Integrative Dermatology with Dr. Julie Greenberg: Rational Wellness Podcast 193

Dr. Julie Greenberg discusses an Integrative Approach to Dermatology with Dr. Ben Weitz.

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Podcast Highlights

1:26  Conventional Dermatology approaches skin problems as if they totally separate from the rest of the body, but the functional medicine or naturopathic or integrative approach looks at the whole person. This is why the conventional dermatology world is having so much trouble with chronic dermatological conditions like acne, eczema, psoriasis, and rosacea.  Many patients with eczema will be prescribed a steroid, which reduces the symptoms, but once they stop the steroid, the condition tends to come back and then they go back and get more steroid like hamster on a wheel.  We treat the skin condition from the outside in and merely suppress the symptoms. We need to understand that the skin is a reflection of what’s going on inside the rest of the body.  The source of many skin conditions is coming from the gut and what’s going on inside the body.  If we take a Functional Medicine/Integrative approach, we search for the root causes and treat your skin condition from the inside out. Of course, we can also do some topical treatments to help with the symptoms, while we are treating the underlying causes of the inflammation.

4:43  Eczema.  There is much discussion about the microbiome in the digestive tract, but the skin has its own microbiome. Let’s take eczema, we often see the pathogen, staph aureus present on the skin in large amounts. When it is present in the skin, it is usually also overgrown in the GI tract and it often colonizes the nose, so we have to treat the staph not just on the skin, but also in the GI tract, and in the nose.

6:09  Leaky gut is when the intestinal mucosal layer is damaged and allows large molecules and toxins to enter the body, resulting in immune problems. But leaky gut often results in leaky skin, such as in eczema when we see that early skin barrier disruptions can lead to food allergies and asthma. Babies with skin barrier disruptions are six times more likely to develop food allergies.

9:05  Leaky skin is also a reason why you want to treat the skin topically as well as treating the gut and the other underlying, root causes of skin conditions.  With eczema, we want to keep the skin moisturized to help that skin barrier. Skin pH is very important and the skin needs to be acidic to function properly, which is from 4 to 5.5. In nearly every dermatological disease, the skin barrier has become more alkaline.  Staph aureus thrives at a pH of 7.5. This is similar for other common skin pathogens, like strep bacteria, herpes virus, malassezia, or candida, which all want a more alkaline skin pH.  There are certain supplements like L-histidine that can help with this.

11:10  Coconut oil is often touted as being good for your skin, but while it has potentially beneficial antimicrobial properties and can be beneficial to use it to spot treat skin conditions and can be blended with essential oils to kill off things like staph aureus on the skin or malassezia, coconut oil should not be used as your main moisturizer since it can dry out your skin. It is often said that coconut oil has an alkaline pH, but technically oils do not have a pH because pH is based on water. If you want to make your skin more acidic, the water-based products like aloe vera gel, apple cider vinegar, and hydrosols would be the best to use.

14:10  There is a strong gut skin connection and there is a lot of research that correlates an abnormal, dysbiotic microbiome with specific dermatological conditions, such as eczema, psoriasis, and rosacea. With most patients with skin conditions, they have something wrong with their gut, whether it be overgrowth of certain bacteria or protozoans or candida overgrowth. Rosacea is often associated with SIBO and H. pylori.  Psoriasis is often associated with pseudomonas and with streptococcus overgrowth. Acne is often associated with H. pylori. So is alopecia areata.  With eczema there is often a staph aureus component.  Dr. Greenberg likes to run the GI Map stool test and the Organic Acids Test from Great Plains Lab for patients who can afford them, since they are not covered by insurance.  The OAT test will tell if there is a candida overgrowth, that doesn’t always show up on the stool test and the OAT test can also test for fusarium and aspergillus, which would indicate a bigger mold problem. 

19:56  H. pylori. If H. pylori is found on a stool test, it is controversial whether or not it is considered a normal part of the gut (commensal) or is it pathological and should be treated?  There is also controversy about whether H. pylori is associated with hyper or hypochlorhydria.  We know that H. pylori can be present and cause problems or it can be present and not cause problems.  If you see elevated H. pylori and a bunch of virulence factors, this indicates that it is pathological. If H. pylori is present with no virulence factors but all of the dysbiotic and autoimmune trigger bacteria are high and they are low on elastase and the steatocrit is high, then H. pylori is a problem and needs to be treated.  Dr. Greenberg usually sees hypochlorhydria when she sees H. pylori and low stomach acid tends to foster the growth of staph and strep and prevotella and fusobacteria that are often associated with skin conditions.  So reducing the H. pylori is often helpful, which Dr. Greenberg likes to use Pyloricil by Orthomolecular.  She will use mastic gum and DGL and GlutaShield.

25:23  Eczema.  Eczema is also known as atopic dermatitis, which is extremely common in children.  And eczema is probably more common in adults than often recognized, though not every rash is eczema.  Eczema in children is a Th2 driven pathway, though Th1, Th17, and Th22 are immune pathways that may also be involved in eczema. Eczema is often associated with staph infection and such infants are usually deficient in filaggrin, which is a protein in the skin that is a master regulator of the skin barrier, a natural moisturizer, and it controls the pH of the skin. Filaggrin is composed of several amino acids, including L-glutamine and L-histidine.  If you give 4 gms of L-histidine per day to adults for one to three months, this improves the skin barrier and reduces staph bacteria equal to the effectiveness of a topical steroid.  For Children she will use Clark’s rule for dosing and then only for 2-3 months and then ramp down.  Here is a study showing effectiveness of L-histidine in eczema:  Feeding filaggrin: effects of l-histidine supplementation in atopic dermatitis. 

29:47  Topically, it is important to reacidify the skin, since staph bacteria love an alkaline pH.  Apple cider vinegar diluted 50/50 with warm water applied to the skin is a way to make the skin more acidic. Hydrosols, which are the water based product that results from making essential oils, can also be helpful in acidifying when applied to the skin.  Making sure your skin is kept acidic will not only help with reducing eczema, but our skin will age slower and you will have less wrinkles and dark spots.  Dr. Greenberg recommends using aloe vera gel, rosemary hydrosol, and a serum blend that she makes every day to try to keep the wrinkles away. 

There are a number of foods that can be triggers to eczema, including dairy. If you see an infant with bad eczema and cradle cap, then you most likely have an overgrowth of candida in their gut, because cradle cap is a yeast on the scalp called malassezia.  The malassezia eats our sebum and overgrows. As they produce antibodies against the candida, then there is often cross reactivity with the malassezia yeast.  Drinking milk (cow, goat or any mammalian milk) seems to make these infants worse.  They would do better with plant based formulas, according to Dr. Greenberg.

35:40  Low vitamin D is a risk factor for eczema and Dr. Greenberg said that she will add vitamin D for nearly every patient, except for those with rosacea, who have an antimicrobial peptide on their skin called cathelicidin, which gets exacerbated by vitamin D.

36:32  There is a topical vitamin B12 pink cream that you can get compounded in the pharmacy that helps a bit with inflammation that is fairly popular, but this is really a symptomatic treatment and Dr. Greenberg doesn’t use it that much.

