Why Your Skin Is Begging You to Heal Your Gut First

Mark Hyman, MD

Full Transcript

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Dr. Mark Hyman
Coming up on this episode of The Doctor Hyman Show.

Dr. Liz Boham
So we can do tests like you said on, is there increased intestinal permeability or leaky gut? Because we know that those imbalances cause inflammation. And we know inflammation causes all sorts of things including acne.

Dr. Mark Hyman
Now before we jump into today's episode I'd like to note that while I wish I could help everyone by my personal practice there's simply not enough time for me to do this at scale and that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real time lab insights. And if you're in need of deepening your knowledge around your health journey, check out my membership community, the Hyman Hive. And if you're looking for curated and trusted supplements and health products for your health journey, visit my website at DrHyman.com for my website store for a summary of my favorite and thoroughly tested products.

Dr. Liz Boham
It's what you're eating is so much more important than what you're putting on your skin.

Dr. Mark Hyman
Yeah.

Dr. Liz Boham
You know, what the the food that you're putting in your mouth is so much more important than what your what topical things you're putting on your skin. And so it made us start to have this conversation, which I thought I was saying all the time, but I think sometimes people don't realize or understand or the connection is not made. Right? That how important, what you're choosing to eat every minute of the day, you know, how much that impacts your skin.

Dr. Mark Hyman
Yeah. Mean, the traditional medicine focuses on the outside in. What stuff you can slather on your face, what creams, potions, lotions or maybe taking antibiotics which is a whole problem we're gonna talk about in a But most of our skin health comes from the inside out.

Dr. Liz Boham
Yes.

Dr. Mark Hyman
So if you want great skin, if you want glowing skin, if you want clear skin, if you wanna get rid of your acne, if you wanna get rid of your eczema, if you wanna get rid of your psoriasis, if you wanna get rid rosacea, all these things come from the inside out and traditional dermatology focuses on the outside in. And it doesn't really work that well most of the time even when you work on the outside in. Yeah. And it's difficult, it's expensive, these medications are absorbed. You you basically my rule is if you wouldn't if you wouldn't eat it, you shouldn't put it on your skin.

Dr. Liz Boham
And and a lot of times with the topical treatments, whether it's, you know, steroids for eczema or, topical antibiotics for acne, they can work in the short term, but in the long term, they disrupt. They disrupt your skin and make you more prone to getting it in the future. For example, you know, we know both topical steroids and topical antibiotics are going to get rid of that really important layer of good bacteria that's on our skin.

Dr. Mark Hyman
So you have a microbiome on your skin is what you're saying.

Dr. Liz Boham
No, it's kind of cool. Right? Not only in our digestive system, but lining our skin. And so those medications, though they can be helpful in the short term, in the long term, they're damaging. They're getting rid of all of those good bacteria, which are really important first line of defense.

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

Dr. Mark Hyman
It's true. And so we put on antibiotics on the skin. We put on these agents that dry it out like benzoyl per peroxide. Mhmm. Which are most of these acne products.

And if that doesn't work, we give people oral antibiotics. Right. Which not only disrupts the oral, the facial microbiome, but also the gut microbiome. And and what we we know now in functional medicine and in medicine in general, if people paid attention to the research on acne, is a lot of it starts in the gut. Yes.

So if I see someone with skin problems, the first thing I think of, what's going on in their gut?

Dr. Liz Boham
Absolutely.

Dr. Mark Hyman
What's going on with their food that they're eating?

Dr. Liz Boham
Yep.

Dr. Mark Hyman
With inflammatory foods, with food sensitivities, with foods that trigger hormonal responses, with foods that increase something called insulin resistance. So tell us about the the pathology and the like the pathophysiology of acne because it's very interesting because we often just think it's like a topical thing, but it's really not.

Dr. Liz Boham
Yeah. I mean, one of the things we know with foods is that when you eat foods that are really refined and processed, foods that are high in sugar and refined carbo hydrates, you'll get a spike in your blood sugar. And you'll often get that spike in insulin after you get a spike in blood sugar. Right? So you eat food, your blood sugar goes up, the body makes a lot of insulin.

And that spike in insulin and blood sugar will cause follicular hyperkeratinosis.

Dr. Mark Hyman
Wow, that's a big word.

Dr. Cindy Geyer
I know. Right?

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

Dr. Mark Hyman
And starchy foods.

Dr. Liz Boham
And starchy foods. Right? Anything that's gonna cause that insulin spike. Yeah. You can really see signs of insulin resistance on the skin in so many different ways.

Dr. Mark Hyman
It's like prediabetes. Right? It's like you need to put sugar, your blood sugar goes up, your insulin goes up, and it creates a vicious cycle. We've talked about so much, which is this prediabetes that affects one out of every two Americans.

Dr. Liz Boham
Yes. Right? Right. And their what what so their insulin is higher than than somebody who doesn't have insulin resistance. And that high level of insulin causes a lot of shifts in the skin.

It causes that follicular hyperkeratosis that causes the acne. It can cause more skin tags. It can cause something called acanthosis nigricans, which is this darkening of the skin folds, like in your neck and in your armpit. And so you can, by just examining somebody right away, you can get a sense of do they have insulin resistance or that prediabetes state because it shifts the growth factors, the high inflammation from eating these high sugary foods causes changes in your skin.

Dr. Mark Hyman
Well, know that, know, for example, PCOS, which is polycystic ovarian syndrome, it's a common condition that affects women that causes infertility. We are going talk about that on another podcast. It causes acne.

