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Jennifer Fugo discusses The Skin Gut Connection with Dr. Ben Weitz.
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Podcast Highlights
1:48 Jennifer got interested in the nutrition field when she got sick. She had gut issues for many years and then she developed rashes, brain fog, and fatigue in her early 20s. She was told by doctors that nothing was wrong, so she went to see a nutritionist, who determined that she had food sensitivities to gluten, dairy, eggs, cruciferous vegetables, and cashews. She had come to accept that having chronic diarrhea and horrific smelling gas was normal. She decided to go into nutrition and when she went for a Masters in Clinical Nutrition at the University of Bridgeport, she developed dyshidrotic eczema on her hands and the skin on her hands was so flared up that her hands would burn even running them through water. She had to wear disposable gloves on her hands and the dermatologist told her to use steroid cream and vaseline and that she would just have to live with it. The toolbox for conventional dermatologists is incredible limited. She had already been gluten-free, dairy-free, and egg-free, so she decided to figure out how to rebalance her skin and cure herself, which she did and then she started the Skinterrupt website and The Healthy Skin Show podcast to spread the information she learned. Part of it was that she was incredibly stressed at the time.
4:58 Some of the underlying, root causes of skin conditions start in the gut. Jennifer explained that you have to not only make sure that you have good digestion and absorption of nutrients from food but you also have to balance the microbiome and makes sure that the gut is not inflamed or that you are not absorbing fats, since vitamin A is so important for the skin. You want to remove infections and correct gut dysbiosis. It is also important to make sure that the hormones, like thyroid, are balanced. Environmental allergens, food allergies, and food sensitivities are also important triggers, as are drug triggers. There are increasing number of drugs, like Atenolol, that can trigger skin rashes like psoriasis. There are even psoriasis drugs that can trigger psoriasis flares. Here’s an article that Jennifer wrote about Medications That Worsen Psoriasis. Other triggers for skin problems can be heavy metal toxicity, liver detoxification challenges, and trauma. There are also genetic factors that can predispose you to certain skin conditions, esp. those with more of an autoimmune like psoriasis, vitiligo, and scleroderma. Jennifer says that there are 16 different possible root causes.
9:31 Jennifer does not consider food sensitivities other than gluten to be a root cause. They are more of a symptom of an underlying gut problem such as leaky gut or poor digestion or dysbiosis of the microbiome. She cautions patient against thinking the only reason they are sick is because of food and to go from one restricted diet to another. Patients can spend years with an increasingly shrinking diet that causes them to become malnourished and feel worse and worse. Jennifer cautions against using an elimination diet as the number one cause of Functional Medicine.
12:44 Jennifer explained that she has a number of patients who have skin rashes but no gut symptoms and you do a stool panel and they have infections and dysbiosis. She said that Kiran Krishnan told her about the connections between short chain fatty acids produced in the gut by bacteria, like buyrate, and skin conditions, and sometimes supplemental buyrate can be helpful. But Jennifer cautions patients against doing this on their own. They should really be working with a Functional Medicine practitioner.
18:55 Even though Jennifer has written a blog post about how some patients react to nickel in foods, she does not recommend following a nickel-free diet. She did mention that some patients are having histamine type reactions, such as developing hives or having itchiness or waking up at night, they may have trouble breaking down histamine in their gut and they may benefit from taking supplemental Diamine Oxidase, which is the enzyme that helps break down histamine, in addition to the digestive enzyme they are already taking. Histamine intolerance can also be related to gut infections or it can be due to cortisol elevations. They may also benefit from a low histamine diet by limiting fermented and pickled food, including vinegar, ketchup, and mustard. Other patients may benefit from a low salicylate diet, since their diet may have difficulty processing salicylates. Nutrients like glycine, magnesium, and vitamin B6 can all be very helpful in supporting the liver, as well as glutathione, and these can help the liver to process salicylates.
24:42 Even though coconut oil is very popular today, Jennifer does not recommend using coconut oil on the skin, and she notes that it can even cause skin rashes. The main reasons for not using coconut oil on your skin are 1. coconut oil is too anti-microbial and it wipes out the good bacteria on the skin and some with skin conditions already are having problems with skin microbiome. 2. coconut oil is too saturated and such long chain fats are difficult to be absorbed, so it just sits on the skin like Saran wrap. 3. It’s too alkaline and your skin’s pH needs to be acidic with a level of 4.5 to 5.5, while coconut oil has a pH of around 8. Jennifer says that jojoba and olive and avocado and sunflower oil are much healthier for your skin than coconut oil.
30:27 There currently is no accurate way to analyse the microbiome of the skin, the way we can analyse the microbiome of the colon with a stool test, though companies are working on it. One company has a sensor you wear on your arm. There are a lot of skin care products with probiotics in them. like Mother Dirt. One complicating factor is that the microbiome on your skin varies by location, so the microbiome of the front of your thighs is different than what’s in your armpit. Jennifer has had good luck with applying some olive oil on her skin where there is a rash and then sprinkling some MegaSpore probiotic and let it sit for a few hours. She has also had luck with clients who have had good luck with taking a swab from their cheek and dabbing it into the areas where there is an issue and then applying some oil over that. For Jennifer, when she had her severe skin issue, it took 6 months of this type of protocol just to stop the flares and another six months to get the rashes to stop. The rashes were gone but she till had dry skin that cracked and messed up nails and it took another 3-6 months for the skin to even out and the nails to come back to close to normal. So patients need to know that it will take a lot of time to heal difficult skin issues.
34:50 The bacteria on the skin are lipid-loving, which means they consume fat, so they are different from the bacteria in the colon. The microbiome of the skin has been called a lipidome, except for the skin around the mouth, where oil is not a good thing to apply to rashes there.
