosacea syndrome but it is yet another condition that we don't really know in the majority up until uh uh 2008 so i was reading one of my journals in 2008 and lo and behold there was a study out of italy where they made a correlation of rosacea and sibo and they took 113 consecutive clinic patients and gave him breath tests and 46 of the those patients had a positive lactulose breath test now i'd like to say one thing about breath testing that patients 30 completely healthy volunteers and 10 percent had an abnormal breath test so you know and yet there was no reason expect it no symptoms and so forth so it's not a hundred percent but even if you looked at ten percent positivity of controls versus forty six percent of the rosacea patients that's still very significant and i looked at 63 consecutive patients that came to my clinic for mainly for colonoscopy i'd identify them and said would you like to get a breath test and see if we could treat you a different way and my percentage was about the same two 41 had a breath test that was positive who had rosacea so um in the italian study um they did look at uh age match controls and they had five percent that were um had a positive breath test um so um in their study if the patients had a positive breath test and they were treated with uh rifaximin or sulfaxin um basically for ten days they had a relatively smaller dose than we're currently using now they used 1200 milligrams a day rather than a significant response approximately seventy seventy percent cleared their rosacea completely and twenty one percent had a marked improvement so close to ninety two percent had a dramatic improvement if their breath test normalized so that's pretty exciting and at the same time they compared them to placebo and the placebo patients two out of 20 uh worsened and the rest 18 were unchanged so that's pretty powerful statistics and their gi symptoms got better as well when they looked at patients who did not have a positive test or bacterial overgrowth none of those patients got better and so that's you know pretty good evidence that we have an effective treatment and then i looked at my statistics and basically um 46 of my patients had a cleared or marked response 25 had a moderate response and these are patients at a positive breath test and we're treated and i'm getting similar results in patients who have ocular rosacea um and and a number of the patients i see with ocular rosacea have the disease limited to their eyes but only about 30 percent had a positive breath test in that setting so dermal involvement is a bit more significant and and yet it can play a role in patients who have the uh ocular rosacea where you get dry eyes and um foreign body sensation and redness of the cornea as a secondary phenomenon how interesting and is there do we understand why sibo can lead to or what the correlation is i should say between sibo and rosacea well it hasn't been tested but my feeling is it's related to systemic cytokines namely these chemicals that are triggered by our leaky gut that then travel systemically and if you've got a gene that makes you predisposed to having rosacea then you're going to get your skin activated inflamed and uh affected and i hear from a lot of people that they often have skin complaints uh as well as abdominal or gastrointestinal complaints as well so they very much seem to go hand in hand absolutely yeah absolutely one of the things that i used to be absolutely terrified of when i was quite unwell was that all of this was leading to cancer and and i know i'm not alone in that fear i hear from people all the time saying i'm so scared i'm i'm just waiting for a diagnosis of cancer can i mean are there studies to show that undiagnosed or untreated digestive disorders can then lead to digestive or gastrointestinal cancers or uh or is it us just being a little bit nervous and hypochondriacs well i think you have to look at two things you've got two big organs in your body you've got the small intestine that's 15 feet and you've got the colon that's six feet of intestine and in the colon you've got anywhere between 13 and 100 trillion bacteria in the gut and i think i mean there are some studies to suggest that colon cancer can have a different set of bacteria in the colon that predisposes towards colon cancer so i think if anything is going to increase the risk for cancer it will be an imbalance or what we call dysbiosis in the colon and there are many uh medical conditions ranging from parkinson's disease to diabetes where an imbalance in the gut bacteria are playing a role and mainly in the colon so i think that sibo per se i've not seen research to really support uh risk of cancer in that setting and how do we find out is there a way for us to find out if we have an imbalance in gut bacteria so there are um companies that do analyze the bacteria send a stool sample into a company like genova and then this rocky mountain company there's um i think one other that you can send stool samples in to get a bacterial balance to see what's out of whack to see if you have a narrow group of bacteria that are there as opposed to a wide spectrum of healthy bacteria then the trick is well how do you treat that if you do have that and at this point there's some evidence that the fodmap free diet can swing yourself to a healthier state i think the same could probably be said for a specific carbohydrate diet although i haven't seen evidence of that but i think it's possible and um probiotics may or may not play a significant role just because we're talking about taking in billions of bacteria and that's thrown in a mix of trillions and the degree that um those billions can make a big difference is questionable i think that's not to say that you can't get benefit symptomatic benefit but can you turn your whole gut bacteria around is uncertain so i think changing the food that your bacteria are eating in the colon are probably the best ways to get a healthier mix of bacteria what about fecal metal matter transplants do you well what do you think about that i was going to say that yeah so i mean i think there are some patients who are totally refractory irritable bowel syndrome and and changes in the gut bacteria in the colon have been associated with irritable bowel with diarrhea that that may be a very good future way to change it my only concern is how effective will it be because you know we do these colonoscopies you clean out the colon perfectly and then two days later you're having bowel movements half of which are fecal byproducts so it comes back very rapidly so putting in healthy groups of bacteria it may require treatment after treatment after treatment to possibly to really get a foothold of this new bacteria to overwhelm your unhealthy mix but i think it's possible i think that it's possible that manufacturers of spores capsules with spores of bacteria where you can get anaerobic bacteria into the colon which is really important could be helpful when we're taking probiotics are generally aerobic bacteria so they're maybe not as likely to survive in the colon which is an anaerobic setting um and just uh just going back to sibo i'd love to know whether uh like how often you see success cases with sibo and if you feel that sibo can successfully be treated and kept away for good so is it curable well i think it's highly treatable and some patients can be cured in time and that is a question to be addressed with future studies so if we had a wonderful treatment for let's say the autoimmune aspect to irritable bowel syndrome with this you know endovin coolant then it's been shown that if you can get rid of the um antivan coolant by experimental means the cells that are causing slow motility could get better and that's where i'm hopeful that some of my patients are being treated with naltrexone where there may be lessening of the auto antibody and perhaps with herbal therapies could get better and their nerves could regenerate in time some people who have autoimmune diseases do get better the stimulus to the production of them get better so if we're aggressive in treating the bacteria were aggressive in treating the gut lining disturbance it may lessen the production of those t-cell activities and the antibodies they're producing so uh what percent get better with standard two-week course of antibiotic therapy i say about about eighty percent and then uh other the other 20 you have to retreat retreat and then many of their those get better if they're due to motility disturbance keeping it away by medications such as low-dose erythromycin or sometimes low-dose naltrexone or pucalopride can stimulate the small intestine and keep the bacteria out by keeping the motility going but if a patient comes to me they've had it for 10 years i you know i i say well there is a concern that we're not going to get this into a cure but we can control it the diet i think plays a big role in getting into somebody into remission faster and perhaps keeping them there because let's say you've got a situation where 90 of the bacteria in the small intestine have been killed off but you're feeding it you're feeding them food um sibo uh friendly food if you will um or bacterial friendly food then at some point it's going to tip the scales and the symptoms are going to be active because the the anim the number of bacteria in the gut have overwhelmed what a motility medicine can and in terms of the nutrition component and it's something that i think people get very uh they can they can get quite upset about because food is something that they can control that they're eating it every day do you advise that people do uh remove or or reduce their carbohydrates um when they're treating sibo if they're taking sarah faximum or do you excuse me have them on you know at what would be a standard american or australian diet what's your approach oh no no no i i do a um low fodmap diet no artificial sugars except stevia but no alcohol sugars at all and as low carb as they can deal with especially during the first four weeks of therapy and how long do you have them stay on that diet generally about eight to 12 weeks and then start reintroducing uh foods that they desire but they always stay away from fructose high fructose corn syrup which like gasoline to a fire and so readily available in our processed food correct yeah unfortunately one of the things that i realized as i started to get well well as i as i worked on my health was that there were it was not just the sibo that i needed to address there was other areas in my life and i i saw it as my five key pillars to success when it came to my health my first step was awareness i had to start to get aware of what was happening to me how important do you believe being aware is in a person's journey to health well i think they have to be aware they've got a condition and that they're going to partner with their doctor in terms of getting better so awareness that they're not at fault for this condition i think plays an important role and i really like what you say about partnering with their physician uh it's so important to to find people that you can work with because it's not always a quick fix in terms of in terms of nutrition and we have talked about it a little bit but i know for for myself when i first had to strip out a lot of foods i felt pretty angry about that how what do you see with your patients are they are they happy to eliminate foods or are they often a little bit angry like i was uh they didn't express the anger to me they may think they may do it at home but they don't express the anger to me yes um they just kind of want to know a time zone when am i going to be able to eat pizza you know it's really it comes down to simple things like that and do you feel that people can go back to what they would consider a normal diet of being able to eat a pizza or burgers or fries many many do yeah i would say many many do but um i would say i've got several patients who say i just fell off the bandwagon i had more much more fruit uh and and wine and that triggered a flare so i'll hear that from time to time and that's where they've got they're living well with the of the original bacterial load in their small intestine they feed it then they're in trouble and that's where i think your book i think is very helpful for people who could you know come up with good diets that are healthy um for the long run um definitely i i know for myself that i allow myself little treats here and there but on the whole i feel so much better for eating clean healthy food that i don't really want to go back to the way i ate before and i'm really happy to make food from scratch and you know to know where my food has come from and to really limit the amount of processed food that now is in my diet because i just i feel good for it and if you'd said to me two years ago when i first started this journey into you know getting well with my digestive health if you'd said to me that i'd be really happy to drink alcohol very rarely and not eat much processed food i would have laughed and said sure right okay in another parallel universe maybe but not this one another component that i worked on was movement i i'm one of those people i'm at i'm lying on the couch or i'm running a triathlon and i when i was feeling very unwell my movement suffered i'd been pretty um i've been feeling pretty flat and i just wasn't moving my body do you feel that there's benefit in people moving and that could just be walking or doing yoga or or it could be going and doing a crossfit session um do you see any correlation with your patients in in whether they're being active and moving versus being sedentary excellent question um conceivably uh indirectly in other words if exercise which it does increases colonic activity and then there's less bacteria sitting around in the cecum where uh retroactive movement of the stool up into the electrical valve could put more bacteria there and at risk for ascension into the uh upper small intestine so it's conceivable that that's the factor involved um i haven't actually discussed that with too many of my patients but that's that's very good um plus exercise in general just makes people feel better mm-hmm it does i know when i uh and for me my exercise today these days is walking so i've i've gone away from the really intense exercise and i i am a podcast addict i not only do i do my own podcast but i love listening to others and it's my time out when it's just me myself my podcast the fresh air and i love it i love getting out and walking now fabulous yeah makes me feel great the fourth component that i had to work on was my mindset because i had identified as being a sick person for my entire life because i always had been and i didn't know how to think of myself as a well person i also found that i was pretty negative about things i've already said i was pretty angry about removing foods and feeling really like the world was unfair that i couldn't eat burgers and fries and pizzas so i had to change how i thought about things do you see that with any of your patients in terms of those that start to look at the positives rather than focus on the negatives get well quicker interesting um i haven't evaluated that i certainly recognize seeing patients who get well and feel better psychologically and then there's some evidence that sibo inflammation directly affects the brain in terms of the cosotropine releasing factor which then results in depression and changes in um serotonin in the brain so uh i've seen people come in for follow-ups who have like just their gi symptoms are better they feel lighter on their feet so to speak and they uh their color is better and they just have a much better mood so is it direct or indirect um you know i'm not sure but i think that it can play a big role um in their own mood so sibo itself and the inflammation it's associated with can be associated with a change in their adrenal hypo pituitary adrenal access so it's hypothalamic pituitary adrenal access is all important about fatigue and perhaps if we improve that we get less inflammation less of the bacterial shells coming into our bloodstream that that will help in terms of uh how they feel as opposed to wishing for better health and getting better health yeah sure and the final piece that i had to work on was my lifestyle so i had been chronically stressed i wasn't sleeping well i was getting to bed really late so you know not getting enough hours sleep at night and i needed to readdress some relationships in my life of of people that perhaps weren't um the best influence on me um and so i needed to do that to support my journey to health do you see any correlation between sleep um you know stress levels or even perhaps toxic relationships that people might be experiencing and their ability to manage or work through a condition like sibo well in general with irritable bowel and the abdominal discomfort and the more stress the worse the discomfort so there's definitely a brain gut relationship going from north to south with respect to rest rest is important because during that time you're fasting obviously you're sleeping and you're giving yourself a little more time for whatever migrating motor complex you have or can generate with medicine to get wash the bacteria out um definitely and and i since uh coming through my sibo treatment i now do intermittent fasting so i fast two days a week where i just eat dinner and i feel fantastic for it it really makes me feel really great so um that's been an interesting self-experiment for me hmm yeah yeah interesting yeah it's really interesting it's uh yeah i feel i have so much more energy i feel really positive um and it's for me i feel like on the days where i do eat two or three meals a day uh that i don't have as much energy as i do on the days that i'm fasting so it's been a fascinating personal experiment of one well yeah you've enlightened me and uh on many aspects this evening oh that's great uh dr weinstock it's been an absolute pleasure to have you on the show thanks so much for coming on i have learned a lot and i'm sure my listeners have as well if anybody wants to uh connect with you what's the best place for or how is the best place for them to do that well uh short questions little questions um if let's say they well if they want learn about my research it's all on my email site my website gi doctor.net that's g i d o c o t r dot net doctor.net and then um inquiries uh as long as they're kept simple i can handle some lw gi doctor.net wonderful it's been an absolute pleasure and uh thank you so much for your time today okay have a great day thank you i hope you enjoyed episode 7 of the healthy gut podcast with dr leonard weinstock and if you're anything like me you have just learned an awful lot about restless leg syndrome and rosacea and why they're so connected to the gut if you would like to access these show notes from today's show or get any of the links that we talked about head to thehealthygut.com co forward slash leonard and that's where you'll be able to see a full transcript of the show you'll be able to get all of the links to dr dr leonard weinstock and uh and also look at the show notes as well so that is the healthy gut dot co forward slash leonard now i absolutely love hearing your feedback it just makes me feel so happy to be able to connect with the listeners of the show so do leave us a review and a rating in itunes and it also helps other people find the show the more ratings and reviews we receive the more likely it is that someone who is looking for help around their gut health is going to find the show now if you'd like to connect with us you can do so on all the major social media platforms such as facebook instagram twitter youtube pinterest and google plus and we are the healthy gut on those platforms coming up on next week's show we are joined by angela pifer who is sibo guru and angela and i talk all about the importance of playing your own private investigator when it comes to understanding your own personal health concerns so do join me for episode 8 with angela pifer which is coming up next week [Music] you've been listening to the healthy gut podcast with rebecca coombs to learn more about the healthy gut or the podcast head to the healthy gut dot co forward slash podcast if you would like to help support the continuation of this podcast you can make a contribution at the healthy gut dot co forward slash podcast with thanks to belinda combs for the production editing and original music score of this podcast to hear more of belinda's music head to soundcloud forward slash belinda combs the healthy gut podcast is a production of the healthy gut thanks for listening
The 4 MOST Effective Leaky Gut Treatments_en (auto-generated)
welcome back let's discuss the four most effective leaky gut treatments leaky gut may affect 25 up to 88 of those of us with symptoms whether they be gastrointestinal diarrhea constipation bloating gerd reflux or systemic fatigue headache brain fog joint pain or just a feeling of generalized inflammation leaky gut may be at the core of 25 to 88 of these symptoms so again let's equip you with the four most effective strategies you can deploy to improve your leaky gut welcome to Dr rooster radio providing practical science-based insights into Health exploring the importance of nutrition lifestyle and gut health through conversations with experts research reviews and personal stories we break through the bias and the noise to bring you simple trustworthy information that matters to set the stage here let's start by defining what leaky gut is if you went back 10 years ago this was much more hotly contested oh he gets not a thing there's no science and some people were saying well there's some science and now we have enough data to wherein we can conclude that yes increased intestinal permeability or the more colloquial way of saying it leaky gut is something that can implicate or be implicated in many syndromes symptoms conditions and disease States and I really appreciate this schematic from Frontiers in Immunology what you're seeing here is the intestinal Lumen specifically important to bear in mind this is the small intestine because remember the small intestine is where 90 plus of calories and nutrition is absorbed and that's where the leaky gut can occur because it's the selectively permeable membrane that has to be tightly regulated and as this schematic is illustrating when there's a disruption of microbial homeostasis the bacteria the fungus our imbalanced or overgrown that can be one of a few different steps that leads to A disruption of the health of the barrier and when this occurs you see endotoxin or LPS leak through so these are the actual particles or one of the particles and the immune system responds with inflammation and this is amongst a few the tnf alpha and interleukin-6 that you're seeing here which you'll see in the bloodstream and you can also directly quantify the leaky gut with serum zonulin and I sort of emphasize serum because we're learning that stool zonulin does not seem to be as accurate as blood or serum zonulin so this is part of the picture of what's happening in your small intestine when leaky gut is present and part of the time here I want to make you aware of is really the inflammatory component this might be how we reconcile seeing leaky gut correlate with both digestive symptoms but also that list of systemic symptoms like brain fog joint pain and skin issues that we covered a moment ago let's go one step deeper and just make sure that we run through some of the most common causes of leaky gut and then we'll Parry that into the protocol of the four most effective things that you can do by the way thank you so much for watching the video please comment like or subscribe I especially enjoy hearing what people think what their questions are future video ideas so please make a comment I'll do my best to respond to as many of those as I can okay so coming over to some of the best documented causes of leaky gut we touched on a moment ago this disruption of microbial homeostasis another way of saying that could be dysbiosis or overgrowth as in sibo in addition to this inflammation as we also covered a moment ago C-reactive protein tnf Alpha interleukin-6 amongst a handful of inflammatory cytokines that can be causal to leaky gut and leaky gut inflammation are kind of a bi-directional entanglement gastrointestinal conditions probably not surprising but IBS IBD celiac gerd everything any GI symptom throws up a flag that there could be leaky gut present additionally probably not obvious but worth just touching on a western diet a high level of alcohol consumption I'm not going to make the claim that any alcohol is going to be problematic I think we can probably have a reasonable intake of even Western food processed food as long as it's not excessive but too much bad food too much alcohol poor sleep and chronic stress all these factors start eroding at the health of this crucially important small intestinal membrane certain medications antibiotics NSAID and anti-inflammatories also chronic use of decongestants as we've covered on the podcast in the past and then chronic disease and aging all can aggregate coalesce to start weakening this barrier and leading to setting the stage four leaky gut okay and we should also just Echo the prevalence because there are some conditions that sound scary yet may only impact 0.3 percent of the population and it's not to take anything away from those but if we understand prevalence then we understand risk again and those with symptoms 25 to 88 percent of individuals have leaky gut whereas only about six percent of healthy controls demonstrate leaky gut so there's certainly a