37:26  Psoriasis.  We used to think of psoriasis as mostly a Th1 mediated inflammatory disease, but then we discovered Th17 and Th22 as other pathways tied in with mucosal inflammation.  There’s an herb scutellaria baicalensis, which is Chinese skullcap. Research study after research study, it has been shown to decrease Th17 and IL-17 and increase Treg and IL-10.  Psoriasis is an inflammatory system condition that is a response to a massive overgrowth of bacteria, like strep. Pseudomonas can also be a driver for psoriasis. When the psoriatic plaques are tested, we find DNA of gut microbial origin. There is often a compromised skin barrier. On top of the primary infection, such as of strep, there is often also a secondary infection with staph or malassezia or candida yeast. With psoriasis we have to treat the strep in the tonsils and the gut as well as the skin.  For older kids and adults she will use nasal sprays, including colloidal silver, propolis, a saline spray with an essential oil blend. Dr. Greenberg’s go to product is an ACS nasal spray with colloidal silver with echinacea and some herbs. For the strep she likes the Biocidin throat spray.  Bile can also be helpful, so Dr. Greenberg will often use a digestive enzyme formula that included hydrochloric acid and ox bile, like DuoZyme by Karuna or Panplex 2 by Integrative Therapeutics. Herbal bitters can also be used, esp. in kids, who can’t swallow capsules.  There is a topical vitamin D that some practitioners use for psoriasis, but Dr. Greenberg feels that it is not addressing the root cause.  Psoriatic skin pH is alkaline, so using topicals to acidify the skin is beneficial, so she will recommend topical emollients made with indigo naturalis, which is an herb that has been studied with psoriasis and it has been shown to decrease IL-17.  However, this product will have a blue color, so it can stain clothes and sheets.

49:34  Dr. Greenberg does not like skin creams that combine oils with water based products mixed together, since they require a chemical called an emulsifier such as parabens or other endocrine disruptors and a preservative. Plus, a lot of oils in lotions are mineral-based or petroleum-based, which are not good for the skin either.  It is much healthier to have the oil and the water based products in separate bottles and apply these products on the skin separately without emulsifiers and preservatives. 



Dr. Julie Greenberg is a Naturopathic Doctor who specializes in Integrative Dermatology. She is the founder of the Center for Integrative Dermatology in Santa Monica, California, a holistic clinic that approaches skin problems by finding and treating the root cause. Dr. Greenberg holds degrees from Northwestern University, Stanford University, and Bastyr University. She lectures at naturopathic medical schools and speaks at conferences across the US on dermatology. Her website is IntegrativeDermatologyCenter.com.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com.


Podcast Transcript

Dr. Weitz:                            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.  Hello, Rational Wellness Podcasters. Thank you so much for joining me again.

Today, we have a fascinating topic, which is integrative dermatology with Dr. Julie Greenberg. We’ll look at a general approach for a naturopathic or integrative approach to dermatology, and we’ll also dial down a little bit on two of the more common and troubling conditions, which are eczema and psoriasis. Dr. Julie Greenberg is a licensed naturopathic doctor who specializes in integrative dermatology.   She’s the founder for the Center for Integrative Dermatology, a holistic clinic that approaches skin problems by finding and treating the root cause. Dr. Greenberg holds degrees from Northwestern University, Stanford, and Bastyr University. Dr. Greenberg, thank you so much for joining us today.

Dr. Greenberg:                 Thanks, Ben. I’m happy to be here.

Dr. Weitz:                         Absolutely. Conventional dermatology approaches skin problems as if they are totally separate from the rest of the body, but the functional medicine or naturopathic or integrative approach looks at the whole person. Can you talk about how your integrative naturopathic approach is different?

Dr. Greenberg:                 Yeah. I think it’s the main point of why we’re having so much trouble in the conventional dermatological world with these chronic dermatological conditions. If you have something acute, if you have a staph infection, you can go to a dermatologist, get a prescription for antibiotics, and the staph infection like an impetigo will be cleaned up right away. But if you have something like eczema or psoriasis or acne, these long-term, rosacea, chronic skin diseases, I think patients and practitioners know that a lot of people experience kind of a hamster wheel where they go in, they get maybe like a steroid for eczema.   The eczema goes down. Then they stop the steroid. The eczema comes back. They have to go back, get more steroid, and you kind of get on this hamster wheel where you have to use more and more topical things and then they’re not working. The reason is because a lot of what we’ve done conventionally is to approach the skin like, oh, it’s happening on the skin, so we’re going to do it from the outside in, and we’re just going to suppress symptoms.

                                                But in the functional medicine and the naturopathic medicine world, we know the patient sitting in front of you is one human, one body, all systems are connected, mind, body, and spirit, and everything affects the other. When it comes to these chronic dermatological conditions, there are so much evidence now that the inflammation that’s happening that’s causing the things to appear on the skin, they’re not happening topically at the skin. I mean, we see them, that’s where the end game is, but the source is actually coming from inside, much of it from the gut.   Therefore, we are not going to successful treat patients and get to the root cause just by coming at it from the outside in and trying to suppress symptoms. We have to take this functional medicine, naturopathic medicine, whole person approach and connect the systems and address it at every level.

Dr. Weitz:                         The skin is really a reflection of what’s going on inside the rest of the body.

Dr. Greenberg:                 Absolutely, and that’s what I tell patients. I think a lot of patients feel that their body has turned on them, like, why is this happening? Why do I have acne or rosacea? Why is my body doing this to me? I try to reframe it for them like, look, your body is always on your side. It’s always trying to do the best for you that it can. And when we see these kinds of skin presentations, whether it’s in an infant having just terrible eczema, I’ve seen 90% of babies covered in crusting bloody lesions or adults who have this chronic nodulous cystic acne, it’s not because your body has turned on you, it’s that it is telling you that it has a problem inside it cannot resolve, and it needs help.  And we’re going to get in there and help it. And that’s all it is, it’s just a signal to your body, to yourself like, we got big problems inside, and we can’t handle it. And that’s why this is happening.

Dr. Weitz:                         Right. And interestingly, most people don’t realize this. They know about the microbiome inside the digestive tract, but the skin has its own microbiome and that’s so important to the health of the skin. We might even consider the skin a part of the digestive system.

Dr. Greenberg:                 Yeah. I mean, for me, again, taking this everything is connected, depending on the disease, like let’s take eczema, I’m thinking about the pathogen staph aureus. It’s always basically present in eczema on the skin in too large of amounts. It’s not an infection like we would see in like an abscess or impetigo, but it’s an over colonization. It’s causing problems on the skin. It also colonizes the nose. And usually when we got tested, it’s overgrown in the GI tract. Again, there’s this concept that we can’t just pay attention to one thing.  The skin microbiome is critical, of course, to what’s happening on the skin, but we have to treat the nasal colonization or the staph will keep coming back, and we have to treat the gut colonization because if you have leaky gut, then leeching staph aureus into the bloodstream as well. It’s critical. The skin microbiome, the oral microbiome, and the gut microbiome are distinctly different. They look very different, but they are all absolutely interrelated and absolutely when it comes to dermatological disease.