35:50 Small Intestinal Bacterial Overgrowth is the underlying cause of Irritable Bowel Syndrome in the majority of cases and it is sometimes associated with rosacea and other skin conditions. Dr. Leonard Weinstock wrote a paper describing this SIBO and Rosacea connection: Rosacea and small intestinal bacterial overgrowth: prevalance and response to rifaximin. While there are more and more topical rosacea products on the market, few dermatologists consider the SIBO connection or attempt to address it.
42:24 Jennifer explained that producing enough hydrochloric acid is very important for proper digestion and a lot of people who have been chronically ill don’t have enough stomach acid. Many patients are taking drugs to reduce stomach acid (Proton Pump Inhibitors like Prilosec) to help with their stomach and digestive problems, but they may actually have low stomach acid, not high. Jennifer she has a simple test for assessing stomach acid levels. You simply mix baking soda and water and drink it and wait to burp in about 10-15 minutes. If you have sufficient acid you will want to make a big belch, a burp. If you don’t have enough stomach acid, you won’t belch or you will only have very tiny little burps. Jennifer Fugo’s Low Stomach Acid Test. Here is the link to the eguide to the low stomach acid test. If you don’t have sufficient stomach acid, you won’t be able to break down your proteins and you’ll lack vitamin B12. Jennifer will recommend her clients take a digestive enzyme that also contains some betaine HCL and some ox bile prior to meals.
45:55 Thyroid function is also connected to skin and patients with hypothyoid, will tend to have chronically dry skin. When there is not enough thyroid hormone, your cells don’t turnover as quickly and there tends to be poor circulation to the skin cells. You want to measure not just TSH, but also Free T3, Free T4, Reverse T3, and the thyroid antibodies. If the patient has Hashimoto’s, you want to make sure over time that you see an improvement in antibody load. Jennifer also finds that many of her clients have low vitamin A, which is important for thyroid function.
Jennifer Fugo is a clinical nutritionist with a focus on skin and gut problems. She has a masters in Human Nutrition and is an Amazon best-selling author of The Savvy Gluten-Free Shopper: How to Eat Healthy without Breaking the Bank, and the host of a popular podcast, the Healthy Skin Show. Her website is Skinterrupt.
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. Ben Weitz: This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research, and by interviewing the top experts in the field. Please, subscribe to the Rational Wellness Podcast on iTunes and YouTube, and sign-up for my free eBook on my website by going to drweitz.com. Let’s get started on your road to better health. Hello, Rational Wellness Podcasters, thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and give us a ratings and review, that way more people can find out about the Rational Wellness Podcast. For those of you who are only listening on your phone with the audio version, I just want to let you know that there is a video version if you go to the YouTube page, the WeitzChiro YouTube page, there are additional videos that are not on the audio version. You might want to check that out and subscribe.
Today we’re going to talk about how to improve your skin with Jennifer Fugo, and what to do with … about all these skin conditions that so many of us are dealing with. Jennifer Fugo is a clinical nutritionist with a focus on skin and gut problems. She has a Masters in Human Nutrition, and she’s an Amazon best-selling author of The Savvy Gluten-Free Shopper, How to Eat Healthy Without Breaking the Bank. (Don’t go to Whole Foods.) I was just kidding, and the host of The Healthy Skin Show. Jennifer, thank you so much for joining me today.
Jennifer Fugo: Well, thank you so much for having me. I really appreciate it.
Dr. Ben Weitz: Good. How did you get interested in the nutrition field? Tell us a little bit about your personal journey.
Jennifer Fugo: Well, I got sick. I think that’s one of the commonalities for most people, is you get sick and you end up thinking, “There’s got to be something else out there.” I had gut issues for probably over 15 years since I was a kid, and rashes, brain fog, and really bad fatigue in my early 20’s, and it got to the point where I was told by doctors that nothing was wrong. I found a nutritionist and she’s like, “Hey, I think you have some issues here.” We determined that I had food sensitivities to things like gluten, dairy, eggs, the cruciferous family, the cashew family, and I had no idea what a food sensitivity was, what that meant. I had no clue, I just thought that having chronic diarrhea, and horrific smelling gas was normal. I got into nutrition that way because I came to realize that there was this whole other side of nutrition, and helping people improve the quality of their daily life by changing food and whatnot, but eventually I came to realize that there’s only so much you could do with food. There are some things that go above and beyond what we can oftentimes do in the kitchen. It’s not to put that down, food is certainly medicine, but there’s a lot of other things that I found to be helpful because of clients that I was dealing with who were chronically ill, and had autoimmune disease and whatnot.
I went back for a Masters in Clinical Nutrition at the University of Bridgeport, I finished that up a couple of years ago, and actually this sort of leads into my story of how I ended up interested in skin issues. My final year in my Masters Program I developed dyshidrotic eczema on my hands, and it got to the point where it was so flared that I was wearing blue gloves that I would buy–these disposable gloves that I could get at Home Depot–just to protect my hands because I couldn’t even run them under water. It burned so badly. I tried topical steroids. I went to the dermatologist, and they’re just like, “I don’t know, just use a steroid cream and put some Vaseline on top to keep the moisture in, and you just have to learn to live with it.”
Dr. Ben Weitz: I remember Woody Allen’s sketch where he said dermatologists are dealing with 5,000 different skin conditions, and they only have four creams.
Jennifer Fugo: That’s a good way to put it, and that’s kind of what it feels like. Their toolbox is incredibly limited. I said, “Look, I’m gluten-free, dairy-free, egg-free,” like I had been that for years, eating a more, not restrictive, I didn’t consider it restrictive, but I had had these restrictions in my diet. It wasn’t like I had to then take them out, I was already like that and I developed this condition, and a lot of it had to do with the amount, the sheer amount of stress that I was under at the time. Anyway, the point where I hit rock bottom, my husband had said to me, “Well, what would you do if somebody came to you and said, could you help me with this?” I was like, “I don’t know. I never thought of it.” I started doing research and came to discover that there really weren’t good resources out there. A lot of the information was super generalized or it didn’t really work after I tried it. I just started playing around, I thought, “Well, I’m my own best experiment, if I screw up I only have myself to blame.” Eventually I did actually figure out how to correct and rebalance my skin issues so that I no longer have eczema at all. I haven’t had it in probably well over a year and a half. I started the website Skinterrupt, and The Healthy Skin Show Podcast in order to share the information that I just … people aren’t telling the patients who are stuck in these chronic skin rash conditions, and all the other options out there aside from those four creams, and maybe some biologics, and immunosuppressants and such.