Dr. Liz Boham
Yes.

Dr. Mark Hyman
It causes really screwed up menstrual cycles and it causes hair growth. And we think of it as a ovarian problem. It's not. It's a mouth problem. It's a fork problem.

It's a dietary problem.

Dr. Liz Boham
Often, yeah.

Dr. Mark Hyman
Right? And so it's caused by insulin resistance and the consequences of that are the acne and all these screw up hormones. So when women have a lot of sugar, it actually can increase their testosterone.

Dr. Liz Boham
Yes.

Dr. Mark Hyman
Which causes acne.

Dr. Liz Boham
Yes.

Dr. Mark Hyman
And it causes hair growth and it causes infertility. So the treatment isn't heavy duty drugs and hormones. It's actually changing your diet.

Dr. Liz Boham
Which is amazing to see. I mean, when we, you know, we know that when we pull away those refined and processed foods and the sugary foods, most of our patients, so many of our patients see great improvement in their acne right away.

Dr. Todd LePine
Right away.

Dr. Liz Boham
Right away.

Dr. Mark Hyman
So so sugar, starch, processed foods, they gotta go. Yeah. And then and then there's another food that is really common in this country and it is a huge driver of acne.

Dr. Liz Boham
Yeah. The dairy.

Dr. Mark Hyman
Yeah. Dairy.

Dr. Liz Boham
Dairy. I mean, because dairy is you know, all of our dairy food, our milk or cheese or ice cream, you know, all of that is very high in hormones.

Dr. Mark Hyman
There's 60 different hormones in milk. And these are not added like growth hormone. These are just naturally occurring hormones. Why? It's a growth food for calves.

Helps the calves grow. Right? So it's got a lot factors that are hormonally active that drive growth.

Dr. Liz Boham
Yes. And we know that those growth factors can stimulate acne in some people. You know, not everybody, but for some people, they're more sensitive to them and they definitely will cause more acne. Actually, I'm I'm

Dr. Mark Hyman
one of them. I'm one of them. I think if I have dairy Yep. I get pimples.

Dr. Cindy Geyer
Yeah.

Dr. Mark Hyman
So if I know I'm going on a TV, I can't eat dairy. I don't usually eat dairy. But I I have sheep or goat, it's a little different. It's not as inflammatory for some reason. But if I have regular dairy, you can count on me getting pimples.

Yeah. And I'm like 60 years old to get pimples from dairy.

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

I mean, we do it often, but there are times when we get a negative test result. But even if we we we still pull it away and people's skin improves.

Dr. Mark Hyman
So this isn't like an an allergy necessarily.

Dr. Liz Boham
Not necessarily. Could be just like you said, all the hormones in dairy too.

Dr. Mark Hyman
But there's another category of things, which are food sensitivities that do drive inflammation and drive leaky gut and can drive acne that are independent. So we've got sugar, we've got dairy, and we've got this other category, which is sort of more sort of amorphous, but it is a factor in a lot of people.

Dr. Liz Boham
Absolutely. Absolutely. So there's so many ways. And I always say this, there's so many ways that somebody can react to food. Right?

You can have and people get confused all the time because they get one negative report and they say, oh, then I must be fine to eat that food. Right? You can get an immediate reaction to food or an IgE. You can get a delayed reaction to food or an IgG, but you can also have a food intolerance. There's just so many ways you can react to food.

Yeah. So just because you have one one negative food test result doesn't necessarily mean that food is not causing you problems.

Dr. Mark Hyman
That's whole other topic, which is how are you know, what are the many ways that we react to food? You know? The 50 ways I love you is like, are the 50 ways you react to food? And it's it's all kinds of stuff from tartrazine and which is a diet that causes asthma, it's an additive or whether it's MSG that can cause an amino acid related cognitive effect or whether it's food or whether it's something like high fructose corn syrup, which people can have fructose intolerance. Or how

Dr. Liz Boham
changes your microbiome and then that changes the inflammation. I mean, this the the you know,

Dr. Mark Hyman
that's Yeah. And by the way, in this age of COVID and coronavirus, it's really clear that that the more sugar we eat, it affects our immune system, but it also affects our microbiome. And our gut health turns out is incredibly important for us to be resistant to the flu through many, many research studies and and likely to coronavirus as well.

Dr. Liz Boham
Absolutely. Absolutely. And, you know, I think that this this first case that we were gonna talk about, this 22 year old who came to see me, it really kind of pulls in the importance of the microbiome in terms of your immune system but also in terms of your skin. Yeah. Right?

She was a 22 year old and she started to develop acne when she was around 12. When we got more history from her, I realized she had had multiple antibiotics as a kid. She had chronic ear infections. And especially when she was getting those ear infections, they were treating most of them with antibiotics. And I think we've kind of calmed down a lot on treating every ear infection with antibiotics, but she got a lot of antibiotics because of her ear infections.

Dr. Mark Hyman
Yeah. Was a family doctor. I remember it's like, give me all that candy, little Yeah. It's like nothing.

Dr. Liz Boham
Right.

Dr. Mark Hyman
Right. I'm like horrified by what I

Dr. Liz Boham
did thirty years ago. So she's, you know, she's she came in to see us because she she was using a lot of different topical treatments. She was also taking a low dose antibiotic. And her skin was better, but she didn't want to stay on these antibiotics. And she wanted to really look at it a different way.