Dr. Weitz:                         You mentioned leaky gut. Most of us who deal with patients with gut problems and people who do have chronic gut problems I’m sure have heard this term a lot is that leaky gut is often common at the intestinal mucosal barrier is broken down, allowing toxins and large proteins to get in, which cause immune problems, et cetera. But often people who have leaky gut often have damage to the barrier in the skin. Leaky gut often results in leaky skin.

Dr. Greenberg:                 Yeah, we see both. Anytime the skin barrier gets compromised, you’re going to get leaky skin. There’s an interesting aspect of leaky skin as it pertains to eczema, because we know that for infants and babies that early skin barrier disruptions can lead to food allergies and asthma. The same idea that we have like… I think most of your listeners know what leaky gut and that things are leaking through the intestinal lining, getting into the bloodstream and causing an immune response. The same thing can happen topically with leaky skin.  And it’s actually quite dangerous in infants because their immune system is learning what in the environment is okay and what is not. And if their first introduction to like a pollen or a food protein comes through the skin, that’s an inappropriate presentation to their immune system and they can get primed in a way that’s not good, and it can lead to food allergies and asthma. We know this not just statistically, like because babies with skin barrier disruptions are six times more likely to develop food allergies. I do mean allergies, IgE, not just IgG, IgA.

                                                But they’ve done studies in mice where they’ve actually first created eczema on the backs of mice. These mice had no problem with eggs before, no antibodies. They then taped gauze filled with ovalbumin or egg white protein in cycles to their backs, and they created IgE and IgG antibodies and full blown egg allergies in these mice where they never had them before. We know what happens because of the numbers, but they can actually be created in the lab. You give the mouse eczema and then you can induce a full blown food allergy.  The leaky skin is a huge issue. And it’s something, particularly in my eczema babies, I talk to parents about we really want to try to clean up the skin barrier as quickly as possible. Because for them, it’s a whole different issue than somebody who’s an adult who has skin barrier disruptions.

Dr. Weitz:                         Of course, it’s also a reason why you want to use some topical treatment to treat the skin, as well as treating the inside underlying root causes of the skin condition.

Dr. Greenberg:                 Yeah, absolutely. I mean, we know with eczema, we want to keep the skin moisturized. We want to try to help that barrier. I focus a lot on skin pH.  I think we know the stomach is supposed to be very acidic. The blood is very tightly regulated at 7.4. If the blood pH gets much off of 7.4, we can die. But people don’t realize that the skin has its own pH that’s absolutely critical.  I ask every patient… Now that I’m doing telemedicine, we do a screen share and there’s a slide on pH.   We go through the scale, what’s acidic, what’s alkaline, and I have them just guess, where do you think the skin pH to be? And I think just to feel safe, most of my patients guess seven, like neutral, water, blood, which is a reasonable guess. But the truth is, it’s acidic. The skin needs to be acidic to function properly, which is about anywhere from 4 to 5, 5.5. I definitely do things to help bring that skin pH back down again to protect it. Because we know that in basically every dermatological disease, the skin barrier has become more alkaline.   It’s not at four to five. It’s up higher at six or seven. And that leads you susceptible to pathogens. Staph aureus, for example, it wants 7.5. But if you name any pathogen, whether it’s like a herpes virus, malassezia, or candida yeast or bacteria, all of those pathogens want a more alkaline skin environment so that it can thrive and so that our natural defenses can’t attack it.  If we can do things topically to pull that skin pH back down and internally, there are supplements I use like L-histidine to do that, we can definitely improve the skin barrier and start to see improvements on whatever the skin disease is.

Dr. Weitz:                            Yeah, I find that interesting. Same thing for the importance of hydrochloric acid to help keep the bacteria from overgrowing in the small intestine. I think there’s been this over emphasis in health enthusiasts about having an alkaline system, about being acidic is bad, being acidic causes disease, causes cancer, causes all this stuff, so the answer is to drink alkaline water and to eat this alkaline diet. There’s a lot of problems with that, and especially when it comes to the skin, trying to alkalinize your skin. I talked to Jennifer Fugo about… She’s a big opponent to using coconut oil on the skin, which a lot of people feel is good, but it’s very alkalinizing, and so it ruins the acidic pH of the skin.

Dr. Greenberg:                 Jen and I have had discussions about coconut oil. I know she’s not a fan. I’m not a fan of people using stripped coconut oil day after day as their moisturizer, because it can dry out the skin. I mean, the things that I do to make the skin more acidic, they’re more of the water-based products, things like aloe vera gel, apple cider vinegar, hydrosols. All the water-based products have this acidic pH. Technically an oil doesn’t have a pH, because the pH scale is based on water and stripped oils don’t have it.  It gets a little more complicated when we’re talking about something like coconut oil. I use coconut oil to spot treat topical skin problems, but I only use it to spot treat, and I only use it when we do essential oil blends to kill off things like staph aureus on the skin or malassezia or something like that. I do think it gets overused, and I don’t like people to use it as a general moisturizer.

Dr. Weitz:                         But for therapeutic purposes, coconut oil has this antimicrobial benefit, right?

Dr. Greenberg:                 It does, and there’s plenty of studies that show that use of coconut oil versus let’s say mineral oil or even olive oil in eczema patients, it’s a lot more effective at lowering staph. I do think there is a time and a place for coconut oil, but it’s not kind of the panacea that sometimes… If you look at YouTube, it’s like you can use coconut oil for everything. You can use it for a lot, but I wouldn’t it as your main moisturizer.

Dr. Weitz:                         It’s funny how Google was kind of the bane of our existence for a while. Everybody is saying, “Oh, I just Googled it.” And now everybody is coming in saying, “Oh, I just watched the YouTube video.” We’re having that with chiropractic. “Aren’t you going to do that adjustment? What about the one where you pull the towel and pull on my head? I saw that on YouTube. That fixed everything.” It’s kind of interesting.  In terms of dermatological conditions, we were talking a little bit about the gut bacteria, and I know that you find it super important to look at the gut as a way to analyze what’s going on underneath. Why is gut health so important?  And then what test do you like to do to analyze gut health for patients with skin conditions?

Dr. Greenberg:                 For me, it really is critical to look at the gut so that I can get to the root cause of what’s driving the skin disease. There is a lot of research out there. It’s not pulled together into a cohesive body. But once you start going looking for it, you can do research for each different type of dermatological disease like eczema, psoriasis, rosacea, on and on. And you will find studies and research that show that the gut of patients with chronic dermatological disease is not the same as normal healthy controls. They have too little good gut bacteria, too much bad bacteria.  Often they have candida overgrowth or other problems like protozoa. I think as integrative practitioners, it actually makes sense. 80% of our immune system is coming from the gut. And obviously when it’s disrupted, we get all sorts of problems. It can lead to diabetes. It can lead to heart problems. Just the inflammation through the system is going to cause problems. Now, specifically why certain people are going to get psoriasis versus rosacea, we haven’t really untangled that. We know that there are some element of genetic components to that.   But the important thing is I know when my patient is sitting in front of me, something is wrong with their gut, even with acne. It doesn’t matter what they’re presenting with. Something is wrong with the gut. I need to get in there and try to figure out what it is. For different conditions, I kind of have different suspects at the top of mind. For rosacea, for example, there’s a lot of research that shoes SIBO and H. pylori are at play. Now, that’s now 100%, so I still have to go test them and figure out what exactly is going wrong.

