Full Transcript Intro and Guest Background 0:01 [music] >> Welcome to the Trip Lab. Kitchen table 0:05 conversations about integrative medicine and psychedelics. [music] 0:08 I'm your host and attending physician, Dr. Mariela Wood. 0:13 Hi everyone. Welcome back to the Trip Lab. Today, we actually have a special 0:18 guest on who's going to talk to us about all things integrative dermatology. Dr. 0:23 Asmi Berry is a board-certified dermatologist who has also done 0:27 additional training in integrative dermatology and Ayurvedic culinary 0:31 medicine. She currently practices at BH Skin Dermatology in Los Angeles and also 0:36 sees patients virtually through Future Clinic. Her focus is taking a whole 0:40 person approach to skin health, weaving in hormonal health, the gut-skin axis, 0:45 nutrition, and Ayurveda alongside conventional dermatology. 0:50 I absolutely loved my conversation with Dr. Berry and we covered a lot in a very 0:55 short amount of time, including integrative approaches to acne, hair 0:59 loss, postpartum hair loss, pregnancy skin care, anti-aging practices, 1:04 inflammatory conditions, and a lot more. We also dive deeper into Ayurveda and 1:10 how understanding your personal doshas can actually help you with your skin 1:13 care routine. We also talk about the gut-skin axis, 1:16 hormones, and why an integrative approach in any specialty really truly 1:20 is about combining the best of both conventional and evidence-based holistic 1:25 medicine. And if you loved her as much as I did after this episode, I did link 1:29 all of her contact information in the episode description, including her 1:32 website, which is drasmi.com, clinic information, Instagram, which is 1:37 just @drasmi, and her YouTube channel. So, without further ado, here is my 1:43 conversation with Dr. Asmi Berry. Dr. Asmi Berry, thank you so much for 1:48 coming on the Trip Lab. Very excited to talk to you about all the things 1:52 integrative dermatology, Ayurveda. So, thank you so much for coming on. 1:56 >> Yeah, thank you for having me. I'm so excited about this podcast. 2:00 >> Why don't you start by telling us a little bit more about what you do? I 2:04 know you're board-certified dermatologist, have done training in 2:06 integrative medicine, Ayurveda. Why don't you just start by telling us a 2:10 little bit about your journey, how you decided to get into this field and and 2:14 all the training that you've done. So, yeah, just tell us a little bit about 2:17 yourself first. >> Yeah, so I I've always known I wanted to 2:20 go into medicine. My father is a cardiologist trained in in the US, so 2:26 the traditional Western cardiology. And then my maternal grandparents are both 2:33 Ayurvedic physicians, so trained in India, but then practicing in the US. 2:40 And so I always knew I wanted to go into medicine because of the science and the 2:43 direct human impact. And I started off the traditional Western way. So, I went 2:50 to medical school and then I did residency in dermatology. And then I 2:55 started practicing and I was really excited about putting everything I 2:59 learned into play and to really make an impact and help my patients. But what I 3:04 started realizing very early on is Western medicine is amazing. They have 3:09 so much research, a lot of clinical evidence in treating conditions, but
Acne Root Causes and Diet 3:15 what that actually translates to is treating symptoms. So, like the bread 3:20 and butter of dermatology, acne, rosacea, eczema, psoriasis, 3:25 pigmentation, hair loss. I had really good tools to help those symptoms. But 3:31 then as soon as the patient stopped the medication, 3:35 the conditions would just come back. And and that's where I I had to pause and 3:39 think, "Something's missing. Like there's there's something that I'm not 3:44 getting." And that's when I realized the Western framework is just 3:50 purely focused on symptom control. And so, I started to ask the why. And 3:57 the why often came down to the same few things: gut, hormones, stress, and 4:02 sleep. And then I found this fellowship uh integrative dermatology, where I 4:07 studied the evidence and the the clinical studies behind Eastern 4:12 philosophies of medicine. So, that included Ayurveda, traditional Chinese 4:17 medicine, and even Western botanical medicine. And gave me more frameworks to 4:24 work with. And then after this, I also went to Ayurvedic culinary school, 4:30 where I learned the science of food as medicine and more practical ways to help 4:37 patients beyond just the traditional tools of conventional medicine. So, now 4:43 I practice using both. So, using the Western tools to help treat the symptoms 4:50 while simultaneously working with patients to get at the root of what's 4:55 happening. So, I I essentially became the doctor that I wished my patients 5:00 could find earlier. >> And I love how you described things like 5:04 acne and rosacea as symptoms. I remember in medical school we learned that's a 5:08 diagnosis. We're diagnosing acne. We're diagnosing rosacea. But it really is a 5:12 symptom of something deeper. What kind of things do you look I guess we can 5:16 just start off with acne since I'm sure that's going to be a big one for 5:19 everyone, myself included. What kind of things do you look for when you're 5:24 digging deeper and trying