highly increased likelihood if you have symptoms a condition or a disease state that you could have leaky gut as a component underlying that the first step of the four is Diet now I'm going to give you some specifics because I know when someone or a doctor says just eat a healthier diet it's quite lackluster okay so specifically processed food and here is a great schematic we adopted from the journal Foods 2022 you see a few emulsifiers this might be one of the key factors emulsifiers and coloring agents this carboxymethylcellulose carrageenan glycerol monolorate polysorbital just to name a few have been documented to lead to increases in leaky gut and also in inflammatory bowel disease because while on the one hand yes they will help to improve shelf life these emulsifying agents they also irritate and can start to break down the lining of your gut now to be careful it's not to say you can never have any processed food we want to be careful to Stave off this sort of pernicious gravity toward a somewhat pathological or unhealthy relationship with food in moderation won't be a problem but if you're consuming processed food every day a few times per day even then this is when I would strongly encourage you to start making some changes because this might be the most foundational piece it's the process foods which actively can irritate and contribute to leaky gut and that's what you're seeing portrayed here in a bit more of an involved schematic but the take home is emulsifying agents amongst other ingredients in processed foods irritate the lining of the gut contributing to leaky gut now the flip side of this is consuming Whole Foods which will be more nutrient dense usually will have less calories or will be less prone to overeating will contain phytonutrients fiber healthier proteins healthier fats so a simple thing you can do is just move from a diet that has more processed food over to a diet that's higher in whole fresh unprocessed foods you may have heard this Axiom of shopping the perimeter of the grocery store this is where you'll have food that can spoil and the interior will be your packaged foods that last longer on the Shelf because of in part the emulsifying agents and what's nice about this is It's dietary agnostic you can move from processed food to Fresh Whole Food in any sort of diet plan paleo vegan Mediterranean high carb low carb whatever you like the other component here that you've likely heard of but it's worth mentioning a elimination and reintroduction of foods that are known to be irritating the short list here gluten dairy eggs soy fish shellfish nuts and also perhaps seeds now not all of these foods have been demonstrated to contribute to leaky gut but they are known to in some people provocate symptoms and I think symptoms is a pretty good proxy for leaky gut but to be careful we don't have data all the way down this list gluten has been shown to provocate leaky gut importantly in the model of non-celiac gluten sensitivity meaning you don't have full-blown diagnosable Celiac but they're still an aversion to gluten however we always have to balance this because if you look at the messaging online oftentimes it will have people believe that anyone not feeling well suspecting leaky gut what have you probably has a gluten intolerance and when you look at the data on ncgs non-celiac Gluten Sensitive it averages at about five percent of the population so something to consider cutting out and reintroducing but the second half of that statement is really crucial reintroduce because you don't want to be avoiding a food in perpetuity just based upon fear based upon faith and this is what's nice about many diet plans I think the paleo diet is a good template to cut out most problematic foods for about a month and then reintroduce them and see when I bring back in bread do I notice my symptoms clearly flare when I bring back in Dairy do I notice I have loose bowels or abdominal pain when I bring back in nuts or shellfish do I notice I don't feel well you know for whatever the reason because remember leakia can manifest as gastrointestinal and systemic symptoms so it's really not about the symptom specifically but about the timing I'm feeling good I reintroduce I feel poorly I wait a week or two I try again I'm feeling good again we're going to introduce one more time again I elicit that same negative reaction that's what you want to look for so that you can be somewhat certain that a given food is causing a problem and the other component to diet that I think is really underappreciated is low FODMAP dieting this really speaks to the person who may have observed sadly the better I eat the worse I feel you'll see this sometimes wherein someone improves their diet the reading less processed foods they're eating more fruits and vegetables yet their symptoms are getting worse and sometimes what happens here is people are eating more fruits and vegetables and many of these are high FODMAP FODMAP stands for fermentable oligodi monosaccharides and polyols structures of carbohydrate that we know are conducive to feeding intestinal bacteria but the problem is for some people too much feeding occurs thus flaring symptoms now this is all conjecture until I show you some evidence so let's look at this really impressive clinical trial where they found 12 weeks on a low FODMAP diet reduced serum zonulin blood zonulin reduced lipopolysaccharide the actual measure of stuff leaking through and reduced interleukin-6 a inflammatory cytokine that usually accompanies the leakage and the other point without getting tuned to the weeds I wanted to Loop you in on stool zonulin did not change one of many a growing data point showing us that stool zonulin does not correlate with improvements in health but blood zonulin does so just be careful because stool zonulin testing is fairly readily done and just be careful because we're learning that doesn't seem to be an accurate marker for tracking zonulin or for leaky gut if you are eating more healthy foods more broccoli cauliflower avocado apples all these things are high fodmount and you can easily find and we'll put some links to low FODMAP diets amongst others that guide you in the description of this video and the podcast but trial three to four weeks in a low FODMAP diet when it works it works and people really notice a resolution in their symptoms as evidenced by this one clinical trial and the final component for your diet probably a little bit obvious but we should point it out is the consumption of fermented foods there is a fairly long history where we have observed people consuming fermented foods are healthier Zoom or forward modern day and we're seeing data like this a clinical trial of 28 subjects they were given either kefir a fermented milk or regular milk and they found in those consuming kefir a reduction in the marker of leaky gut zonulin quoting our study is the first showing that kefir supplementation causes an improvement in serum zonulin levels and I would argue the same likely holds if we had further data for other fermented foods so sauerkraut kombucha kimchi are all things to consider integrating into your diet and in recap reduce processed food consumption and correspondingly increase Whole Food consumption reduce the amount of common allergens at least for a little while and then you can reintroduce and figure out what if any triggers you may have reduce consumption of fodmaps and again with this it's usually anywhere from one to three months and then people can reintroduce and tolerate fodmaps without difficulty and finally four make fermented foods a commonplace foodstuff that you consume so that's the dietary piece and that breaks it down to the four probably most important components let's move on to the next aspect of this the second factor is lifestyle and I want to just make a quick comment that it's such a slippery slope into supplements supplements supplements supplements for improving whatever it might be right because it's just a market pressure influence that we have to be aware of but we can't Overlook the fact that exercise has been shown to reduce leaky gut and the data that we have here are pretty darn compelling 2021 systematic review appearing in the Journal of Frontiers and nutrition 23 studies were summarized and they found that exercise reduced leaky gut let me break down a quote moderate exercise May preserve the intestinal mucosa so right there when the mucosa erodes that is leaky gut so that right there is point one but let's continue by accelerating gastric emptying and improving intestinal motility meaning the food moves through your stomach and intestinal tract at the appropriate pace if things move too fast or too slow this can contribute to overgrowth and dysbiosis probably unironically when you move your intestinal contents move also continue with the quote increasing the abundance and diversity of the gut microbiota so there's the healthier bacteria also increasing burate producing bacteria and the synthesis of short chain fatty acids so you see multiple positive shifts occur improving that you got when you exercise I think a minimal for most people not necessarily for leakya but just for General Health two resistance training sessions per week and two endurance or cardiovascular sessions per week as a minimum if you can do that anywhere from maybe 20 to 40 minutes as a starting point moderate intensity that is going to be a great start don't forget about how powerful exercises for improving the health of your gut now in step with this I guess pun intended would be stress here is what I found to be one of the most compelling studies looking at the correlation between stress and how inflammatory someone's blood was when that LPS lipopolysaccharide leaked through and again contacted the person's blood now what you're seeing here in all narrate for those not watching this has a video you're seeing a few different cytokines inflammatory mediators interleukin-6 tnf Alpha interleukin-8 you want lower levels of these higher levels means there's heightened inflammation when these researchers took blood samples from low stress or normal stress people and compared them to highly stressed individuals and then they expose the blood to LPS they found consistently higher levels of inflammatory cytokines tnf Alpha and leukon 6 and Luke 8 in the more stressed individuals now if you are stressed I don't mean to pile on top of that the good news here is other data have shown simply taking a walk in nature it could be a park it could be a river it could be a lake it could be Woods it could be the ocean any Naturescape can reduce levels of stress as verified by functional MRI scans of the brain so again I understand the the weight that stress can pose if you can just take a walk outside in nature most days preferably every day that will start to mitigate this there's other things you can do also of course therapy meditation time with friends Hobbies I think time and nature is one of the simplest because it doesn't cost anything and doesn't require any special training but just make sure to take a little bit of time to decompress if you're not doing so because this is another powerful tool to help reduce leaky gut and then in addition to exercise to stress mitigation there's also sleep probably not surprising but poor sleep whether it be timing intensity or duration does correlate with disruption of the bacteria in the intestinal tract there's also a bi-directional relationship where when people have irritable bowel syndrome inflammatory bowel disease gastrointestinal conditions that does seem to cause poor sleep so you can intervene in both directions you can aim to get to bed consistently at the same time leave yourself enough time for Sleep practice good sleep hygiene so dimming the lights relaxing activity before bed no caffeine too late in the day usually past 12 and you can also take steps like we've talked about to improve your gut health and that should also help you sleep more soundly because again it is it is bimodal you may be doing everything right and then going to sleep and saying I can't sleep well that could be because there's an issue in the gut that has to be remedied thus allowing you to sleep so come at it via this dual pronged approach go through this four-step plan that should improve your gut health helping with your sleep and also just tend to basic good sleep hygiene practices okay so point three is a supplement and I would use this after addressing points 1 and 0.2 meaning diet and lifestyle because that will be sufficient for some absolutely but probiotics are a powerful tool maybe one of the best if not the best studied tool for improving one's gut health a 2023 meta-analysis appearing in Frontiers in Immunology summarized 26 randomized control trials and found that probiotics do the following decrease direct leakage as measured by LPS or endotoxin reduce the corresponding inflammatory cytokines tnf tnf Alpha interleukin-6 and also C-reactive protein and reduced blood zonulin also this was another data point that did not find stool zombulin correlated so blood donelon accurate stools onnula not accurate and that's what you're seeing in this schematic they found that two types of probiotics can reduce leaky gut either blends of bifidobacterium and lactobacillus or soil based probiotics which are typically some type of bacillus species so two different formulas because remember they summarized 26 clinical trials so these different trials used different products different dosages but they summate to all being either soil based formulas or blends of lactobacillus and bifidobacterium and across all these trials benefit was demonstrated or at least most of the trials and again reduction of inflammation reduction of leakage and reduction of the direct measure zonulin indicating leaky gut was improved the other aspect of probiotics that especially this year the ability of probiotics to improve the stress response and to attenuate a overzealousness in the limbic system in the brain which governs fear anxiousness and emotionality and that's what you're seeing depicted here by this 2023 randomized control trial and the Journal of Psychiatry and Neuroscience they assessed via functional MRI the impact that probiotic supplementation is compared to placebo had on the activation of the hippocampus the hippocampus is one of a few regions contained in the limbic system and in conditions of stress and anxiety the hippocampus can be overactive so something that helps to decrease or attenuate that hyperreactivity can be very beneficial and what they found is that the group supplementing with probiotics had a reduction of the activation of the hippocampus so a normalization and this did not occur in the placebo group leading these researchers to quote as follows the hippocampus appears hyperactive in patients with oppressive symptoms the hippocampal deactivation over the time in the probiotic group is assumed to reflect the beneficial effect of the probiotics on depression-related cognitive impairments so just one more reason that stems from the gut all the way up to the brain that probiotics are something to consider after steps one and two the dietary and lifestyle changes in terms of a probiotic protocol this is our evidence-based protocol wherein we looked at a number of Trials across different conditions using different formulas to give you this summary of the three different types of probiotics and the corresponding dosages and time intervals if it's a blend of lactobacillus and bifro bacterium between 1 to 10 billion will be sufficient for most some Studies have used higher but as this data set is evolving we're seeing that we don't need a very high dose and something more moderate one to ten billion for two to three months is a good Target the other probiotic we covered in the leaky gut meta-analysis was a soil based probiotic and the range to Target here is between two and six billion again for two to three months and then third and finally saccharomyces bellardi which is a healthy fungus at a dose of between 10 and 15 billion per day for two to three months regarding time to response most people will see an improvement inside of a month and I would encourage you to look and to assess if a therapy especially a probiotic is helping you you will see some movement of the needle within a month however other data are showing that you may not see a peak in Improvement until two or three months in so like I've said many times before your first checkpoint is about at the four week Mark is this helping yes or no if yes continue and then you may see a pinnacling or a peeking of benefit by the second to third month and then you can work to wean yourself off and then the final Point here and I look at this as kind of a a rescue therapy would be doing a gut reset with an elemental diet now gut reset is the term that I've used it's not necessarily published an elemental diet is a pre-digested hypoallergenic meal replacement and the analogy I use is if you sprained your ankle and you kept running three miles per day your ankle may never heal similar to gut health if there's inflammation and leakage and you're eating three meals per day it may be difficult for your gut to fully heal and this is where using a easy to absorb hypoallergenic and pre-digested formula like an elemental diet may help when other therapies have not and there's three evidence points here I want to share I also want to disclose that the elemental diet has not been studied specifically for leaky gut but there's enough circumstantial and anecdotal evidence that it's become one of the Mainstays of what I use clinically a 2004 clinical trial that found a resolution of sibo and IBS symptoms when using the elemental diet a 2007 clinical trial finding that in rheumatoid arthritis so this inflammatory arthritity that affects the joints and its autoimmune nature the elemental diet was as effective as prescription steroids and then thirdly a 2018 Cochrane meta-analysis of 27 randomized control trials that found a disease when using the elemental diet so I would be remiss if I didn't mention this even though the research has not yet studied directly the impact on zoninglin when we see improvements in IBS improvements in sibo improvements in ra and improvements in inflammatory bowel disease I think this is another tool to consider as step four if you haven't yet seen the level of results that you would like to so in recap diet reducing your processed food eating more Whole Foods reducing triggers lowering your FODMAP content and also making sure you're going to get fermented foods in there lifestyle exercise and Stress Management third Factor probiotics and then if you're still in Need You can try a reset with a Elemental diet and if you do this my observation has been 70-ish percent of individuals will see very clear and long lasting improvements in their gut health there are other tools but I feel these are the most well studied and the most efficacious and so this four-step plan is what I would follow if you're trying to improve your gut health really with the most root causative interventions possible [Music] thank you
The GutSkin Axis Explained- How Your Diet Impacts Acne, Rosacea & Inflammation_en (auto-generated)(1)
If you are wondering if your skin condition is actually getting worse from the foods that you eat, you might be on to something. Believe it or not, our gut and our skin actually talk and communicate with each other. And that is why what we eat and what we put on our skin actually matter and affect each other. I'm Dr. Mary Almina. Welcome to my channel, The Skin Real, where I give real people real information about their skin health so that they can make informed decisions. On this week's episode, I am so excited to have boardcertified gastroenterologist Dr. Pia Pash joining me. She is a GI doctor in private practice in the DC area. And she is a amazing, phenomenal educator about gut health and patient advocate on the importance of gut health. and she's on a mission to help reduce the stigma around gut health and some of the gut symptoms that can be downright embarrassing to talk about and maybe you don't feel like sharing with even your loved ones. I'm super interested in gut health because I see how it affects my patients and their skin conditions, things like psoriasis, acne, hydronitis, rosacea, right? These can all flare and worsen because of our diet and what we eat. And so that is why it is so important that we actually are what we eat and why it's important to focus on our diet not just for our gut health but also for our overall health including our skin health. Let's get into it. [music] Dr. Pash, thank you so much for joining me. I am so excited to talk about this cuz I have patients asking me all the time about their gut health and how it relates to skin. I think a lot of people are like, "Wait a minute, how is my gut affecting my skin and vice versa?" Right? So, I'm so glad you're here and uh yeah, help shed some light on this. Is there really this connection? >> There is really this connection. Um absolutely there is this connection. So we I think are in a time right now where we are really seeing and discovering the importance of the gut microbiome and how that that can the disruption in that gut microbiome can cause inflammation and the question is how is that inflammation presenting in patients? What symptoms are they having and could that be contributing to some skin conditions or flaring underlying skin conditions? >> Right. Absolutely. Yeah. So, we we definitely know in dermatology, right? Like some skin conditions are what we call really inflammatory. It's like the body's immune system is revved up. It's hyper. It's on overdrive, right? Like things like acne, psoriasis, attopic dermatitis, hydrainitis, right? Like I could go on. And and so we're learning actually that underlying revved up inflammation isn't just affecting the skin and their skin conditions, but we're also seeing it in in their gut and other parts of the body. And before we dive even further, when you said gut microbiome, like break it down to me. I'm a 5-year-old. What is a microbiome? Yeah, absolutely. So, we all have a collection a makeup of good and bad bacteria in our intestines. And that is the gut microbiome. Trillions of bacteria and that microbiome is always changing and shifting with number one where we live in the world which is really interesting. >> I know that is really cool. but medications and stress level and underlying diseases um and illnesses and >> age right age as we'll talk about hormones and all the things um >> and I think the focus on how can we protect it how what can we do to keep it consistent and in a good place and how that can help with some of these underlying disease these states, >> right? Yeah. I I think a lot of people are are kind of blown away when I tell them the skin actually has trillions of bacteria and and microbes on our skin, right? Like we think, "Oh, but I just washed my hands or I washed my face. Like, it's clean, right?" But but actually, we we want a lot of those microbes and bacteria, right? It's not that we're trying to eliminate them all, right? But they need to be in the right balance and not >> and not have overgrowth or what we call medicine, right? like homeostasis. >> Exactly. Yep. >> So, question about the microbiome. Is that why people say eat local honey? Because the microbiome is different in depending on where you live and if you eat local that it has better benefits for our health. >> That's so I haven't heard people say that, but I'm sure that has something to do with it. Yeah. >> Yeah. I thought that was so cool. Like, wow, that's such a great point. But yeah, I think that's really cool. Okay. So that >> or even the concept behind um soilbased probiotics soil S O I L, right? So maybe the bacteria from the ground is what you know what we need in our intestines. I mean so so much to talk about, >> right? Well, and I've also read that again getting food locally, right? not just good for the local community, right, and environment and all that, but yes, like the the soil, the ground, where you live, um that will potentially affect your microbiome as well. >> Absolutely. >> Well, so I think also people are surprised to know our gut plays such an important role in our immune system, right? >> Can you talk a little bit more about that? >> Sure. So, we have an intestinal barrier and we want it to be can you am I can you see my hands? We want it to be like this like a tight fence with some small openings and very regulated planned openings to allow the good things through like the nutrients that we get when we eat. When we have a disruption in that fence and it turns into this where you have holes, that's an issue because now we are having bacteria and toxins coming in through the intestines into the bloodstream and potentially creating an inflammatory response and triggering our immune system. And then we're in this inflammatory state. And so stuff that's not supposed to be getting in is getting in >> is getting in. Exactly. Right. And so we know that changes to the gut microbiome or dispiosis can lead to that kind of open fence and cause that what people commonly refer to as leaky gut and that could trigger the immune system. >> Yeah. I Well, I'm glad you brought that up because just like in dermatology, right? I'm sure in in GI like they're these like trigger words, these buzzwords that people hear and they leaky gut, leaky gut. Like what is that? Like to me when I first heard it, I'm like is like my intestine leaking? Is it diarrhea? But >> thank you for for breaking that down. And it's it's really cool because just you know our skin has a a skin barrier just like the gut has a