                                                I have two tests that I like to run on every patient who can afford it, because of course, unfortunately, they usually aren’t covered by insurance. One is the stool test. I want to look at what is in the colon, what are the strains of good bacteria, what are the strains of bad bacteria, how many of each, where is the problem. Is it an enormous pseudomonas overgrowth? I see a lot of psoriasis and psoriatic related diseases, there’s a lot of pseudomonas overgrowth that tends to trigger it. It’s high in LPS or endotoxins. With acne, there’s a lot of correlation to H. pylori.  With eczema, of course, there’s a big staph aureus component. With psoriasis, there’s a big strep component. Strep is the number one environmental trigger that we know that can cause psoriasis. I use the stool test and also for their digestive health. To your point, the stool test I use has H. pylori. I have to know what’s the H. pylori situation in their stomach and is their stomach acidic enough.   Because if it’s not acidic enough, then I’m going to see overgrowth of all the commensals, overgrowth of all the dysbiotic and autoimmune ones, and I have to treat the H. pylori since it’s at the top of the stream. If I just go in and treat the overgrowth, but I haven’t corrected the H. pylori and stomach acid problem, we’re going to have this problem and this discussion in a month, and we’re going to keep having it. That’s really critical. And then the other test that I like is an OAT or an organic acids test, which is a urine test.  That one I use because the stool test don’t always pick up candida, because candida tends to overgrow in the small intestine. There’s plenty of times when it won’t come out in the stool test, but it does come out on the OAT. And also the OAT that I use test for fusarium and aspergillus. I need to know not only is there a yeast or a candida problem, is there a bigger mold problem, and then that might lead us to look at mycotoxins.

Dr. Weitz:                         Which OAT test do you like?

Dr. Greenberg:                 I personally like Great Plains OAT and I use the GI-MAP, which I know you’ve had them on. I work with them. That’s the stool test that I prefer. It’s the one that I just find most actionable. Together, I love both of those tests. Once I get those labs back, it’s like suddenly this curtain opens and everything is revealed and I see why exactly what’s happening on their skin is happening. We just go in and we start to address the things one by one, because it’s usually multiple things happening.  Certain diseases like once we get to alopecia areata and we’re attacking hair follicles and it’s full blown autoimmune, I usually see that there is a huge amount of gut dysbiosis that needs to be addressed and usually also a toxic element that needs to be addressed. But I can always start with those two gut tests and start to see great improvement usually within the first month. We come back for our visit and it’s like, yeah, things are definitely getting better. Much better. Baby is sleeping through the night. The rash is gone X percent.  Sometimes it’s just gone, but I have to tell them, we still have to treat all the stuff or it’s going to come back. Patients are usually just thrilled with it. They finally have answers. They finally are getting solutions, and they’re off of this kind of hamster wheel of convention medicine where it’s like, well, I didn’t know what else to use on my baby besides steroids, so that’s what we were using. But I knew it wasn’t right and that’s why I was looking for something else. It’s really fulfilling.

Dr. Weitz:                         You mentioned H. pylori. I know I probably should stay on topic and not jump down a rabbit hole, but I love rabbit holes. Recently I’ve had a number of discussions with different practitioners and there’s a lot of controversy about H. pylori. Should we even treat H. pylori? H. pylori is a commensal. I know Dr. Steven Sandberg-Lewis said for the most part, you usually don’t want to treat H. pylori. It’s a commensal. Other gut experts have said absolutely, it’s crucial. Some people feel that only if there’s certain virulence factor should the H. pylori really be treated.  There’s controversy about whether H. pylori is associated with hyper or hypochlorhydria.  I don’t want to spend too much time on it, but maybe you could just give your take on H. pylori.

Dr. Greenberg:                 Yeah, no, it’s a good point, and I have that issue with H. pylori and then with some of the protozoa, right?

Dr. Weitz:                         Yes. Yes. Right. That whole discussion.

Dr. Greenberg:                 I know. It’s kind of a similar issue, but I’ll stick with the H. pylori for now. Yeah, for me, it definitely depends. I don’t think we fully unraveled the H. pylori story. We know that it can be present and not cause problems and it can cause problems. For me, that’s part of why I’m looking at the stool test in whole. I want to see how much H. pylori is present. I want to see if there’s virulence factors. And then as I start to look down the stool test, that’s where I start to see, is there overgrowth of the normal bacteria? Is there overgrowth of the dysbiotic and potential autoimmune bacteria?

                                                Let’s say I see H. pylori in moderate amounts with no virulence factors, but then the stool test just starts lighting up. All of the normal bacteria are high. All of the dysbiotic and autoimmune are high. Then when I get to the intestinal health section, they’re maybe low on elastase and the steatocrit is high. I know they’re not digesting their food property. Then absolutely for me H. pylori is a problem and I need to treat it.   If the H. pylori is moderately low, the normal is not overgrown, and there’s not a lot of huge overgrowth of the other dysbiotic bacteria and the elastase is good, and they’re digesting their fat, then I probably won’t choose to go after H. Pylori, or I’ll kind of put it in the back of… If I think H. pylori is a problem, it’s one of the first things I go after, because, as we talked about, it’s upstream. But if it’s on the fence and I’m like, well, I’m not entirely sure, I might start with other things. And if I’m not getting the response that I need, then I might add like digestive enzymes.   See did that make a difference? Did adding a little hydrochloric acid help things? And then maybe I will go back and go after the H. pylori. But it is definitely on my radar and I don’t think it’s an innocent bystander. In older patients, we know that already the stomach acid is not as acidic. Is it a 74 year old patient with alopecia areata with H. pylori? Now I’m getting more concerned about that H. pylori than I would in a 21 year old.

Dr. Weitz:                         Because you’re thinking one of the issue is H. pylori tends to be associated with hypo, low hydrochloric acid secretion.

Dr. Greenberg:                 Yes.

Dr. Weitz:                         Even though we first learned about H. pylori as a cause of ulcer from hyperchlorhydria.

Dr. Greenberg:                 Yeah, but I have to say that for me, for the derm stuff that I deal with, really almost 100% of the time the H. pylori is causing hypochlorhydria. The stomach acid is too low. I look for specific strains of oral bacteria that are high. Staph and strep, prevotella and fusobacteria are usually coming from skin and oral. And if those are overgrown, I know they’re not dying in the stomach acid. So yeah, for me, it is so rare that I’m concerned with hyperchlorhydria. It’s almost always hypochlorhydria.