to find what is the root cause of acne? 5:28 >> So, for acne, a lot of it is related to diet, especially for the 20-30-year-old 5:34 female dealing with acne. Teenage years, it it is mostly the surge of hormones 5:41 that comes with puberty. And that's something that it's it's more my focus 5:46 is really treating the symptoms because I know that eventually their hormones 5:51 are going to kind of level out. But yeah, it's it's primarily for acne, the 5:56 post-teenage year female patient who's suddenly dealing 6:01 with cyclic acne that happens like a certain time around her period. So for 6:06 those patients, I I find out if there's any sign of something undergoing like 6:11 metabolically like is there PCOS or something internal happening. Um I 6:17 also ask questions about their lifestyle, stress, and sleep. But diet 6:22 usually plays the biggest role in this population. And everybody's different, 6:28 but I would say the two things that come up the most and are the best studied are 6:34 dairy, especially low-fat dairy, and high glycemic index foods. The mechanism 6:40 is the insulin-like growth factor one, which 6:44 eating dairy or consuming high glycemic index foods will spike your insulin and 6:50 or increase insulin-like growth factor one, which leads to the sebocytes, the 6:55 cells that create sebum, to go into overdrive, leading to acne. 7:01 >> Mhm. You mentioned low-fat dairy. I think this is a big topic that comes up 7:06 a lot, and not just for acne, but for a lot of things like people think low-fat 7:10 is healthier. What are your thoughts about in general low-fat versus high-fat 7:15 dairy if people if people are going to consume dairy at all? 7:18 >> So So definitely for everyone I recommend the high-fat dairy um 7:22 unless somebody is dealing with other conditions like 7:26 like high cholesterol, then then it's becomes more nuanced, but in general 7:33 the way that I like to tell patients to think about is low-fat dairy is more 7:38 processed. So they usually do more work to get rid of the fat to make the food 7:44 low-fat dairy. But also, the fat that comes with dairy 7:49 naturally is protective. And when you get rid of that, then your 7:54 your hormones become more reactive. >> What about non-dairy milks? Because 8:00 those technically are more processed as well. Do you have any thoughts about 8:03 those for acne or other skin conditions? >> Yeah, so with non-dairy milk, it all 8:08 comes down to whether it's high glycemic index or not. So, oat milk tends to 8:16 be extremely high in sugar. Naturally, like it's not They don't tend to add 8:22 sugar, but just the way they turn oats into milk, like 8:25 in that process, the end result has a pretty high amount of sugar. So, there's 8:30 there's been some studies where patients wore CGMs, and they saw that after 8:36 drinking oat milk, their blood sugar just would spike just because of how 8:41 high the milk is in sugar. So, I definitely tell my patients stay away 8:46 from oat milk. And then in terms of other non-dairy milks like almond milk, 8:52 soy milk, pea protein milk, just make sure that it's not sweetened. And then 8:58 it it shouldn't spike your blood sugar as much. 9:02 >> So interesting. Yeah, the sugar content or at least the glycemic load of the oat 9:05 milk really does really does trick people. My rule of thumb is in 9:09 moderation, if you're drinking a little bit of oat milk in your latte, probably
Ayurveda and Skin Constitution 9:13 okay if you have a dairy sensitivity or dairy causes acne. But yeah, oat milk is 9:17 one of those those tricky ones. What other food recommendations do you 9:21 give people? Is there any particular conditions that you recommend specific 9:25 foods? >> Yeah, so so going back to acne, so I 9:28 tell people to be like careful around the the low-fat dairy and high glycemic 9:32 index foods. But things to add, so the research has shown that green tea 9:38 catechins can actually reduce sebum production. So, I always recommend that. 9:44 And then zinc-rich foods, and this is like pumpkin seeds, seafood, oysters, is 9:51 really good for acne. It's has direct antibacterial effects. It helps your 9:55 body heal. And it also inhibits 5-alpha reductase, which turns testosterone into 10:03 DHT, which is a very heavy driver of production and hair loss. So, for both 10:09 my hair loss patients and acne patients, I I recommend zinc. 10:13 >> Do you ever recommend spearmint tea? I know that one's talked about as also 10:17 blocking that conversion of DHT as well. >> Yeah, so for specifically 10:22 androgen-powered acne, 10:25 I've seen the studies. They're good, but they haven't looked at a lot of 10:29 patients. But, it is something I recommend to patients as an adjunct. 10:33 It's not a replacement for other acne medications that have more evidence, but 10:39 it's harmless. So, it's a good thing to try in addition to the rest of your acne 10:45 management tools. >> Is there anything else specific for 10:48 acne, like topical for anything Ayurvedic? 