Dr. Ben Weitz: What do you think are some of the underlying root causes of skin rashes? What are some of the most common triggers?
Jennifer Fugo: Well, the first thing I will tell you is absolutely gut issues. I’m sure for anybody listening to this who is a practitioner is like, in the functional, integrative realm you’re like, “Duh, sure. Yeah, of course, Jen, you’re not sharing anything that isn’t obvious.” But here is the thing, what a lot of people discount is that you have to balance your digestion and absorption with what’s going on with the microbiome, both are equally important, and you can’t just do digestive enzymes and be like, “Oh, that will take care of the problem.” You have to look and make sure that the person has enough stomach acid, that they have a gall bladder. Is there too much inflammation for example, where the … there is such a thing where we see that when somebody’s gut is very inflamed their body has a hard time absorbing fats. We know that the cellular membrane is made up of lipids, and if you’re not able to absorb lipids, especially Vitamin A is vital for the skin, the thyroid, your eyes, your eyesight, you have a real problem. Again, you got to balance that with what’s going on with the microbiome. We can certainly talk about that in a little while, because dysbiosis and infections are both two problems, as well as the amount of acidity in the colon, which I’m sure we can talk about too.
I’d also say hormones, thyroid is really important. You can have genetic factors that can predispose you to having certain skin conditions, specifically those with more of an autoimmune like psoriasis, vitiligo, scleroderma, however with eczema it’s a little trickier, there’s a lot more factors involved in it unfortunately than some of the other conditions. Because sometimes we can have things where you’ve got more histamine-dominant, you’re looking at environmental allergens, environmental triggers, food allergies, food sensitivities, but I consider those a symptom. Your thyroid has to be balanced, I will say that. The other piece to this is drug triggers. You have to also do a really good … You have to actually ask people what drugs they’ve taken in the past, because believe it or not the research that I’ve done shows that there are increasingly number or increasing number of drugs that are prescribed by doctors, like Atenolol for example, that can trigger skin rashes. Atenolol for example can actually trigger psoriasis. There’s also-
Dr. Ben Weitz: Interesting.
Jennifer Fugo: Psoriasis drugs that can trigger psoriasis flares, which doesn’t make any sense whatsoever. Those are some of the key pieces that you could be looking at heavy metal toxicity, liver detoxification challenges, trauma, and trauma as in maybe you experience something like your father passed suddenly when you were a child or you’re in a horrific car accident or like I lived in New York City when 9/11 happened, that was a terrible thing, or it could be small traumas, like you go to work everyday and your boss is incredibly abusive. There’s a whole litany, I consider it to be about 16 different root causes, but those are probably the most common that I see.
Dr. Ben Weitz: Which psoriasis drugs trigger psoriasis flares?
Jennifer Fugo: I have to look that up for you. I got an article for you on that.
Dr. Ben Weitz: I am sorry, I didn’t mean to put you on the spot.
Jennifer Fugo: No, that’s okay. It’s a good question. I don’t know offhand, I just don’t remember offhand, but I’m-
Dr. Ben Weitz: That’s okay.
Jennifer Fugo: We can certainly share that if you want to share that in your Shownotes. I could send you that link.
Dr. Ben Weitz: Yes, sounds good. You can e-mail me that.
Jennifer Fugo: Absolutely.
Dr. Ben Weitz: What’s your take on food sensitivities triggering skin rashes?
Jennifer Fugo: Food sensitivity, I don’t consider to be a root cause as I was saying, I consider them to be a symptom, and this is an important distinction that I think has gotten very muddied in functional medicine. We fixate so much on taking foods out, and the first … You should remember, when people have chronic skin problems they come out of the dermatologist, the first thing they do is go, “The dermatologist hasn’t told me everything, maybe it’s something in my diet.” They start reading online, and they see all these information, there is something called the eczema diet, there is also something called the psoriasis diet. They will begin seeing as they join Facebook Groups the people who’ve taken out increasing number of foods, and what happens is they end up on a smaller and smaller diet. They oftentimes don’t feel better, and a lot of times people who do things like the eggs in the diet or the psoriasis diet sometimes will get better, but then cannot add those foods back in without triggering flares, and it becomes an incredibly frustrating state.
My thing is like, “Hey, you know, food doesn’t cause leakiness throughout the gut.” It really doesn’t. Gluten is the only protein that has been clinically proven through studies to have that capacity, so we can’t blame all foods. You can’t blame eggs. You can’t blame dairy. You can’t blame all these other food groups that we keep telling people, “Oh, you should avoid them because they’re bad for you.” I’m not saying that everyone should eat all of these things or that they’re going to work for everybody, but the thing is they’re not the reason that the gut ultimately became leaky to the point where it can no longer find it’s sense of tolerance again. It’s lost that tolerance for those gut junctions to be closely sealed.
The thing from having done so many interviews and talked to so many microbiome experts, it’s really a state of, A. Are we digesting our food? Are we absorbing it? Because that impacts the microbiome. What then is the state of the microbiome? Do we have infections present? Do we have, say too much e-coli? Even though it’s an opportunistic bacteria and should be there or candida, which it’s an opportunistic yeast, and it should be there to some degree in the gut, but is it in too much of a quantity? That’s where usually, I mean stress certainly plays a role, NSAIDs can play a role, but we’re so fixated on food we don’t realize that as practitioners what we do is we make people afraid of food. They get to a point where they are thinking that the entire reason they’re sick is just because of food, and they spend years with increasingly shrinking diet that causes them to become malnourished and feel worse, and worse, and worse. That’s why I think food sensitivities are important to identify, but we can’t rely on an elimination diet to be the number one tool of Functional Medicine. That really confuses me because all the clients that I see who have chronic skin conditions have done all of these like sugar-free, dairy-free, egg-free, salicylate-free, nightshade-free, and they’re not any better.