Dr. Weitz:                         What’s your favorite strategy for reducing H. pylori?

Dr. Greenberg:                 I like Pyloricil by Ortho Molecular. I’ll use mastic gum and DGL and GlutaShield and stuff like that. That’s how I tend to go after it. I’m licensed in California, Oregon, and Washington. And with our fun naturopathic licensing by state, I have different scope of practice. In Oregon and Washington, I can prescribe just about anything because it’s physician level. But in California, we’re doctor level. I mostly turn to herbals first unless there’s a skin infection and you need an antibiotic or something, but I tend to mostly use herbs to treat the gut dysbiosis in all states.

Dr. Weitz:                         Have you prescribed mastic gum for kids?

Dr. Greenberg:                 Yeah, mastic gum and DGL. Just kind of using Clark’s rule. They’re pretty safe. It’s helpful. Usually they taste pretty good, and so they’ll take it.

Dr. Weitz:                         Oh really? The mastic gum?

Dr. Greenberg:                 The DGL. Not the mastic gum, but the DGL.

Dr. Weitz:                         Oh okay. The mastic gum has a nasty smell too.

Dr. Greenberg:                 Yeah. I mean, there’s other stuff I use. I use butyric acid on kids, which smells kind of poopy too. A lot of the stuff I feel like you have to hide in other things.

Dr. Weitz:                         Right. Okay. Let’s drill down a little bit on eczema, which we’ve just been talking about kids. And eczema is also known as atopic dermatitis. This is extremely common in children. I have a feeling it maybe more common in adults than commonly recognized.

Dr. Greenberg:                 It’s a little hard in adults. I think a rash is like… Whenever we see a rash, we call it eczema, right? In my mind, there’s like the infant eczema that’s true eczema, that’s this Th2 driven pathway. There’s other immune pathways in eczema that we know like Th1, Th17, Th22, but it’s a heavy Th2 driven pathway. When an adult comes to me and they’re now having rashes for the first time, for me, that’s not eczema. Usually that’s being driven by something else. It can be yeast overgrowth or bacterial overgrowth, but it’s not classic eczema as I think about it.   It’s more of a dermatitis. But in the kids and the babies who come to me, that’s eczema.

Dr. Weitz:                         You mentioned that it’s often associated with staph infection.

Dr. Greenberg:                 Yeah. And I think infection confuses people. It is an infection, but it’s easier for people to understand if we say colonization. The staph will get on the skin. What happens in a lot of these babies is they’re deficient in something called filaggrin. Now, I feel like most of us as doctors haven’t heard of filaggrin, but it’s really important. It’s a protein in the skin and we call it the master regulator of the skin barrier. Filaggrin is something that we use then to create a natural moisturizing factor. We breakdown the filaggrin into its amino acids.  It’s very high in L-glutamine and L-histidine, and then we create acids out of it, and we build natural moisturizing factor. That natural moisturizing factor controls the pH of our skin, which we talked about is so critical. It really is the critical thing to whether or not you have healthy skin, because it keeps the moisture in. If you dry out the stratum corneum, like 20 to 30% of it should be natural moisturizing factor. This is a big deal in the skin.

                                                And a lot of kids have filaggrin gene mutations where they’re not just producing enough filaggrin, and therefore not producing enough natural moisturizing factor. That’s something that needs to be addressed, especially in kind of the early days for them, to try to help them with the skin barrier. The interesting thing is I think we think of skin barrier, well, let’s put something on it, which is true. We know that putting emollients and moisturizers on babies with eczema is helpful.   But there is a very interesting amino acid called L-histidine, which filaggrin used to be called histidine-rich protein, because it was so abundant in it. There’s good evidence, there’s this good study on humans that show that dosing four grams a day in adults for one to three months really improved their skin barrier. They had reductions in their eczema about 30%. The effect was the same as about a mid-potency topical steroid, but with no negative side effects. I use L-histidine widely in everybody from my infant to my adult patients.   Because the nasty thing about staph is there’s 11 different ways that we know of that it attacks the skin and creates just a horrible situation for the person, but a great situation for staph. It is able to more easily kill filaggrin-deficient cells. We need to build up that filaggrin in anybody who’s got staph colonization on their skin and that protects them from the inside out. And then, of course, we’re also doing things topically to address the staph overgrowth. And nasally, as I said. We have to address the colonization in the nose or it just keeps coming back.

Dr. Weitz:                         Give us some specific treatments for staph.

Dr. Greenberg:                 For adults, I use the four grams a day of L-histidine. And then for infants or smaller people, I use Clark’s dosing. I usually keep them on a full dose for like two to three months and then I start to ramp down. Because we don’t have any long-term studies of L-histidine, so I don’t keep them on long-term. Topically, I use lots of things to get that acidic pH. Staph aureus hates acidic pH. It wants 7.5. If the skin can tolerate it, apple cider vinegar diluted 50/50 with water or hydrosol is great. Now, at the beginning, that might be very stingy to really compromised skin.  Hydrosols are wonderful. Hydrosols are gentle, yet powerful, and they’re acidic.

Dr. Weitz:                         What is a hydrosol?

Dr. Greenberg:                 I feel like everyone knows what an essential oil, and they’ve taken over. It worries me that people create their own essential oil stuff at home, which is actually quite dangerous because essential oils are very potent things. Hydrosol is a part of the process of making an essential oil. Let’s say we wanted to make rosemary essential oil. You’re going to take hundreds of pounds of plant material of the rosemary. You’re going to put it in like a copper distiller with water. You heat it up and boil that plant material with the water, and then it’s going to evaporate and cool in a secondary receptacle.   Water evaporates and the volatile oils evaporate. What we collect in the second unit on the top, “the floating top” oily layer, is the essential oil and underneath it is water. And that is the hydrosol. They siphon this top floating layer, and they put it into essential oil bottles. But that water that gets left behind is really a beautiful substance. It’s infused with a lot of the plant properties, so the microbial aspects. I love rosemary hydrosol. It’s got good antibacterial and antifungal action, but it’s very gentle, so you can use it on infants.  You can use it on pets. Essential oils are toxic to cats, so you can kill your cat using essential oils. I don’t like using them on infants, because they’re just too concentrated and we absorb them into our skin. It’s a lot for a baby, but hydrosols are totally safe.

Dr. Weitz:                         That would be a great name for the podcast, how not to kill your cat.

Dr. Greenberg:                 Right. People don’t know. It’s like, oh, essential oils, we’re going to diffuse them day and night and close the windows and the doors. Honestly, if your cat is in there, they can’t detoxify it, and it’s toxic to them. Essential oils is a whole different podcast on how to use them responsibly, but I don’t like to use them on infants and babies if I can help it. And I use hydrosols every day as part of a beauty regimen. Because not only is acidic skin healthy skin in terms of not having eczema, but our skin will age slower. You will have less wrinkles and dark spots if you keep your skin acidic.  I use aloe vera gel, rosemary hydrosol, and then a serum blend that I make every day to try to keep the wrinkles away.

Dr. Weitz:                         Cool. I noticed from reading some of your literature that eating dairy is often a trigger for eczema.