barrier, right? And when absolutely that skin barrier is broken down, you have rashes, you're itchy, you um have allergic reactions, infections, right? It's just we can't see our gut. So, we don't we don't see it going on versus we can with our skin barrier. >> Yeah. >> So, what are some of the symptoms of leaky gut? Right. Like if someone's like, "Oh, I might have leaky gut." Like, do you know you have it? What are some symptoms? >> So, GI symptoms can be like, you know, bloating, changes in stools, diarrhea, abdominal pain, but then it goes beyond the GI tract, right? Because now you're in potentially in this inflammatory state. And is that presenting as joint pain and arthritis again? Is that presenting as a rash? Is that leading to another autoimmune condition? So really that breakdown in the intestinal barrier, that leaky gut, I think can contribute to so many underlying disease states. And that's why our gut is so important. >> Yeah, it's it's key. And we and what we're realizing, right, is how it's so connected. Really all organs have this connectivity. >> Absolutely. Absolutely. And so right now we know that certain conditions cause that leaky gut, right? GI wise, inflammatory bowel disease, we know obesity, um you know, there many conditions that are known to to cause that open fence. >> Yeah. Well, and I feel like we're also hearing a lot about sort of this persistent inflammation in our bodies, right? Like people talk about that like I'm inflamed. I need to reduce my inflammation. All that, right? And we know stress is a big cause. I I diet, right? Not sleeping, right? These can all contribute to this elevated inflammation in our bodies. So, are there things that we can be doing to help keep our gut healthy? You know, I I would concentrate on diet first, specifically a high-fiber diet, keeping in prebiotics. So prebiotics are food that we think feed that good bacteria and promote growth of that good bacteria and that healthy microbiome and we think that if you have more of that in your diet then you are contributing and hopefully keeping that integrity for that fence and so that would be my number one. >> Can you give us some examples of prebiotic foods? >> Sure. um whole grains, um certain fruits like apple, citrus, berries, certain starches. Yeah, it's very easy to find a good list, but it's it honestly it's like all the foods that we would think think would be would be healthy, right? That you should eat. >> Exactly. The lentils and all things. >> So, um and then you had said fiber, right? And I think we hear that word a lot, but maybe people don't know what is fiber like is fiber a potato, a starchy potato, or is fiber lettuce? Is it What would you recommend as a GI do? Great. I would recommend whole grains. So, um, we're thinking about fiber. We're thinking about we'll start with carbohydrates, right? So, when you're thinking about bread can be a great source of fiber, but not a white bread. I would do a sprouted grain bread or a whole wheat bread because that's going to have a lot more fiber. When we're thinking about pastas, a white pasta is probably not going to offer too much fiber, but if you go to a whole grain pasta, that's going to offer more fiber. Same thing with tortillas, moving to whole grain tortillas, you know, it's really changing those carbohydrates from white to wheat or whole grain is a great way to increase that fiber. beans and lentils. Um, chia seeds, flax seeds. Yeah. No, I I feel like there was this movement. I mean, I I love bread. I love carbohydrates, I have to admit, but I do try to make the choices to the to the whole grain and the sprouted and stuff like that. But I I feel like there's this like movement and maybe we're moving away from it a little bit where it's like everything was gluten-free, no breads, no carbohydrates, like there was this kind of fear of eating those, but you're saying our body meets fiber. I feel so many different ways on this topic. I I think unfortunately the way gluten, so carbohydrates are processed in this country, it's not the best and it actually can trigger symptoms. So I do recommend a gluten low diet to patients who are coming in with GI symptoms. That being said, you know, I think that for instance, sourdough, I push a lot to sourdough or like a whole grain sourdough would be like the ultimate and the best because you're getting the fiber, but just the way sourdough bread is made. Um, it it's like a probiotic, it has lactic acid, less gluten. So that's a good shift. But no, you're right. I I don't think that we should be I disagree with that. >> Yeah. And but like you said, like making good choices, right? Like choosing the whole grain version and and I think it's just good to know like not to be afraid of those, right? Like eating whole grains and everything actually can be helpful for your gut. >> Absolutely. And also just kind of in general, these are the things that we want to be doing on the day-to-day, but it's okay, you know, that once in a while to have that pizza or that white bread or that white tortilla and go to Chipotle and enjoy those things as well, right? We want to take away from that. But yeah, the dayto-day making those good choices. >> I'm personally having a cheat day today because we had our office holiday party. So [laughter] >> Oh, yum. I love that. >> You know, right, you you have to live your life and enjoy your life. >> Oh, yeah. Absolutely. Okay. So, so those are great about the fiber, the prebiotics. Um, what else can we do for a healthy gut? So, fermented foods are fantastic. Kimchi, um, kefir, fantastic for again that gut microbiome, that intestinal integrity. Um, probiotics are a big topic. Um, and you know, the concept behind probiotics is legit. And you know, it's it's giving where we're trying to give ourselves back what we think are the the good bacteria, the beneficial bacteria, which we want to populate the intestines. Um, the problem with probiotics is we in in some conditions, we don't have great research um that backs it up. We don't know always which type of bacteria we need, how much, for who or when. So the research, we need more, but because probiotics are so safe and we know that they can offer benefit to the gut microbiome and therefore to that barrier and reduce leaky gut, I I think it's worth a shot if you're having symptoms to start a probiotic. Are you talking about foods that are probiotics or taking like supplements? >> Great question. I would a supplement probiotic foods. Sure, foods. That's fine, but the quantity is important and you're not going to really, for instance, like a a probiotic yogurt is probably not going to give you enough probiotic to to really hit a benefit. So, I would do a probiotic supplement. But again, I don't think that's for everybody. >> Maybe talk to your GI doctor or your primary care doctor. >> Exactly. Now, what about Greek yogurt? Um, I put that in my smoothie most days. Am I doing a good thing with that? >> I think if you do not have symptoms with dairy, so you do not have diarrhea or bloating or constipation, then yes, I think that's absolutely fine. Again, in my clinic, most of my patients that I see have some GI complaints. And so, along with a low gluten diet, a low a trial, I should say, a trial of a low dairy diet is something I often recommend. >> Yeah, that's a good point because that is a lot of people have that issue. >> Yeah. So, um am I thinking about pre and probiotics in the right way? Prebiotics are almost like the food for the bacteria and then probiotics are the actual bacteria. >> Absolutely. Exactly right. >> Okay. It's just taken me a couple years to get the talking to you guys to get this right. Me too. Me too. Amazing. Okay. Well, great. All right. And then any other tips to help improve our gut health beyond diet? you know just talking about the derm GI connection and now that it's becoming more researched and studied and we really believe that there is this connection I think it's important for uh us to work together so for us to be aware that you know for instance in doing all this research seeing that hey H pylori is actually been tied to rosacea and linked to chronic udicaria urtdicaria I'm sorry and so And that's something that I learned, right? So, should those patients be tested for H pylori? Maybe, potentially. But it's just great to know these connections. And anybody with an underlying skin condition or a skin condition that isn't improving that also has GI symptoms, I would absolutely refer them to a gastroenterenterologist to look for underlying GI inflammation, right? Inflammatory bowel disease, Crohn's disease, ulcerative colitis. that could be playing some role. >> Oh yeah, for sure. And I and I think a lot of times people with these conditions like hydrainitis, sepa, it can be really embarrassing for patients. They feel very stigmatized and psoriasis too. Like people might think they're infectious. They don't want to touch them. They're they might have um inflammation in sensitive areas. And then the last thing they want to talk about is, oh yeah, I'm also having diarrhea and I'm also having bloating and all that. like it's I I feel for these patients cuz it can be really stigmatizing but it is important to know that there is that connection and often times treating one can help with the other and vice versa and um and we do know sort of a lot of times like weight management and focusing on diet will help acne will help um hydraonitis like these conditions. So, it's really amazing uh that connection that's there that people don't automatically think about. >> I know. I know. And I'm so excited to see, you know, what the research brings, what our future brings. You know, I wish we were in a place right now where we could say if you have acne, I want you to start this probiotic and here's the diet, you know, and and we're not there, unfortunately, but I think we we could be. >> I I saw this is a funny story. I saw firsthand my husband, this is years ago, but this is how sometimes you can't see what's right in front of you in your own house, right? But he um has always had great skin, but he started taking a protein powder and I didn't make the connection that all of a sudden he was really breaking out. I mean, this is someone who's never had acne in his life and it was getting to the point I was going to put him on Accutane and it was it was really bad. And and then I I like put it together that it was the whey protein powder that was causing him to get this horrible like pretty nodular cystic acne. So it it that to me was like wow. Just what he was eating was flaring his acne like that. Someone who had never had acne in his whole life. So it's it's powerful. >> It is really and such a ma it's such a major reaction. Like that's a that's a big deal, right? Yeah. It's very practical. I had a whole list of skin conditions and skin lesions since childhood starting with eczema. And that's why this topic has been so interesting for me. And a lot of things like like a patch here that I had for eight years that would flare. I never knew why that went away to a patch here. Some person some germ says is subre dermatitis. You know, like you'll see it flaring. And even now when these things flare, I don't know why. I don't I don't really have great answers, right? And so I do turn to, you know, how's my diet been this week? Am I drinking more alcohol? Like what what disruption is happening in my body that could be flaring these underlying things? Um, and I know there's a connection >> for sure. And and we know our diet like nowadays like even when you try it is so hard to get away from processed food and sugar and I know sugar is a huge culprit in glycation and causing our collagen to become very stiff and brittle. And so I've become aware of that now that I'm in my mid-40s. I'm like okay let's like be a little more mindful about the sugar that we're eating. Um and and then alcohol I'd love to know if if alcohol affects your gut. It does. It does. And it does. And you know, again, this is a hard conversation to have with patients. And it it's just difficult cuz, you know, I want everyone to enjoy. And it's like, well, what do we do? Can we have two glasses of wine? Can we, you know, have that night out where I have five tequilas? You know, what's the impact, right? Um, bottom line is it will impact your gut. Obviously, binge drinking, I would say no. And then also I think now big concentration on it being linked to so many different cancers that it's a hard topic um and uh and definitely you know a toxin >> and we don't know really like well what is a safe amount right like is is a glass a day okay is three glasses a week okay like we don't know that >> right and of what right of what of beer of and remember we learned in medical school that you know like the the definition was like three for men or four for ladies and you know and that is so outdated. We really don't have a good a good measure. But it kind of brings us back to the other things that we can do to improve the microbiome which could potentially improve our inflammation. And it's it is it's cutting out those foods, those processed foods, the sugars, the artificial sweeteners and artificial flavors because flip we know that those cause the irritation in the intestines, the disruption of the gut microbiome and again opening up of that fence, >> right? What what about are you familiar with the term SIBO? >> Yes, of course. Yeah. Is that a real thing? >> SIBO is absolutely a real thing. So SIBO SIBO is small intestinal bacterial overgrowth. That is a very known condition in GI. It is an imbalance of like exactly we're talking about an imbalance of the bacteria in the intestines, overgrowth of you know the bad bacteria leading to bloating, stool changes. Um it's we can test for it with a breath test. Um and and I think some academic centers can actually test for it during um an endoscopy. Uh but what's important with with kind of all these things is there's usually an underlying cause, right? So if you had the SIBO, is there an underlying inflammation, a Crohn's disease, something that is changing the motility of the small intestine? So you're not you don't have the movement to flush out the bacteria. Same thing if you have this leaky gut, you know, is there something underlying that we're missing that's actually causing that leaky gut? Yeah. Yeah. Is it like the canary in the coal mine? Like it's the harbinger of of something else. And yeah, we've I I know in dermatology we know about SIBO um with rosacea patients >> that people who have rosacea which is different from acne but inflammatory uh have a higher incidence of SIBO. >> Yeah. >> Yeah. Absolutely. >> And again easy testing pretty easy treatment. >> Yeah. >> You know and if it were it was going to improve the rosacea I mean that that's a game changer. >> Sure. Absolutely. Now I know um in dermatology we at least I' like to say number one prescriber of antibiotics in the medical field which is crazy to me considering we were prescribing more than infectious disease doctors but we were using a lot of antibiotics for these inflammatory conditions and and we still do in some regards but like I am so mindful now um about prescribing antibiotics like I I need to have like a culture rack or I need to know what I'm treating or it needs to be, you know, pretty specific things. Like I try to use other other things if I can because I couldn't believe these studies coming out showing like even a week of antibiotics can really just like decimate your intestines and and the microbiome in there. Is is that is that real? >> Yeah, it's real. I agree with you. I think we should be very mindful about antibiotics. Um, and what we see sometimes is patients who are taking these antibiotics or maybe repeat courses, they have a very hard time getting back to that baseline microbiome and then they can have years of symptoms because of that imbalance. >> Yeah. I mean, it's amazing. I think also I just want people to know. I think sometimes people get frustrated. They go to the doctor, you're told it's viral, and you you almost feel like, well, I need an antibiotic. I need a prescription. I need something, right? Um, and I think that's anatomy. My husband will say that, too. Like, oh, the pediatrician didn't do anything. He didn't give us anything. I'm like, it's viral, right? Um, but I think it's important for people to know these antibiotics have consequences that you don't necessarily see and that they can last for years, which is really crazy. >> Exactly right. I agree. It should be targeted. Just targeted therapies. Absolutely. >> Yeah. Exactly. No. Um, I'm 45 and I am really interested in like perry menopause and midlife health and I I think at 40 is when it sort of hit me like I can't just like keep burning the candle at both ends and like you know hoping it all works out like I really need to focus on my health and um and I'm noticing my friends are noticing my patients are noticing changes in the skin, changes in their sleep and and uh things. I used to be able to handle a glass of wine a night and now I I just can't. Um, so things are changing, right? And we know that our well, we know in our skin that the microbiome changes as we get older. It becomes less diverse. Are there changes in our gut as well? Absolutely. Yeah. So with pmenopause and menopause, the decrease in estrogen absolutely changes the gut microbiome and absolutely changes that intestinal barrier and that can lead to symptoms. It also changes motility, right? So new stool changes, new constipation in perry menopause and then the stress, the cortisol levels, right? and and and the sleep changes that then may lead to those you know all the things connected also have independent effect on the microbiome. Yes. Yes. Yes. Yes. Yes. And yes. Yeah. So just you know get rid of stress, eat right. Right. So easy. So easy. Uh does hormone replacement therapy help? Do have they looked at studies on that? >> It will. Yes. I I I see many patients in pmenopause and um hormone replacement therapy will help if if if and again not everyone is having GI symptoms and pmenopause, right? But if you are, yeah, it could be helpful. Well, and I I think that's what's tricky about per menopause, right? There are so many pretty much every organ's affected by estrogen and and everyone's going to experience different symptoms. So, it's hard to to know and you may not associate feeling more bloated. You may just think, okay, well, I'm I'm getting older. That's just what happens, right? Like, you don't necessarily put the pieces together that it can be connected. So, I think that's why it makes it so tricky and we know there has been such a lack of research in this area, too. I'm I'm just excited that people are finally talking about it. Right. >> Me, too. I I think that, you know, five years ago, I didn't hear about this. I wasn't, you know, and now patients are asking and we're talking and it's all over social media. And I love that because it just gives all of us the opportunity to get more information and learn more and and feel better and just overall feel better, you know? >> Right. Well, and you know, we're living so much longer, so just 45 hopefully I'm just hitting the halfway point, right? >> 45 is like the new 25. >> I mean, that's what I say. >> Yeah. But um yeah, so we have to think about like how do we want to live the rest the the second half of our lives, right? And and I think people nowadays are like, "No, I want to I want to be healthy, vibrant. I want to keep doing the things I love." So, um I love that people are talking about it. Speaking of colonoscopies, right? Yes. Yes. Thank you for bringing that up. 45 is the age for colonoscopies. Absolutely. Um you should have Yeah. And that's that's if you have no family history or of colon cancer or you haven't had polyps in the past, 45. If you do have a family history of colon cancer, talk to your physician. You may need to come in a little bit earlier than that. But yes, that is on my to-do list. I will do it, Dr. Pash. >> I I hear you. I hear. Please. But I hear you. But even Yeah, it's hard. It's hard to keep up with all the things, right? Like >> Yes. I I'll just say I had a a mammogram and then they were like, "It's time for your next." And I'm like, "No, no, I promise I just had it." They're like, "No, it's been a year." And I'm like, "Oh, wow. Wow." Yeah, >> it goes. >> And now I'm late on that. It goes. It just It goes. Yeah. >> But if you get it done, you'll most likely be good for 5 to 10 years. So, >> yeah, that's what I'm telling myself. I just need to lock it in, schedule it, do it, >> get the small volume prep, not that big gallon. Oo, >> the small volume, which is like just two tiny bottles. >> Still doesn't taste great, >> but it's tiny. So, you know, most of us can get that down. >> And and I hear it's the best nap of my life. >> Yes, it is. That a lot of my my mom just recently had one and she was like, "Can I can I stay longer?" No, you cannot stay long. >> You got to go. >> Yeah, it's not a hotel. you do need to leave the >> it's a very common thing we hear from patients like just a little more time. Yeah, it's a good nap. >> Amazing. Um were there any other points you wanted to hit on? >> No, this has been fantastic. Thanks so much for having me. >> Yeah, Dr. Pash, I I have learned a ton. I'm definitely going to get that colonoscopy scheduled. I promise. And I would love if you could maybe give your top three tips for someone who is maybe wanting to improve their gut health. and they're not really sure what's going on. They're having some symptoms. Like top three takeaways. >> Great. I love that. Top three takeaways. Number one, let's focus on diet. So, all the things we talked about, let's increase the fiber. Let's take away the white carbohydrates like the white breads, the tortillas. Um increase the fruit, increase the vegetables. Number two, we really want to decrease red meat. Um red meat has been shown to increase colon cancer. and not only red meat but processed meats, right? Like the sausage and the bacon and the deli meats. So, you know, again, we don't need to cut those out completely, but definitely decrease the processed meats. Um, so that's diet. Number two, fiber. Not not even dietary fiber. I would I would add a fiber supplement because a lot of times I think that people are not even evacuating their bowels completely and >> a lot of us don't really know what what is normal and how we should be you know evacuating >> and it can't hurt to just get an extra fiber supplement in to kind of add water and bulk so you're eliminating which can really help with bloating and and pain and all the symptoms. Mhm. Yeah. That And I'm always amazed to like how much how much fiber should I be having? Is that 25 grams or 35? >> I'm going to say 35. I say if you say >> Okay. >> That's hard. Hard to hit 35 grams of fiber. And then also >> you want to hit the fiber, but some of the fiber causes bloating. So you're like confused like wait, what what you know, how do I do this? >> Do you have do you have a fiber supplement you like? >> Yes. Oh yeah. Okay. So, psyllium husk powder. >> Okay. >> Powder. So, so you don't want like a you don't want the gummy because it has some artificial color and flavor and all that. You want the powder mixed with water. So, I also don't want you to mix it into a smoothie because you really need water when you're doing fiber. >> Okay, that's good. >> Psyllium husk is a soluble fiber. So it forms this like beautiful what I think is beautiful gel-like substance in your intestines that really helps to move things along. Very beneficial. >> Okay. Amazing. >> Okay. Well, I I would also love to get your thoughts just quickly on like these people who talk about these colonic cleanses. >> Is that like a whole another >> I love this is a great conversation. No, it cuz you're hitting on like every one of my videos >> asking truly like I I am just curious because when I see these places I'm like oh my goodness like >> Yeah. No, no, you do not need a colonic. You know, I see hundreds of colons >> a month, right, and colonoscopies. And of course, that's after the prep, but I also see a lot of colonoscopies that they haven't really done a great job with the prep. And there is no layer of debris or parasite that you need to clean out with a colonic. That just doesn't exist. Our bodies do a great job of of getting out what needs to be gotten out. And um and and again, I think that could be also very disruptive to the microbiome, to the barrier. And so I I I'm not a big supporter of colonics. >> Yeah. No, I I feel like we we need to just like stop getting in the way of our body knows what to do. We are like our own worst enemy. we're getting in the way of letting it kind of like with our skin like scrubbing scrubbing trying to get every ounce of oil off, right? Like we're damaging it. And I I think of a a cleanse like that where you're just, you know, >> overdoing it versus go get that psyllium husk powder, right? And and do it daily. Exactly. >> And do it daily. >> Do these things regularly and just get into the habit and you will have, you know, a very healthy and happy GI tract. Yeah, Dr. Pash, I took us on a little detour at the very end, but thank you for uh >> of course >> answering that question for me. I know people are going to want to find you, follow you. You have lots of great information on social media. Where's the best place for people to do that? >> So, um I'm gastroal MD on Instagram, on Tik Tok. I also that's also my YouTube handle. Um and yeah, that's where I am. >> Amazing. I'll put all of that in the show notes so people can find you. really appreciate it. Thank you so much and I'll see you so much. This is so awesome. Take care. >> Bye >> bye.