10:51 >> Yeah, there's so many things for acne. Some other things for especially 10:55 hormonal acne, DIM supplements. So, DIM, it's the compound that you can find in 11:02 cruciferous vegetables, like broccoli, cauliflower, red cabbage. And this is 11:08 really good in modulating estrogen. So, again, similar to the spearmint tea, 11:13 not a replacement for acne, especially acne topicals, but something that if 11:20 it's estrogen-driven, I tell patients to do in addition. And also pumpkin seed 11:25 oil also helps with that hormonal acne. And then for Ayurvedic, I do recommend a 11:31 lot of skin oils topically. So, for people who have oily skin, there's a 11:37 misconception that you can't use oil on oily skin, but you can. You just have to 11:41 make sure it's a thinner oil, like a thinner consistency. So, I really like a 11:46 hobart oil for my oily skin patients. And then for patients who have really 11:50 dry, I really like sesame seed oil. And these are more the Ayurvedic. And 11:56 then also, I love recommending patients to do some type of facial massage. This 12:02 can help healing acne scarring, and it's also activates the parasympathetic 12:07 system, so it just it's overall good in grounding you as well. Maybe we can back 12:12 up a little bit. I haven't done a full episode on Ayurveda. I've talked about 12:15 it a couple times in my podcast, but could you just give your perspective or 12:19 just a brief explanation of what Ayurvedic medicine is? No, so Ayurveda, 12:24 it's the system of medicine practiced in India for thousands of years. And the 12:28 whole philosophy is they don't see the skin as a separate organ. They see it as 12:34 part of the whole picture. And especially for skin is viewed as the 12:39 external expression of the internal constitution. 12:43 So, the doshas, which is how Ayurveda kind of frames different conditions, it 12:51 gives us a framework for skin patterns that helps predict tendencies before the 12:57 conditions fully manifest. So, there's three doshas. There's vata, pitta, and 13:02 kapha. Vata, these are people who have dry, thin skin that's more delicate and 13:10 fine pored, and they're more prone to dehydration, 13:16 early signs of aging, eczema, and it gets worse with dry, cold climates and 13:24 irregular routines. And then pitta, this is people who have like more sensitive,
Hair Loss, Supplements, and Postpartum Shedding 13:30 reactive, warm skin. And they're prone to redness, rosacea, 13:35 inflammatory acne, and also pigmentation, especially like melasma or 13:41 post-inflammatory hyperpigmentation. Like the classic rosacea patient is 13:46 almost always Pitta. And then finally, it's Kapha. And Kapha is those who have 13:51 more oily, thick, congestion-prone skin. And they tend to get things like cystic 13:57 acne, enlarged pores, sluggish lymphatic flow, milia, those sebaceous 14:04 hyperplasia, like the thick yellow oil glands. They need stimulation and 14:09 circulation support. >> One question I always had, cuz it can 14:14 get confusing thinking about a constitution and then your current 14:17 presentation. >> Constitution is what you're born with. 14:20 >> Okay. >> The Sanskrit word is your Prakriti. 14:23 >> Mhm. >> So, everybody, for example, I can use 14:26 myself. For my whole life, I've had Vata-Pitta skin. So, my skin's always 14:31 been dry and sensitive. And that's that will never change. That's my like 14:35 baseline throughout the years. But then my Vikruti, which is my current state, 14:42 that's according to maybe my lifestyle or the 14:46 environment I'm in, that can change my current to like a newer constitution. 14:52 So, for example, if I'm in Florida in the summer and it's super humid, then 14:58 I'll be more Pitta than usual. So, then I might get like heat rashes or like 15:04 really sensitive skin. Or if I'm in Chicago in the winter, then my Vata will 15:11 be activated. So, then my skin issue, my Vikruti at that time would be extreme 15:17 Vata, very dry skin. Probably my eczema would get flared. 15:21 >> And so, you when you're treating, you treat what's going on actively, not 15:25 necessarily the constitution that you're born with. Is that how it goes? 15:28 >> Kind of. So, you treat what they're presenting with, but keeping their 15:33 constitution in mind. So, in the examples I gave, 15:38 if I'm in Chicago and my skin is super dry, knowing that my constitution is 15:44 already on the drier side, I'm not going to treat myself with the goal that my 15:50 skin is super hydrated and ultra plump, because I know that I'm just prone to 15:55 having dry skin in general. So, I'm going to treat myself, but not in an 16:00 excessive amount. >> Okay, that makes sense. I guess another 16:03 big topic that I'm sure you get questions on a lot is hair thinning, 16:06 hair loss, hair loss supplements. We can start with top recommendations or any 16:11 specific nutrition. I'm also very curious about your thoughts on the hair 16:15 loss supplements and what the evidence shows. If you could talk a little bit 16:18 more about that. >> Yeah, so this is one of the most common 16:21 things I see patients for. And I'm always seeing the same thing, 16:25 unfortunately, with the onset of wellness influencers 16:29 and people getting their advice from Instagram and TikTok, is 16:34 there's a massive myth that biotin is the go-to 16:38 for growing hair. This is definitely over acclaimed. Biotin only works if 16:43 people are deficient in biotin, and most people aren't. So, I get this patient a 16:49 lot. They come to me and they're so confused why they're having hair loss. 16:53 They're like, "I take so much biotin every day." I'm like, that's 16:58 that's not treating the condition. >> Yeah. 17:01 >> So, for my hair loss patient, usually the first thing I do is try to identify 17:05 a nutritional deficiency, because that is the most common reason. So, 17:11 typically, it's it's iron or vitamin D. Those are the two most common things I 17:16 see in my clinic. With iron, it's a little bit confusing 17:21 because when you get a lab, it says ferritin, which stores iron, it says 17:27 it's normal if it's between 18 and 280, something like that. But for healthy 17:34 hair growth, it has to be 70 or above. >> That's a lot higher. 