Dr. Greenberg:                 Yeah, there’s lots of different foods that tend to make eczema flare. The problem a lot comes from infants who maybe can’t be breastfed, or they’re being supplemented with cow and goat’s milk. In infants who have bad eczema and cradle cap, once I see cradle cap, then I know that they’ve pretty much got an overgrowth of candida in their gut, because cradle cap is a yeast on the scalp called malassezia. We all have malassezia. It’s a commensal again. But what happens with cradle cap or even dandruff in adults is we have this malassezia on our scalp.  It’s eating our sebum. We think in some level it probably starts to overgrow. But what really goes wrong is instead of looking at it as a commensal, which the body should be doing, suddenly the body is producing an inflammatory response to it. I see clinically and in my test they always have candida overgrowth. I think that internally they’re starting to produce antibodies against the candida, which is a yeast, and then the body I think misfires and sees the malassezia yeast and thinks, oh, well, wait, we’ve got this problem with candida yeast in the gut, and we’re producing antibodies to that.  And this malassezia yeast looks a lot like it, so let’s attack it too, and you get that inflammatory cradle cap. Every time when these babies are on cow or goat’s milk, there’s something about it with the candida overgrowth. Usually we take the cow and goat’s milk away and their skin gets dramatically improved. Sometimes, I don’t know why the parents fight me on it, we have to find other plant-based formulas. It’s hard, but they’re out there.

                                         These kids don’t do well with cow and goat milk, and I just have to talk to the parents and say, “Your baby is not a baby cow. It’s not a baby goat. I know you want to give them milk from a mammal, but it’s just not working.” Every time we pull that other mammalian milk source, usually the skin gets better. Not for human milk, but the other milk sources. And then you get the negotiation, “How about camel’s milk? How about donkey milk?” No. All mammalian milk is out. Unless it’s you, unless it’s human, we have to cut it out. Every time it gets better.

Dr. Weitz:                         You ever do testing for milk allergies or milk sensitivities?

Dr. Greenberg:                 I don’t, because I don’t want to stick an infant. The easiest thing is just to pull it and see if it gets better. There’s plenty of supplements for formulas that we can use to get them through that stage where they still need milk. Yeah, I just don’t like sticking babies, so generally not.

Dr. Weitz:                         I understand low vitamin D is a risk factor for eczema, as it is for almost everything.

Dr. Greenberg:                 I think D is one of those things where we see the test and the D is low, is associated to be low with the conditions, but then we can’t always show that supplementing improves the conditions. But I still think giving D is like giving probiotics. I think it’s one of those things that can’t hurt. I will say, the only condition where I don’t supplement with D is rosacea, because rosacea, there’s something happening with an antimicrobial peptide on the skin called cathelicidin, and we know that it actually gets exacerbated by vitamin D.   That’s the one condition where I don’t supplement with D, but everybody else, I feel pretty good supplementing with D because we’re all deficient. It might help and it’s not going to hurt.

Dr. Weitz:                         I understand there’s a number of topicals for eczema as there is for many of these conditions, and one of them topical B12.

Dr. Greenberg:                 Dr. Peter Leo is an integrative dermatologist and he talks a lot about pink cream. The B12 is kind of antiinflammatory. It comes in as a red or pink powder. If you’re using that ointment, it is going to pink. You can get compounded in the pharmacy. It helps a little bit with inflammation. It’s not one that I tend to use just because again… It’s more symptomatic. It’s not that the person is deficient in B12 on the skin, but it certainly can help with the eczema.   So I’m going at things from a different perspective, but it is popular and it does help improve the skin topically. It seems to be antiinflammatory.

Dr. Weitz:                         Let’s touch on psoriasis a little bit. How has thinking on psoriasis changed, as well as treatments? I know we think of psoriasis as a systemic autoimmune condition.

Dr. Greenberg:                 That’s one of the changes. I mean, we really used to think of psoriasis as, oh, look at what’s happening on the skin. That’s a dermatological disease. This person has a skin disease. And then over the past few decades, it’s really evolved into understanding… And we used to think it was mostly a Th1 mediated inflammatory disease. Then we discovered Th17 and Th22 as another pathway that’s highly tied in with mucosal inflammation. So now we know that psoriasis is a heavily Th17 mediated disease with a dash of Th22 and Th1. There’s a lot going on.

Dr. Weitz:                            What does that really mean though? How that does help us?

Dr. Greenberg:                 It helps the pharmaceutical industry because they’re going for suppressive effects, right? Everything now in the psoriatic is an anti, an anti-IL-17, an anti-IL-23. Those are functions of Th17. For us as functional medicine docs…

Dr. Weitz:                            Blocking agents.

Dr. Greenberg:                 Right, although I will say that I do do research and use certain herbs. There’s an herb scutellaria baicalensis, which is Chinese skullcap. Research study after research study, it has been shown to decrease Th17 and IL-17 and increase Treg and IL-10. There is away that we can use that information herbally.

Dr. Weitz:                            Also, something helpful to reduce cytokine storm.

Dr. Greenberg:                 Right, exactly. Psoriasis, as we know, it is an inflammatory systemic problem. We call it an autoimmune disease, but the interesting thing is we haven’t found what that piece is. The more research I do on it, the more I actually am not sure that it is autoimmune. Not in the same way of like Hashimoto thyroiditis where we can test for antibodies against thyroid. We have never found that for psoriasis. And the more research I do and the more I treat psoriasis, I really think it’s just a response to massive overgrowth of a lot bacteria.   Earlier I talked about strep. Strep is a huge, huge trigger for psoriasis. I see other kind of similarities, like pseudomonas seems to be a big driver of it. But it’s just massive gut dysbiosis, massive leaky gut. It gets into the bloodstream. It gets into the skin plaques. When we test the plaques, we find DNA of gut microbial origin. We find all of these connections to what is happening in the gut. It gets into the bloodstream, and it lodges in the skin. There is a genetic component to psoriasis.

                                                And again, why somebody is getting psoriasis as opposed to another disease, we don’t fully have the answer for that, but it’s massive gut dysbiosis. And once we start to clean that up, then it really starts to resolve. With psoriasis, again, we talk about compromised skin barrier. I’m always thinking about secondary skin infection, so a lot of times there is a secondary staph aureus infection on top of psoriasis, and there can also be malassezia or candida yeast infections on the psoriasis.   We definitely want to treat those as well if that’s a factor, because the psoriasis is only going to get so much better while it’s still got a colonization and an overgrowth of pathogens on the skin.

Dr. Weitz:                            I think I read in one of those courses that strep is often associated with psoriasis as well.

Dr. Greenberg:                 Yeah. It’s the number one most associated environmental trigger. We know that people who have a case of strep throat, that can trigger an outbreak of particularly a guttate psoriasis.

Dr. Weitz:                            What is guttate psoriasis?