The GutSkin Axis Explained- How Your Diet Impacts Acne, Rosacea & Inflammation_en (auto-generated)
If you are wondering if your skin condition is actually getting worse from the foods that you eat, you might be on to something. Believe it or not, our gut and our skin actually talk and communicate with each other. And that is why what we eat and what we put on our skin actually matter and affect each other. I'm Dr. Mary Almina. Welcome to my channel, The Skin Real, where I give real people real information about their skin health so that they can make informed decisions. On this week's episode, I am so excited to have boardcertified gastroenterologist Dr. Pia Pash joining me. She is a GI doctor in private practice in the DC area. And she is a amazing, phenomenal educator about gut health and patient advocate on the importance of gut health. and she's on a mission to help reduce the stigma around gut health and some of the gut symptoms that can be downright embarrassing to talk about and maybe you don't feel like sharing with even your loved ones. I'm super interested in gut health because I see how it affects my patients and their skin conditions, things like psoriasis, acne, hydronitis, rosacea, right? These can all flare and worsen because of our diet and what we eat. And so that is why it is so important that we actually are what we eat and why it's important to focus on our diet not just for our gut health but also for our overall health including our skin health. Let's get into it. [music] Dr. Pash, thank you so much for joining me. I am so excited to talk about this cuz I have patients asking me all the time about their gut health and how it relates to skin. I think a lot of people are like, "Wait a minute, how is my gut affecting my skin and vice versa?" Right? So, I'm so glad you're here and uh yeah, help shed some light on this. Is there really this connection? >> There is really this connection. Um absolutely there is this connection. So we I think are in a time right now where we are really seeing and discovering the importance of the gut microbiome and how that that can the disruption in that gut microbiome can cause inflammation and the question is how is that inflammation presenting in patients? What symptoms are they having and could that be contributing to some skin conditions or flaring underlying skin conditions? >> Right. Absolutely. Yeah. So, we we definitely know in dermatology, right? Like some skin conditions are what we call really inflammatory. It's like the body's immune system is revved up. It's hyper. It's on overdrive, right? Like things like acne, psoriasis, attopic dermatitis, hydrainitis, right? Like I could go on. And and so we're learning actually that underlying revved up inflammation isn't just affecting the skin and their skin conditions, but we're also seeing it in in their gut and other parts of the body. And before we dive even further, when you said gut microbiome, like break it down to me. I'm a 5-year-old. What is a microbiome? Yeah, absolutely. So, we all have a collection a makeup of good and bad bacteria in our intestines. And that is the gut microbiome. Trillions of bacteria and that microbiome is always changing and shifting with number one where we live in the world which is really interesting. >> I know that is really cool. but medications and stress level and underlying diseases um and illnesses and >> age right age as we'll talk about hormones and all the things um >> and I think the focus on how can we protect it how what can we do to keep it consistent and in a good place and how that can help with some of these underlying disease these states, >> right? Yeah. I I think a lot of people are are kind of blown away when I tell them the skin actually has trillions of bacteria and and microbes on our skin, right? Like we think, "Oh, but I just washed my hands or I washed my face. Like, it's clean, right?" But but actually, we we want a lot of those microbes and bacteria, right? It's not that we're trying to eliminate them all, right? But they need to be in the right balance and not >> and not have overgrowth or what we call medicine, right? like homeostasis. >> Exactly. Yep. >> So, question about the microbiome. Is that why people say eat local honey? Because the microbiome is different in depending on where you live and if you eat local that it has better benefits for our health. >> That's so I haven't heard people say that, but I'm sure that has something to do with it. Yeah. >> Yeah. I thought that was so cool. Like, wow, that's such a great point. But yeah, I think that's really cool. Okay. So that >> or even the concept behind um soilbased probiotics soil S O I L, right? So maybe the bacteria from the ground is what you know what we need in our intestines. I mean so so much to talk about, >> right? Well, and I've also read that again getting food locally, right? not just good for the local community, right, and environment and all that, but yes, like the the soil, the ground, where you live, um that will potentially affect your microbiome as well. >> Absolutely. >> Well, so I think also people are surprised to know our gut plays such an important role in our immune system, right? >> Can you talk a little bit more about that? >> Sure. So, we have an intestinal barrier and we want it to be can you am I can you see my hands? We want it to be like this like a tight fence with some small openings and very regulated planned openings to allow the good things through like the nutrients that we get when we eat. When we have a disruption in that fence and it turns into this where you have holes, that's an issue because now we are having bacteria and toxins coming in through the intestines into the bloodstream and potentially creating an inflammatory response and triggering our immune system. And then we're in this inflammatory state. And so stuff that's not supposed to be getting in is getting in >> is getting in. Exactly. Right. And so we know that changes to the gut microbiome or dispiosis can lead to that kind of open fence and cause that what people commonly refer to as leaky gut and that could trigger the immune system. >> Yeah. I Well, I'm glad you brought that up because just like in dermatology, right? I'm sure in in GI like they're these like trigger words, these buzzwords that people hear and they leaky gut, leaky gut. Like what is that? Like to me when I first heard it, I'm like is like my intestine leaking? Is it diarrhea? But >> thank you for for breaking that down. And it's it's really cool because just you know our skin has a a skin barrier just like the gut has a barrier, right? And when absolutely that skin barrier is broken down, you have rashes, you're itchy, you um have allergic reactions, infections, right? It's just we can't see our gut. So, we don't we don't see it going on versus we can with our skin barrier. >> Yeah. >> So, what are some of the symptoms of leaky gut? Right. Like if someone's like, "Oh, I might have leaky gut." Like, do you know you have it? What are some symptoms? >> So, GI symptoms can be like, you know, bloating, changes in stools, diarrhea, abdominal pain, but then it goes beyond the GI tract, right? Because now you're in potentially in this inflammatory state. And is that presenting as joint pain and arthritis again? Is that presenting as a rash? Is that leading to another autoimmune condition? So really that breakdown in the intestinal barrier, that leaky gut, I think can contribute to so many underlying disease states. And that's why our gut is so important. >> Yeah, it's it's key. And we and what we're realizing, right, is how it's so connected. Really all organs have this connectivity. >> Absolutely. Absolutely. And so right now we know that certain conditions cause that leaky gut, right? GI wise, inflammatory bowel disease, we know obesity, um you know, there many conditions that are known to to cause that open fence. >> Yeah. Well, and I feel like we're also hearing a lot about sort of this persistent inflammation in our bodies, right? Like people talk about that like I'm inflamed. I need to reduce my inflammation. All that, right? And we know stress is a big cause. I I diet, right? Not sleeping, right? These can all contribute to this elevated inflammation in our bodies. So, are there things that we can be doing to help keep our gut healthy? You know, I I would concentrate on diet first, specifically a high-fiber diet, keeping in prebiotics. So prebiotics are food that we think feed that good bacteria and promote growth of that good bacteria and that healthy microbiome and we think that if you have more of that in your diet then you are contributing and hopefully keeping that integrity for that fence and so that would be my number one. >> Can you give us some examples of prebiotic foods? >> Sure. um whole grains, um certain fruits like apple, citrus, berries, certain starches. Yeah, it's very easy to find a good list, but it's it honestly it's like all the foods that we would think think would be would be healthy, right? That you should eat. >> Exactly. The lentils and all things. >> So, um and then you had said fiber, right? And I think we hear that word a lot, but maybe people don't know what is fiber like is fiber a potato, a starchy potato, or is fiber lettuce? Is it What would you recommend as a GI do? Great. I would recommend whole grains. So, um, we're thinking about fiber. We're thinking about we'll start with carbohydrates, right? So, when you're thinking about bread can be a great source of fiber, but not a white bread. I would do a sprouted grain bread or a whole wheat bread because that's going to have a lot more fiber. When we're thinking about pastas, a white pasta is probably not going to offer too much fiber, but if you go to a whole grain pasta, that's going to offer more fiber. Same thing with tortillas, moving to whole grain tortillas, you know, it's really changing those carbohydrates from white to wheat or whole grain is a great way to increase that fiber. beans and lentils. Um, chia seeds, flax seeds. Yeah. No, I I feel like there was this movement. I mean, I I love bread. I love carbohydrates, I have to admit, but I do try to make the choices to the to the whole grain and the sprouted and stuff like that. But I I feel like there's this like movement and maybe we're moving away from it a little bit where it's like everything was gluten-free, no breads, no carbohydrates, like there was this kind of fear of eating those, but you're saying our body meets fiber. I feel so many different ways on this topic. I I think unfortunately the way gluten, so carbohydrates are processed in this country, it's not the best and it actually can trigger symptoms. So I do recommend a gluten low diet to patients who are coming in with GI symptoms. That being said, you know, I think that for instance, sourdough, I push a lot to sourdough or like a whole grain sourdough would be like the ultimate and the best because you're getting the fiber, but just the way sourdough bread is made. Um, it it's like a probiotic, it has lactic acid, less gluten. So that's a good shift. But no, you're right. I I don't think that we should be I disagree with that. >> Yeah. And but like you said, like making good choices, right? Like choosing the whole grain version and and I think it's just good to know like not to be afraid of those, right? Like eating whole grains and everything actually can be helpful for your gut. >> Absolutely. And also just kind of in general, these are the things that we want to be doing on the day-to-day, but it's okay, you know, that once in a while to have that pizza or that white bread or that white tortilla and go to Chipotle and enjoy those things as well, right? We want to take away from that. But yeah, the dayto-day making those good choices. >> I'm personally having a cheat day today because we had our office holiday party. So [laughter] >> Oh, yum. I love that. >> You know, right, you you have to live your life and enjoy your life. >> Oh, yeah. Absolutely. Okay. So, so those are great about the fiber, the prebiotics. Um, what else can we do for a healthy gut? So, fermented foods are fantastic. Kimchi, um, kefir, fantastic for again that gut microbiome, that intestinal integrity. Um, probiotics are a big topic. Um, and you know, the concept behind probiotics is legit. And you know, it's it's giving where we're trying to give ourselves back what we think are the the good bacteria, the beneficial bacteria, which we want to populate the intestines. Um, the problem with probiotics is we in in some conditions, we don't have great research um that backs it up. We don't know always which type of bacteria we need, how much, for who or when. So the research, we need more, but because probiotics are so safe and we know that they can offer benefit to the gut microbiome and therefore to that barrier and reduce leaky gut, I I think it's worth a shot if you're having symptoms to start a probiotic. Are you talking about foods that are probiotics or taking like supplements? >> Great question. I would a supplement probiotic foods. Sure, foods. That's fine, but the quantity is important and you're not going to really, for instance, like a a probiotic yogurt is probably not going to give you enough probiotic to to really hit a benefit. So, I would do a probiotic supplement. But again, I don't think that's for everybody. >> Maybe talk to your GI doctor or your primary care doctor. >> Exactly. Now, what about Greek yogurt? Um, I put that in my smoothie most days. Am I doing a good thing with that? >> I think if you do not have symptoms with dairy, so you do not have diarrhea or bloating or constipation, then yes, I think that's absolutely fine. Again, in my clinic, most of my patients that I see have some GI complaints. And so, along with a low gluten diet, a low a trial, I should say, a trial of a low dairy diet is something I often recommend. >> Yeah, that's a good point because that is a lot of people have that issue. >> Yeah. So, um am I thinking about pre and probiotics in the right way? Prebiotics are almost like the food for the bacteria and then probiotics are the actual bacteria. >> Absolutely. Exactly right. >> Okay. It's just taken me a couple years to get the talking to you guys to get this right. Me too. Me too. Amazing. Okay. Well, great. All right. And then any other tips to help improve our gut health beyond diet? you know just talking about the derm GI connection and now that it's becoming more researched and studied and we really believe that there is this connection I think it's important for uh us to work together so for us to be aware that you know for instance in doing all this research seeing that hey H pylori is actually been tied to rosacea and linked to chronic udicaria urtdicaria I'm sorry and so And that's something that I learned, right? So, should those patients be tested for H pylori? Maybe, potentially. But it's just great to know these connections. And anybody with an underlying skin condition or a skin condition that isn't improving that also has GI symptoms, I would absolutely refer them to a gastroenterenterologist to look for underlying GI inflammation, right? Inflammatory bowel disease, Crohn's disease, ulcerative colitis. that could be playing some role. >> Oh yeah, for sure. And I and I think a lot of times people with these conditions like hydrainitis, sepa, it can be really embarrassing for patients. They feel very stigmatized and psoriasis too. Like people might think they're infectious. They don't want to touch them. They're they might have um inflammation in sensitive areas. And then the last thing they want to talk about is, oh yeah, I'm also having diarrhea and I'm also having bloating and all that. like it's I I feel for these patients cuz it can be really stigmatizing but it is important to know that there is that connection and often times treating one can help with the other and vice versa and um and we do know sort of a lot of times like weight management and focusing on diet will help acne will help um hydraonitis like these conditions. So, it's really amazing uh that connection that's there that people don't automatically think about. >> I know. I know. And I'm so excited to see, you know, what the research brings, what our future brings. You know, I wish we were in a place right now where we could say if you have acne, I want you to start this probiotic and here's the diet, you know, and and we're not there, unfortunately, but I think we we could be. >> I I saw this is a funny story. I saw firsthand my husband, this is years ago, but this is how sometimes you can't see what's right in front of you in your own house, right? But he um has always had great skin, but he started taking a protein powder and I didn't make the connection that all of a sudden he was really breaking out. I mean, this is someone who's never had acne in his life and it was getting to the point I was going to put him on Accutane and it was it was really bad. And and then I I like put it together that it was the whey protein powder that was causing him to get this horrible like pretty nodular cystic acne. So it it that to me was like wow. Just what he was eating was flaring his acne like that. Someone who had never had acne in his whole life. So it's it's powerful. >> It is really and such a ma it's such a major reaction. Like that's a that's a big deal, right? Yeah. It's very practical. I had a whole list of skin conditions and skin lesions since childhood starting with eczema. And that's why this topic has been so interesting for me. And a lot of things like like a patch here that I had for eight years that would flare. I never knew why that went away to a patch here. Some person some germ says is subre dermatitis. You know, like you'll see it flaring. And even now when these things flare, I don't know why. I don't I don't really have great answers, right? And so I do turn to, you know, how's my diet been this week? Am I drinking more alcohol? Like what what disruption is happening in my body that could be flaring these underlying things? Um, and I know there's a connection >> for sure. And and we know our diet like nowadays like even when you try it is so hard to get away from processed food and sugar and I know sugar is a huge culprit in glycation and causing our collagen to become very stiff and brittle. And so I've become aware of that now that I'm in my mid-40s. I'm like okay let's like be a little more mindful about the sugar that we're eating. Um and and then alcohol I'd love to know if if alcohol affects your gut. It does. It does. And it does. And you know, again, this is a hard conversation to have with patients. And it it's just difficult cuz, you know, I want everyone to enjoy. And it's like, well, what do we do? Can we have two glasses of wine? Can we, you know, have that night out where I have five tequilas? You know, what's the impact, right? Um, bottom line is it will impact your gut. Obviously, binge drinking, I would say no. And then also I think now big concentration on it being linked to so many different cancers that it's a hard topic um and uh and definitely you know a toxin >> and we don't know really like well what is a safe amount right like is is a glass a day okay is three glasses a week okay like we don't know that >> right and of what right of what of beer of and remember we learned in medical school that you know like the the definition was like three for men or four for ladies and you know and that is so outdated. We really don't have a good a good measure. But it kind of brings us back to the other things that we can do to improve the microbiome which could potentially improve our inflammation. And it's it is it's cutting out those foods, those processed foods, the sugars, the artificial sweeteners and artificial flavors because flip we know that those cause the irritation in the intestines, the disruption of the gut microbiome and again opening up of that fence, >> right? What what about are you familiar with the term SIBO? >> Yes, of course. Yeah. Is that a real thing? >> SIBO is absolutely a real thing. So SIBO SIBO is small intestinal bacterial overgrowth. That is a very known condition in GI. It is an imbalance of like exactly we're talking about an imbalance of the bacteria in the intestines, overgrowth of you know the bad bacteria leading to bloating, stool changes. Um it's we can test for it with a breath test. Um and and I think some academic centers can actually test for it during um an endoscopy. Uh but what's important with with kind of all these things is there's usually an underlying cause, right? So if you had the SIBO, is there an underlying inflammation, a Crohn's disease, something that is changing the motility of the small intestine? So you're not you don't have the movement to flush out the bacteria. Same thing if you have this leaky gut, you know, is there something underlying that we're missing that's actually causing that leaky gut? Yeah. Yeah. Is it like the canary in the coal mine? Like it's the harbinger of of something else. And yeah, we've I I know in dermatology we know about SIBO um with rosacea patients >> that people who have rosacea which is different from acne but inflammatory uh have a higher incidence of SIBO. >> Yeah. >> Yeah. Absolutely. >> And again easy testing pretty easy treatment. >> Yeah. >> You know and if it were it was going to improve the rosacea I mean that that's a game changer. >> Sure. Absolutely. Now I know um in dermatology we at least I' like to say number one prescriber of antibiotics in the medical field which is crazy to me considering we were prescribing more than infectious disease doctors but we were using a lot of antibiotics for these inflammatory conditions and and we still do in some regards but like I am so mindful now um about prescribing antibiotics like I I need to have like a culture rack or I need to know what I'm treating or it needs to be, you know, pretty specific things. Like I try to use other other things if I can because I couldn't believe these studies coming out showing like even a week of antibiotics can really just like decimate your intestines and and the microbiome in there. Is is that is that real? >> Yeah, it's real. I agree with you. I think we should be very mindful about antibiotics. Um, and what we see sometimes is patients who are taking these antibiotics or maybe repeat courses, they have a very hard time getting back to that baseline microbiome and then they can have years of symptoms because of that imbalance. >> Yeah. I mean, it's amazing. I think also I just want people to know. I think sometimes people get frustrated. They go to the doctor, you're told it's viral, and you you almost feel like, well, I need an antibiotic. I need a prescription. I need something, right? Um, and I think that's anatomy. My husband will say that, too. Like, oh, the pediatrician didn't do anything. He didn't give us anything. I'm like, it's viral, right? Um, but I think it's important for people to know these antibiotics have consequences that you don't necessarily see and that they can last for years, which is really crazy. >> Exactly right. I agree. It should be targeted. Just targeted therapies. Absolutely. >> Yeah. Exactly. No. Um, I'm 45 and I am really interested in like perry menopause and midlife health and I I think at 40 is when it sort of hit me like I can't just like keep burning the candle at both ends and like you know hoping it all works out like I really need to focus on my health and um and I'm noticing my friends are noticing my patients are noticing changes in the skin, changes in their sleep and and uh things. I used to be able to handle a glass of wine a night and now I I just can't. Um, so things are changing, right? And we know that our well, we know in our skin that the microbiome changes as we get older. It becomes less diverse. Are there changes in our gut as well? Absolutely. Yeah. So with pmenopause and menopause, the decrease in estrogen absolutely changes the gut microbiome and absolutely changes that intestinal barrier and that can lead to symptoms. It also changes motility, right? So new stool changes, new constipation in perry menopause and then the stress, the cortisol levels, right? and and and the sleep changes that then may lead to those you know all the things connected also have independent effect on the microbiome. Yes. Yes. Yes. Yes. Yes. And yes. Yeah. So just you know get rid of stress, eat right. Right. So easy. So easy. Uh does hormone replacement therapy help? Do have they looked at studies on that? >> It will. Yes. I I I see many patients in pmenopause and um hormone replacement therapy will help if if if and again not everyone is having GI symptoms and pmenopause, right? But if you are, yeah, it could be helpful. Well, and I I think that's what's tricky about per menopause, right? There are so many pretty much every organ's affected by estrogen and and everyone's going to experience different symptoms. So, it's hard to to know and you may not associate feeling more bloated. You may just think, okay, well, I'm I'm getting older. That's just what happens, right? Like, you don't necessarily put the pieces together that it can be connected. So, I think that's why it makes it so tricky and we know there has been such a lack of research in this area, too. I'm I'm just excited that people are finally talking about it. Right. >> Me, too. I I think that, you know, five years ago, I didn't hear about this. I wasn't, you know, and now patients are asking and we're talking and it's all over social media. And I love that because it just gives all of us the opportunity to get more information and learn more and and feel better and just overall feel better, you know? >> Right. Well, and you know, we're living so much longer, so just 45 hopefully I'm just hitting the halfway point, right? >> 45 is like the new 25. >> I mean, that's what I say. >> Yeah. But um yeah, so we have to think about like how do we want to live the rest the the second half of our lives, right? And and I think people nowadays are like, "No, I want to I want to be healthy, vibrant. I want to keep doing the things I love." So, um I love that people are talking about it. Speaking of colonoscopies, right? Yes. Yes. Thank you for bringing that up. 45 is the age for colonoscopies. Absolutely. Um you should have Yeah. And that's that's if you have no family history or of colon cancer or you haven't had polyps in the past, 45. If you do have a family history of colon cancer, talk to your physician. You may need to come in a little bit earlier than that. But yes, that is on my to-do list. I will do it, Dr. Pash. >> I I hear you. I hear. Please. But I hear you. But even Yeah, it's hard. It's hard to keep up with all the things, right? Like >> Yes. I I'll just say I had a a mammogram and then they were like, "It's time for your next." And I'm like, "No, no, I promise I just had it." They're like, "No, it's been a year." And I'm like, "Oh, wow. Wow." Yeah, >> it goes. >> And now I'm late on that. It goes. It just It goes. Yeah. >> But if you get it done, you'll most likely be good for 5 to 10 years. So, >> yeah, that's what I'm telling myself. I just need to lock it in, schedule it, do it, >> get the small volume prep, not that big gallon. Oo, >> the small volume, which is like just two tiny bottles. >> Still doesn't taste great, >> but it's tiny. So, you know, most of us can get that down. >> And and I hear it's the best nap of my life. >> Yes, it is. That a lot of my my mom just recently had one and she was like, "Can I can I stay longer?" No, you cannot stay long. >> You got to go. >> Yeah, it's not a hotel. you do need to leave the >> it's a very common thing we hear from patients like just a little more time. Yeah, it's a good nap. >> Amazing. Um were there any other points you wanted to hit on? >> No, this has been fantastic. Thanks so much for having me. >> Yeah, Dr. Pash, I I have learned a ton. I'm definitely going to get that colonoscopy scheduled. I promise. And I would love if you could maybe give your top three tips for someone who is maybe wanting to improve their gut health. and they're not really sure what's going on. They're having some symptoms. Like top three takeaways. >> Great. I love that. Top three takeaways. Number one, let's focus on diet. So, all the things we talked about, let's increase the fiber. Let's take away the white carbohydrates like the white breads, the tortillas. Um increase the fruit, increase the vegetables. Number two, we really want to decrease red meat. Um red meat has been shown to increase colon cancer. and not only red meat but processed meats, right? Like the sausage and the bacon and the deli meats. So, you know, again, we don't need to cut those out completely, but definitely decrease the processed meats. Um, so that's diet. Number two, fiber. Not not even dietary fiber. I would I would add a fiber supplement because a lot of times I think that people are not even evacuating their bowels completely and >> a lot of us don't really know what what is normal and how we should be you know evacuating >> and it can't hurt to just get an extra fiber supplement in to kind of add water and bulk so you're eliminating which can really help with bloating and and pain and all the symptoms. Mhm. Yeah. That And I'm always amazed to like how much how much fiber should I be having? Is that 25 grams or 35? >> I'm going to say 35. I say if you say >> Okay. >> That's hard. Hard to hit 35 grams of fiber. And then also >> you want to hit the fiber, but some of the fiber causes bloating. So you're like confused like wait, what what you know, how do I do this? >> Do you have do you have a fiber supplement you like? >> Yes. Oh yeah. Okay. So, psyllium husk powder. >> Okay. >> Powder. So, so you don't want like a you don't want the gummy because it has some artificial color and flavor and all that. You want the powder mixed with water. So, I also don't want you to mix it into a smoothie because you really need water when you're doing fiber. >> Okay, that's good. >> Psyllium husk is a soluble fiber. So it forms this like beautiful what I think is beautiful gel-like substance in your intestines that really helps to move things along. Very beneficial. >> Okay. Amazing. >> Okay. Well, I I would also love to get your thoughts just quickly on like these people who talk about these colonic cleanses. >> Is that like a whole another >> I love this is a great conversation. No, it cuz you're hitting on like every one of my videos >> asking truly like I I am just curious because when I see these places I'm like oh my goodness like >> Yeah. No, no, you do not need a colonic. You know, I see hundreds of colons >> a month, right, and colonoscopies. And of course, that's after the prep, but I also see a lot of colonoscopies that they haven't really done a great job with the prep. And there is no layer of debris or parasite that you need to clean out with a colonic. That just doesn't exist. Our bodies do a great job of of getting out what needs to be gotten out. And um and and again, I think that could be also very disruptive to the microbiome, to the barrier. And so I I I'm not a big supporter of colonics. >> Yeah. No, I I feel like we we need to just like stop getting in the way of our body knows what to do. We are like our own worst enemy. we're getting in the way of letting it kind of like with our skin like scrubbing scrubbing trying to get every ounce of oil off, right? Like we're damaging it. And I I think of a a cleanse like that where you're just, you know, >> overdoing it versus go get that psyllium husk powder, right? And and do it daily. Exactly. >> And do it daily. >> Do these things regularly and just get into the habit and you will have, you know, a very healthy and happy GI tract. Yeah, Dr. Pash, I took us on a little detour at the very end, but thank you for uh >> of course >> answering that question for me. I know people are going to want to find you, follow you. You have lots of great information on social media. Where's the best place for people to do that? >> So, um I'm gastroal MD on Instagram, on Tik Tok. I also that's also my YouTube handle. Um and yeah, that's where I am. >> Amazing. I'll put all of that in the show notes so people can find you. really appreciate it. Thank you so much and I'll see you so much. This is so awesome. Take care. >> Bye >> bye.