And when she stopped taking the oral antibiotic, which she realized she didn't want to be on forever, her acne started to get worse again. So she said, okay. I really wanna figure out

Dr. Mark Hyman
Which is which is not uncommon. And then doctors say, oh, you need more antibiotics. Right? It's like, that's the that's the vicious cycle.

Dr. Liz Boham
It becomes a vicious cycle. We see these vicious cycles all the time with medications, right? Because they're shifting because there's antibiotics, as we've mentioned, are shifting the microbiome. They're shifting the microbiome in your gut. They're shifting it on your skin.

They're getting rid of that first line of defense. And then they're allowing then it's more common to get the acne again when you stop them. And so just because of her history of all of those antibiotics as a kid and being on the antibiotics and because she sort of she we we got more information. She was having a lot of digestive issues. She was having some bloating, some diarrhea, constipation.

Her digestion was was off.

Dr. Mark Hyman
And her dermatologist never was like, what's going on with your gut? Right?

Dr. Cindy Geyer
No, right.

Dr. Liz Boham
Right. No, he didn't ask that.

Dr. Mark Hyman
Didn't ask

Dr. Liz Boham
that. So because of that, I said, you know what? I really need to focus on the microbiome here for this woman to help improve her acne. And so we did a stool test, which is kind of a neat, it's a neat way to get a sense of what's going on in the microbiome. Yeah.

It looks for real

Dr. Mark Hyman
How is this different than like what a traditional doctor would do with a regular stool test?

Dr. Liz Boham
You know, it just, it looks at a lot of different biomarkers, right? So it's looking at all of your levels of commensal bacteria, like all the good bacteria. And is there an imbalance in the good and bad bacteria? So it does look for acute infections, for real infections as well, but it also is really paying attention to something we call dysbiosis, which is an imbalance in the good and bad bacteria and trying to get a sense of, is there an overgrowth of not good bacteria or not good yeast or it also looks at parasites. It looks at digestion and absorption and inflammatory markers.

Dr. Mark Hyman
Yeah. You look at your your enzymes are working, are you digesting your food or you're absorbing your food?

Dr. Liz Boham
Yep. Is

Dr. Mark Hyman
there inflammation in there? Mhmm. So it's like a like a window into a dark world. And we can learn so much from that through these tests which are really not available through traditional doctors. I mean they could order them if they wanted to but it's just not something we're trained in which is how do we take a deep look in the gut.

We're talking about the microbiome, microbiome but as some future state of medicine will somehow figure out what to do with it. Well we've been doing this for thirty years in functional medicine and now we understand even more than we ever did and we're learning better and better how to actually optimize the microbiome and fix the problems of leaky gut and all these things that happen as a result of like your patient who had all these antibiotics and this crappy diet and developed, you know, overgrowth of bacteria that you found in yeast.

Dr. Liz Boham
Right. So when when the stool test came back, we found that there was this overgrowth of unwanted bacteria and there was an overgrowth of unwanted yeast. And yeah, and so we can do tests like you said on, is there increased intestinal permeability or leaky gut? And she of course had that because of these imbalances and the inflammation going on in her digestive system. Because we know that those imbalances cause inflammation And we know inflammation causes all sorts of things, including acne, right?

So we said, okay, we need to work to fix. We need to work to fix this imbalance. Let's work to rebalance the bacteria in her gut. And so for her, she wanted to use an herbal approach and I agreed with that. So we put her on a combination of a couple different, herbs that can work to get rid of the overgrowth of bacteria

Dr. Mark Hyman
and And

Dr. Liz Boham
that worked really well. The one thing I always say about skin though is you kind of have to be patient sometimes. So if you are pulling away a food like dairy or which we did with her, we took her off a dairy. We took away a lot of added sugar. If you're adding in something to treat the dysbiosis and we also gave her a lot of probiotics too, You got to give it some time for the skin to improve.

You might see some improvement in the inflammatory acne right away, but for the skin to really improve, it takes like six weeks for the skin to turn over. So you want to give it some, we always give it some time to say, okay, how this improving?

Dr. Todd LePine
And

Dr. Liz Boham
we also added in some nutrients that are really important for skin turnover. So we know that zinc and vitamin A are really critical nutrients to help the skin turn over. So you don't get so much of that hyperkeratinosis, that elevated, levels of of, you

Dr. Todd LePine
know,

Dr. Liz Boham
the the skin not turning over, which can cause more acne to develop.

Dr. Mark Hyman
And Accutane is a derivative of vitamin A,

Dr. Cindy Geyer
which

Dr. Mark Hyman
is actually what is used for really bad acne. Yeah. And by using this comprehensive approach we use in functional medicine that we do here at the Ultra Wellness Center, with the deep diagnostics we do and knowing how to optimize function, right, of your skin, of your gut, etcetera. We we can get people better where often they don't get better and and do it in a way that not only improves their skin, but improves their overall health. Right?

So very powerful.

Dr. Liz Boham
We we put her on some some zinc and vitamin a. Now the both of those, you know, I just wanna caution listeners if you're not working with the doctor, you know, both of those you can get too much of and they can cause imbalances in other vitamins and vitamin A is fat soluble. So you have to, if you're gonna use a higher dose You'll go beyond it. Yeah. You know, like I use ten thousand I use per day with her

Dr. Mark Hyman
A vitamin a.

Dr. Liz Boham
A vitamin a.