Dr. Greenberg:                 There’s different types of psoriasis. The most common and the one that’s most well-known is plaque psoriasis, and those are the big pouches that you would see typically on the outside of the elbows or the knees. Guttate psoriasis are kind of spots or teardrop psoriasis that happen all over. There’s inverse psoriasis that happens in the intratendinous zones or the folds, so women will get it below the breasts, in the armpits, in the groin. There’s different types of psoriasis. Strep is associated with all of them. When I do gut testing, I often see strep overgrowth in the gut.  When they do antibody testing, pretty much everyone with psoriasis has titers or some sort of response to strep, whether they knew that they had it or not. Sometimes in my psoriasis patients, I’ll treat their throat with antimicrobial throat sprays because strep tends to hide and colonize the tonsils. It can form biofilms that it can be hard to get to. This is another instance of… With eczema, we have to treat the staph on the skin, in the nose, and in the gut. With psoriasis, we have to treat the strep in this case in the tonsils and in the gut as well.

Dr. Weitz:                         How do you treat the strep in the tonsils? And then going back to the last discussion, how do you treat the staph in the nose?

Dr. Greenberg:                 The staph in the nose, I use various nasal sprays. There’s a lot of different options. I don’t do this in infants or children because it’s just torture. For this, I just have the parents try to wipe stuff into the nose. But for older kids and adults, it’s nasal spray. I like colloidal silver spray. There’s colloidal silver sprays with herbs in it. There’s propolis sprays. You can take a saline spray and make an essential oil blend and shake it vigorously and spray. There’s a lot of different options for the nasal treatment, but my go-to is like a colloidal silver with herbs.

Dr. Weitz:                         Is there a particular product?

Dr. Greenberg:                 Yeah, there’s an ACS nasal spray that is colloidal silver with echinacea and some herbs, and I like that one. That’s kind of one of my standards. And then for the strep, there aren’t studies and we don’t know for sure if it’s helping, but I like Biocidin throat spray. It’s interesting. They do all these studies with psoriasis patients where they remove their tonsils and they get dramatically better. It is because they’re basically removing the staph. That’s pretty dramatic to remove somebody’s tonsils, right?   But time and time again, you have these small studies, like 15 people, and they removed all their tonsils, and like 13 of them the psoriasis improved. There are significant numbers that we know that this strep colonization is causing problems, but a lower intervention seems to be using a throat spray.

Dr. Weitz:                         Well, in this society, we remove tonsils all the time. It’s not that big a deal. You know?

Dr. Greenberg:                 I know. We remove tonsils. We remove uteruses, appendixes. It’s like, well, we don’t need it. Cut it out.

Dr. Weitz:                         It’s just extra bar. Who really need them?

Dr. Greenberg:                 Exactly. I feel like let’s try to a throat spray before we remove the tonsils and see if that helps.

Dr. Weitz:                         Oh my god, that’s so dramatic. You’re going to take some herbs.

Dr. Greenberg:                 Yeah, exactly.

Dr. Weitz:                         Let’s use surgery. What’s the connection with bile acids in psoriasis?

Dr. Greenberg:                 Bile is really interesting. I think most of us in the functional medicine think of bile as like, okay, we need bile to emulsify fats and digest the food. If we saw high steatocrit…

Dr. Weitz:                         Bile solidify liver and stored in the gallbladder and the intestines.

Dr. Greenberg:                 Exactly. It’s like, okay, yeah, that’s the function of bile is to emulsify fats. And if we see high steatocrit…

Dr. Weitz:                         Except that half the people have had their gallbladder removed too.

Dr. Greenberg:                 Right. Exactly.

Dr. Weitz:                         Get rid of it.

Dr. Greenberg:                 Yup. That’s one of those, like chop it off. Bile is interesting in that it’s actually hugely antibacterial and antimicrobial. There are definitely case studies that have been done trying to treat psoriasis just by using bile acids, just by trying to make sure that when someone is eating, that there’s enough bile to kill the bacteria that’s part of the leaky gut.

Dr. Weitz:                         When you say bile acids, do you mean things like ox bile or drugs like cholestyramine?

Dr. Greenberg:                 Again, I tend to use more herbal protocol, so I use ox bile. Either ox bile by itself or what I usually like are… I like enzymes that have hydrochloric acid, pancreatic enzymes, and bile salts. I tend to use…

Dr. Weitz:                         Is there a particular product that you like?

Dr. Greenberg:                 Yeah, I really like DuoZyme by Karuna. That’s kind of a go-to.

Dr. Weitz:                         I’m not familiar with that one. We usually use Digestzymes from Designs.

Dr. Greenberg:                 But that one I don’t… I don’t know if it has hydrochloric acid and bile salts.

Dr. Weitz:                         It does.

Dr. Greenberg:                 It’s hard to find that.

Dr. Weitz:                         It has a little bit of both.

Dr. Greenberg:                 Oh okay. Panplex 2 by Integrative Therapeutics also has all three. A lot of them will have just the pancreatic or just HCL and pancreatic, but I look for the trio. I’m usually just giving all three together. Bile does an amazing job at killing bacteria. As you’re eating and as there’s a leaky gut, we definitely want to kill off that bacteria.

Dr. Weitz:                         What about herbal bitters to stimulate bile?

Dr. Greenberg:                 Yeah, you can use that too. It’s obviously a higher intervention to give the ox bile. For kids, I have to use more of the herbal bitters, because anybody who can’t swallow a pill, they can’t take ox bile. I have tried. As a naturopathic doctor, I feel like I’m pretty immune smells and taste of things. Andrographis isn’t even that bitter to me. It is possible to ask a patient to take the ox bile and open up the cap? It was so vile, I literally almost vomited. I was like, this is going to be… There’s no way to hide this.  Of all the things I ask patients to do, there’s no possible way to ask them to do this. And somebody who can’t swallow a capsule, it’s going to have to be bitters. If any of your listeners have found a way to get ox bile in somebody not in a capsule, please contact me because it is appalling. It’s just horrific.

Dr. Weitz:                         I know there’s a topical vitamin D that is sometimes used for psoriasis.

Dr. Greenberg:                 Yup. Again, it is used. It can be somewhat helpful. For me, again, it’s not a root cause. I’m not addressing a pathogen overgrowth with it, and I’m not addressing kind of other things. I tend not…

Dr. Weitz:                         Are there any topicals that you like to use for psoriasis?

Dr. Greenberg:                 For me, it’s somewhat similar in terms of addressing the skin pH. Psoriatic skin pH is definitely alkaline. I’m going to pull it back down to acidity and try to improve the barrier. There is a particular herb that is very well researched for psoriasis called indigo naturalis. There are topical emollients like body butters and stuff that are made with indigo naturalis that can be helpful. Indigo naturalis has been shown to decrease IL-17. Again, knowing the cytokine pathways can be helpful for our herbs. It is blue as the name indigo would indicate.  Depending on if they’re making their own, it can stain things, so you should warn them. There are a couple products out there with the indigo that aren’t quite as stainy, but that’s a well-known Chinese herb that’s used topically with pretty good success in psoriasis because we think it’s decreasing the IL-17 in the skin.