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
Understanding Rosacea- From Skin Redness to Emotional Wellness_en (auto-generated)(1)
are you struggling with facial redness postural spots or just irritated skin keep watching to learn a holistic approach to rosacea on its treatment in today's video if you're new here I'm Dr Finbar a family doctor now specializing in dermatology and on this channel I help you learn to love the skin you're in and enhance your skin health for longevity I often tell my patients that I flare up on their rosacea is similar to how a warning light flashes on the dashboard of a car just as the car has sensors built in to let you know it needs some attention or a trip to the garage so too can our bodies communicate with us and warn us that something is wrong the problem is that we don't understand the message as facial redness doesn't tell us exactly what or where the problem is and it can lead to further frustration and psychological upset this is why today I'm taking a holistic approach to the management of rosacea what it is how it affects your emotional health lifestyle and dietary factors I'll also cover prescription medical treatment options so be sure to watch to the end of the video for all of that information rosacea is a chronic inflammatory skin condition characterized by facial redness small bumps and visible blood vessels it commonly affects the cheeks nose and forehead but it can also appear on the neck chest and ears there are several types of rosacea and I'm not going to go deep into all the individual subtypes in this video but it's important to know a little bit about them as different interventions may be required for each subtype from a diagram a medical staff the subtypes include populism postures these dome-shaped papules often appear in clusters with or without pustules some patients develop deeper nodules also then we have a fair flushing frequent and prolonged flushing is common with rosacea but is more noticeable in patients with lighter skin talangectase are dilated blood vessels commonly visible in patients with rosacea in-depth examination of rosacea patients with darker skin may also reveal these changes even if they aren't immediately visible to the naked eye rosacea can affect the patient's eyes some of the most common signs or symptoms around the eyes include bloodshot eyes redness around the eyelid margin styes crusty accumulation at the base of the eyelashes changes to the patient's skin include a bulbous appearance of the nose glandular hyperplasia or overgrowth and skin thickening I should also mention perioral dermatitis some researchers consider perioral dermatitis to be a variant of rosacea perioral dermatitis is a rash that appears around the mouth and nose and it's often mistaken for acne so although there are seemingly multiple subtypes and variants of rosacea the common condition of rosacea isn't just about the rash the psychological and emotional effects can go well beyond the visual rash what causes rosacea is not an easy question to answer now while there's strong hereditary component to rosacea having the genetics for it doesn't mean that you're destined to get it the strong links also between rosacea and gosh health and I'll be talking about that in more detail soon rosacea has multiple triggers that contribute to its development and severity so if you want to get rid of your rosacea it's best to take a holistic approach that addresses all these areas which I'm going to talk about namely emotional health lifestyle and dietary measures and then Medical Treatments now while there are certain things that seem to trigger most rosacea sufferers like sunlight other triggers such as dietary triggers like eating tomatoes or Nightshade plants may only affect a small number of rosacea sufferers occasionally rosacea can be brought on by or made worse by the use of steroid creams given to treat eczema I think emotional health is often ignored misunderstood or brushed over by doctors as we reach for our prescription pods under emotional health I include your mental health mindset spiritual health and health in our relationships while emotional issues may or may not directly cause rosacea they can certainly exacerbate it living with rosacea often brings emotional challenges that further impact the condition for instance consider the case of one of my patients let's call her GM now Jane had been struggling with rosacea for years and despite numerous treatment plants she wasn't seeing the Improvement that she hoped for so after discussing her emotional health she ensured that she had been carrying unaddressed Trauma from her early childhood this emotional burden manifests as stress in her daily life which often triggered her rosacea flare-ups and once Jean recognized this connection she sought a therapy to work through her childhood traumas as she began to heal emotionally and let go of the fear and anger issues that she was suppressing she noticed a significant reduction in her rosacea symptoms now this isn't to say that therapy cured her rosacea but rather that addressing her emotional health proved to be a vital part of managing her condition Jane's story underlines why it's essential to address underlying emotions that may be affecting your health professional help such as therapy or counseling can provide safe place and a safe space to explore these emotions and healthy coping strategies moreover incorporating practices like meditation mindfulness yoga breathing exercises journaling or engaging with support groups can help navigate the emotional challenges associated with rosacea many people find such practices can provide a sense of community and understanding further improving your emotional health and your resilience remember nurturing your emotional well-being is a crucial step in taking control of your skin and your overall health your emotional health is just as important as your physical health in managing rosacea I'd love to hear about your own experiences or thoughts in the comments section Below in relation to emotional health I do read them all and reply to as many as I can I hope you're enjoying this content if so please hit the like button and consider subscribing to the channel let's move on to look at lifestyle and other dad refactors starting with sunlight sunlight can make rosacea symptoms worse the UV rays or the ultraviolet rays from the Sun creates substances known as reactive oxygen species in the skin that lead to inflammation or swelling and redness now this inflammation can trigger your immune system in a way that increases certain molecules in your skin that are connected to rosacea also these same sun rays can boost signals in the skin that help blood vessels grow and this might be why people with rosacea often have small widened blood vessels known as talange activities on their skin sunlight can also weaken the structures that support your skin like collagen and elastin this could make rosacea worse by interfering with the natural drainage process in your skin because of these effects it's especially important for people with rosacea to protect their skin from the Sun you may need to trial a variety of sunscreens before you find one that suits you most people find that they need a mineral sunscreen with ingredients like zinc or titanium which reflect the cylinderase and manage rosacea symptoms better there are also some chemical sunscreens which do a good job at reducing the Skin's redness but it's not just UV sunlight though it's also things like cold weather wind and hot weather or indoor heating can also flour rosacea let's discuss alcohol now it's becoming clear that even small amounts of alcohol aren't the best thing that we can do for our Health and Longevity in relation to rosacea research has shown that alcohol worsens the flushing or the redness this study has shown that alcohol consumption can increase the risk of a certain type of rosacea called fimatus rosacea this conclusion was based on a review of multiple studies that compare people who drink alcohol with those who don't interestingly the risks seem to be higher in Maine than in women now anyone interested in their health knows that smoking unvaping for that matter is bad for them this systematic review on meta-analysis AIM to examine the relationship between rosacea and smoking they analyzed 12 studies which included over 50 000 patients with rosacea and 80 000 controls and when they looked at specific subtypes of rosacea they found a few interesting patterns smoking appeared to increase the risk of two specific types of rosacea namely the popular postular rosacea characterized by redness and swelling and acne like decades and like alcohol the famous rosacea and it's characterized by the thickening of the skin and enlargement often resulting in that bulbous shaped nose but interestingly and I'm nearly afraid to tell you this they discovered that current smokers those who were smoking at the time of the study seemed to have a slightly decreased risk of rosacea while ax smokers those who had previously smoked but had quit and they had an increased risk of rosacea now obviously this does not mean that you should smoke two reduce your rosacea exploring the link between diet and rosacea is a topic so fast it could easily fill its own separate video now if you'd like me to delve deeper into that drop a comment below now what rule does Diet play in managing musician according to a survey conducted by the national rosacea Society almost 80 percent of the 400 patients surveyed reported that they had made changes to their diet due to rosacea and all these an impressive 95 percent observed a reduction in flare-ups underscoring the potential influence of dietary habits on their skin condition now to better understand the relationship between diet and rosacea let's turn to this scientific paper that specifically investigated this connection it was found that Foods triggering rosacea can generally be grouped into four categories firstly we have hot foods secondly alcoholic beverages and then thirdly foods containing capsicum like spices and peppers and then foods containing cinnamaldehyde such as Tomatoes citrus fruits cinnamon and chocolate now you might wonder why these Foods well it turns out that they can activate certain channels in skin cells known as transient receptor potential channels when these channels are activated they can increase blood flow to the skin leading to symptoms like redness flushing and a burning sensation however there's an important caveat the impact of diet on rosacea symptoms can vary widely from person to person while some individuals may find certain foods trigger their symptoms others have no effect with it at all and this makes it challenging to come up with a set of dietary guidelines that would apply universally to all rosacea patients but in a minute I'm going to try with my own recommendations anyway some foods have been noodle to potentially have protective effects against certain forms of rosacea for instance omega-3 fats found in foods like oily fish walnuts flax seeds may help Safeguard against ocular or eye rosacea I'll share my diary recommendations shortly but before I do that I want to talk a little bit about gut health while more research is certainly needed it's becoming increasingly clear that gut health plays a significant role in rosacea this suggests that strategies targeting gut health could be promising areas for research for rosiation treatment to understand the rule our gut health plays and conditions like rosacea we need to talk about the gut microbiome this is a community of trillions of bacteria and other microbes that live in our digestive tract these tiny organisms play a crucial role in our overall health including digestion creation of vitamins and our mood and our immune system regulation now you may be asking what does my gut have to do with my skin well this is where the concept of the gut skin axis comes in the gut skin axis refers to the relationship between the health of our gut and the health of our skin imbalances in the gut microbiome is a condition known as dysbiosis and dysbiosis can affect our skin in fact Studies have shown differences in the gut microbiome between rosacea patients and patients without rosacea prebiotics and probiotics can help prebiotics are compounds that we consume that feed these beneficial bacteria in our gut probiotics on the other hand are beneficial bacteria that we consume often through foods like yogurts and kombucha kimchi sauerkraut are through other dietary supplements now consuming probiotics and prebiotics can potentially help maintain or restore a healthy gut microbiome recent research suggests that probiotics like lactobacillus KSI could have a positive impact for rosacea symptoms for example one Australian study reported a significant Improvement in rosacea symptoms after participants took lactobacillus KSI probiotic supplement over eight weeks it started the probiotics might have helped by targeting an overgrowth of a certain bacteria in the small intestine which is often seen in rosacea patients however it's important to note that while these results are promising more research is needed in fact there's an ongoing clinical trial exploring this exact question so we can look forward to more information on that in the near future as promised here are some dead reconsiderations I recommend to my patients with rosacea firstly keep a food diary and try to identify links with certain foods on your rosacea flourish two avoid processed foods basically anything in a packet glycemic foods our Western diet is full of processed foods and highly refined carbohydrates reduce foods with a high glycemic index as these are rapidly digested and absorbed resulting in markedly Wild fluctuations in blood sugar levels now this could potentially lead on doors lead to inflammation which in turn May contribute to the progression of rosacea fourthly consider an Elimination Diet removing foods with cinnamaldehyde like tomatoes citrus fruits cinnamon and chocolate and other foods like spices and peppers for four to eight weeks now some people may also benefit from moving dirty from their dad so this was also worth traveling slowly reintroduce Foods if you want to back into your dad every few days and observe for changes in your skin also try to eat a wide variety of colorful Whole Foods and fibrous carbohydrates basically think vegetables which grow above the ground consider adding a good omega-3 supplement or a Prebiotic or a probiotic supplement I have quite deliberately left the medical management to the last working on your emotional health and take an appropriate lifestyle measures as described earlier is crucial on your journey to Healing eurization now there are quite a few Medical Treatments available for rosacea ranging from topical creams to oral medications and laser therapy most of these require a doctor visit and a prescription but this information may help you and your doctor decide a treatment plan that suits you let's start with the topical treatments patients with rosacea have a dysfunctional Skin Barrier therefore water is lost from the skin and the skin is often sensitive and irritable so any topical preparations that contain moisture and are not irritant can help rebuild the Skin Barrier and for the same reason you should be careful not to exfoliate or use harsh treatments on your skin even talling too hard May flare your rosacea so there's no harm in using anything that doesn't irritate your skin and can moisturize it to moisturize daily before we get into the medical products it's worth mentioning camouflage makeups specific makeups and even sunscreens are made with a green tint that can reduce the redness when applied directly to the skin now you don't have to worry your skin won't be green over the top of the redness it will neutralize and be normal skin tone then let's look at azelic Acid it can help reduce inflammation and redness on the skin it's good for the redness but not so helpful for treating papules or spotty rosacea niacinamide is another useful product in rosacea it is anti-inflammatory properties and improved Skin Barrier function so that's a double Huawei for it next we have Ivermectin now I have some personal experience using Ivermectin or patch of rosacea I had on my forehead for several years it kept flaring and etching especially when I was stressed and it reminded me back to that what I mentioned at the beginning about the warning indicator light on the car when it flirt I would be sure to deal with my stressors and look after myself a bit better because I knew when this went rare that there was something going on however I did eventually get around to doing something about it so I got some Abram Martin and it actually took it away with daily use after about four weeks now that's over a year ago and it hasn't come back since Ivermectin is a medication that is used to kill parasites in the case of rosacea it's believed to work by reducing the number of demo Dax mites in the skin these little parasites which live in most people's skin seem to play a role in causing rosacea when they get out of control Ivermectin is best for postular rosacea and it's usually very well tolerated although some people do get a redness with it metronidazole is another topical prescription treatment it's an antibiotic that can help reduce inflammation and redness but it's common to get a recurrence of symptoms on stopping it next bromonidine which is a visual constructure which means it helps narrow the blood vessels down and when it's applied topically it can help reduce the rareness associated with rosacea it's important to start with a really small amount of it and build it up gradually as some people report a burning and a lot of redness with it good old retinoids may be useful in rosacea to improve collagen and reduce abnormal blood vessel formation but you need to be careful with them retinoids can cause redness even in someone with healthy skin so if you and your doctor decided to use a retinoid please start with a very low dose and go slow with it over time besides topical treatments there's also some oral medications that can help manage rosacea symptoms tetracycles are a class of antibiotics often used to treat rosacea they include doxycycline and lime recycling although that could vary depending on what part of the world you're in they do have anti-inflammatory properties that can help manage rosacea symptoms and doxycycline is often used at a low dose like 40 milligrams slow release for rosacea because that exploits as anti-inflammatory properties but doesn't activate its antibacterial effects and that helps avoid antibiotic resistance and it's usually taken once daily alternative antibiotics such as erythromycin may be used if tetracyclines are not tolerated or if there's a reason why you can't use them while antibiotics can help manage rosaceous symptoms they're not a cure and symptoms May recur after the treatment is stopped the risk of bacterial resistance is also of a serious concern especially with a long-term use of antibiotics therefore the low dose or the modified release preparations are commonly used if someone does require the treatment for long-term use in more severe cases of rosacea or cases that don't respond to our earlier treatments isotret known may be considered it's a powerful retinoid medication that's often used to treat severe acne but it can also be effective in treating rosacea it's only prescribed in specialist centers if you have difficulty accessing and appropriately qualified medical professional there are online Dermatology Services who can assess your skin where you upload photographs and describe your symptoms a dermatologist then assesses your individual case and prepares a personalized blend of topical treatments suitable for your condition and your skin type I use dermatica for my own personalized night cream and contains a retinoid and a pigment reducer signing up with them at dermatica.com or demonica.co.uk and entering the code Dr Finbar on checkout means you'll get a 10 discount of any products that you purchase so rosacea can be a challenging condition to manage but by looking out for your emotional health make an appropriate lifestyle and dietary adjustments you can take control over your skin and enjoy a better quality of life if these methods alone don't get you the desired results have a look on their Monica's websites for personal treatment plans or visit an appropriately trained Healthcare professional don't let rosacea hold you back you deserve to feel confident and comfortable in your skin now if you found this video helpful watch this short video on how we can start start our journey to self-healing
Understanding Rosacea- From Skin Redness to Emotional Wellness_en (auto-generated)
are you struggling with facial redness postural spots or just irritated skin keep watching to learn a holistic approach to rosacea on its treatment in today's video if you're new here I'm Dr Finbar a family doctor now specializing in dermatology and on this channel I help you learn to love the skin you're in and enhance your skin health for longevity I often tell my patients that I flare up on their rosacea is similar to how a warning light flashes on the dashboard of a car just as the car has sensors built in to let you know it needs some attention or a trip to the garage so too can our bodies communicate with us and warn us that something is wrong the problem is that we don't understand the message as facial redness doesn't tell us exactly what or where the problem is and it can lead to further frustration and psychological upset this is why today I'm taking a holistic approach to the management of rosacea what it is how it affects your emotional health lifestyle and dietary factors I'll also cover prescription medical treatment options so be sure to watch to the end of the video for all of that information rosacea is a chronic inflammatory skin condition characterized by facial redness small bumps and visible blood vessels it commonly affects the cheeks nose and forehead but it can also appear on the neck chest and ears there are several types of rosacea and I'm not going to go deep into all the individual subtypes in this video but it's important to know a little bit about them as different interventions may be required for each subtype from a diagram a medical staff the subtypes include populism postures these dome-shaped papules often appear in clusters with or without pustules some patients develop deeper nodules also then we have a fair flushing frequent and prolonged flushing is common with rosacea but is more noticeable in patients with lighter skin talangectase are dilated blood vessels commonly visible in patients with rosacea in-depth examination of rosacea patients with darker skin may also reveal these changes even if they aren't immediately visible to the naked eye rosacea can affect the patient's eyes some of the most common signs or symptoms around the eyes include bloodshot eyes redness around the eyelid margin styes crusty accumulation at the base of the eyelashes changes to the patient's skin include a bulbous appearance of the nose glandular hyperplasia or overgrowth and skin thickening I should also mention perioral dermatitis some researchers consider perioral dermatitis to be a variant of rosacea perioral dermatitis is a rash that appears around the mouth and nose and it's often mistaken for acne so although there are seemingly multiple subtypes and variants of rosacea the common condition of rosacea isn't just about the rash the psychological and emotional effects can go well beyond the visual rash what causes rosacea is not an easy question to answer now while there's strong hereditary component to rosacea having the genetics for it doesn't mean that you're destined to get it the strong links also between rosacea and gosh health and I'll be talking about that in more detail soon rosacea has multiple triggers that contribute to its development and severity so if you want to get rid of your rosacea it's best to take a holistic approach that addresses all these areas which I'm going to talk about namely emotional health lifestyle and dietary measures and then Medical Treatments now while there are certain things that seem to trigger most rosacea sufferers like sunlight other triggers such as dietary triggers like eating tomatoes or Nightshade plants may only affect a small number of rosacea sufferers occasionally rosacea can be brought on by or made worse by the use of steroid creams given to treat eczema I think emotional health is often ignored misunderstood or brushed over by doctors as we reach for our prescription pods under emotional health I include your mental health mindset spiritual health and health in our relationships while emotional issues may or may not directly cause rosacea they can certainly exacerbate it living with rosacea often brings emotional challenges that further impact the condition for instance consider the case of one of my patients let's call her GM now Jane had been struggling with rosacea for years and despite numerous treatment plants she wasn't seeing the Improvement that she hoped for so after discussing her emotional health she ensured that she had been carrying unaddressed Trauma from her early childhood this emotional burden manifests as stress in her daily life which often triggered her rosacea flare-ups and once Jean recognized this connection she sought a therapy to work through her childhood traumas as she began to heal emotionally and let go of the fear and anger issues that she was suppressing she noticed a significant reduction in her rosacea symptoms now this isn't to say that therapy cured her rosacea but rather that addressing her emotional health proved to be a vital part of managing her condition Jane's story underlines why it's essential to address underlying emotions that may be affecting your health professional help such as therapy or counseling can provide safe place and a safe space to explore these emotions and healthy coping strategies moreover incorporating practices like meditation mindfulness yoga breathing exercises journaling or engaging with support groups can help navigate the emotional challenges associated with rosacea many people find such practices can provide a sense of community and understanding further improving your emotional health and your resilience remember nurturing your emotional well-being is a crucial step in taking control of your skin and your overall health your emotional health is just as important as your physical health in managing rosacea I'd love to hear about your own experiences or thoughts in the comments section Below in relation to emotional health I do read them all and reply to as many as I can I hope you're enjoying this content if so please hit the like button and consider subscribing to the channel let's move on to look at lifestyle and other dad refactors starting with sunlight sunlight can make rosacea symptoms worse the UV rays or the ultraviolet rays from the Sun creates substances known as reactive oxygen species in the skin that lead to inflammation or swelling and redness now this inflammation can trigger your immune system in a way that increases certain molecules in your skin that are connected to rosacea also these same sun rays can boost signals in the skin that help blood vessels grow and this might be why people with rosacea often have small widened blood vessels known as talange activities on their skin sunlight can also weaken the structures that support your skin like collagen and elastin this could make rosacea worse by interfering with the natural drainage process in your skin because of these effects it's especially important for people with rosacea to protect their skin from the Sun you may need to trial a variety of sunscreens before you find one that suits you most people find that they need a mineral sunscreen with ingredients like zinc or titanium which reflect the cylinderase and manage rosacea symptoms better there are also some chemical sunscreens which do a good job at reducing the Skin's redness but it's not just UV sunlight though it's also things like cold weather wind and hot weather or indoor heating can also flour rosacea let's discuss alcohol now it's becoming clear that even small amounts of alcohol aren't the best thing that we can do for our Health and Longevity in relation to rosacea research has shown that alcohol worsens the flushing or the redness this study has shown that alcohol consumption can increase the risk of a certain type of rosacea called fimatus rosacea this conclusion was based on a review of multiple studies that compare people who