388: The Gut-Skin Connection: Unveiling the Secrets to Radiant Skin | Dr. Suzanne Bruce

Dr. Suzanne Bruce  00:29

that last talk was a great talk and I can cut to the chase on mine, if you have a healthy gut, you'll have healthy skin. So that's that's pretty much the whole story there. But I'll go into a little more detail here. But so I won't go into a lot of detail on this because you just heard it beautifully in the previous talk. But basically, you're it's called the get skin X is there's a lot of interplay between what's going on in the gut with our microbiome, and what's going on with our skin health. So this is kind of again, busy diagram. But at the bottom there, you've got the the gut barrier, and you can see the microbes that are producing some of these, the unhealthy microbes produce these toxic products, there's neurotransmitters, there's alterations of the T and B cells, and so forth. And then if you have a dysbiotic gut with the over proliferation of those unhealthy microbes that can affect on the the left side of the screen, that's the healthy skin, and it can turn healthy skin into unhealthy skin and affects the skin microbiome. So that's why you know, it's so important to keep that gut microbiome healthy. Because if you get a dysbiotic skin microbiome, that releases inflammatory cytokines, and that causes chronic inflammation, which can result in these lists of diseases at the top there. So these are some of the diseases of the skin that we do have studies pointing to evidence that diet affects these various diseases. I don't know why that hopped ahead. Let me go back on the previous slide, but And as that saying goes genes load the gun but lifestyle pulls the trigger. We definitely know there's genetic predisposition to things like acne, psoriasis, eczema, male pattern hair loss and female pattern hair loss. But lifestyle it doesn't mean you're predestined to get these things because the lifestyle and diet can pull the trigger. So one of the most common skin conditions we see in the US of course, is acne. 85% of people ages 12 to 24 experience at least minor acne. And of course we know now in the US with rates of obesity and overweight and unhealthy diet being so predominant it's not surprising, we see a lot of acne. But if you look at studies, ethnographic studies around the world, there are populations where they have no acne like these, this native tribe in Papua New Guinea, no acne, this Guarani tribe in South America, no acne. If you look at Japan, pre World War Two, they didn't really have acne, or the Inuit tribes in Canada, no acne. But then after World War Two as the Japanese diet began become more westernized rates of acne, just like rates of prostate cancer and other Western diseases have gone up. The same with the Inuit in Canada, now they see acne in those folks. So when I was a resident back in the 80s, in dermatology, we were taught that, you know, when you hit puberty, your hormones kick in the testosterone goes up, it activates your oil glands in your skin, and then the lining of the pore over proliferates and gets blocked, you get blackheads and whiteheads. And then the p acnes. Bacteria gets trapped behind that blockage. They over proliferate by feeding off the sebum and you get the red inflamed papules. And of course, all that is still true. But now we know that a big part of that is the what's going on in the gut. And so the diet has a big effect on that. So there have been a number of studies that have indicated correlation between having gut dysbiosis those unhealthy gut bacteria predominating and correlating that with more acne and some of the patho. The pathophysiologic mechanisms that have been worked out is via the high glycemic load diets, trigger increase insulin levels, and increase insulin growth factor signaling and that stimulates the mTOR pathway. And then that leads to the development of acne. Same with a high fat diet can result in the gut dysbiosis, the over proliferation of unhealthy bacteria, chronic inflammation. So those are two pathways that we can get it. That mTOR pathway causes your skin to become oily, you get increased lipid synthesis and then the hyperplasia or overgrowth of the keratinocytes. Also the other thing that stimulates mTOR is leucine, which is A common amino acid in meat and dairy proteins. So we have a number of observational studies. This was a big meta analysis that looked at the correlation between high GI diets, glycemic index diets. So that would be a lot of processed foods and so forth. And they have shown that this supports that association between high glycemic index and acne. And then there are even some randomized control trials showing that if you put people on a low glycemic index, diet, their acne gets better. I went ahead too far. Let me go back on that so. So as far as dairy, that same meta analysis looked at the correlation between dairy and acne, and 70% of those studies supported that we do think dairy exacerbates acne, and particularly whey protein from dairy. So a lot of teenage boys are taking supplements or powders with whey protein trying to bulk up and they come in with bad acne. We don't have any randomised controlled trials on dairy. But there's definitely anecdotal evidence and when kids come in, we tell them, avoid dairy, you know, meat, processed foods, high fat foods, waste supplements, try to up the amount of fiber ie plants in the diet and decrease the animal products in the diet. I recommend to the teenagers that come in with acne, to try to get them to read this book. It was written by Nina and Randa Nelson, who are the daughters of Jeff Nelson, who's very prominent in the plant world and they actually grew up plant based but then they started eating a lot of peanut butter, which was very high fat. And they started getting it getting acne. So they, you know, dove into the literature and the medical literature wrote this book. So I give it to the teenagers trying to get them to read it, some will, some won't. But a lot of them just want to stick with their pizzas and french fries and pizza and all that. A related condition that sometimes called adult acne is rosacea. So this is where about 5.5% of the adult population in the US has it and affects both men and women, this skin gets very red, very inflamed, they get pimples and outbreaks. And it can be pretty miserable to have flushing. There have been a number of studies associating rosacea with problems in the gut, things like h pylori infection, inflammatory bowel disease, the SIBO small intestinal bacterial overgrowth. So, you know, statistically that if you have rosacea, you're more more likely to have one of those. And the common thread, of course, is the gut dysbiosis, the over proliferation of unhealthy bacteria. In addition to gi problems and rosacea, there's increased problems with neurologic diseases like Parkinson's, Alzheimer's, multiple sclerosis, higher rates of coronary artery disease hyperlipidemia. In basal cell carcinoma type of skin cancer, all of those are increased in realization. Another kind of sort of related condition to acne is Hydra retinitis super Teva. And this acne involves the sebaceous glands on the face, chest and back, and hydrate and itis involves the African glands, which is a type of sweat gland. And these people are just miserable. They have draining pus filled, boil like things in their armpits and groin area. And it can be just horrible. There have been a lot of studies showing people with hydrated ninus have higher rates of diabetes up to 30%. The obesity prevalence is 75%. And they have doubled the risk of death of cardiovascular disease. Again, all the same problems that are causing these, you know, common chronic Western diseases, that's what's causing the hydride and itis. So, we there have been some studies looking more specifically at diet in the prevention of hydrated itis, and pointing out that the casein and dairy increases the IGF one. And then the way in dairy and also the highly refined simple carbs, carbohydrates raise the insulin levels up. So again, through those same mechanisms and the effects on the androgen receptor. So we try to get the hydrogen out as patients to again, get off of dairy and go plant based. Another very common disease that we see being affected by diet is psoriasis. About 3% of adults in the US have psoriasis. So that makes it one of the most common immune immune mediated diseases in the US. And at least the self reported prevalence appears to be going up. Same story, all of these comorbidities psoriasis, psoriasis patients have higher rates of obesity, dyslipidemia, heart disease, stroke, psoriatic arthritis, inflammatory bowel disease, and on and on and on all those chronic Western diseases.