Dr. Weitz:                         I noticed in one of your articles you mentioned that when applying things to the skin, that you don’t like… I’m not really familiar with skin creams and stuff. I personally don’t put anything on my skin, but my wife certainly does. One of the products contains oils along with water-based stuff sort of mixed together and you don’t like that. You like doing them separately.

Dr. Greenberg:                 Yeah. I get on my little soap box rant about lotion. I really hate lotion, and I don’t know why it’s so prevalent in our society. But here’s the problem with lotion.

Dr. Weitz:                         You mix it all together and just do one thing.

Dr. Greenberg:                 I know. Yeah, I mean, I guess it’s the convenience. But the problem with mixing it up is this, fundamentally, a lotion is oil and water together. Well, we know from fifth grade science class, when you pour oil and water together, they don’t mix. They float on top of each other. Well, that would make for a horrible product, right? So what the product company needs to do is add a chemical called an emulsifier. An emulsifier will smash together at the molecular level the oil and water and keep it together. Well, now that we have water in this product, we must have a preservative.

                                                You have to or it’s not going to shelf stable and it’s going to be overrun with bacteria and fungus very quickly. Anytime you buy a lotion, what you’re buying is oil, water, emulsifier, and preservative. Those are the bulk of what’s in there. A lot of the oils that are used in classic lotions are mineral-based or petroleum-based, which are not good for the skin either. And a lot of the things like parabens or endocrine disruptors, those are in there as emulsifiers and preservatives. A lot of the products that now we know cause huge problems for people fall into the emulsifier and preservative camp.   For me, it’s like, well, why would we do that? Let’s just keep our water-based products separate from our oil-based products. We don’t need emulsifier. We don’t need preservative. And now we can put 100% good things on the skin just by keeping them in separate bottles. Like how hard is that really?

Dr. Weitz:                         What does that mean?

Dr. Greenberg:                 That means that using things… My water-based products are the things like the aloe and the hydrosol. Those stay in separate bottles. And those you spray on the hydrosol, you let it dry for 30 to 60 seconds. Then you apply the aloe vera gel. You let that dry for 30 to 60 seconds. And then you’re going to apply your body butter or your facial serum separately. We’ve kept all the products separate. We have not mixed the oil and the water. And just literally by keeping them on separate bottles and applying them one after the other, we have avoided emulsifiers, preservatives, and a lot of those chemicals.

Dr. Weitz:                         Forgetting about the skin conditions, what’s the best oil for the skin?

Dr. Greenberg:                 It depends. For the face, I really love pomegranate seed oil. It’s wonderful for antiaging, for helping to prevent wrinkles. It’s got ellagic acid and some special punicic acids. Some special things that we only get from pomegranate seeds. The pomegranate plant is just so wonderful all around. I love that for the face. It’s pretty pricey, so it’s hard to imagine using that as like a full body moisturizer.

Dr. Weitz:                         Besides that, are there other oils for the face?

Dr. Greenberg:                 Mm-hmm (affirmative). Yeah. For acne, I like grapeseed oil because it tends not to cause breakouts. For the body, I mean, I like blends for everything. You can us straight oil. The cheapest thing to do is probably go to like your local market and buy a high quality organic cold pressed avocado oil. You can just keep that in your bathroom and use that as a body moisturizer, and it’s cheap. I don’t like olive oil. It’s high in oleic acid and a lot of people have problems with oleic acid. I don’t actually like products heavy in olive oil.

Dr. Weitz:                         It’s hard to find organic avocado oil.

Dr. Greenberg:                 It’s not. It’s not. If you go to Whole Foods or here in LA, we’ve got fancy places like Erewhon, you can find it. But I also like blends, so I like body butters, which is oils mixed with a shea butter or cocoa butter, and that makes it a little bit thicker. That’s good in the winter, let’s say, where we might need a little more hydration to sit on the skin. But really just all the oils and butters. They’re great for your skin. Just be careful with what you put on the face. I don’t put coconut oil on the face. It’s comedogenic and can pretty easily cause breakouts.  But if you stick with grapeseed or pomegranate on the face, it usually doesn’t cause any breakouts or anything. Yeah, just anything. Grab your avocado oil and lather up.

Dr. Weitz:                         One more obscure comment. I noticed in your webinar you discussed the negative effects of polyamines. I just recently went down a wormhole. I guess there’s a number of articles. One of the polyamines is called spermidine, and I guess there’s some interesting antiaging benefits to spermidine.

Dr. Greenberg:                 I’ve seen those new things out. I mean, I think the problem with polyamines… Polyamines are naturally occurring substances. They do contribute to growth. We tightly regulate them. But what can happen particularly in psoriatic patients is when we eat meat and we don’t digest the meat properly, it goes into the large intestine and it gets fermented by more pathogenic bacteria there that create these polyamines like putrescine and cadaverine, which as the names indicate, oh, it’s putrid, it’s a cadaver. Yes, these are the things that create a stench in rotting meat and corpses.   I think we already know that having high amounts of those is probably not something we want in a living body. There are other polyamines like spermidine and spermidine, which we’re learning about, but these high levels of putrescine and cadaverine and the polyamines are found in the plaques of psoriatic patients and in their blood and urine. When we reduce the levels of these polyamines in psoriatic patients, we see improvement. I personally would not take a spermidine supplement. I don’t want high levels of those. I will wait and see what the research says about it.   So far for the research I’ve done, we really don’t want to be pushing high levels of polyamines. I wouldn’t personally do it.

Dr. Weitz:                         Interesting. Okay, great. Thank you, Dr. Greenberg. This has been a fascinating discussion. How can listeners and viewers get a hold of you, find out about your programs?

Dr. Greenberg:                 My clinic is the Center for Integrative Dermatology. I practice and see patients in California, Washington, and Oregon. My website is integrativedermatologycenter.com. I also do consults for healthcare practitioners nationwide. If you need help on a touch patient, I can help you out. I’ve also got a series. For your healthcare practitioner listeners, they might be interested in a series of 20 CE courses, and they’re AMA… They’re CE accredited for both MDs and NDs. I’m not sure what other ones, but there’s 20 courses.   They’re all free. You can earn up to 10 CE credits, and it’s at learnskin.com. It’s the Naturopathic and Integrative Dermatology Series. I’ve written some of the courses, and I’ve worked with thought leaders on many of the other courses. It’s all the things I’m talking about here. You can find a course on gut health and skin health. You can find a course on skin pH and skin disease. We have specific courses on diseases, so there’s a naturopathic approach to acne or a naturopathic approach to psoriasis.  We’ve really tried to pull together all this information, because there’s so much information out there, but the dots have not been connected well. Either in functional medicine or naturopathic medicine, we don’t have a lot of continuing ed or modules on dermatology. But when you do the research, it’s all there. You pull it together. Clinically you will get results. If anybody’s interested in learning more, it’s free. Head on over to LearnSkin and look for the Naturopathic and Integrative Dermatology Series.

Dr. Weitz:                         Awesome. Thank you, Dr. Greenberg.

Dr. Greenberg:                 Thanks so much for having me, Ben.


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