Dr. Mark Hyman
You don't wanna be on that for, like, a long No.

Dr. Liz Boham
It was we did it for, three months, and then we started to spread it out. And I was monitoring her levels. And the same thing with zinc. You know, you you just have to be a little bit cautious of just taking a lot of this on your own because it can throw off some of your vitamin levels or vitamin A can be toxic at high doses. But it really helped I mean, the whole comprehensive approach really helped her skin improve.

And she was able to stop using both the oral antibiotics as the topical antibiotics. She was able to get off of them. And and and her skin her you know, that that dysbiosis started to rebalance, and she wasn't getting all the acne all

Dr. Mark Hyman
the time. I bet there were a lot of great side effects too. I she lost weight and had more energy and felt better. Right? Absolutely.

Yeah. Instead of the side effects being all bad, they're all good. Let's take sunscreen, for example. This is something, you know, it's summertime, blowing against skin cancer, then putting on a sunscreen in it. Is it, is it okay?

Like, what should we be doing, and how do we figure out what's going on? I mean, a lot of the sunscreens also have compounds that destroy reefs too. There's, like, reef damage to the coral reefs. So not only killing yourself, but you're killing the reefs.

Dr. Cindy Geyer
Right. Well, it there's a lot of the chemical sunscreens like Abobenzone, I believe that know all of the names of them, the chemical sunscreens, and many of those are potential endocrine disrupting chemicals as well. The flip side is, Mark, I'm one of those people who grew up in the South, had more than my share of sunburns, had my first skin cancer when I was 37 so I also want to slow down skin aging and wrinkles and skin cancer. We kind of have to say well how do you get the protection you want without putting yourself at risk. I personally am a real fan of the zinc and titanium the mineral based sunscreens or even just a hat covering your skin staying out of the sun in the middle of the day.

I mean I think there's a lot of other things we can do that are going to be safer for us and safer for the planet. One of my favorite one stop shopping places to learn more about safety levels and which either skincare or sunscreens contain things we do or don't want is the environmental working group and I know you've been a big supporter of their works for years. Think they were some of the pioneers really raising awareness. And what I love about them is they'd have a safe cosmetics database that you can search by type. So you could search sunscreens or you could search by brand, plug in your favorite brands and see how it rates to others on their list.

Dr. Mark Hyman
What about the it's sort of things like the the tick stuff because if people are worried about ticks and deed is really common, which is a terrible toxin. It's used to kill insects, but also it's a neurotoxin that can affect humans. And they, you know, they say not to touch yourself, don't put your mouth, but, like, put in your skin, it goes straight. So tell us tell us a little bit about DEET and and what to do about that.

Dr. Cindy Geyer
Yeah. So that that's another one. I mean, you know, in the Berkshires. Ticks are everywhere. So for those of us who love to be in the woods, you always have to be mindful of enjoying your time in the beautiful woods and hiking without putting yourself at risk for getting a tick borne illness.

So how do we navigate that balance as well? You know for people who are super concerned, I don't know how you feel about this but you know if you tuck your pants into your socks and put a little deed around where they join maybe that's enough. I don't know. I I don't do it. I mean, I hike all the time and, you know, the other nice thing about being in the Berkshires, I can come home, strip on my front porch, sling my gloves on the outside, go in and do my tick tack because I think that's probably the most important thing.

Dr. Mark Hyman
Okay.

Dr. Cindy Geyer
The other interesting piece though is there's there's emerging science based evidence that some essential oils may be almost effective as as d at repelling ticks. There's been some research on lemon eucalyptus oil, on thyme oil, on citronella, so I think that is another reasonable option to try to get some of the tick repellent benefits without causing harm.

Dr. Mark Hyman
Doctor. So those essential oils are basically plant chemicals that are repelled. Right. Doctor. And this sort of moves back to it, know, sort of view of functional medicine, which is that plants are highly intelligent.

They're in fact sentient beings, believe it or not. They have 20 different senses and they do all kinds of smart stuff that we don't really attribute to plants, but they produce these molecules to deter insects from the cells. So and they communicate with other plants. So if there's a caterpillar eating a plant, that plant goes, oh, I'm getting eaten by a caterpillar. I'm gonna produce this molecule.

And by the way, I'm gonna send a message to my neighboring plant friends over there through the mycelium horizon network that you should secrete this chemical too. And so these plants produce all these wonderful chemicals that we use, you know, for our own benefit, but they're really for their benefit. And and and I think the essential oils are great, and there's a lot of natural alternative products out there that that are for insects, for pollen, for skincare, for makeup. The only thing you don't realize is makeup is like lead. You know?

And and a lot of makeup and a lot of lipstick is leaded lipstick thing.

Dr. Cindy Geyer
Yes. Oh my gosh. Oh my gosh.

Dr. Mark Hyman
Those things are really avoidable. Yeah. It's just a matter of education. I think the beautiful thing about it as we move in the right direction, as people start to become conscious, we push those companies by our financial choices, we actually can drive the marketplace into a better set of products. That is really what we need to be doing.

Okay. So it's a big deal to think about what you put on your skin. I remember learning that basically you wouldn't eat it. You shouldn't put it on your skin. And you and I both know that when we were in medical school, that we deliver all kinds of drugs to the skin.