17:39 >> Yeah, it's a lot higher. So, the lab would say, for example, 30, and then 17:44 patients are like, "Oh, it's normal cuz it's within the range." But for hair 17:48 loss specifically, that's not considered normal. It does It does need to be above 17:53 70. So, for that patient, they would benefit a lot from iron supplements. 17:59 And then vitamin D, kind of similar. Vitamin D should be 60 or above for good 18:04 hair growth. And I think I want to say the lab says it should be like 30 or 18:08 above. >> Yeah, I think it's 30 to 100, which 18:11 Yeah, I find that even besides hair growth, I find 30 is just way too low 18:15 for a lot of different conditions. >> And so So, I always check these, and 18:18 also B12, zinc, thyroid. These are all things that can lead to to hair loss. So 18:25 then, once these nutritional deficiencies are 18:29 addressed, then I do I do like specifically Nutrafol or Viviscal to be 18:34 used on top of that. Um but if you're not correcting the deficiency, you're 18:37 kind of just wasting your money. With Nutrafol, some of the ingredients that I 18:42 really like are saw palmetto. This helps with that DHT inhibition. Ashwagandha, 18:48 which there's so many studies now showing that it's really good for 18:52 cortisol modulation because stress-driven hair loss is extremely 18:56 common. And then also collagen. Marine collagen is stronger than bovine 19:01 collagen, so it's just something to to know. And Nutrafol does use the marine 19:06 collagen. >> That does make it kind of a nice 19:08 package. I always think you can do the saw palmetto or this one, but if it is 19:12 including everything, it probably is one of the better ones. 19:15 >> Yeah, so it's it's really good especially for postpartum patients 19:18 because it's addressing like just like you said multiple pathways. 19:22 >> Is there anything else for postpartum hair loss specifically? I certainly had 19:27 that when I was postpartum and I did a lot of things and I think it worked, but 19:31 I'm curious what your recommendations are for patients. 19:34 >> So if postpartum, when your body's under a lot of stress with the delivery, then 19:38 your hair is shifted into the telogen stage, which is the resting stage and 3 19:45 months after that it goes into the shedding phase. So a whole bunch of your 19:50 hair starts shedding after about 3 months. It can be scary, but 19:55 it is temporary. Your hair will get back to how it was after a year. You have to 20:00 be careful because a lot of women if they're breastfeeding, they have to be 20:03 careful about what type of topicals and medications they use. But the safe ones 20:07 are Nutrafol is really good. And I also really like and there has been a lot of 20:12 evidence behind hair massage. >> Like that's part of Ayurveda, too? Cool, 20:16 yeah, tell us a little bit more about that. If someone wanted to incorporate 20:19 that either in pregnancy or postpartum, what would that look like? Any certain 20:23 oils? How often? >> So you have to be careful with oils. If 20:28 you get coconut oil for example, it's really good at strengthening your 20:32 hair, but you don't want to get it onto your scalp. You want to get it like 20:37 mid-shaft and lower because it gets onto your scalp and I've seen this so many 20:41 times in clinic, it can clog your pores because it's a very thick oil. So a lot 20:45 of patients complain of folliculitis on their scalp after using coconut oil. But 20:50 you can use thinner oils. I know there's this study about rosemary oil. In the 20:56 clinical trials, it showed to be comparable to minoxidil 2.5% 21:02 which honestly for my patients whenever I I minoxidil, I go 5% or higher. So,
Pregnancy Skin Care and Safe Actives 21:08 it's not comparable to rosemary oil, but post-pregnancy, 21:13 rosemary oil is totally fine as just a small way to increase hair growth. And 21:18 then red light therapy is also a really good way, a safe and pregnancy safe and 21:23 breastfeeding to help stimulate new hair growth. And 21:27 a lot of evidence for it, it activates the mitochondria, which increases ATP 21:31 production. So, that's another thing that I recommend. And with hair loss in 21:37 general, like any type of hair loss, you really get the best benefit by using 21:42 multiple modalities. So, if somebody is concerned about postpartum hair loss, I 21:47 say like number one, watch your diet, make sure 21:51 you're getting enough protein because that that is what creates your hair 21:55 follicles. But then also, think about supplementing with things like Nutrafol, 22:00 think about hair massage, thinking about red light therapy, and maybe 22:05 incorporating rosemary oil, doing all the things. 