Dr. Ben Weitz: Well, I think where it comes from is so many … like yourself, who is maybe seeing the really advanced cases, once the patients go down this chronic gut road, and they’ve layered one diet on top of the next, the FODMAP diet, and the no-histamine diet, and the no-this diet, and there’s nothing left to eat, and then they’re afraid to eat anything. For those patients it’s definitely not a good idea to start talking about eliminating any foods. Then you do have some of these patients who don’t really have any gut problems, and they’re coming to you for something else, and then they get a skin rash and you take out one or two common foods. You take out gluten and it’s gone, and they eat it again, and it comes back. We know there’s some relationship, but-
Jennifer Fugo: Absolutely. I’m not saying there is none, and actually the one thing that I do ask people regardless of what their gut circumstance is, I do ask them to take gluten out because of that increased leakiness. However, I will share this, and I don’t know how many people listening to your podcast are practitioners, but pretty much every single chronic skin client, they’ve got eczema, psoriasis, whatever, those who have no gut symptoms, like literally I’m asking and I’m digging, no gut symptoms. Completely fine, they poop like a champ, one to three times a day, no straining, no diarrhea, no gas, no bloating, whatever. When we do a stool panel they either have dysbiosis or they have infections. You can’t say that just because they don’t have any gut symptoms that there’s no problem with the microbiome. One of the reasons why that a lot of people don’t know about, this blew my mind, I learned about this last summer from Kiran Krishnan, was that butyrate.
Dr. Ben Weitz: I’ve had him on the podcast before, he’s really good.
Jennifer Fugo: He’s a genius. Man, I love talking to Kiran. I always learn like 20 million things every single time. The one thing that he had shared with me was about a bunch of studies that had been done looking at the different … the importance of short-chain fatty acids in the gut, and how that communicates with the skin. I was like, “What? What are we talking about here?” I go and look it up, and lo and behold there were some really incredible research of linking the acidity essentially of the colon to establishing this healthy microbiome balance, because dysbiosis of the skin is one significant problem or challenge that a lot of people with skin rashes have, and butyrate specifically … for those of you who are like, “Butyrate?” Well, it’s a small, short-chain fatty acid that these bacteria, the healthy gut bugs produce when they munch up your fiber basically. Butyrate is really important to help maintain that healthy microbiome balance on the skin. If you do, say like a GI effects, and you discover that they have low butyrate, that’s a problem if that person we already know has dysbiosis of the skin because they’re missing this important link between the two.
Dr. Ben Weitz: Right. It brings up the issue of fiber, which is such an important issue, and we have patients with chronic gut problems who get flared with fiber, but yet fiber is a prebiotic, and can help the growth of those bacteria in their colon. It can be beneficial and not beneficial, and sometimes it depends on the type of fiber.
Jennifer Fugo: There’s also too, now there are butyrate supplements that you can try. I’m actually testing them out in some clients, and I can’t speak about it extensively and say, “This works,” but in the clients that I’ve tested this out with, who have issues with dysbiosis of the skin, using supplemental butyrate has actually really helped them. I would just say if you’re not working with a practitioner I wouldn’t recommend you doing this by yourself, but if you’re working with a practitioner or you are a practitioner it might be something to look into.
Dr. Ben Weitz: In some conversations with some other practitioners a lot of people seem to like this one product that has a combination of butyrate, acetate, and propionate, which are three of the short-chain fatty acids.
I’ve really been enjoying this discussion, but now I’d like to pause to tell you about the sponsor for this episode of the Rational Wellness Podcast. This episode is sponsored by Pure Encapsulations, which is one of the few lines of professional nutritional supplements that I use in my office. Pure Encapsulations manufactures a complete line of hypoallergenic, research-based dietary supplements. Pure products are meticulously formulated using pure, scientifically-tested, and validated ingredients. They are free from magnesium stearate, gluten, GMOs, hydrogenated fats, artificial colors, sweeteners, and preservatives.
Among other things, one of the great things about Pure Encapsulations, it’s not just a quality product, but the fact that they often provide a range of different dosages and sizes which makes it easy to find the right product for the right patient, especially since we do a lot of testing, and we figure out exactly what the patients need. For example with DHEA they offer 5mg, 10mg, and 25mg dosages in both 60 and 180 capsules per bottle size, which is extremely convenient. Now back to our discussion.
Dr. Ben Weitz: In one of your blog articles I noticed you mentioned foods that are high in nickel, which I have never heard before. I find that kind of interesting. I’ve had several patients where we ran like the NutraEval, and they’re high in nickel, and it’s like, “Where did I get nickel? I don’t know.”
Fugo: Yeah, there’s foods, and actually a lot of them unfortunately are gluten-free foods.
Dr. Ben Weitz: Which foods are high in nickel?
Jennifer Fugo: Well, I’m going to tell you this much, I actually don’t recommend the nickel-free diet. One of the reasons why is in having done my research, and actually talked with a bunch of dermatologists, Dr. Peter Leo for example, he’s been on my podcast, he …
Dr. Ben Weitz: Wait a minute, would eating nickel foods help to prevent breaking the bank?