Mean, one of the quickest ways to get someone relieved from chest pain if they came into the emergency room with an engine or, you know, heart disease was to slap a toothpaste tube full of, like, nitroglycerin cream and put a put a bandage over it, and that got away right through the skin. You know, there's hormone patches for women. There's pain patches. There's all sorts of patches that people use because the skin is a vehicle for delivering medicine. So it makes a logical sense to think that we should be aware of what we're putting on our skin in terms of sunblock, insect repellent, makeup, you know, body care products, and yet most of us never give a thought about it.

So tell us, Cindy, why why should we really care? And and I think it's it is, you know, because this is seems to be, like, maybe a trivial issue. But how how big of an issue is this, and and why should we worry, or should we?

Dr. Cindy Geyer
Well, I'm glad you pointed out that we absorb things through the skin. So we think we put it on our skin, it's just gonna stay on the outside, but it can potentially get inside our bodies. And one of the challenges Mark is trying to do good research to actually prove cause and effect when you're looking at some of the carriers or preservatives that are added to the things like the cosmetics that we put on our skin. You know our old model of what happens with toxicity is the dose makes the poison. You know you have to have massive amounts for it to have a negative impact.

But there's so many things that are in our skin care products like phthalates or parabens that have been dubbed endocrine disrupting chemicals. And what that means is even tiny amounts, especially at critical windows, may actually muck up hormonal signaling and have a long lasting impact that's less related to the dose but the cumulative exposure over time. Yeah. And it so so it's hard to tease out. I mean, might be having exposures every day in teeny tiny amounts that don't seem immediately problematic, but down the road when you're struggling with insulin resistance or breast cancer or uterine fibroids or thyroid issues, it could be related to these endocrine disrupting chemicals that have wreaked havoc on our hormone balance.

Dr. Mark Hyman
I mean, see, yeah. So it's like, why why are all these compounds used in these products? I mean, why do we need all these petrochemical endocrine disrupting hormone busting disrupting compounds? Why are they there?

Dr. Cindy Geyer
It's a great question. So parabens typically are added as a preservative to extend the shelf life of your skin creams or your your topical creams

Dr. Mark Hyman
Phthalates. Yeah.

Dr. Cindy Geyer
We'll rinse it. So you can keep it on your shelf for a year or two and it won't smell funny or it won't go bad. And so you don't get bacteria. Mean, of them are trying to keep contaminants out. Phthalates tend to be embedded with fragrances to make things smell pleasing to us, so we'd put them on our bodies.

And those are also endocrine disrupting chemicals. And

Dr. Mark Hyman
and is there a way to measure in the body whether there are these chemicals that are there from these products that people are using?

Dr. Cindy Geyer
That's a great question, Mark. In studies that are trying to tease out how they influence our health, they often look at urinary levels to see how much people are exposed to. It's a little bit challenging however because it turns out that all of us show evidence of exposure to these chemicals so it's a little bit hard to know what to do with measurements other than trying to do it from a scientific standpoint to say do the levels track with health outcomes. In clinical practice I have not done that. Don't know if you found it helpful or not and when I was first looking at it We ended up coming back to the same recommendations anyway.

We need to

Dr. Mark Hyman
Yeah.

Dr. Cindy Geyer
Reduce exposure and find ways to support your body's getting rid of them.

Dr. Mark Hyman
Right. I mean, everybody should cut out toxins from your life, and everybody should do all the things they can to upregulate their biology to detoxify these compounds for sure. Since then, it's really helpful. Like, you know, people just don't know about their exposures. I had one woman who was doing a sunblock for years in her makeup.

We checked her urine super high levels of parabens. I'm like, oh, this isn't good. And other people, you know, have high levels of phthalates because they're drinking plastic water bottles or people have BPA because they're not aware of where it's coming from, which is bisphenol A that comes from credit card receipts or restaurant receipts or, you know, just all kinds of you know, gas station, all that stuff. It's just a lot. It's in plastics bottles.

So I think I think we really can raise awareness by seeing that it's in your system. You know? Right. I think I think I find that often helpful for people to change their behavior too. Like, then you can actually track it and see that it's coming down and see what's happening.

And I think it is a little amorphous because when you look at on an individual level, it's hard to draw the connections in a one to one level of whether this caused the problem or not. If you look at a population wide level, these toxins clearly are linked to all sorts of harmful effects in terms of endocrine disorders, heart disease, cancers, and more. I think it really is important for people to understand what they're doing, what they're putting on their body. Right. The other thing I'd love you to talk about is some of the epigenetic effects of the toxins on the fetus when the mother is exposed to the products that could cause this hormone disruptor chemicals to get in the blood of the baby.

Dr. Cindy Geyer
Yeah, I think that's really important to understand that there are critical windows or critical time frames that it's even more important to reduce exposure and one of those classic time frames is when a woman is pregnant. Even little bits of exposures in utero may affect the fetus and then those impacts persist into adolescence. A study a few years ago, what they did, a lot of the data has to be correlative, but they measured urinary levels of phthalates and parabens in women at two different points in their pregnancy and then when their babies were born they tracked them for nine, ten, eleven years and they found that higher levels of phthalates and parabens in the urine, the daughters of women with those higher levels ended up going into puberty earlier. Which now that does approve cause and effect but sometimes you can't ethically design a study and when we see research like that that it does correlate with endocrine challenges down the road, we have to take that seriously. We have to take that seriously.

There's been some other research linking exposure in utero in particular or early childhood to phthalates and parabens to higher incidence of ADHD like symptoms in adolescents, so even neurodevelopment. Again, a lot of the data is correlative and epidemiologic, but we can't really design a placebo controlled double blinded trial to willingly expose one group of women and not expose another to attract their children for twenty years.