drink alcohol with those who don't interestingly the risks seem to be higher in Maine than in women now anyone interested in their health knows that smoking unvaping for that matter is bad for them this systematic review on meta-analysis AIM to examine the relationship between rosacea and smoking they analyzed 12 studies which included over 50 000 patients with rosacea and 80 000 controls and when they looked at specific subtypes of rosacea they found a few interesting patterns smoking appeared to increase the risk of two specific types of rosacea namely the popular postular rosacea characterized by redness and swelling and acne like decades and like alcohol the famous rosacea and it's characterized by the thickening of the skin and enlargement often resulting in that bulbous shaped nose but interestingly and I'm nearly afraid to tell you this they discovered that current smokers those who were smoking at the time of the study seemed to have a slightly decreased risk of rosacea while ax smokers those who had previously smoked but had quit and they had an increased risk of rosacea now obviously this does not mean that you should smoke two reduce your rosacea exploring the link between diet and rosacea is a topic so fast it could easily fill its own separate video now if you'd like me to delve deeper into that drop a comment below now what rule does Diet play in managing musician according to a survey conducted by the national rosacea Society almost 80 percent of the 400 patients surveyed reported that they had made changes to their diet due to rosacea and all these an impressive 95 percent observed a reduction in flare-ups underscoring the potential influence of dietary habits on their skin condition now to better understand the relationship between diet and rosacea let's turn to this scientific paper that specifically investigated this connection it was found that Foods triggering rosacea can generally be grouped into four categories firstly we have hot foods secondly alcoholic beverages and then thirdly foods containing capsicum like spices and peppers and then foods containing cinnamaldehyde such as Tomatoes citrus fruits cinnamon and chocolate now you might wonder why these Foods well it turns out that they can activate certain channels in skin cells known as transient receptor potential channels when these channels are activated they can increase blood flow to the skin leading to symptoms like redness flushing and a burning sensation however there's an important caveat the impact of diet on rosacea symptoms can vary widely from person to person while some individuals may find certain foods trigger their symptoms others have no effect with it at all and this makes it challenging to come up with a set of dietary guidelines that would apply universally to all rosacea patients but in a minute I'm going to try with my own recommendations anyway some foods have been noodle to potentially have protective effects against certain forms of rosacea for instance omega-3 fats found in foods like oily fish walnuts flax seeds may help Safeguard against ocular or eye rosacea I'll share my diary recommendations shortly but before I do that I want to talk a little bit about gut health while more research is certainly needed it's becoming increasingly clear that gut health plays a significant role in rosacea this suggests that strategies targeting gut health could be promising areas for research for rosiation treatment to understand the rule our gut health plays and conditions like rosacea we need to talk about the gut microbiome this is a community of trillions of bacteria and other microbes that live in our digestive tract these tiny organisms play a crucial role in our overall health including digestion creation of vitamins and our mood and our immune system regulation now you may be asking what does my gut have to do with my skin well this is where the concept of the gut skin axis comes in the gut skin axis refers to the relationship between the health of our gut and the health of our skin imbalances in the gut microbiome is a condition known as dysbiosis and dysbiosis can affect our skin in fact Studies have shown differences in the gut microbiome between rosacea patients and patients without rosacea prebiotics and probiotics can help prebiotics are compounds that we consume that feed these beneficial bacteria in our gut probiotics on the other hand are beneficial bacteria that we consume often through foods like yogurts and kombucha kimchi sauerkraut are through other dietary supplements now consuming probiotics and prebiotics can potentially help maintain or restore a healthy gut microbiome recent research suggests that probiotics like lactobacillus KSI could have a positive impact for rosacea symptoms for example one Australian study reported a significant Improvement in rosacea symptoms after participants took lactobacillus KSI probiotic supplement over eight weeks it started the probiotics might have helped by targeting an overgrowth of a certain bacteria in the small intestine which is often seen in rosacea patients however it's important to note that while these results are promising more research is needed in fact there's an ongoing clinical trial exploring this exact question so we can look forward to more information on that in the near future as promised here are some dead reconsiderations I recommend to my patients with rosacea firstly keep a food diary and try to identify links with certain foods on your rosacea flourish two avoid processed foods basically anything in a packet glycemic foods our Western diet is full of processed foods and highly refined carbohydrates reduce foods with a high glycemic index as these are rapidly digested and absorbed resulting in markedly Wild fluctuations in blood sugar levels now this could potentially lead on doors lead to inflammation which in turn May contribute to the progression of rosacea fourthly consider an Elimination Diet removing foods with cinnamaldehyde like tomatoes citrus fruits cinnamon and chocolate and other foods like spices and peppers for four to eight weeks now some people may also benefit from moving dirty from their dad so this was also worth traveling slowly reintroduce Foods if you want to back into your dad every few days and observe for changes in your skin also try to eat a wide variety of colorful Whole Foods and fibrous carbohydrates basically think vegetables which grow above the ground consider adding a good omega-3 supplement or a Prebiotic or a probiotic supplement I have quite deliberately left the medical management to the last working on your emotional health and take an appropriate lifestyle measures as described earlier is crucial on your journey to Healing eurization now there are quite a few Medical Treatments available for rosacea ranging from topical creams to oral medications and laser therapy most of these require a doctor visit and a prescription but this information may help you and your doctor decide a treatment plan that suits you let's start with the topical treatments patients with rosacea have a dysfunctional Skin Barrier therefore water is lost from the skin and the skin is often sensitive and irritable so any topical preparations that contain moisture and are not irritant can help rebuild the Skin Barrier and for the same reason you should be careful not to exfoliate or use harsh treatments on your skin even talling too hard May flare your rosacea so there's no harm in using anything that doesn't irritate your skin and can moisturize it to moisturize daily before we get into the medical products it's worth mentioning camouflage makeups specific makeups and even sunscreens are made with a green tint that can reduce the redness when applied directly to the skin now you don't have to worry your skin won't be green over the top of the redness it will neutralize and be normal skin tone then let's look at azelic Acid it can help reduce inflammation and redness on the skin it's good for the redness but not so helpful for treating papules or spotty rosacea niacinamide is another useful product in rosacea it is anti-inflammatory properties and improved Skin Barrier function so that's a double Huawei for it next we have Ivermectin now I have some personal experience using Ivermectin or patch of rosacea I had on my forehead for several years it kept flaring and etching especially when I was stressed and it reminded me back to that what I mentioned at the beginning about the warning indicator light on the car when it flirt I would be sure to deal with my stressors and look after myself a bit better because I knew when this went rare that there was something going on however I did eventually get around to doing something about it so I got some Abram Martin and it actually took it away with daily use after about four weeks now that's over a year ago and it hasn't come back since Ivermectin is a medication that is used to kill parasites in the case of rosacea it's believed to work by reducing the number of demo Dax mites in the skin these little parasites which live in most people's skin seem to play a role in causing rosacea when they get out of control Ivermectin is best for postular rosacea and it's usually very well tolerated although some people do get a redness with it metronidazole is another topical prescription treatment it's an antibiotic that can help reduce inflammation and redness but it's common to get a recurrence of symptoms on stopping it next bromonidine which is a visual constructure which means it helps narrow the blood vessels down and when it's applied topically it can help reduce the rareness associated with rosacea it's important to start with a really small amount of it and build it up gradually as some people report a burning and a lot of redness with it good old retinoids may be useful in rosacea to improve collagen and reduce abnormal blood vessel formation but you need to be careful with them retinoids can cause redness even in someone with healthy skin so if you and your doctor decided to use a retinoid please start with a very low dose and go slow with it over time besides topical treatments there's also some oral medications that can help manage rosacea symptoms tetracycles are a class of antibiotics often used to treat rosacea they include doxycycline and lime recycling although that could vary depending on what part of the world you're in they do have anti-inflammatory properties that can help manage rosacea symptoms and doxycycline is often used at a low dose like 40 milligrams slow release for rosacea because that exploits as anti-inflammatory properties but doesn't activate its antibacterial effects and that helps avoid antibiotic resistance and it's usually taken once daily alternative antibiotics such as erythromycin may be used if tetracyclines are not tolerated or if there's a reason why you can't use them while antibiotics can help manage rosaceous symptoms they're not a cure and symptoms May recur after the treatment is stopped the risk of bacterial resistance is also of a serious concern especially with a long-term use of antibiotics therefore the low dose or the modified release preparations are commonly used if someone does require the treatment for long-term use in more severe cases of rosacea or cases that don't respond to our earlier treatments isotret known may be considered it's a powerful retinoid medication that's often used to treat severe acne but it can also be effective in treating rosacea it's only prescribed in specialist centers if you have difficulty accessing and appropriately qualified medical professional there are online Dermatology Services who can assess your skin where you upload photographs and describe your symptoms a dermatologist then assesses your individual case and prepares a personalized blend of topical treatments suitable for your condition and your skin type I use dermatica for my own personalized night cream and contains a retinoid and a pigment reducer signing up with them at dermatica.com or demonica.co.uk and entering the code Dr Finbar on checkout means you'll get a 10 discount of any products that you purchase so rosacea can be a challenging condition to manage but by looking out for your emotional health make an appropriate lifestyle and dietary adjustments you can take control over your skin and enjoy a better quality of life if these methods alone don't get you the desired results have a look on their Monica's websites for personal treatment plans or visit an appropriately trained Healthcare professional don't let rosacea hold you back you deserve to feel confident and comfortable in your skin now if you found this video helpful watch this short video on how we can start start our journey to self-healing
What Causes Rosacea- THIS Triggers 90% - Dr. Allison Siebecker_en (auto-generated)
when the sibo is treated if somebody has sibo not everyone with rosacea is positive for sibo but then the rosacea goes away and the results are absolutely incredible like up to about 90% resolution in fact some studies show pretty much 100% resolution and also that that resolution holds in one study they went out for 3 years so that the resolation was gone for 3 years another study looked at 9 months gone welcome to the show Dr C Becker how are you doing today I'm doing great thank you for having me I'm so excited to have you here and I'm I honestly can't believe that it's taken this long to have you on the healthy skin show because you are considered one of I I think you're one of the most Brilliant Minds when it comes to small intestine bacterial overgrowth and I had the pleasure of watching you lecture at a conference this past fall that I learned a ton in so I'm excited that we're going to talk about this today me too so um let's get into to a little bit of an overview on sio what it is the different types of sio and maybe some symptoms both common and uncommon that could be a sign of this this I guess we'll call it like a gut dysfunction diagnosis whatever you want to describe it as okay well it stands for small intestinal bacterial overgrowth and what it is is kind of what it sounds like it's when um a whole bunch of bacteria uh sort of home for themselves in the small intestine there's it's an overgrowth it isn't technically an infection because it doesn't meet all the criteria of an infection but it sure behaves like a chronic infection and it is chronic for many people um so there are three types of of CBO basically and this is based on both the bowel movement pattern and the gas and what I mean by the gas is the gases that the bacteria make because they they excrete gases and so we have hydrogen methane and hydrogen sulfide and the methane type of sibo actually has gotten a new name in the last few years and it's called intestinal methanogen overgrowth methanogens make methane and it's a little different than um the hydrogen type sibo because the methanogens can overgrow in the large intestine as well and that's also the truth for the bacteria that make hydrogen sulfide they can overgrow on the large intestine too and so we've had to sort of with gnomen clature like the names of things we've had to uh there's sort of a new name for this methane one um but I still use the word sio to really mean all of it just for Simplicity so uh it it causes a lot of problems for people we're not supposed to have this situation our small intestine is where we digest and then absorb our nutrients from our food and when there's too many bacteria overgrown there or methanogens they interfere with that process um it can cause malnutrition and then all sorts of other problems uh skin problems can be one of them which we could talk about but the core symptoms are the symptoms of irritable bowel syndrome or IBS for short IBS is basically a collection of symptoms that um and then you have to sort of figure out why you have it and sibo has been identified as um a main underlying cause of IBS so studies show about an average of 70% 60 to 70% of people with IBS actually have sibo they could also have other things wrong too so so that's a very important connection so uh the symptoms now what are those symptoms abdominal bloating it that could come with discomfort General pain or discomfort in the abdomen constipation or diarrhea or a mixture of the two so those are our core symptoms there there can also be nausea a feeling that food is sitting in the stomach and won't move down uh there could be um gas exiting so burping or excessive flatulence um yeah I think I mentioned nausea oh acid reflux acid reflux actually can be caused by sibo and which is new to a lot of people's thinking you treat the sibo and the acid reflux goes away so very important to know now what are some of the like less common I'd say actually it's very common but people don't think of it is anxiety sibo causes anxiety and this is through um what how the bacteria stimulate inflammation and and their effects in the brain basically and mood and also depression but anxiety is more common and then skin skin issues can occur that which I know we want to focus on well I did want to ask you um quickly uh before we actually get into the skin conditions um the issue with food poisoning I think a lot of people don't realize that food poisoning or about of food poisoning could have been a trigger is it just food poisoning specifically or getting like a stomach bug yeah so this is perfect because now we could talk about what causes it right so the most common cause is food poisoning as you mentioned which is brand new thought to a lot of people this has been very well studied over the last 10 to 15 years a lot of work went into this figuring this out it's bacterial food poisoning and one could say it's stomach flu as well because nobody really knows like you know traveler's diarrhea stomach flu food poison you don't really know where you get it a lot of the times sometimes you do you know you everyone ate a certain meal and all got sick so I think of it in all of those words but what we're really talking about medically is bacterial food poisoning turns out that the all the bacteria that cause food poisoning share the same toxin they all secrete the same Toxin and it's called cyol lethal distending toxin or CDT for cdtb for short and this uh looks like this toxin looks like a protein that's a component of small intestine nerves and so what happens is in some people they probably have a genetic predisposition because it doesn't happen in other people uh their immune system uh sort of confuses the toxin with that protein in on the small intestine nerve and it starts attacking the small intestine nerve and it actually creates nerve damage and then what in an autoimmune process and then what that does is make it so this natural Movement we have which is our number one protection the body's number one protection against sibo which is called the migrating Motor complex it's basically like um a housekeeper movement or wave where it sweeps bacteria down and out of the small intestine and it actually has soap with it like some biolin enzymes it's like it's like a scrubbing cleaning Well it can't function anymore because you need nerves and muscles to make that motion happen and if there's damage to the nerves it can't happen and so then this becomes a chronic condition because the autoimmunity continues for most people and currently this this condition um is there's no known cure but this is being actively worked on and I I know and believe we will have a solution for it uh probably in the not too distant future so yeah so the other thing to know about this is that it can be delayed and so that's a hard thing to piece together for both somebody who has it and even a doctor because it could it could happen six months after so you have about a food poison the other thing is you may not even remember because maybe it was just one night of diarrhea like and it wasn't that bad you don't you don't even remember and then you know 6 months later four months later 3 months later you develop you know the IBS symptoms and you're not linking it to that you can't even remember I mean of course then some people will remember if it was awful if it was you know vomiting and diarrhea I feel like the vomiting piece nobody forgets that but if you just had like if you just had diarrhea you'd be like oh maybe I ate something maybe you know who knows it's nothing you would regard right so this is a very interesting thing there is actually a test now that can test for this exact situation the test is called the IBS smart test it's a blood test and it checks for the auto antibodies against the vinculin protein uh that's the protein the name of the protein and the toxin CDT cdtb and so if that is positive then you know you have sibo you also can say you have IBS and it's actually called there's a subtype of IBS that this is post-infectious IBS and post-infectious IBS is none other than sibo but the distinction here is sibo can be caused by about 40 50 different things more uh this is one of those things so um you know this is one type of SEO caused by one thing this episode is brought to you by my skincare line Derma quel the beauty of these skincare products are that they are especially crafted for those struggling with chronic skin rash issues based on my research and clinical experience from my private practice they focus on organic ingredients that are clean like zinc aloe and hemp oil that support and calm rash dry angry skin there's no unnecessary chemicals or additives that can further dry out your skin or mess with your hormones and I'm so excited for you to add these creams into your routine check them out at quell shop.com and use the coupon code get 15 off to get 15% off your first order I'll put a link in the description below and now let's jump back to the video well I did want to just touch on a couple connections especially with the skin for the listeners who are tuning in um most research I've looked at especially with rosacea it's like 77% of rosacea cases have sibo or they at least found sibo and about piece or connection here I mean what what we know is there's all these articles showing the sibo Rosa rosacea connection and we know that when it's treated uh when the sibo is treated if somebody has sibo not everyone with Rosa is positive for sibo but uh then the rosacea goes away and the the results are absolutely incredible like up to about 90% resolution in fact some studies show pretty much 100% resolution and also that that resolution holds in one study they went out for three years so that the resolation was gone for three years another study looked at nine months um gone so that therefore what these articles theorize is that sibo was a cause so you know no one has stated that anywhere they just but it's like well if you get rid of the sibo and then the rosacea is gone for good it sort of just makes sense right it makes sense I know and it's the same with uh ocular rosacea can also be triggered by this as well so it could be something that maybe your opthalmologist or optometrist picks up on and then you're like oh yeah I do have these GI symptoms and you start to hopefully put some pieces together but I feel like a lot of times those connections get missed still uh in conventional medicine at times if you don't the rosacea the rosacea connection to sibo you know I'm um an educator myself and this is one of the things that I pull out in particular for people uh doctors to listen to and of course obviously patients if somebody has rosacea you should be thinking about sibo because it the connection is so strong and the solution and the result is so impactful you know so it's like that is one of the things to listen to listen for if somebody says that in ocular rosacea I've seen many patients with ocular rosacea and it's actually just as you say they'll they'll often come with a main complaint of ocular rosace saying I have no GI problems and then when you really question there actually are but they they they don't matter to the person and they're not even caring they don't think about it because they just care about the rosacea well with other skin conditions do you tend to see anything else as a possible like skin sibo connection the really the the other main one is psoriasis um it's not as prevalent the sibo um connection at least in the St there's very few studies whereas there's a lot on rosacea about looked at so far but also really good results from treating not like a full remission but very much decreas in like plaque size and intensity um for psoriasis when sibo is treated so it doesn't seem to be the whole primary situation but treating it really really helps so those are the those are the main connections one one could speculate of course about General um you know exzema and dermatitis but we don't we just don't have any literature on it and I myself haven't seen a lot a lot of patients with it so I cannot comment from my own practice but I think it's a worthy thing to test does someone have sibo who has eczema or dermatitis yeah and so you've mentioned a lot about testing for sibo we mentioned this IBS smart protein correct um IBS smart blood test blood test sorry uh so are aside from that are there any other tests available yeah that test really just lets you know if you have your sibo from food poisoning and in general that test is used should be used um in Primary Care setting as a screening test for IBS just to find out if somebody has IBS and if they do uh it's SEO right and then what you then need to do is go on and do the the real test for sibo which is the breath test and it's a breath test that checks for the gases so typically hydrogen and methane there's also a newer test now that also checks for hydrogen sulfide um and that's actually called a trios smart test and the others are just called like hydrogen methane breath test and uh there are discrepancies in the way the test is offered and that is based on length and which gases are being tested for and what substrate is used so the way this test works it's it's a simple test to do you do it at home with a kit usually and so what you do is you do a one-day prep diet where you have a reduced carbohydrate diet and that's because bacteria make the gas out of carbohydrates that's that's what they use as their fuel as what they eat basically so you want to remove carbohydrates so that you can get a clear reaction to the test substrate which is a carbohydrate and so we we typically use lactose but you you can use fructose as well and unfortunately in the US lacos is prescription which can make it a little hard for some people to get a hold of this test because not every doctor is fully educated on this and wants to run the test but I can also say there are places that like do you have a Rupal Labs account I do I I would I think most alternative ative or integrative practitioners do so yeah so you can get it through Rupa and they have a physici Services where you know someone can get it without a prescription and like direct Labs through Health Labs there's places people can order um lactose but the the key is you want to do it for three hours um and that is not every test offers it for three hours and the reason why is the first two hours indicate the small intestine time generally on average and the final hour the large intestine we need to see that final third hour because me or methanogens and the hydrogen sulfide can overgrow there so we need to see that and there's other reasons we need to see it as well so anyway when you have once you have that test um you base treatment on the gas types so we need to know which gases are present and in what amount and the hydrogen sulfide type is much rarer so even though we do have one option now for testing that it is okay for a lot of people to just do the hydrogen and methane one because it's not it's much less um common to have that other gas positive and is it possible to I mean I sometimes because I don't generally run because I mean sibo is not the primary focus of things that I look for um but there can be times where with symptoms and different things and we do stool testing like I'm like well there's a good chance that this might be a factor here is it possible also from looking at stool testing where if you started to see the methanogens high in on like a stool test in large intestine could that possibly also be a clue that there's a problem there as well yeah you know I hopefully I'm not mistaking this but I believe you know Dr pimentel's teammate is Dr Rai Dr pimel is our lead researcher and uh Dr Rai is you know his teammate a phenomenal uh physician uh if I'm not mistaken he said he does interpret um high methanogens on stool test as accurate and so what that would mean is that there's an overgrowth