09:42

So, same story, there have been studies looking at their gut microbiome, and they have a reduced number of the beneficial gut microbes. And that is affecting the bacteria that get into the systemic circulation through that impaired barrier there. And then that improper activation The immune pathways drives us immune cells to attack the skin cells, resulting in the redness and swelling and joint pains and so forth. This was a study looking at psoriatic arthritis patients in Brazil, almost 93% and more obese 54% had metabolic syndrome. And in the people that had a lot of joint disease activity, they had higher body, higher percent body fat. And then the skin disease activity was worse in folks that had the high cholesterol and LDL. So it's all kind of going together. This was a case report in 2021, of a woman with psoriatic arthritis who was able to get her disease to go into remission by adopting the whole food plant based diet. And as was pointed out earlier, there's many many anecdotal we don't have a lot of randomized control trials. But there's a lot of anecdotal evidence that like it true north, or I'm sure people that the chocolates have worked with, they can get their psoriasis and psoriatic arthritis to go into remission. So when we have patients coming in with psoriasis, we're explaining to them about, you know, the same diet that's causing their psoriasis could cause them to have heart disease, stroke, high blood pressure, diabetes, etc. So we try to get him to read these books, and try to, you know, motivate them to make changes in some will, and some won't. But you know, we're always attempting to get them to go that way. And in particular, people with psoriatic arthritis, it's very similar to rheumatoid arthritis can be very debilitating. And Clint Patterson is an Australian who had pretty bad rheumatoid arthritis. And he was able to reverse it with a plant based diet. So he now has this program where he's helped 1000s of people with adopting a whole food plant based diet, he's got a book and website and online coaching. So again, we try to direct people to a resource like that, or working with a child who is here locally to try to reverse their disease. Another very common skin disease that affects about 15 to 30% of children, and 10% of adults is a topic dermatitis. And the prevalence seems to be going up in urban areas. And again, we think that gut skin axis plays a role. But these people are red and itchy, and just miserable. Studies have shown decreased gut microbial diversity, reduced number of the beneficial microbes and increased proportion of the bad actors, the bad microbes in the microbes in the gut. And it's getting back to that leaky gut that we heard about in the last talk. When you have that leaky gut, it allows toxins to get across the barrier, food residues and pathogens to access the blood circulation. And then when they reach the skin, they release those pro inflammatory cytokines that makes the skin red and itchy. And these folks are just miserable. So we're encouraging a topic patients to eat more fiber, the beans, vegetables, whole grains, eat fermented foods to get the beneficial bacteria, avoid alcohol drink less or ideally no alcohol. And again, sometimes we can get it to do it. Sometimes we can't. Another autoimmune disease that is so interesting, because it's so visible. That's the thing about skin diseases as you can see what's happening in our right with your own eyes. And alopecia areata is an autoimmune disease that can cause hair loss. And in the beginning, it's often patchy with just these round patches like in the man there, but then it can start to become more and more extensive. And then the woman on the lower part of the slide there, she's got what we call alopecia universalis. She's lost everything, her hair, her eyelashes, or eyebrows, her body here. And there's studies coming out more and more associated with again, gut dysbiosis. And a large percentage of people with alopecia areata have ulcerative colitis. And it's fascinating when these case reports began to come out about had Clostridium difficile, the bad bacteria in their gut, and they received a fecal microbial transplant from a healthy person to treat the Clostridium and then they regrow their hair. Here's an example from one of those case reports where, on the bottom left hand side, the the man began to get alopecia when he was age 16. It was just kind of localized and then by age 20, it had become where it almost lost all his hair. And he for the C Diff infection in his gut, he received a fecal transplant from a healthy person, and then his hair grew back. So that was a dramatic illustration of how that gut skin axis Interplay happens. This was an interesting podcast that