Dr. Mark Hyman
Yeah. I mean, it's it's and, you it's linked to ADD, to neurodevelopmental issues, behavioral issues, later stage symptoms of, you know, obesity, even diabetes, heart disease, cancer, when they're exposed to these compounds in utero, which is kind of striking because I think people don't seriously think about what they're putting on their skin, but it is one of the most important things that you do every single day. Literally, you're doing besides eating, most of us put stuff on our skin every day, whether it's shampoo, whether it's Mhmm. Face cream, whether it's makeup, whether it's sunblock, whether it's insect repellor. Like, these are things that we use a lot of in America.

Unfortunately, they're really problematic. So let's say you go, geez, I've using this stuff for a while. I'm going to switch to all these other products. But what do I do to get rid of these embedded toxins? Because if we did a fat biopsy in every American, it wouldn't be too pretty.

There'd be a lot of these compounds in there that are stored in there. We begin to help get them down. We've done podcasts on detoxification, but we're not talking about like a water fast or some crazy thing. We're talking about you supporting the body's natural built in detox pathways. How do we do that?

You

Dr. Cindy Geyer
know Mark before we jump into that I want to come back to something that you just said about the fat biopsy. I know that urine levels can sometimes be really helpful at motivating people to say, Oh my gosh, need to look at this. But we have to be aware that even if they're not showing up in the urine, if we've had old exposures they do tend to get deposited in fat, and we're not doing fat biopsies on people. I just want to point that out. Don't use an okay looking urine to say okay not a problem for me.

Dr. Mark Hyman
Right, for sure.

Dr. Cindy Geyer
And it's been a concern as well if those are all residing as deposits in fat tissue. If somebody really rapidly loses weight and starts to mobilize all those stored toxins, it could potentially put extra burden on a lot of different processes in the body, so it's just food for thought. And you have and you have done a lot of podcasts on detoxification and it really is coming back to the basics. I mean, how do we get rid of things? We sweat by we break a sweat by going out in the woods or exercising or sitting in a sauna.

Really have to focus on optimal gut function, hot fiber dense diet, a healthy microbiome, and specific foods that support all of our detoxification pathways, we can talk about a few of those. Drinking enough water, I it's really I don't know that there is a super magic for these endocrine disrupting chemicals except it's really important to make sure our detoxifying enzymes have the new chance they need to do their job.

Dr. Mark Hyman
And what are those things that our body needs most of to actually get rid of these toxins?

Dr. Cindy Geyer
Yeah, we need B vitamins, we need magnesium, we need the sulfur containing amino acids that are rich in foods like broccoli, kale, brussels sprouts, garlic, onions, the allium family. Antioxidant rich foods can kind of fill the gap, some of the deeply pigmented fruits and vegetables. A similar theme, I think, that's come up in other areas, but those are some of the foods that are most important. Prebiotic rich foods that can select out a healthy, robust, diverse microbiome that can also, if we have detoxified and mobilized things, can help us get rid of it and clear it out of our system.

Dr. Mark Hyman
No. Was just saying, other other practices that we can do to help our detox system like saunas, exercise, limping Yep. Drainage and infrared saunas, hot and cold therapy, all those things help mobilize toxins from our system. Right. Do you

Dr. Cindy Geyer
have any favorites yourself?

Dr. Mark Hyman
Do I have any favorites? I do have a lot of things that I do to actually mobilize my coxswains every day to make sure that I eat brassicas every day. So last time we had to do a bunch of broccoli rabe for that night with brussels sprouts, lots of garlic and onions. I use a lot of spices in my cooking, and I also make sure I do saunas. I do ice baths.

I sweat. I actually like to sweat a lot. So my exercise is great. Yoga is great for lymphatic drainage. Getting massages is great to mobilize tissue at lymph stores.

So there's a lot of techniques you can use to actually help. Then I take the right supplements. I make sure I take a cocktail because I've had mercury poisoning. I have weak detox enzymes. I take N acetylcysteine.

I take all the methylation vitamins. I take a lot of the things that that that actually help to mobilize these toxins, giving us sulforaphane boosting compounds. Mhmm. I have even used indolendamethane as a way of sort of helping with, you know, some of the effects on hormone metabolism. So I'm sort of pretty fanatic about it because I've been so sick from being toxic that I don't want to be psychic anymore.

But the truth is it's hard. I didn't stop eating fish and I got my mercury levels down years and years ago from like almost 200 to like eight or five.

Dr. Cindy Geyer
Wow.

Dr. Mark Hyman
And I was like, oh, it's been a bunch of years and I've been sort of a little bit lazy about fish. I don't eat tuna. I don't eat swordfish, but occasionally I have a piece of tuna when I go out. Occasionally I'll eat halibut. I never eat swordfish.

Occasionally I'll have, you know, more fish than I would think. And I thought, oh, I'm good. But I just checked my levels and I, again, my level was super high. I have like 37 on a challenge test. Oh

Dr. Cindy Geyer
my gosh.

Dr. Mark Hyman
You know, like I think we're just in such a toxic world and it's hard. It's hard. I mean, last night I made a delicious, you know, Spanish y kind of Greek baked cod with tomato sauce, but like cod is not terrible. It's not the worst, but it's definitely got mercury. I'm just like, what am I doing?