Jennifer Fugo: Basically the problem is that there’s such little nickel in food that for those who actually have a sensitivity to it sometimes this becomes too much of a challenge, and not actually worth it. While it may be something where people say, “Hey, if you have a really extreme nickel allergy,” I mean you’ve got to get tested by somebody. I think it’s more than just like, “Oh, I wear a piece of cheap jewelry, and my skin reacts to it,” but in his clinical experience, because I was one … I was kind of on the fence about whether it was even worthy to suggest it, because that’s a problem I recommend people go gluten-free, but a lot of the gluten-free grains, a lot of gluten-free foods have some level of nickel in them. He just said that in his clinical practice, and he is up at Northwestern University I believe, that they found it to be of almost no benefit to have people fixate on removing nickel foods, that they found other things to be more important in helping them. There is a lot of other diets that can be, I think helpful to some degree, but I think one thing that people oftentimes confuse is if you have an issue with histamine for example, like you’ve got a lot of itchiness, and you’re waking up at night or you become incredibly itchy at night or you’re developing hives, that can be caused sometimes by infections, gut infections. It can also be issues due to cortisol elevations. We also see sometimes that people have difficulty breaking histamine down in the gut, and they may require a DAO supplement in addition to any digestive aid that they’re taking, that can sometimes help.
Dr. Ben Weitz: That’s diamine oxidate.
Jennifer Fugo: Correct. Also, too, limiting their diet in fermented foods and cured foods, and pickled foods as well, and all types of like … and that includes vinegar. A lot of people don’t realize that, they go, “Oh, well, I don’t really eat a lot of fermented foods.” I’m like, “Do you eat ketchup? Do you eat mustard?” They’re like, “Oh.” That can be something that can sometimes be helpful. Some people will also focus on low salicylate foods, but here is the thing with that, you don’t have a sensitivity to salicylate foods, your liver has difficulty processing salicylates, which is basically a chemical, a naturally-occurring chemical that exists in certain foods to help preserve them. It’s Mother Nature’s brilliance at work, but it’s just your body for whatever reason has difficulty, and using something else-
Dr. Ben Weitz: By the way it’s the active ingredient in aspirin.
Jennifer Fugo: Yes, exactly. Well, that’s what got me thinking, I’m like, “Why does everybody think they’re sensitive?” Because it doesn’t make any sense, salicylates are processed in the liver, it’s not a gut problem but we position them as if it is a food problem in it of itself, and it’s not. Things like glycine, B6, magnesium can all be very helpful in supporting your liver, as well as glutathione in making sure that your liver has enough of it’s, I like to call them ingredients that they requite in order to do their jobs. But specifically glycine and B6 are necessary because that’s the pathway, the glycine pathway is where salicylates are processed.
Dr. Ben Weitz: Great, interesting. In one of your articles you talked about the difference between food allergies, food sensitivities, and food intolerances, and I think there’s a lot of confusion about that. Can you help clarify that?
Jennifer Fugo: Food allergies are typically described as an IGE response, you could think of the E as emergency, like throat swelling closed, eyes are closing, if it’s really bad you could die, whereas a food sensitivity is an IGG reaction, it’s a different type of immune cascade that’s happening, typically not life-threatening, and it could be delayed as well, you might not experience something for a number of days. Another reason why I’m not the biggest fan of relying on extensive food sensitivity testing is sometimes they’re kind of transient, and they can change with time depending on what you’re eating and exposed to, whereas food intolerances are an entirely different piece, it just means that you don’t have an enzyme in your system that’s capable of breaking down that particular thing like histamines. Histamine-intolerance is a thing, where’s you’re not … there’s no histamine sensitivity, you’re missing that DAO enzyme in the gut that’s necessary to break histamines down, and so it’s an intolerance, like lactose-intolerance you’re missing lactase, the enzyme. They’re very different, and people like to interchange those terms and it’s very incorrect, and it’s also confusing to me as a practitioner. I have to question when people say, “Oh, I have this allergy to this,” I’m like, “Okay, could you describe that? Did you go to an allergist? Do you have an allergy panel?” “Oh, no, no, I had a food sensitivity test.” I’m like, “Okay, that’s not an allergy, it’s a different response.” I think we have to, as practitioners have to get a little clearer with people. I know that it’s easy because that’s what they’ve read about, but it also is our job to make sure that they understand what’s actually happening to them, not just making it super easy so we can breeze through the appointment.
Dr. Ben Weitz: In one of your articles you talked about the fact that a lot of people see coconut oil as a super healthy oil, really good for us, and people use it in cooking, and people put it on their skin, but that’s probably not the best idea, right?
Jennifer Fugo: No, as far as skin rash conditions are concerned. Initially when I wrote the article I was very much just focused on people with skin rashes, but I’ve noticed recently that we’ve had more and more people who were using it, and then developed skin rashes as a result of using coconut oil. This may be a heads up to those of you who don’t have issues, and are using coconut oil as your lotion, but there’s three reasons why, well four, but the fourth reason is basically there are way better options out there than coconut oil to be using as part of your moisturizing regimen, but basically coconut oil is way too anti-microbial. For those who have skin rashes, you’re basically wiping out everything that’s on the skin, and if you’re already struggling, and you’ve got this tug of war going on, on the skin and say you don’t have enough butyrate in your gut to help establish that, you’ve got gut infections, you’re wiping out everything, and then the bad guys rush back faster. It’s not a good situation in that front.
Number two, it’s also too saturated. I’m not going to get into the debate about how coconut oil is really good for us, we need these medium chain triglycerides, blah-blah-blah, our digestive system is much different than our skin, they’re not the same thing. I know it’s a part of the body, but for your skin to properly absorb those lipids they have to be smaller. A lot of times people will notice that coconut oil feels like it’s just laying on your skin, it’s not being absorbed, and that’s the reason why, it is not being absorbed, the molecules are too large. For some people that it feels almost like the skin is being covered in Saran wrap, and at times almost feels like the heat from the body is being trapped as a result of that. That’s not good.