of methanogen in the large intestine stool test just lets you know about the large intestine but but that is part of the condition right and it would be the same if you saw high dulov vibrio or fusobacterium varium these are the organisms it's m smithi that causes the methane overgrowth and those other two that cause hydrogen sulfate and by the way the organisms that are causing the hydrogen small intestine overgrowth are eoli and Cella pneumonia and um Arin so if you see uh the methane on stool test yes then you know they have an overgrowth in the large intestine so um you could you could treat it but it would be the the best if you could do the breath test because that will let you know how high the gases go and when you know how high the gases go that informs your treatment because and we can just get into that but just briefly there are three um antibacterial treatments that we can choose from pharmaceutical antibiotics herbal antibiotics and Elemental diet and the pharmaceutical and herbal antibiotics on average lower gas about 30 parts per million per treatment round or course whereas the elemental diet lowers it on average about 70 parts per million per treatment course but it's a more challenging treatment for people to do and so if you know the severity of the gas you can choose your treatment based on that and and even calculate and project how many rounds of treatment you think you might need because um overgrowths we treat until we get effects basically it one it's not like an acute infection where 10 days and you're done we typically need multiple rounds of treatment depending on how high the gas is so if it if it's at all in someone's possibility to get the breath test it's the best idea because then you're being the most methodical you know what you're starting with you you can project your rounds of treatment choose your treatment exactly and really do the best job possible it sometimes you know budgetary concerns exclude it but can I just ask you quickly because you know we've talked before even we started this interview about there's this fear that if you go the antibiotic route so the the the medication route you're somehow going to always deeply damage your microbiome but my experience has been now granted I'm not a naturopathic doctor I'm a nutritionist but my experience has been that there is a time a place for medications and if there is really really severe overgrowth often times like you kind of I think alluded to here that one round might not be sufficient to even really you know you really have to do multiple rounds to finally feel a significant impact so can you just speak a little bit to that antibiotic fear that some people have yes of course it's understandable especially because many people do think they feel that antibiotics actually triggered or caused their their sibo symptoms and we actually do have a study that's a pilot study that showed that uh some antibiotics they're not commonly used ones but at least not for this condition can slow the motility in the stomach uh stomach into the small intestine which could mean they could cause it but the antibiotics that we use for sibo are are different they're targeted and in particular this main one we use is called raax in the US that's sold as xifaxan and Dr pimel Who who so he's involved right now years of studying and mapping the small intestine microbiome that has not been done before all the microbiome mapping has been done on the large intestine and he actually had to develop equipment and validate equipment to be able to do this it's a very hard place to reach and test the small intestine so he's undergoing this massive reimagine study it's called to map the small intestine microbiome what he has found this has not been published yet but he has taught it in lectures is uh when you look at the signature of the microbiome it's all Disturbed in sibo it's terribly Disturbed in sibo when you treat with rafaam and then you relook at the microbiome it has restored to normal so in this case the antibiotic restored the microbiome to normal it's the exact opposite of what everyone is afraid of so it's a really important thing to think about if you have a completely microbiome antibiotics can actually fix it restore it to normal at least rifaximin in particular that's what they were looking at so raxin is what we use for the hydrogen sibo when you have methane or hydrogen sulfide you additionally have to add a second antibiotic to be able to Target those organisms that are involved okay is that the neomin I've read about yeah so we add neomy or metrol for methane and for hydrogen sulfide we add bis which you can you can get over the counter but you need a good amount of it you need about the forms that you can get it in that don't have the sugar alcohols because some people are really bothered by sugar alcohols they could be fermented by bacteria some people can tolerate them okay though so that that's for the pharmaceutical side okay can I also ask quickly um in regards to the low FODMAP diet which sometimes people do need to avoid certain types of fermentable starches and fibers and food but I've also read online oh just go low fod map it'll starve your sibo do you agree with that statement I wish that was true I mean wouldn't that be so incredible I have never ever seen that to to work so I'll tell you what I have seen work you know there are LOD map is one of about five core diets that we use for sibo it wasn't developed for sibo and honestly it's not the the best match um for and what do we really use diet for we use it for symptom relief we use it for symptom relief and also to generally assist in the once someone's got their sibo cleared the prevention of relapse phase because being on a lower carb diet can help during that phase there's a lot of nuances here but anyway um I've just never seen like if somebody tests positive for sibo and they do it they do the diet that then they get a neg negative test but what I have seen is is when the diet matches perfectly for that person whichever sibo diet we're using and let's say we've we've done testing um what I mean is experiments to figure out with a person what foods are really triggering and not you can get to 100% symptom relief so there are people who can get 100% symptom relief with diet what I find though is that that is not satisfactory to the person and the reason why is that they've altered their diet and they don't want to live like that for the rest of their life they would rather get that condition treated so they could then expand their diet and this is a personal choice for people but I I've I've had people who have had 100% symptom relief and they're like this is all I want Doc and they maybe there are people who don't but these people show back up in my office saying I'm frustrated let's go ahead and treat it now let's treat this overgrowth so that's what I see it's not necessarily the most sustainable option would you you say that if someone was to go on a low FODMAP diet because they're they're having these GI symptoms right that you've discussed and they do see a substantial Improvement could that be a sign or an impetus that maybe they should get checked for sibo it's a great one one thing I would say is you wouldn't want to say that means I have sibo because the what we call the differential diagnosis meaning what are all the list of conditions or diseases that can cause the same symptoms is huge and there are other conditions that a a low FODMAP diet will alleviate the symptoms but that are not SEO and one example would be lactose intolerance so like let's say a genetic lactose intolerance meaning you don't have the enzyme to break down lactose aod map diet is lactose free uh although you're actually supposed to figure out whether you have lactose intolerance or not when you're doing that diet but anyway um and the treatment for that is completely different than sibo so you wouldn't want to assume and not do testing I think testing but it's a really good point yes do the testing for sio well I have I feel like I have a million other questions for you so I'm going to leave it with this last question because it was something that I found so thoughtful and fascinating from your presentation gastro was you talked about nervous system regulation training that could potentially be helpful and I think a lot of times everybody just thinks about the diet or about killing things but there there is another part or component of healing that may not necessarily have anything to do with that it's how our nervous system interacts with things can you speak just briefly about how that could be helpful for somebody who's going through this absolutely yeah so that presentation was about tough cases of sio so so this wouldn't necessarily be something you need to do immediately you know want to you'd want to see if you have trouble with the regular treatments although on the other hand some of these treatments I'll mention in just a second um help people tremendously so maybe you do want to try them right at the beginning so what what these are is uh treatments like gut centered hypnotherapy um uh brain retraining like dnrs or the Gupta protocol and I know there's others um and and and there's other things too that work on the nervous system you know heart math all sorts of things the idea behind this is that in some people with sibo they're they're like parasympathetic nervous system which is really what handles the digestive components and function is almost like it's dampened or turned off it's not truly turned off but it's it's not working well and these treatments help it to turn it back on help it to work better and we need that we need that aspect of the body working well to to get a good response to the sibo treatment and really keep it gone and so just as an example um a colleague of mine has had patients who've had constipation for most of their life who um went on who went and did the nerva app so the nerva app is a gut centered hypnotherapy app you could do at home I I want to just mention they they force you to agree to some statements in the beginning that are factually incorrect so please just ignore that about IBS it is not fact correct but they do do this at home and got an 80% Improvement in symptoms with the nerve app alone now look there are other people who have tried it and gotten no benefit right so maybe don't pin all your hopes on it but it is remarkable for many people and and the Brain retraining and any of these what what my colleagues because I intervie interviewed a bunch of colleagues to ask them about um treatments they're using for tough SEO what they said to me what they all said was no one ever says that it was a waste so it you know it seems to really be helpful for so many people well Dr C Becker how can everyone find you and and by the way I'm G to have to we're going to have to meet again we have to do this again I have more questions but for today I would love to for today how can everybody connect with you and I'll make sure to put all the links and everything in the notes because I know you number one have your own I think clinical practice but you also train professionals as well and we have a lot of professionals that listen listen to the show too I don't I don't see patients in in office anymore I I just focused on education and half for years I teach at University Etc how you find me is siboinfo docomo my email list my newsletter list that's how you get notified of everything I I do research updates with all the researchers I do free trainings I do all sorts of things that's how you can find out about everything thank you so much for this I really appreciate the time and I'm excited to have you back the next time so we can dive deeper into sibo and complex cases and recurrent issues because I do think that this is a topic where we can provide so much benefit to not only somebody who's dealing with this but also those who are listening who do support patients or clients who are struggling with this and I always find knowledge is power even if it's not something that's within your wheelhouse sometimes knowing can help you get to the right person agree completely thank you so much Jen if you enjoyed this video you need to tune in to this video next then make sure to hit the Subscribe button so you get notified as soon as a new episode drops I'm excited to see you there and dive deeper with you on your skin healing Journey
What Is The Gut-Skin Axis with Alex Manos_en (auto-generated)
okay so good afternoon everyone and thank you for tuning in today on this thursday afternoon and morning afternoon evening to everyone who is watching the recording as obviously you're all aware we're going to be exploring the gut skin access today um so before we dive into the presentation and even before we kind of summarize the objectives which are quite simple and it's probably worthwhile me introducing myself because um some of you are not going to be familiar like me with who i am and what i do here at healthpath so my name is um alex manos i am one of the co-founders of healthpath and i'm the functional medicine director um so i certified with the institute for functional medicine um in 2016 and my background is in nutritional therapy so i have a masters in personalized nutrition a degree in nutritional therapy and i started out in the industry i think 15 years ago now as a personal trainer and sports massage therapist so i sort of evolved over the last 15 years from being more involved in the fitness and health space and over the last few years i very much focused on supporting people with chronic complex conditions ultimately in particular around digestive health um chronic fatigue syndrome and mold illness and mycotoxins but today we are taking a a slightly different focus in the sense that we're going to be talking about conditions associated with the skin but we're going to mix exploring really the connection between the gut and the skin and we're focusing on five of the most common conditions from a skin perspective psoriasis eczema rosacea acne and vitiligo so to ensure that we're all on the same page to begin with ultimately the gut skin axis is obviously referring to this relationship between our digestive tract and our skin and as we go through today's presentation it will become increasingly clear that we have an increasing amount of research showing us that at least in a subset of people with these conditions imbalances within the digestive system in particular when it comes to the gut microbiome and the integrity of the gut lining i.e this concept of leaky gut are incredibly important and can be a real driving force in the imbalances that are then found um on or in the skin so a key question really that we need to to answer today is you know what is this connection and how does it actually work how can two very um distal sites of the body have such an intimate connection um and what we know at this point in time is that the connection comes really through three primary routes shall we say and that is related to our immune system our metabolic health and our nervous system so what we understand is that the gut microbiome is significantly influencing systemic immunity and systemic immunity is significantly associated with some of these conditions especially i would say psoriasis but also um acne eczema and vitiligo ultimately now these connections become even more pronounced when our intestinal barrier is disturbed for whatever reason that may be it could be related to antibiotics it could be related to some form of chronic stress it could be related to poor diet it could be related to sibo small intestine bacterial overgrowth among other factors and when we have this excessive permeability or leakiness to the gut lining it allows certain things to get from the gut into our bloodstream where there will be an immune response leading to inflammation and especially if ongoing that can disrupt our overall immune state or immune system and increase the likelihood of going on to develop some of these conditions the metabolites being produced by our gut microbiome are also intimately connected within this so as we'll see in today's presentation the metabolites that our bacteria produce often in response to the food that we are consuming not only will help maintain a healthy gut lining but also modulate our immune system so one of the most well understood and researched mechanisms of the gut skin access is that a healthy gut microbiome produces a healthy quantity um and a healthy sort of quality gut bacteria metabolites that maintain a healthy gut barrier and a healthy immune system and therefore healthy skin what's really interesting is in some studies we've actually found gut bacteria the locations where psoriasis is in the skin so we also know that certain sort of fragments of bacteria are literally translocating or traveling across the leaky gut lining into our bloods where they're being transported to the site um of the skin condition ultimately so we're going to start with psoriasis in regards to some of the mechanisms i've broken this down into kind of two sections today we're going to briefly talk about each of these conditions and what research we have to help us understand some of the things that might contribute to the condition from a gut perspective and then we're going to talk about interventions that we can consider um in the second part of today so when we think about psoriasis and the role that the guts can play in this condition there was a brilliant paper that came out last year um a current state-of-the-art review on psoriasis and the gut microbiome and to kind of highlight what we're going to very briefly touch on now this paper helped us understand that large intestine imbalances within our bacteria this term dysbiosis microbial metabolites gut inflammation which can be tested for via markers such as calprotectin in a stool test sibo small intestine bacterial overgrowth leaky gut and then gluten reactivity whether that's celiac disease or gluten sensitivity these are the factors that have to be considered if we're trying to understand whether someone's gut health is contributing to their psoriasis so we're gonna there's kind of a slide coming up on each of these so when we think of large intestine dysbiosis what we see in the research is that this is one of if not the most significant findings related to psoriasis and gut health and what we're saying there for is that significant imbalances within the microbiome in the large intestine are a very common and significant finding now one of the reasons why that can be is because there is an issue with the diversity of the microbiome what we see in patients or clients with psoriasis is often their diversity the number of bacteria that reside within that large intestine is actually lower than compared to healthy individuals and there's a relationship between what diversity is there and the severity of the symptoms which it kind of strengthens this argument that there might be a direct relationship between these two things it is worth highlighting that research is mixed as it is for a lot of what we discussed today so there is a study that actually showed that microbiome diversity had increased in some patients with psoriasis and i don't think that should be overly surprising in the sense that nothing that i say today is 100 percent present in patients with psoriasis these are key findings that a subset of people with psoriasis or eczema or vitiligo may have and therefore may need ruling in or ruling out through certain functional tests so a question obviously becomes well what contributes to the dysbiosis in the first place and that could be related to antibiotics stress we actually see that those living in more rural environments generally have a greater diversity into their microbiome than those living in urban environments one of the reasons being is that our gut microbiome is partly a representative of the microbiome around us um you know around our environment there are organisms bacteria that are living they're living on pretty much most surfaces and that exposure is a really important part of developing a robust immune system as many of us know with this hygiene hypothesis that has been around for a while the fact that in the modern world we live in an increasingly more sterile environment and we need that exposure especially in the first three or so years of life to develop a healthy robust well-modulated immune system but not only are we living in some ways in a more sterile environment certainly in regards to our exposure to sort of certain natural organisms but many of us are being exposed to environmental pollution and that could be everything from pollution from cars and buses if we live or work in cities and through to obviously more national or global concerns around industries for example and the pollution that is being released nutrient deficiencies poor diets just general poor health may also have an impact on the health and diversity of our microbiome so the microbiome in our gut isn't just influenced by these external inputs or stimuli is impacted by our health and therefore it is a bi-directional relationship the healthier we we are as a human as a whole organism the healthier the sub-components of us and that includes our microbiome leaky gut has been associated with psoriasis and that is because leaky gut when chronic will contribute to systemic inflammation which will disrupt all of our microbiomes and has been associated with psoriasis sibo has been not only associated with psoriasis but the eradication of the bacterial overgrowth in our small intestine has been shown to improve the symptoms of psoriasis again strengthening the relationship between the two here so the conclusion from this paper was that psoriasis as well as rosacea made benefits for the treatments of sibo we also see in a different paper that absorption seems to be compromised in those with psoriasis so in this study 60 percent of participants um had altered absorption compared to three percent of the controls in the study so the healthy individuals compared to those with psoriasis now of those 33 people with psoriasis that had a degree of malabsorption six percent were then found to actually have celiac disease remember that we've mentioned celiac disease and gluten sensitivity is a a common ish finding in those with psoriasis in this study six percent had celiac disease in the small intestine so over one in five people with psoriasis may have sibo three percent had parasitic infections and only one patient presented with isofina phenelic and gastroenteritis so inflammation related to um specific immune activity shall we say and then we have microbial metabolites so what some of these studies have found that in patients with psoriasis they have a depletion in what we call short chain fatty acids scfas these short chain fatty acids are produced by certain bacteria and the bacteria produce these fatty acids by fermenting our dietary fiber and therefore if we're not eating enough dietary fiber that might be one reason why we see lower levels of short chain fatty acids but again and what is less well known and less well understood is that the bacteria themselves can have an issue with the fermentation process and the production of these fatty acids when they themselves aren't particularly healthy which takes us back to we can't separate the guts from the host i.e uri but we do know therefore that supporting the microbiomes ability to produce these short-chain fatty acids is important and it means that in the short term there might be some people who would benefit from supplementing what we can so we can supplement butyrate which is one of the main short chain fatty acids produced by certain gut bacteria we also see in these studies increased amounts of slightly more problematic metabolites one that is just referred to as tmao so there is a metabolite imbalance within patients with psoriasis there isn't isn't necessarily always easy to test for ultimately either and some research suggests that these imbalances regarding the microbial metabolites are some of the most significant findings um i personally have this sort of perception or belief that the fitter the host the fit of the bacteria we do know that people who are adequately physically active so people who are doing appropriate levels of exercise on a daily weekly basis generally do produce more short-chain fatty acids such as butyrate so exercise is actually a great therapy to support gut health if done at appropriate intensity and volume and what i mean by that is too much exercise people who are doing lots of um you know serious endurance work maybe training for marathons or longer events that can actually be quite problematic for gut health in some people gut inflammation so six out of ten patients in one study were had elevated calprotectin calprotectin is an inflammatory marker that can be tested for in the stool and is actually often used by gps and other practitioners as a way to differentiate between someone with about syndrome to someone with inflammatory bowels so when calprotectin is significantly elevated it can actually in one with inflammatory bowel disease which is an autoimmune condition now bear in mind that psoriasis is thought by something to potentially be an autoimmune condition and then that suddenly makes a lot more sense as well one reason being the biggest risk factor for having an autoimmune disease is having an autoimmune disease i.e when you have one you're much more likely to go on to develop another one unless you get that first one under control obviously so in summary we need to be thinking about the microbiome in the large intestine and that's where something like a stool test can be helpful we need to think about microbial metabolites things like short chain fatty acids such as butyrate we need to potentially rule out inflammation via markers like calprotectin we need to kind of con consider sibo leaky gut and then gluten reactivity as well so there's a really strong link in the research between psoriasis and gut health and i would argue based on the research i found that the this is probably the skin condition with the strongest connection at this point in time at least so what about rosacea well there's research looking at microbiome diversity here as well so there are only a couple of studies at this point in time um that have looked into this and there's been a bit of inconsistency so one study found that alpha diversity was lower and the other one didn't but both studies point to significant differences in beta diversity between those with roses compared to healthy volunteers now alpha diversity and beta diversity are slightly difference alpha diversity is related really to the richness of the microbiome how many actual species of bacteria are present within your large intestine and that might be something like 150 while there are something like i think a thousand species of bacteria that can be in the intestine most of us have something between 100 and 250 depending on how resilient and diverse that microbiome is beta diversity is actually looking at your microbiome from sort of also not just a richness perspective but also a composition perspective comparing it to a healthy cohort sort of a healthy reference range and then giving results so what we're saying here is that 50 percent of studies so far i.e one has shown that actually the richness of the microbiome the number of species of bacteria that are there was lower and the other study said it was similar but both studies showed that the compositional and richness of the microbiome was less and therefore again it's great information that at some level the microbiome is compromised in paper in people with rosacea and what's interesting is this condition has been associated with most gi conditions ranging from inflammatory bowel disease to irritable bowel syndrome to celiac disease to reflux h pylori and sibo and i've put inflammatory bowel disease in bowls because the research has stated that this has the most connection with the skin condition and to strengthen the argument that the gut has a relationship here is the fact that medications to eradicate sibo i.e antibiotics and medications or antibiotics to eradicate h pylori have actually been shown to provide effective and prolonged therapeutic response to rosacea meaning there's improvements so there's clearly a relationship between the gut and the skin in this condition as well and this takes us back to really i guess the overarching principle of the gut skin axis at this point in time which we've already mentioned you know this presentation could be kept super short and simple