was on a few weeks ago on the exam room podcast by PCRM. And an interview with these two brothers who both had alopecia areata, again genetic predisposition, but both of them had also been on a just a total junk food diet. So they had you know was getting more and more extensive hair loss from that autoimmune alopecia areata. And then both of them went plant based reverse their hair loss. And now they've started an organization called all it's called all love, no beef. So they're organizations trying to get people on a plant food diet and also decrease violence in their neighborhoods and so forth. So very, very interesting podcast. I was surprised when I came across this evidence about androgenetic alopecia. So that is hair loss due to male pattern or female pattern hair loss. And we know that the incidence is going up of male and female pattern hair loss. And the age at onset is going down. We're seeing it in you know, younger and younger people coming in. And then this article a few years back was in CNN talking about how in Asia, male pattern baldness is increasing. And so there's, you know, people doing more hair transplants and all that because they're very dismayed by this male pattern hair loss. And we know that men who have male pattern hair loss have higher rates of coronary heart disease, high blood pressure, and prostate cancer. So again, some of those same factors that are at play. And the diet research is pointing to, you know, things like this study from Taiwan show that men who drank more soybean drinks were protected against moderate to severe male pattern hair loss, thought to be due to the ISO flavor bones in the soybeans. Another study from Italy show that high consumption of raw vegetables and fresh herbs decrease the risk of male pattern hair loss in men. So some tantalizing evidence there. So if people won't do it for health, maybe they'll do it for vanity reasons. And eat plant based for that reason. This is actually a study I was involved in when I was in Baylor, in the faculty back in the 90s. And in rats, it's very clear if you do skin cancer, where you shine UV lights on the rats, and then you feed them different rat Chow, you feed them low fat, they get less skin cancer induced by the light. But if you feed them high fat, they get more skin cancer. So one of our faculty members got an NIH grant to look at people who've had their first basal cell carcinoma skin cancer. And then we put one group on a low fat diet we were trying to get to 20% but we can only get 21% and the other stayed on their standard American diet. And we did see less skin cancer in the folks that were on the low fat intervention group. And then melanoma. There's some more and more studies coming out recently about how diet affects melanoma. The most deadly form of skin cancer of course, this one from Australia, looked at newly diagnosed melanoma patients and looked at their healthy eating index in the year before diagnosis. And the ones who had the healthier eating index. were less likely to be diagnosed with thick melanomas which the thicker the melanoma the more risk of recurring and metastasizing. So the healthy diet seemed to help, you know alleviate that or make it less common. And the people that had the low healthy eating index score had lower intakes of the fruits, beans, grains, whole grains, etc. And then the people with a low score had higher intakes of the high fat. Here was a study looking at the gut microbiome in melanoma. And they found that people who had melanoma had more of the unhealthy or pathogenic fuse of bacterium compared to healthy volunteers. And they found that the microbial diversity in patients with early stage melanoma they had better and higher microbial diversity compared to those with late stage. Another one looking at melanoma prognosis and found that people eating fruit daily had a better survival rate from their melanoma than the people that ate red meat. So more and more of these studies are coming out all the time. This was one that people found very interesting because some people will say, Well, I don't eat meat, but I'll still eat fish. This was an NIH study that looked at folks and looked at their diet and who got melanoma, and they found that those who ate the most fish had 22% more cases of melanoma than those who ate hardly any fish, and the author speculated that it was due to contaminants in the fish like mercury and arsenic. So again, if you won't do it for health reasons, how about for vanity reasons, will you would you eat a plant based diet to prevent aging of the skin? We know of course, that a huge factor is UV radiation, so sun exposure, and but other factors like smoking pollution, poor sleep, and certainly poor nutrition play a role?