Last but not least, it’s too alkaline. Your skin environment actually needs to be on the more acidic side. I know everybody loves alkalizing everything, that’s like a big thing in nutrition, but the problem is that your skin’s ph to be healthy needs to be around 4.5 to like 5.5 on the ph scale, that’s acidic. Unfortunately coconut oil is around 8, it’s much more alkaline than your skin is, and as you apply that to what should be a more acidic environment you’re causing the ph to go up, and what happens is the ph is really important. You might think like, “What does it matter?” But the ph helps, it’s basically one of the chemical waste that your body prevents microbes that shouldn’t be there or shouldn’t be there in the quantity that they end up being there. It’s a control mechanism, and when you start manipulating the ph from what it should be you’re inviting in problems.
Those are three reasons why, the fourth is just basically like if you want something that’s closest to your natural sebum it would be jojoba, but olive oil is a great choice, even sunflower oil. Believe it or not there’s some great research for eczema that sunflower oil … not the cooking stuff, the stuff that’s meant for your body. Avocado, I’ve heard great things about, and especially testimonials from people who have given that a shot. Olive oil, avocado, jojoba, even sesame oil can be a good option, it just has a pretty strong odor that some people find a bit of a turnoff.
Dr. Ben Weitz: Right, interesting. This alkaline thing, it’s very common in the Functional Medicine world to eat a alkaline diet, there’s alkaline water, and people say a high alkaline diet as being better for hormonal balance, for cancer prevention, for all these different things. But I think number one, people forget about the fact that our body needs, it prefers an acidic environment, especially in the stomach, especially in the large intestine colon, where I think everybody assumes that your intestinal tract is supposed to be more alkaline, but don’t forget about those acid-loving acidophilus, acid-loving bacteria that need a somewhat acidic environment in the colon. I think there’s a lot of hype associated with these alkaline diets. I’m not so sure that they’re beneficial for the reasons people think they are, number one. It’s my take that probably the fact that they’re eating more green vegetables, and maybe cutting back on their grains, they’re getting some benefit from it, but probably not because of the alkalinity.
Jennifer Fugo: I totally agree with you, and plus, you don’t want an alkalized stomach, you can’t digest anything, your stomach has to be very, very acidic in order to appropriately break proteins down for example. It’s complete, I mean it flies in the face of human physiology that every part of your body needs to be alkalized, that’s ridiculous and that’s not based on science.
Dr. Ben Weitz: By the way I think you’re pissing in the wind if you think that drinking some alkaline water is going to suddenly turn the environment in your stomach into this alkaline state anyway.
Jennifer Fugo: No.
Dr. Ben Weitz: You were talking about the microbiome of the skin, it’s interesting, is there any way that you assess the microbiome of the skin?
Jennifer Fugo: I wish. I really wish there was one test.
Dr. Ben Weitz: Right, that you could just take a skin.
Jennifer Fugo: I know.
Dr. Ben Weitz: Test, and send it in like you get a stool sample, that would be cool.
Jennifer Fugo: There’s this one test that I found that they did that, but I don’t think it’s actually being utilized anymore. I know that a lot of companies, big companies, pharmaceutical and skin care companies are really driving in full steam ahead into the more probiotic microbiome realms. We are going to see more and more products coming out that actually have … that have the microbiome in mind. There is actually a sensor I believe, that I can’t remember whether it’s L’oreal or who is making the sensor that you would wear on your arm, I think it’s a patch, and it will tell you what the ph of your skin is. There’s a lot of creams now that have probiotics infused into them, how well they work is questionable. A lot of people also want to believe, and this is the other piece, I mean I love products like Mother Dirt. It’s nice because it’s helping to replace some of the microbiome, the good bugs that help establish that healthy balance, but the thing is if you’ve got really bad rashes it’s probably not just one thing, like one cream. You’re not one cream away from being fixed. I think unfortunately that’s the mentality, and it’s not, and here is the other piece, the microbiome on your skin actually varies upon location. What’s going on the front of your thighs is very different from what’s going on in the armpit. There’s different regions, and it varies, but some things that are interesting is that you can apply probiotics topically. I’ve had really good luck with MegaSpore for example, and you apply your olive oil, not coconut oil, to that area, and then sprinkle lightly some MegaSpore on and let it sit for a couple of hours. I wouldn’t do this during the day when you’re at work, probably wait until you get home, and that can help rebalance the skin microbiome. I’ve also had some great luck with people just saying that they’ve taken like a swab from say their cheek or some place that has no rash whatsoever, and then dabbing it into the areas where there is an issue, and again applying the oil and whatnot, and they’ve had some luck with that. Those are two things that can be helpful, but again if you’ve got a lot of stuff internally that’s out of balance that might help some, but again you’re not one step away from getting your skin rashes figured out if you’ve had them for a long time unfortunately. I wish it was simple, and this is the thing with the gut world, and the chronic health world we’re like, “Oh, if you just take this one supplement, if you just do this protein powder, if you just do this you’re going to be better. You’re going to have all these energy.” Like we’re super hype-y about it, but with skin it’s so complicated because the skin is the lowest on the totem pole, and nobody tells you that.
For me, the thing I didn’t actually tell you in the beginning, it took six months of consistently taking action on the protocol that I built for myself in order to stop just the flares. I still had rashes. I still had cracked, dry skin. My nails were all messed up, and it took another six months to finally get the rashes to stop. I still had dry skin that cracked. I still had messed up nails, it took another almost three to six months to finally see then that the skin evened out, and the nails were pretty close to being back to normal. It takes time because the rest of the body needs attention before the skin unfortunately. I think when we don’t appropriately provide people that expectation of what’s ahead it is a long journey, especially if you decide to go the natural route it’s a scenic route. Think of it as taking a scenic route, it’s going to take a while and you have to be mentally prepared for that journey. You’re not going to get better in a month, if you do I’m happy for you, but that’s not most people’s experience.
Dr. Ben Weitz: Do we know about which organisms are present on the skin compared … are they similar to the bacteria that are present in the colon?