22:09 >> Speaking of pregnancy, congratulations. She's actually pregnant. So, I'd love to 22:15 hear a little bit about how your journey has been, if you've been doing any of 22:19 your integrative Ayurvedic practices, what you've like noticed about pregnancy 22:23 or or any insights. I'd love to talk to you a little bit more about that if 22:27 you're open to it. >> Yeah, thank you. Thank you. We're really 22:29 excited. So, prior to pregnancy, I'm I am very prone to acne and melasma and 22:38 rosacea. So, going into pregnancy, I knew that 22:42 these were things that I needed to watch out for. For some people, you get the 22:47 pregnancy glow and your skin is amazing, but for others, pregnancy, because of 22:51 the shifts in hormone, you can get acne flares. And then with the increase in 22:57 estrogen, what estrogen does is it increases a specific receptor on your 23:02 melanocytes or pigment producing cells so that they're more sensitive than 23:07 usual to things like inflammation and UV. So, that's why they call melasma the 23:13 mask of pregnancy because it tends to be found more commonly in those who are 23:18 pregnant. So, I do use uh throughout my pregnancy I've been using prescription 23:23 topicals to help prevent these from flaring and affecting my skin. So, for 23:30 acne, the two prescriptions that are safe are 23:35 topical antibiotics like clindamycin and azelaic acid. And then for melasma, 23:41 azelaic acid as well. Azelaic acid, I would say that's my 23:45 pregnancy workhorse. It's anti-inflammatory, 23:49 it's anti-pigment, and it's anti-acne, and completely safe. Other topicals that 23:54 I've been using beyond this are tranexamic acid, which is really good 23:58 for post-inflammatory erythema and for hyperpigmentation of all types. And this 24:04 is something that I just used over the counter. And then vitamin C, everybody 24:09 should be using it especially if you live in the city because it helps not 24:13 only stimulate new collagen because vitamin C is a cofactor for collagen 24:17 synthesis, but it also helps it's an antioxidant so it helps protect your 24:21 skin from pollution and environmental toxins, which living in any city you're 24:27 much more exposed to. It also helps your sunscreen work better. 24:31 I use vitamin C for antioxidant protection and brightness. And then the 24:37 non-negotiable is sunscreen. So, throughout my pregnancy I used a mineral 24:42 sunscreen with iron oxides every single day. And this is the biggest factor in 24:48 protecting against melasma. And then diet, dietary changes during 24:53 pregnancy really important for your for your baby, growing baby, for your 24:58 health, but then also for your skin. >> Mhm. 25:00 >> Um so the three things I the really the four things I focused on nutritionally 25:05 is number one is protein for growing baby, but also like protect your hair, 25:10 skin, and nails. Omega-3s for the skin barrier integrity, and also they're 25:15 anti-inflammation. Zinc, 25:19 which we talked about before, and then also vitamin C orally. So a lot of fresh 25:23 fruits and vegetables. >> I love that. And there's actually a lot 25:27 of evidence that vitamin D deficiency is associated with preeclampsia, and 25:31 omega-3s may help with pregnancy brain fog. So it kind of all ties together. 25:36 The skin health, the baby, the mom, all all the things you can do. 25:40 >> Yeah, for sure. Vitamin D is also one of the biggest um 25:44 >> [clears throat] >> factors for hair loss. 25:46 >> Mhm. Oh yeah, I'm sure that would help, too. And I feel like most prenatals 25:50 don't contain enough vitamin D, in my opinion. Most almost always I find that 25:55 people still have vitamin D deficiency with that. So I almost always recommend 25:58 an additional vitamin D supplement. >> Yeah, and it's 26:01 it's unfortunate that prenatals aren't standardized. 26:05 >> Mhm. Yeah, to really and I think about this with multivitamins, too. So to 26:09 actually fit all of the ingredients that you need, there's no way you can pack 26:13 all that powder into one tiny little capsule. So I mean, the one that I took 26:18 in in pregnancy is needed, and it requires eight capsules a day. 26:22 Which was hard to do when you're really nauseous in pregnancy, but to actually 26:27 get all the stuff that you need, it needs to be more than just one tiny 26:30 little thing. Just so interesting. >> Yeah. My prenatal has two capsules, but 26:35 then I supplement. So in total, I think I had take 12 pills a day. 26:40 >> Oh my gosh. Are you able to tolerate that? Did you get any pregnancy nausea, 26:44 or were you able to tolerate the supplements? 