with this understanding that the microbiome is modulating our systemic immune system and our systemic immune system is having a profound impact on the health of our skin and therefore if we can improve microbiome diversity and composition which will by default in many ways improve its metabolites production we're reinforcing the barrier of the gut we're having a more well-balanced immune system systemically and therefore we're at much reduced risk of developing any of these skin conditions that we're talking about so let's look at eczema well in eczema there is a strong relationship with allergies and eczema and what we know through the research is that again the microbiome through its production of not just short chain fatty acids but especially in relation to sort of eczema or atopic dermatitis other metabolites including d tryptophan conjugated linoleic acid or cla as you can see in the image and other derivatives of our microbiome they're having a direct impact on various receptors and immune cells uh you can see on the left hand side of this image trek trig cells are often described as the quarterbacks of the immune system they're there helping regulate and manage the immune response um and short chain fatty acids such as butyrate help maintain a healthy um state of these treg cells and as a result our immune system is much more well modulated appropriate immune response is isn't one that might um contribute to development of allergies and therefore we see improvement or a reduction in atopic dermatitis or eczema so again we have some really strong mechanistic understanding around how the gut influences the skin within the context of eczema as well i don't think no so in regards to eczema things like mode of birth where we vaginal born or c-section where we breast-fed or bottle-fed did we live in rural or urban environments was there a family pet did we go to kind of kindergarten or nursery so essentially did the things happen that meant we were exposed appropriately to all sorts of different bacteria and organisms that meant that our microbiome in the first three four five years of life could develop as robustly as it could do to ensure that we have an appropriate immune system and therefore aren't at risk of developing allergies or things like eczema so this is really close to my heart because from really a few weeks old i developed horrendous eczema to the point that when my mum walked in in the morning when i was certainly a few months old um there would be blood on my skin from me just itching myself all night um and i was someone that was vaginally born i was breastfed but there was probably something going on in my mom's health that she wasn't aware of that meant that i was being exposed to something and therefore didn't have this immune system that develops as it should have and that's led to and this is me sort of my theory of my own health journey that led to me having certain low level allergies throughout my life and also an immune system that is a little bit more susceptible to psoriasis so if my self-care isn't as good as it could be if i'm stressed at work or whatever it may be i can have tiny patches of psoriasis to this day that pop up and it's almost a barometer for me around how well is my physiology doing and that goes back to really those first three years or so so when we think about our state of health at this point in time we can't ignore our entire life story because it all relates to how we are today then we have acne and acne is one where there are some really strong connections separate to the gut as well so insulin resistance um you know blood sugar dysregulation sex hormone imbalances inflammation from whatever cause that may be as well as microbial dysbiosis these are really um significant causative factors in acne which isn't too surprising when we think of you know our teenagers when they're going through their hormonal changes when they might be eating a slightly worse diet contributing to blood sugar dysregulation and things like this all driving this condition so this is an interesting little quote from this paper and basically what the one of the studies found that individuals with acne had a high local burden of lipid peroxidation meaning that the fats in the cell were basically being oxidized they were being damaged um and as a result they had a really high demand for certain antioxidants so we can see straight away that antioxidants may be really helpful in supporting people with acne what's also really interesting is that prebiotics and probiotics have been shown to reduce systemic markers of inflammation and oxidative stress and therefore help with this concept that we've just mentioned also remember in the last side we said that inflammation is a causative factor of acne whatever's causing that inflammation pro and prebiotics may be able to help just modify that while we address the actual underlying issue um and obviously probiotics not only can help and prebiotics moderate they help modify the gut microbiome specific ones can help modify the gut lining but some studies indicate they can also modify the microbiome of distal sites meaning the microbiome in our skin or on our skin in our lungs in our respiratory tracts in our sort of vaginal tract or urinary tract we've got these microbiomes all over the body it's not just the gut microbiome and modifying the gut seems to have an impact at least sometimes on these more distal microbiomes as well and therefore pro and prebiotics have been found to be quite helpful for acne then we have vitiligo so this is something that is a little bit more complex in some ways and from what i can find there's a little bit less research than some of these other skin based conditions but like all of them there are environmental triggers there are genetic polymorphisms so you might be genetically predisposed metabolic alterations taking us back to this concept of blood sugar dysregulation and insulin resistance and also autoimmunity they are all things that we need to be considering and when we look at the interventions for some of these conditions there is a strong overlap um at least without taking a more personalized approach which would mean really no a case study would be needed from that perspective but in vitiligo we do see reduced richness and diversity so again the microbiome is compromised in people with this condition modulating the microbiome and looking to improve that microbiome diversity again through the use of prebiotics probiotics and postbiotics which is a relatively new term referring to these metabolites that are produced by bacteria and probiotics but also fecal microbiota transplants all of these things that can help modulate the microbiome could therefore be an alternative complementary approach to supporting people with the condition so with all of that in mind it becomes very apparent what tests we might want to consider from a gut skin perspective comprehensive stool testing will be looking at microbiome diversity we'll be looking at butyrate-producing bacteria it will be looking at cow protecting an inflammatory marker it will be looking at key organisms other than boots rate that help maintain a healthy gut lining and it will be looking to see whether you have a um adequate production of digestive enzymes it can give you sometimes signs about whether you may have an overgrowth of bacteria in the small intestine we can also do sibo breath testing which we've seen as a really strong component of a lot of these skin based conditions and we might want to consider some form of food reactivity testing and that could be anything from getting tested for celiac disease by your gp or doing some allergy testing by your gp in a referral to doing some food intolerance testing or some sensitivity testing and these are actually all very different food reactions food intolerances are related to when you're lacking an enzyme to digest the sugar found in the foods so the most obvious example is lactose intolerance when you're lactose intolerant you're lacking the lactase enzyme to digest and break down the lactose so it can be absorbed properly in your small intestine fructose intolerance is also very common in people with digestive disorders a sensitivity and an allergy are both immune based reactions whereas a food intolerance is nothing really to do with your immune system sensitivities are more related to antibodies like igg and iga and allergy you're looking at ige antibodies so they're three distinct mechanisms meaning that you can't do one of them and know with a hundred percent certainty that you're okay consuming the foods which makes food reactivity testing quite complex ultimately which is why even in the research most of the time the gold standard is still the elimination of the foods completely 100 it has to go and then approximately 30 days later reintroducing it to see whether you experience an adverse reaction and you've got two opportunities some people will notice the removal of the foods you notice an improvement in some symptoms that's obviously a sign that yeah you need to keep that out but bringing it back in can be a really powerful way of understanding how things are going and if you do that with more than one foods then obviously you need to reintroduce them to understand well which ones can you reintroduce and which ones may you actually want to continue avoiding for the time being the elimination diets is lit it really is one of the most powerful tools we have when it comes to understanding the connection between our health and food so gluten dairy corn soy eggs sugar alcohol some people include um pork and actually beef in there and i have a colleague that does an awful lot of comprehensive elimination diets and she's been really surprised how many people seem to actually be having some form of adverse reaction to beef which i thought was really interesting she works with a lot of people with autoimmune conditions so there could be a connection there and then leaky gut testing um do we want to consider what's going on specifically in the barrier of guts so these are the tests from a gut skin perspective i was debating to whether to add a bullet point here which says just something like you know a practitioner recommended test because it's important to appreciate that today we are focusing on the gut and the skin um stress environmental toxins such as mycotoxins or heavy metals such as mercury certain other types of infections including viral infections have been associated with some of these skin-based conditions so it's not just the gut that needs to be investigated really
Why You Have A Skin Condition - Functional Medicine Doctor Explains_en (auto-generated)
hello everyone welcome back this is Dr Maria zian today we will be discussing the role of functional medicine in diagnosis and especially in treatment of skin conditions and skin is the largest organ of our body and I usually stop here when I say that because I should say the skin is the largest external organ of our body as the gut is actually the largest organ of our body and a lot of people don't know that but the skin is the largest external organ and of course this is something that we see we see our skin every day and most people if not all do pay attention to how their skin looks there are many skin disorders that are benefited from functional medicine approach some but not limited to our eczema psoriasis contact dermatitis acne rosacea atopic dermatitis that actually falls under eczema Vitiligo autoimmune skin conditions and more and more and more in approach to skin disorders it is very important um to understand that just like a famous metaphor says that your eyes are windows to your soul in the same way I view the skin the skin is a window to an inside condition of your body so it's essentially a window into your almost to cellular condition cellular representation and cellular health of your whole organism so that's why um the rash or eczema or whatever the diagnosis is is not just that it's not just the skin diagnosis there is usually much more to it and before I delve into how we deal with um or how we approach skin disorder in our Clinic I would like to point out that um there are of course differences on how conventional medicine looks and treats skin disorders and how functional medicine does that and as you the viewer viewers of our Channel um are educated on that already I assume however it is important to sort of delineate that difference when we see patients come in let's say with eczema which is a very common diagnosis and we see of course more eczema in um colder times of the year it starts in the late fall or rather flares up in the late fall in many people and then gets worse in the winter and finally gets better by May so we uh that's a very common pattern but there are people who do not follow their pattern and that pattern and there are of course different types of eczema I'm just using the most common and basic um example here so when we see a patient with eczema um conventionally so this is a conventional approach conventional approach is to tell the patient oh your skin needs more moisture please moisturize it and do it more than once a day especially if it's um if it's in the winter and then if eczema is bad enough we do end up prescribing a topical steroid cream so what's wrong with that approach by itself it's not wrong um and especially in a sense of that um uh topical steroid creams are fine and they are very helpful if you use them sparingly meaning me that this is not a chronic cream so usually in conversation with our patients I always stress the importance of um not doing the topical cream for more than two weeks at a time so I usually tell them you know use it twice a day for no more than two weeks at a time or less because you really don't need to finish the whole course if you see the results earlier however what kind of approach is that is that really a Curative approach and that's where one of my personal dis satisfaction is with conventional medical approach because I feel that there's so much more that we can gain from the condition of the person's body and this is a little clue um skin clue that we get but instead of really looking deeper into that we are giving this patient a steroid cream and see you later type of thing and yes the truth is most people do get better with a topical steroid cream but is it sustainable because what happens that periodically we get a call from patients like that and of course they need um another refill and we try not to do that and now we try to delve in a little deeper so uh looking at this from functional medicine standpoint it's almost like putting a Band-Aid on uh this problem because patient comes to you with this condition and um really you're just giving him a Band-Aid and sometimes this Band-Aid could be uh sustainable meaning that it could actually work for some time it's not u a quick fix for some patients so it could work for some time and people could say oh wow I got cured I got that topical steroid cream and all is wonderful um and and it's gone but usually uh unfortunately this condition does come back and that's why the conditions that I listed you know like exzema atopic dermatitis and many um rashes especially autoimmune rashes or contact dermatitis and um other rashes that I didn't mention such as hives they do come back because there's something in the body that keeps triggering them and the goal of the functional medicine provider is to find that trigger or as we say in functional medicine to get to the root cause of this problem and that's where the fund begins because now you're not just putting a Band-Aid on the problem but you're trying to investigate what is happening why is this person developing this condition why now and uh why does it look like this specifically and of course it it is also important to look is it a severe manifestation or is it mild how often does it come on be the history taking in functional medicine is extremely important because that's really it's it's um being a detective who is gathering Clues um to what is going on is it something that's there's a correlation with something we do of course ask lots of questions in our conventional approach as well however the more questions you ask and especially sometimes asking just openend ended questions um the more information we will get from the patient and the more information could come out that patient didn't even think that it would be related but in reality there is a causal relationship between this specific something and the onset of this rash so there is nothing wrong with prescribing topical steroids however that is essentially I look at it as a temporary measure and if it's possible I try not to do that I try to talk patient um my patient out of it and try to look into the causes of this condition and um basically trying to eradicate this condition in the difference between conventional and functional medicine approach is that in conventional medicine the doctor cures treats and hopefully cures the patient in functional medicine it's more of a partnership of course the physician um the nurse practitioner PA whoever is seeing the patient the medical provider they are there to treat the patient to make them better however it is a complete partnership meaning that if patient doesn't um participate in this partnership then the results may not be all that satisfying because there may be no results and unfortunately there is no guarantee because some causes are very hard to find and in addition of course we do need patient not only be fully present and aware but to be completely compliant with the treatment because let's say if somebody comes to us with rosacea for example and rosacea has many causes including by the way a genetic uh causality as well and um the first thing the the the simplest thing with a patient like that is of course they need to be very very diligent with their sunscreen they need to use sunscreen every single day including in the winter um and including indoors and by the way that's a good advice for for just anybody who wants to have a good skin and who wants to protect their skin from sunspots from sun damage and from skin cancers that are um uh due to the sun which are basil cell cancers sell cancers and more so however back to the patient with rosacea somebody with rosacea they do need to use sunscreen it it's really imperative and if the patient is not using sunscreen then really at that step I feel like there's not there is not a partnership there is more like a old-fashioned medical model when a physician prescribes something and patient uses it it either works or doesn't work but in a patient like that the patient who is non-compliant it is hard to get to the bottom of things I mean we still try and both in conventional medicine and of course much more so in functional medicine try to get to the bottom of it but if the patient is not into it so to speak then you can't really push that on a patient you try to help as much as possible so you know we would prescribe something specifically for rosacea but again if the patient is not using sunscreen then you know the the a lot of other creams will not work because the moment they go into the sun they get much redder than an average person just from a very short exposure or same happens for example basic example with hot showers many people say oh I have rash in a shower well hot water brings out any rash so it does stimulate your skin to get hot so it is something that really nobody can fix because if you keep showering with very hot water you will see that rash and thankfully that is a transient issue so I usually try not to get into um uh um a lot of conversation with the patient about that because if somebody really likes hot water let it be uh but of course yes hot water brings out all of the rashes so that's why just decreasing temperature tempure of the water not too cold of course in the uh during the winter that's not realistic but to have it less um hot would would definitely help but those are very minor um uh Minor Details so just to start discussing as to the causes of skin problems from the functional medicine standpoint um well let's start with number one number one is actually um U gut problems I know maybe somebody or some of you did not expect me to say that but gut microbiome I know those words are becoming more and more popular but this balance in bacteria of the gut is a huge huge contributor to for example acne and not only acne but many other skin conditions and it can work on many many levels it can work on the level of the um breakage in a gut barrier what we call leaky gut um informally or it can just work on the fact that the G gut is not absorbing the nutrients because something is broken with it and that of course brings us back to the diet but before we get to it of course it has to be diagnosed we need to know that there are serious disbalances of the gut floor of the gut micro uh of the gut microbiome and that of course is the um place to start so a lot of times in approach to skin issu we actually start with that that's a very big one the second uh another very big one which a lot of people know of is um food sensitivities food sensitivities and food intolerances um and I will for the sake of this discussion I will group them together although their food intolerances and food sensitivities are a little bit different from each other but um for example for acne um it eating sugary Foods eating pizza for example you're eating very greasy foods and unfortunately eating chocolate those types of things are not good because in most people not everyone of course they trigger an acne breakout and once I attended a very nice um dermatology conference uh where the speaker was a renowned um dermatologist whom I respect a lot and he said that oh it doesn't matter what um what acne patients eat they can eat pizza that this is all just that's not true and of course that was sort of strange to hear that but it always proves that we're human all of us make mistakes and of course I disagree with that and not only I but the science has shown more and more and more how what we eat is extremely important especially for our skin so definitely food sensitivity and a lot of patients by the way um know that because they would say oh I would I ate this chocolate I was stressed out I ate this chocolate bar and then I had a breakout so food sensitivity is probably is not a surprise for U many of you uh food obvious food sensitivities are are something that you have noticed that there is a correlation in approach to food sensitivities in general the key in that approach is that many times we don't know our food sensitivities because what happens as a result of eating certain food doesn't happen right away it happens later it can happen next day so you can have acne due to a certain food that you eat all the time but you don't know that you're sensitive to it because you don't have immediate symptoms to it and the symptoms that you have let's say you have well acne and let's say you have mild bloating and some GI symptoms in addition to it and you take it that that's just normal that's just the way you are but that's not the way you are that's that's basically your food sensitivity so that's why a food sensitivity testing plays a big role um as well and of course food intolerances um uh is something that uh to be um to be aware of that that is the key in many skin conditions so um the next is uh micronutrient deficiency so those are deficiencies of um minerals and vitamins such as for example zinc or vitamin A B D um and uh those are very important because testing for micronutrients is a little bit different just from just um it's different from having just a regular serum or your blood tested micronutrients is those minerals and vitamins tested inside of the cell so you really want to have that because that's more precise that's more accurate when you that's why it's called micronutrients and sometimes the re the data the number the value of uh micronutrient is different than the one from a conventional serum lab so that is why it is so important to have that tested as well zinc is a very big player in um skin health and also in hair loss so it's very very important to know the zinc value and to take supplements if you need to take zinc supplements um I would like to throw here another little fact that we see it sometimes is actually people who take vitamin B12 too much there is such a thing that people who essentially overdose on vitamin B12 and they have high vitamin B12 and they can develop all kinds of rashes as a result and sometimes it's difficult to diagnose because we're so um programmed to think that most people are are vitamin B12 deficient that we don't think of that that somebody could be actually overdose overdosed and to have too high of a level of vitamin B12 so that's also very important the next one is hormonal cause of skin disorders and that is we see a lot of course in acne uh but also I would like to add to it um just in general different types of dermatitis acne rosacea and also um older uh people acne especially in women you do see uh postmenopausal or param menopausal acne and uh periodically I see um female patients who say to me oh I used to have a great skin all of my life I had a wonderful skin and now I have all this breakouts and pimples I thought that I that that would never happen to me because I never had it as a teenager so and those are um often they do have hormonal causality to it and hormonal I mean androgens progesterone estrogen uh those are all important hormones that that do play role and um we do test for that um one of the tests that uh we use when there's a suspicion for hormonal cause is a Dutch uh complete test uh which is um actually a great test to um look into that uh another hormonally related is um a stress test which is a u looks into a level of cortisol and it reflects your stress level and also looks into um into your whole hormonal um situation right now because obviously it does change and a lot of times well I I should say overwhelmingly frequently I do see patients who would say to me something that yes I've been through a lot of stress it is a very stressful time for me or you know somebody died or there's illness in the family I mean they're big stressors and that that's life we we do unfortunately go through stresses in our lives and how we deal with them you know nobody's always prepared that's completely human so and our body reflects that our body reflects uh these stresses and um stress is not just a word so stress has a material implication meaning that stress is not just bad emotions or bad feelings stress turns into a certain hormonal changes in your bodies and those bodies lead to certain diseases and conditions so that's why management of stress is one of the cornerstones in functional medicine and you can't really talk to the patient only about medical issues without discussing how to manage stress because that's that's that's truly a biggie and of course the last one which is sort of I look at it as like a throwaway bucket is um inflammation of the whole body like if you have some kind of processes other processes going on that um your whole body is inflamed for whatever reason and inflamed I mean internally there are s processes um for example like uh inflammation if you're fighting a cold or fighting some disease then you your skin actually can manifest that as well so the skin becomes a byproduct of um uh manifestation of those uh inflammatory processes that are going on in your body so we see that as well and usually in that case the skin rash or whatever skin condition it is shortlived in most people shortlived as long as the inflammatory response subsides and you're back to your regular um level but if you're not of course the skin issues may even get worse unfortunately so um so these are sort of groups of causes that can lead to skin issues and the important part is to know where to start in conversation with the patient it is important as to where to start and not to um overwhelm the patient and also listen to the patient to get the clues as to what is going on and where would be the most um um efficient in terms of the time and financially way to focus on to eradicate this problem instead of just prescribing topical steroids again I'm not against topical steroids I prescrib them myself but I think it's very unsatisfying and very temporary way of helping somebody so very exciting topic so this was just a little overview because there are just so many skin issues um that are addressed with functional medicine in a proper way as I think so thank you very much for listening until next time