Jennifer Fugo: There is a little bit of a similarity, but the bacteria on the skin are actually lipid-loving, which is different from what goes on in the colon. They call the microbiome on the skin a lipidome, and they actually consume fat. For most skin conditions they do … You’re okay, you’re good with using oils, the only one that I know of, and I mean I’m not necessarily an expert in every single chronic skin condition, but if you do have peri-oral dermatitis where it affects right around the mouth, oil is usually not a good thing to apply to your rashes. I don’t know why, it’s one of the most frustrating, difficult conditions to work with unfortunately.
Dr. Ben Weitz: Good. I just came back from this Integrative SIBO Conference in Seattle this past weekend, and a condition I often see in my practice is small intestinal bacterial overgrowth, which is the underlying cause of irritable bowel syndrome in quite a number of cases. Can you talk about how this can be related to skin conditions?
Jennifer Fugo: Absolutely. One of the really interesting things that I’ve been reading up on, I mean, A. It’s gut, right there you know that if we’ve got SIBO for example that’s a problem. However, there’s a really interesting connection to rosacea that a lot of people don’t realize. What’s fascinating to me is it was an incredible study done back in 2013 by Dr. Weinstock, who discussed and looked into this because he is a GI doctor. He started to notice this interesting correlation between both ocular and skin rosacea, and what was going on with the use of Rifaximin in treating the SIBO, and that once they did that treatment a lot of times rosacea would clear up. It’s staggering to me to think after all this time they’re coming out with more and more rosacea products, more and more, and yet why is this research that’s been out there for a while, I mean it’s six years, why isn’t that something that’s used in clinical practice. I can’t even tell you how many times I’ve said, “Go back to your dermatologist. Talk to your dermatologist about doing these tests.” The dermatologist don’t want to do any tests. They say that’s not their responsibility, that you have to go see a primary care doctor, and I’m like, “You know you’re a doctor too, you’re allowed to run labs.” I’m confused. They don’t see any-
Dr. Ben Weitz: I can tell you it doesn’t fit into the model.
Jennifer Fugo: No.
Dr. Ben Weitz: It’s basically since everything’s dictated by the insurance companies the conventional docs are limited to short office visits, if they’re going to go out and start testing your gut, and these tests are really complicated to understand and to interpret. Then you have to put people on complicated protocols, and then it takes a period of time, and they have to watch your diet, and it just does not fit into the model.
Jennifer Fugo: No, not at all. It’s really sad. Even my father who is an ophthalmologist, he’s in his 70’s, he was just like … I was like, “Dad, did you see this? Have you heard of this, like ocular rosacea SIBO?” He’s like, “What’s SIBO?” I explained it to him and he was like, “Can you send me that? That sounds fascinating.” Because apparently ocular rosacea tends, if you do have rosacea, and you end up with ocular rosacea usually the ocular form will show up first before it results in the skin, at least that’s my understanding. I just think it’s a shame that we’re not … We talk about all the research being done, but I think people, they are only looking at certain areas, and we don’t realize that medicine is evolving, but the way that it’s being handled and done is really only evolving at the pace of drug companies. Because now on the TV you see all these ads for Dupixent biologic drug for eczema, and that’s considered, I read an article, it’s considered to be one of their next blockbuster drugs because of how much money it’s going to make them, and all it does is suppress the inflammatory, one of the inflammatory pathways, and that’s it.
Dr. Ben Weitz: This unfortunately is the story of why so many of the drugs that have come out for a lot of chronic conditions, just look at the Alzheimer’s Research, they’re trying to find the one pathway, and the drug that blocks that one pathway, and that’s the end of the story. Unfortunately there’s many pathways, you have to look at a number of things and address a number of days if you’re really going to get success, but that’s just not part of the model.
Jennifer Fugo: No.
Dr. Ben Weitz: That’s what’s going on with the skin too, they want to find this one inflammatory pathway, how do we block that one pathway with this one particular product that blocks it, and that’s what fits into their model.
Jennifer Fugo: Well, and I’ll say this much to anybody who is listening who’s like, “Wait, I’m on one of those drugs or I’m considering one of those,” I’m non-dogmatic. Listen, you have to make the decision within your values, and what’s going on in your life, and where you are with things about what your choices are, because it’s your choice in the end, but I personally think that you as a patient, you as a steward and caretaker of the one body that you have in this life, you should do your research. You should decide if that 2% or 1% risk is worth it for you, because there are risks of cancer. There are very serious complications that can occur, and you can have bad reactions to those drugs. I had worked with people who have had bad reactions to them, and so you shouldn’t assume it will never be you, but at the end of the day I don’t think you should throw the baby out with the bathwater and say that all pharmaceutical drugs are necessarily bad.
There’s a time and a place for everything, but I think you as the patient, again that steward type position, you have to do your research and be comfortable with the decision that you’re making. Go in with your eyes wide open, and know what the potential issues and hiccups could be, and especially too the thing that’s nice is if you combine complimentary and the conventional together … I still used steroids when I was going through my journey. I had to use topical steroids. I had to keep the … I couldn’t even touch a stinking knob on the door. I couldn’t open a door. I had to do what I had to do to get through daily life, but in the meantime I was working on all the other stuff under the surface. You can find a way forward that meets your needs and values, and I just want to encourage people to know that it’s okay, and you should never feel bad or ashamed for whatever your decision, but just own it, and make it with eyes wide open.
Dr. Ben Weitz: I want to clarify, I’m not trying to bash pharmaceutical companies for trying to help people with medications, and I don’t want to tell people to stop taking their medications, especially if they’ve been helping them. But they need to understand that there’s underlying reasons for this conditions, and simply blocking the immune response long-term is not going to be the best answer.