26:46 >> So I did in the very beginning, but then I started incorporating more protein, 26:50 and the nausea just disappeared, which was amazing. And then second trimester, 26:55 I started getting nausea but because of GERD. 26:58 >> Okay. >> And I'm not a snacker, so I had to learn 27:00 how to like stop eating three meals and start like eating six small ones, which 27:05 is so hard, and I I kind of started relating to my patients is like the 27:09 lifestyle change when you're so used to eating a certain way and then like have 27:13 to change. It is It's really hard. >> It's hard. Yeah, there's so many things 27:18 in pregnancy and postpartum that I mean, I've always I was always in women's 27:23 health and thought about going to OBGYN route at one point and was so passionate 27:27 about it, but now that I've been through it, I feel just so much more passionate 27:31 about whatever women are going through in 27:34 pregnancy, fertility, postpartum. I just want to support them in every way that I 27:38 can. >> That's great. Yeah. Women's health, I'm 27:41 so glad that it's becoming a hot topic now, and we're learning so much more. 27:45 >> I'm curious to your thoughts. So, I know topical retinol not supposed to use in 27:49 pregnancy. I did some research myself. Again, just when I was pregnant, like, 27:53 can I really not use my retinol? Ultimately, no, I did not use the 27:57 retinol. But it's interesting. I found some studies that there actually is no 28:01 systemic absorption of topical retinol. Have you done any research about this or 28:05 looked into it or any thoughts about that about, you know, potentially 28:10 the non-absorption of topical retinol during pregnancy? 28:13 >> Yeah, I actually did a lot of research on this because my retinol, I use a 28:16 prescription Arazlo. It's my favorite skincare product. It has been If I would 28:22 say one thing that's completely changed my skin through the years, it's that. 28:26 So, I was really sad about dropping that during pregnancy. But 28:31 the the studies that are used is because retinol is the topical form of Accutane. 28:36 They're both vitamin A. Topical is like topical vitamin A, and Accutane is just 28:41 a very high dose of oral vitamin A. And there's countless evidence and studies 28:46 and the anecdotal reports that we know for sure that Accutane, taking a high 28:51 dose of vitamin A, or even just taking a high dose of vitamin A supplements, 28:56 >> [clears throat] >> um can 28:57 have profound effects on the neural development of of the growing fetus. And 29:04 so, it was kind of more of a 29:08 we know that oral is bad, so let's just be safe and say don't do topical. And 29:14 there's been When I was doing my research, there's been a couple of 29:17 studies showing that there's some I think it was more in the context of 29:22 breastfeeding that there may be like a little bit of systemic absorption, but 29:27 there also were a lot of studies that say there aren't. So, it's one of those 29:32 things that I I've noticed that there's a lot of this in the women's health and 29:36 pregnancy space where we don't know the answer, so we just pick the safest
Anti-Aging Skincare and Gua Sha 29:41 option. And then, once we do know the the guidelines change, which can be a 29:46 lot very confusing for a lot of people, but it's just because we're we want to 29:50 be safer rather than sorry. So, 29:54 I I did not use my retinol throughout pregnancy just just in case. Cuz I just 29:59 feel like we don't have enough evidence, but you're right. It it does seem like 30:04 it may be safe, but I just I don't want to take that chance. And I I tell my 30:09 patients not to take that chance as well. 30:12 >> Mhm. Yeah, I was of the same notion. It may be okay, but no one wants to risk 30:17 that for their unborn child and the pregnancy anxiety really gets to you 30:22 too, and so it's just better to be on the safe side. That goes for a lot of 30:25 herbal supplements too with pregnancy, unfortunately. 30:27 >> Yeah, I will add there is there is a lot of evidence about the retinol substitute 30:34 to use during pregnancy. Bakuchiol, it's a plant-based retinol alternative, and 30:39 it has a lot of the same benefits of retinol in terms of anti-aging, but it's 30:45 not as powerful as retinol. So, for my patients who are very sad about coming 30:52 off of the um retinol, I I do recommend that they start using bakuchiol with the 30:57 understanding that one, it is natural, it is completely safe in pregnancy, but 31:01 also they won't get the same level of effects as retinol. But, for those who 31:08 are sad about giving it up, this is a good alternative. 31:10 >> Yeah, I I use that one, actually. I think it made some kind of a difference. 31:13 >> [laughter] >> I guess kind of along those lines, do 31:16 you have any recommendations, I guess, either 31:19 pregnancy, when you can't use the retinol, or just aside of pregnancy, 31:22 like what are your top go-to for improving skin elasticity, reducing 31:26 wrinkles, reducing risk of wrinkles? What are your top nutrition, topicals, 31:32 or what's something big that people think works that doesn't work? Just 31:35 curious your thoughts on all that. >> Yeah, so number one, I would say is 100% 31:40 sunscreen, non-negotiable. It's the single most evidence-supported 31:44 anti-aging and anti-pigmentation intervention that exists. 31:49 Specifically, I like the tinted mineral sunscreen with iron oxides, especially 31:54 if you have pigmentation, because iron oxide is the only ingredient that's been 31:58 shown to block visible light, which comes from like laptops and screens. 32:03 >> Ah. >> A lot of people don't realize. And then, 32:06 if you aren't pregnant or breastfeeding, then retinols. And number three would be 32:11 vitamin C because of the how it's a collagen 32:14 cofactor, and also inhibits tyrosinase, which is the enzyme that can create 32:19 pigmentation. Niacinamide is also something I highly recommend. 