I was like, what are you going to eat? So I've to believe that, you know, rasped, regenerative meat or wild meat is probably the safest protein on the planet. I know it's maybe controversial to say that, but even you've got unless you've got really well grown whole grains and beans that are generally raised and have no glyphosate spray on them and are not genetically altered. Mean, there's like a lot of messy stuff on the plant world. What are the steps you would take initially to treat a patient with rosacea from a functional medicine perspective?

Dr. Todd LePine
You know, again, taking the history is the big one. Know, I always will ask people, what's your ethnic background? A lot of people say, you know, I'm white. It's like, you know, are you Irish, English, German, Jewish, Russian, whatever. Mhmm.

Because the rosacea is typically found 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 have in terms of the history, and then I'll just ask them, you know, what is it you're eating? Are you eating a standard American diet? How much alcohol are you drinking? How much stress do you have, stress also.

Caffeine. Yeah, caffeine can play well.

Dr. Mark Hyman
Spicy foods can

Dr. Todd LePine
trigger that. Yeah, those are all things which can sort of, you know, it's like adding gasoline to the fire because literally rosacea is the skin on fire in the facial area. But doing the testing for essential fatty acids, making sure that they have the right balance of the essential fats in their diet. A lot of people have too much omega-six, which tends to be more pro inflammatory. Lack of the omega-3s.

One of the oils, I don't know if you've used it, that I found it very helpful with patients who have rosacea is borage oil and even primrose oil. They help to dampen down that inflammatory response.

Dr. Mark Hyman
That's a key omega-six that people don't think about much, but it's called gamma linolenic acid, which is very powerful anti inflammatory. It's not like the omega-3s, but it's sort of like the omega-3s, but on the omega-six side.

Dr. Todd LePine
Exactly.

Dr. Mark Hyman
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. Evening primrose oil. So yeah, that's very powerful. Agree.

And I also think that you know when I see these patients I also think about looking for other clues like do they have yeast issues? Have they been in lots of antibiotics? Are they in acid blockers which cause yeast overgrowth? Yeah. Do they have other fungal issues?

They have dandruff. Do they have anal itching? Do they have thrush or a white coating in their tongue? You know, do they have vaginal yeast infections? Do they have other skin markers of yeast like little tinea or other kinds of things?

You'll see often a pattern of other issues around fungal stuff. I'll check for H. Pylori. I'll check again all the tests we did talk about and see what's really going on. And then from the treatment point of view, you start with an elimination diet with an anti inflammatory diet, Exactly.

Dr. Todd LePine
Putting patients on an anti inflammatory elimination diet, 80% of the time, it doesn't matter what they come in with, will actually get Getting them off of the pro inflammatory foods and then putting in foods which are anti inflammatory. Cold water fish, sardines, wild salmon, the essential oils like evening primrose oil help to sort of dampen down that inflammatory response.

Dr. Mark Hyman
Yeah, I agree. I think we don't understand, most of us, how powerful food is as medicine and how it can drive tremendous amounts of inflammation throughout the body. And obviously if it's on your skin it's visible, but there's also invisible inflammation that you're not seeing that's driving all the chronic diseases.

Dr. Todd LePine
And actually you triggered a thought because there's actually a paper that says if you have rosacea you have a higher incidence of Alzheimer's Oh wow. It's not a cosmetic issue, it's actually systemic erosion. It's red

Dr. Mark Hyman
face and a red brain that's on fire.

Dr. Todd LePine
Exactly, yeah. I'm sort of blown away by that.

Dr. Mark Hyman
That's fascinating.

Dr. Todd LePine
Especially in women, it's actually more common in women.

Dr. Mark Hyman
So you advise people the obvious things, cut off alcohol, the caffeine, stay away from the sun, stay away from spicy foods. But you also tell them stay away from gluten, which triggers leaky gut, often dairy. You actually add in all the anti inflammatory foods that are important, all the phytochemicals from plant foods and turmeric and ginger and garlic and rosemary and all these powerful foods that can really help to reduce inflammation. And then we often directly treat the issues that are going on. It could be leaky gut.

So we give them a gut repair program. This could be fungal or bacterial overgrowth. So we'll take care of those with either herbs or antibiotics or any fungals. And you'll see these patients really dramatically improve when they change their diet and they resort their gut. And then sometimes we'll use things like eating primrose oil.

I found that digestive enzymes and hydrochloric acid often are really helpful too.

Dr. Todd LePine
I've been surprised at how many people have what I would call a relative lack of hydrochloric acid in the stomach. I venture to say that the majority of people don't have too much acid, they have not enough acid in the stomach.

Dr. Mark Hyman
Yeah, well that's interesting because the third leading category of drugs are the acid blockers like Prilosec and Prevacid and Pepcid and all these other drugs, these Nexium, Mass Effects. I mean, they're just like out there everywhere. And now they're over the counter and everybody Exactly. I mean, we've talked about this before on the podcast, but when I was in medical school, the drug reps came in because these drugs had just come out and they're like, listen, guys, these guys, these drugs work. They're great.

They will help you with ulcers if they're really bad. You don't want to keep anybody on it for more than six weeks.

Dr. Todd LePine
Right. Those are huge. Was a big red

Dr. Mark Hyman
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

Dr. Todd LePine
deficiency, osteoporosis,

Dr. Mark Hyman
pneumonia, bacterial overgrowth, irritable bowel syndrome. You get rid of your heartburn, you get all these other problems.