Jennifer Fugo: Absolutely. I mean that’s what I said, go to the simple things, look at … The first thing to do no matter where you are in your journey, I would say the first thing I ask people to do honestly is to check their stomach acid level. Because if you’re not able to properly digest your proteins, number one, for example B12, which is a really important nutrient is actually connected in foods to proteins. If you don’t have enough stomach acid you’re never going to break that apart, number one. Number two, if the proteins aren’t broken down into their smallest little building blocks, I like to think of it as like Legos, they’re not going to be able to be absorbed. As they head further down stream they feed the gut bugs, which is not necessarily a good thing, and then you’ve got some very expensive poop on your hands, which nobody wants because you want to absorb that expensive food, you don’t want to be pooping that out. You don’t want to be feeding bad gut bugs either. I typically recommended people check the level of stomach acid that they have because we want an acidic stomach acid environment, we want to make sure we’re producing enough stomach acid. It’s a really simple and easy test, to be able to do that you’re basically just combining some water and baking soda. I don’t know if you are open to sharing the resource that I have, it’s just a really simple direction of how to actually do that test at home. It doesn’t cost anything, and it will get you-
Dr. Ben Weitz: Is this the test where you start taking hydrochloric acid tablets?
Jennifer Fugo: No, no, you actually just mix baking soda and water.
Dr. Ben Weitz: Then what?
Jennifer Fugo: You wait to burp, about 10 or 15 minutes, it’s really simple. The thing that’s nice is that the hydrochloric acid, that test makes me uncomfortable because-
Dr. Ben Weitz: The hydrochloric acid challenge test…
Jennifer Fugo: Yeah, it just makes me uncomfortable. I’ve had really good luck correlating this with actually doing like a GI effects, and also taking a look at the products of protein breakdown and whatnot. You can really see that there is some great correlation even if you don’t have GERD or any heartburn issues. A lot of times people who have been chronically ill don’t have enough stomach acid, and just that alone can really start to alleviate some of the issues immediately, because you’re feeding the gut bugs that you don’t want to be feeding. That’s not a good situation right there. We start to right the shift, and obviously if you don’t … if you discover, basically you want to burp. You want like a big, big belch, like when you’re a kid and you drink a lot of soda, and if you’re not belching or you have the little tiny, little burps, that basically means that you don’t have enough stomach acid present. Then the next thing to consider is do you have a gall bladder? If you don’t, you really need to supplement ox bile for the rest of your life, and that’s before every single meal. Then consider, I like to do usually a full spectrum digestive aid, it will typically be between HDL, ox bile, and digestive enzymes. That way we’re making sure that all pieces are supported, because if you’re really not well it’s just, “Let’s try and do our best to help your body, let’s make it easy,” but again it’s just a really simple, easy, free thing to do, and get some answers quickly.
Dr. Ben Weitz: That’s great. What’s your resource for patients to go to your website and find out about the acid, stomach acid test?
Jennifer Fugo: I will be honest with you the link is a little tricky. I can certainly give it to you, and make sure that you have it, if you will put it-
Dr. Ben Weitz: Well, you know what, we’ll just put it in the Shownotes.
Jennifer Fugo: That will make it super easy for people because the link is … I don’t think anyone would get it from me. They’d be like, “What?”
Dr. Ben Weitz: There’s so many things we can talk about, I like to hit on one more thing.
Jennifer Fugo: Sure.
Dr. Ben Weitz: I know you’ve talked about thyroid and the connection with skin, can we talk about that for a few minutes?
Jennifer Fugo: Absolutely.
Dr. Ben Weitz: Give me everything you know in the next three minutes.
Jennifer Fugo: I would say this, you should make sure that your thyroid is optimized, the function is optimized, because we know for sure that in people who have hypothyroidism and Hashimoto’s, a lot of times some people don’t realize that they’re … Hashimoto is a low thyroid state, and that chronic dry skin is one of the symptoms, and one of the reasons why is that thyroid hormone helps tell your cells what to do, how fast to go. It’s part of your whole system of homeostasis, and so when you don’t have enough appropriate thyroid hormone the cells don’t turnover as quickly. It also, from what I understand in talking to a lot of thyroid experts it causes there to be a poor circulation out to the cells of the skin, and we’re seeing less removal of waste as a result, and as an end you’re seeing less nutrients getting out to those cells. Optimizing your thyroid and making sure that you’re seeing optimal levels of T3, T4, TSH, that the reverse T3 level is in balance with T3, and I’ll just say this too, always make sure that your T3, T4 are that you’re looking at the free values. That is important, and that you’re also making sure that there are no antibodies or that you’re slowly with time, seeing an improvement in antibody load if you do have Hashimoto’s for example, but that’s a really important part to the piece. Again, Vitamin A, I can tell that pretty much everybody that I talk to and I work with has low Vitamin A, and low Vitamin A is really important to improve because your thyroid needs it, your skin needs it, your eyes need it. I think there’s just some very basic things that we should look at, that way we can just make sure to support the body as a whole.
Dr. Ben Weitz: That’s great. Thank you so much for providing us with a lot of interesting information about the skin, and what we could do to improve our skin. How can listeners find out about you, and the things that you have to offer?
Jennifer Fugo: You can visit me over at skinterrupt.com. This is basically the words skin and interrupt slammed together, and then basically also if you love-
Dr. Ben Weitz: Can you spell that? Can you spell that out?
Jennifer Fugo: Yes. S-K-I-N-T-E-R-R-P … U-P-T, there we go. I know it’s a little tricky, that’s what I say, it’s skin and interrupt slammed together. If you certainly search my name it will come up with very easily. You can also check out the healthy … just healthyskinshow.com, and that will bring you to my podcast, which we’re on most of the podcasting platforms. It’s a twice a week podcast where we’re delving into all the different areas of chronic skin conditions. I also have inspirational stories, looking at research, we even answer listener questions. It’s a great resource for people. Those are really the two spots you can find me, and I’m on Instagram, I do a lot of stuff on Instagram too.
Dr. Ben Weitz: Wow, twice a week podcast.
Jennifer Fugo: Yes.
Dr. Ben Weitz: I know how hard a once a week podcast is, that’s great to be able to do that. Okay, thank you, Jennifer.
Jennifer Fugo: Thank you for having me, I really appreciate it.