19:43

Here are some of the studies that have looked at diet and skin aging. We know that a high fat diet causes oxidative stress which produces inflammatory damage which ages the skin faster. Earlier, I think one of the talks talked about these advanced glycation In products and eating a high sugar diet and eating the barbecued foods leads to the accumulation of the advanced glycation end products and faster aging. So some authors use the term sugar sag where these ag E's get in the skin and it causes a stiffening of the collagen in the elastic tissue the skin resulting in the sagging of the skin. And then you get this like thickening appearance with a deep wrinkles from those sugar and advanced glycation end products. Some of the other studies from around the world in one looking at patients in Greece, Australia in Sweden, showed that a high intake of vegetables, lagoons and olive oil helped protect against sun damage, but a high intake of meat, dairy and butter, they got more wrinkles and sun damage. In American women. A study show that people that ate a lot of foods with vitamin C and linoleic acid had less wrinkles and less skin thinning. But if they had a higher intake of fat and carbohydrate, they had more wrinkles and skin thinning of the skin. One from elderly Dutch women that showed a diet with red meat and a snack dominant dietary pattern. They got more facial wrinkles, but a fruit dominant diet they had fewer wrinkles. Another one from Australia, this was a longitudinal one where they looked over 15 years and found that people who ate a high antioxidant capacity had less aging over a 15 year period than those who ate a food with low antioxidant capacity. So we know that the antioxidants in the plant based foods helped to you know, quench those reactive oxygen species from all the sun damage and so forth. So you want to really up your antioxidants by eating a plant based diet. And of course, where do you get all the antioxidants? Here's the vitamin E is the number one antioxidant in the skin and here's where you can get it with your spinach, almonds, Mango tomatoes, but also Vitamin C, Vitamin A chlorophyll are all important to get. This was alluded to earlier by Dr. Klapper. And I thought this was very interesting, this study about body odor where they took 17 young men and had him wear these pads and their armpit to collect the sweat for two weeks. So for two weeks, they were on a non meat diet. And then they went off and did nothing for a month. And then they did another two weeks on a meat diet. So they just crossed over. And then they had women smell the pad. I'm not sure I'd want to do that study. But the women smell the pads and they judge the men on the non meat diet as more attractive, more pleasant and less intense than the men on the meat diet. So and I mean my husband I talked about this and we both feel like we smell better when now that we're eating plant based than we used to so other people feel the same. So in summary, the high fiber diet that promotes the healthy gut microbiome, that reduces chronic inflammation is skin, it's going to make your skin healthier, you'll avoid all those inflammatory skin diseases, and then all of the antioxidants, vitamins phytonutrients. That's going to make your skin healthier. And of course avoid the bad stuff. The dairy animal products, processed foods that create the unhealthy gut and the unhealthy skin. So I kind of adapted some of my favorite plant based heroes adapted their quotes. Kim Williams always says he talks about there's two kinds of cardiologists I'm gonna say there's two kinds of dermatologists, vegans and those who haven't read the data. And then Dr. Klapper says it's the food and I'm gonna say it's the food that causes acne. And Esselstyn talks about how heart disease is a toothless paper tiger. Same with psoriasis. It's a toothless paper tiger that need never exist. And then another big hero, John McDougall, he recently got the award at the plant trician project meeting, and he says, the fat you eats the fat you wear and I'm gonna say the fat you eat is the fat that makes your skin oily. So you want to want to avoid all of those animal products and eat plants and thanks for your attention.

Maya Acosta  24:12

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