32:23 >> Mhm. >> It's one of those jack-of-all-trades. It 32:26 does a lot of things. So, it helps support the skin barrier, helps regulate 32:31 oil production, it's anti-inflammatory, it's brightening, and it's one of the 32:36 small number of ingredients that is uniquely well tolerated across every 32:41 skin type. >> Mhm. 32:43 >> So love a good niacinamide. There most people's moisturizers have 32:47 niacinamide in them. But if yours doesn't, then definitely recommend 32:51 topical niacinamide. Then azelaic acid comes in prescription like what I'm 32:56 using, but it also comes in a lot of skin care products. And then tranexamic 33:00 acid is also a great one that I recommend to patients because of its 33:05 effect on melasma. Peptides, this is one of the the newer medication I'm sorry, 33:11 the newer active ingredients in skin care. It does have a a solid mechanism 33:17 and there's early evidence that helps with collagen and barrier support. And 33:22 there's bakuchiol like we talked about. And then another one that's fairly new 33:27 is polyglutamic acid. This is a humectant, so similar to hyaluronic 33:32 acid, but actually significantly more powerful. Some ingredients that are a 33:37 little bit more overhyped, I would say snail mucin. This is good for like 33:43 younger kids. It's got a nice texture, but it's got minimal clinical evidence. 33:47 It's more good for a hydration. But if somebody's looking for 33:51 actual hydration because their skin is dry, then there are much better 33:55 ingredients. >> What about facial gua sha? I know that 33:59 has become popular. Do you have any thoughts about that? 34:02 >> So yeah, facial gua sha, it's traditional Chinese medicine at home 34:06 device. Um and the lymphatic drainage and circulation benefits, these 34:11 mechanisms are like biologically plausible and anecdotal reports are 34:15 consistent enough that I do recommend patients to like do it if they're 34:20 currently doing it. It makes sense that doing like a facial massage would help 34:25 with blood flow. But there is a lot of again like wellness influencers like a 34:30 lot of overhyping of the effects of lymphatic drainage and detoxing, which 34:36 the evidence doesn't really support. So, if one of my patients is doing it, I 34:41 would say like continue doing it, but it's not something that's going to give 34:45 you a massive difference. >> Mhm. 34:48 >> But it's safe and it's low risk. Except I I have seen some patients who were a 34:53 little bit aggressive with their gua sha, especially if it's over someone who 34:58 has like a lot of acne or rosacea, then you don't want to be aggressive and you 35:02 want to be a little bit more careful because doing gua sha, you're just going 35:06 to be stimulating blood flow into already overreactive tissue. 35:12 >> Mhm. Yeah, that's a good point. One thing that I think is interesting the 35:15 traditional Chinese medicine gua sha that's done on the body, it's supposed 35:19 to cause petechiae or the little blood vessel ruptures. That's how it works for 35:23 healing the muscles and things like that, which I'm assuming you don't want 35:26 to do on the face. >> Exactly. [laughter] Yeah. 35:28 >> Okay. Very gentle if if you're going to do it. 35:31 Kind of pivoting a little bit talking a little bit more about nutrition. Hear a 35:35 lot of people using probiotics for skin. Do you have any thoughts about gut 35:39 health, the connection with gut health and skin, or use of probiotics or other 35:43 things? Any thoughts about that? >> Yeah, so the evidence for the gut-skin 35:47 axis is now there's so much evidence. So, it's no longer considered fringe
Gut-Skin Axis and Probiotics 35:51 medicine. It's showing up in all the mainstream journal literature. This gut 35:56 talks to your skin, it talks to your nervous system. It can help topically in 36:02 terms of especially if somebody's been on a lot of topical or oral antibiotics 36:06 and they want to rebalance their skin's microbiome. But I do recommend and 36:11 there's a lot of research in using probiotics for specific skin conditions. 36:16 For acne, for example, there's a lot of data around two specific probiotics. So, 36:22 it's lactobacillus acidophilus and lactobacillus rhamnosus. 36:29 And the study shows that incorporating these probiotics will actually reduce 36:33 the number of acne lesions and the gut skin barrier markers. 36:40 Um and then for eczema, especially my um like my younger population, there's a 36:45 lot of research on specifically it's called lactobacillus rhamnosus GG. It's 36:51 a specific strain that has been shown to decrease the severity of eczema. You can 36:56 buy this online. There's a lot of supplements made meant for kids that 37:00 have this probiotic in it. >> I loved all the the microbiome research 37:04 and we're finding out it's connecting to everything like mental health, skin, 37:07 lots of different things. Are there any foods you recommend for 37:12 gut health as it relates to skin health or just gut health in general that are 37:16 your go-to for patients? >> Yes, so going back a little bit, 37:20 something that cuz we've mentioned Ayurveda, I do want to say Ayurveda has 37:23 been talking about the gut for since at the beginning. So over thousands of 37:27 years they've mentioned there's this gut bacteria, which is really fascinating 37:31 because I feel like in the West, it's like a 37:34 relatively new discovery. So