Dr. Todd LePine
Yeah. And

Dr. Mark Hyman
then it's one of those drugs. It's so sneaky because it's addictive. Once you get on it, it's hard to get off it because it causes this rebound. When you suppress the stomach acid and you stop the drug, the acid production goes crazy.

Dr. Todd LePine
Exactly.

Dr. Mark Hyman
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.

Dr. Todd LePine
And you bring it you bring up a really good point because a lot of the pharmaceutical medications, especially some of the psychotropics, so the antidepressants are like that too. The PPIs and the antidepressants, when you try to get off of them, get this rebound process. The body tries to get back into balance, and it can be very difficult. You've got to go low and slow when you're trying to taper off the PPIs or taper off antidepressant psychotropic meds. Absolutely.

Dr. Mark Hyman
Amazing. So what cases have you recalled about rosacea that you want to share that gives you a sense

Dr. Todd LePine
of this? Yeah, had a patient who came in and she was an undiagnosed celiac, not just a gluten sensitivity, she was an undiagnosed celiac. She was Irish and she was having a standard American diet. She was self medicating for her heartburn with over the counter acid blocking medications. Had a lot of bloating type symptoms.

Came in and her major complaint was her skin. But she had all these other things, but her big thing was how I look. So people are vain.

Dr. Mark Hyman
It gets people's attention.

Dr. Todd LePine
Exactly, right. Then when I did a dive into her testing, it turned out that she was deficient in her essential fatty acids, especially the gamma linolenic She had lack of stomach acid because of the PPIs. You can actually measure a test, a blood test, as a commercially available test called gastrin. And gastrin levels will go up when you block acid. 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.

And that's sort of like it'll tell you how easy you

Dr. Mark Hyman
can get off of Get off of blockers as a PPI, right?

Dr. Todd LePine
Exactly. And then she also had low vitamin D levels. I mean, we spend a lot of our time clothed and indoors, so we don't get way enough sunshine. That's one of the big things. Low vitamin D, you don't just fix low vitamin D.

This is one of my, I get up on my soapbox all the time here, you don't just fix low vitamin D by taking vitamin D. Vitamin D deficiency is basically a sunshine deficiency. There are certain times when there can be other causes, like you might have fat malabsorption that can cause low vitamin D, or you may have problems with the synthesis because of lack of skin oils, which when you get exposed to the sun. But by and large, low vitamin D levels is related to sunshine deficiency. Low vitamin D is not the problem.

It's a symptom of another problem. And the immune system is also benefited by sunshine exposure, healthy sunshine. I think you said you enjoy going to the tropics now and then, Caribbean, Hawaii, whatever. And we also feel good. This is another thing that I find fascinating is that there is a condition which is called sunshine addiction.

You know these people who are like suntan addicts? Well, turns out that our bodies actually produce endorphins when we are exposed to the sun. So there's a feedback mechanism. That's incredible. Yeah, yeah.

There's a compound that's called pro opiomelanocorticotropin hormone. And what it means is that our bodies give a reward when we're in the sun. So we feel good. We have these feel good molecules, these endorphins that make us want to get the sun.

Dr. Mark Hyman
Oh, that's interesting. That's why I love going in the sun.

Dr. Todd LePine
Exactly. No. And then there are these people who

Dr. Mark Hyman
I always feel so good when I go to the beach in the summer. It just makes me so happy.

Dr. Todd LePine
Exactly. And the interesting is it actually you can get addicted to the sun. 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. Our nature has built in these feedback mechanisms so that it encourages us to do it.

Dr. Mark Hyman
That's incredible.

Dr. Todd LePine
Yeah, isn't that wild?

Dr. Mark Hyman
So what happened with this patient? What did you do for her?

Dr. Todd LePine
Well, I did a lot. 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 Xifaxan, for SIBO.

I actually find that I do just as well using antimicrobial herb preparations. I supported her stomach acid using Betaine HCL. Some patients don't respond to that. They don't tolerate it as well. So sometimes I'll use things like apple cider vinegar.

And then got her fatty acids up, gave her a little bit of borage oil and a combination of that. Then also just told her to get some healthy sunshine. 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. And interestingly, you know, just off topic, but with COVID, there are some really interesting studies that giving high dose vitamin D helps with COVID infections.

Absolutely. And so COVID actually or vitamin D, when it's at high enough levels, actually helps to keep the immune system in balance. Keeps it from getting

Dr. Mark Hyman
over Yeah, controls hundreds of genes of regular immunity and inflammation. It's pretty amazing. It's not really a vitamin. It's more like a hormone.

Dr. Todd LePine
Exactly, exactly. It's like a hormone. And it's also actually acts like a steroid too. It's a cholesterol molecule moiety. And I oftentimes when if I'm going to come down with a cold or flu, I'll up my dose of OUD, especially in the winter.

Absolutely.

Dr. Mark Hyman
It's true. I when I feel like something's coming on and I take like fifty thousand units for three or four days and I never get sick. Yeah, it can. Literally goes away by the next morning.

Dr. Todd LePine
It is. It's pretty powerful.

Dr. Mark Hyman
So Todd, we just covered a lot here and 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. We don't just take it at face value. Pun intended.

But we actually go under the hood and look at what's going on. Exactly. Know, you love this podcast, please share it with someone else you think would enjoy it. You can find me on all social media channels at Doctor Mark Hyman. Please reach out.

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This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic and Function Health where I am chief medical officer. This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services.

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