I found that to be really cool. 37:39 >> Mhm. >> But yeah, for cuz a lot of dermatology 37:42 conditions are inflammatory and balancing your gut microbiome can make a 37:47 significant difference in calming down that inflammation. So I would say 37:51 fundamentally across pretty much most dermatology conditions, kind of food 37:56 guidelines, I would say low glycemic index foods, but also adequate protein, 38:01 omega-3s, antioxidant-rich vegetables, and a variety of different types of 38:07 fiber. So you have the soluble, the insoluble. And there's a lot of evidence 38:11 that eating prebiotic foods, so this is things like 38:17 garlic, leeks, bananas. When you consume these, your gut microbiome ferments it 38:23 and creates these short-chain fatty acids like butyrate, which are very 38:28 healing, healing the gut barrier. So, it helps fight that leaky gut, but also 38:33 it's strongly anti-inflammatory. And also, like you said, it's been shown to 38:37 help with mental health conditions, which is pretty cool. 38:42 >> It is cool, and I I love that you brought up that yes, Ayurveda has been 38:45 talking about this way long ago. It's It's just so interesting that there's a 38:49 lot of things in Ayurveda and traditional Chinese medicine, like 38:52 around longevity and and all all the things that are now popular that they've 38:55 been talking about for thousands of years, and now we're finally catching up 38:59 to some of that ancient wisdom. So cool. Well, as we close out here, a couple 39:04 questions. I guess first question, biggest misconception or biggest 39:08 wellness trend that you find people are trying that are just has no evidence, 39:13 and if you could leave everyone with one lasting recommendation as it relates to 39:17 integrative dermatology. >> Yeah, so for the first one, I would say 39:22 the biggest thing, and this is something I 39:24 >> [clears throat] >> feel like I'm repeating to patients over 39:27 and over again, is when they see something online or they hear about
Personalization and Integrative Dermatology Takeaways 39:32 anecdotally that something helped for somebody, you have to realize that 39:36 everybody's different. And this this is one of the cores of Ayurvedic medicine, 39:40 but also one of the cores of integrative medicine and functional medicine, is the 39:45 personalization. Everybody's different. So, I see a lot of patients saying, "Oh, 39:50 but this thing worked for this person, why isn't it working for me?" Or they 39:55 come to me and say, "I want this prescription because I think this will 39:58 help." when something else will. So, I would say that's the biggest thing I 40:02 want people to leave with is everybody's different. Everyone has their unique 40:07 makeup and their unique way that their body responds to things in the 40:12 environment and things that they do. So, don't do something expecting, "Oh, it 40:17 worked for this person. Why isn't it working for me?" Because 40:21 everybody is different. >> I love that way, and that one is so hard 40:24 to explain to people because that's kind of what social media is now. It's one 40:28 person sharing their story, sometimes sponsored by a product, but then 40:32 everyone thinks it's going to work for them. So, I think that is such an 40:35 important thing for people to realize, especially in our field in integrative 40:39 medicine. >> Yeah, for sure. And then, the piece 40:42 about integrative medicine is dermatology and integrative medicine are 40:46 not opposites. The conventional tools that we have, like the retinoids, the 40:51 sunscreen, even the procedures, they're great, and I use all of them. But, I 40:56 want to use them as part of the complete picture, not the entire answer. And 41:01 that's where combining the dermatology with integrative medicine comes into 41:05 play. >> And I think every specialty of medicine, 41:08 like even cardiology, that's what integrative is. It's not, you know, 41:12 herbs or drugs or herbs or procedures. It's combining both and just looking at 41:16 what is the evidence for everything and what can we do from all aspects of 41:21 health that can help the patients sitting in front of us. 41:24 >> I love that. >> Exactly. And I feel like another way to 41:26 think about it is and Western medicine works well. That's why it's been used 41:30 for so many years. And Eastern medicine works well because it's been used for so 41:34 many years. So, why not use the best of both? 41:37 >> I love that. Perfect thing to end on cuz that's that's exactly how I would 41:41 explain it to you. Well, thank you so much for coming on 41:45 the podcast. I loved learning about your background, learning about everything 41:49 that you do, and I got a lot of tips, and I hope everyone learned a lot, too. 41:53 And I loved all the explanations for everything that you gave. So, thank you 41:57 so much, and I really appreciated this conversation. 41:59 >> Thank you. Yeah, so excited to be on this, and thank you for having me. 42:04 >> Thanks for listening to the Trip Lab. If you liked this episode, please subscribe 42:08 and share so we can get the conversation started about integrative medicine and 42:12 psychedelics to destigmatize it and fully explore what this could mean in 42:16 the world. >> [music]
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