Lyndi

Host

00:01

Hello everyone and welcome to this week's episode of No Wellness Wankery. And this show has No Wellness Wankery because today we are joined by Dr Thivi Maruthappu, and she is a renowned dermatologist, a nutritionist and a leading researcher. In fact, she's the UK's first and only dual qualified expert in both nutrition and dermatology and she's very interested in how what we eat impacts our skin health. In fact, she's gone ahead and she's written a book called Skin Food which is now out. I'm going to link it in the show notes of this episode and this is part of a two part series. So there's this episode dropping today and next week we'll be dropping part two, so stick around to hear all of her advice. 

00:42

Now Dr Thivi practices at the NHS and she has her own clinic in London, and she's also conducting research at King's College while being a mum. She is pretty incredible and when it comes to our skin health, she's very much encouraging us to have a more holistic view and talking about the fact that skin really does start with food and things. We each have such a huge influence in it, and I really enjoy our conversation. Talking to Dr Thivi, I feel inspired and I feel motivated by the fact that we don't need to create restrictions. We don't need to cut out all these foods, like we have been told that we need to. Hello and welcome to the show Dr Thivi. 

Dr Thivi

Guest

01:21

Thank you so much, Lyndi. You're so excited to be here. 

Lyndi

Host

01:23

Oh, I'm excited to have you. I am deeply into my skin health by skincare. I slather on my sunscreen, I am always wearing a hat and I think for the early part of my life I always thought that skin was how you looked. Honestly, I don't think I put too much attention into it. How did you come to do this work, to being a dual qualified doctor and being a nutritionist? How did that happen? 

Dr Thivi

Guest

01:49

So I started my career as a normal dermatologist. You know, I just used to do mold checks and rashes and all of that. And then, as I became more senior and I did quite a bit of research, I started to get asked the same questions over and over again. So if I would see someone with eczema, they would say well, is it a food allergy? If I would see someone with acne, they would be asking me do I need to cut out dairy? Do I need to cut out gluten? What do I need to do? 

02:16

And this question around food became the question that everybody was asking and because of that I thought I really don't have a good answer to this question and that's not good enough. I need to have a good answer. So I realized my colleagues didn't have a good answer either. So I thought, well, let me try and do a bit of research. And the more research I did, the bigger it grew, until it was the majority of the work that I do. And now it's something I lecture about all over the world and it is really in demand as a topic. So people really want to learn more about it which is amazing. 

02:47

I'm thrilled that that's the case. 

Lyndi

Host

02:49

One of the things I noticed about reading your new book Skin Food. In the introduction you talk about how marvelous our skin is and why it matters. Can you talk to that for a bit oh. 

Dr Thivi

Guest

03:00

So I obviously. I love the skin and I feel a bit sorry for the skin because people are so fixated on just how it looks, and I get that because it's the most visible organ that we have. I mean, we can't see our heart, we can't see our lungs. The skin is the one we can see, but it is so much more than just how it appears. We all want that fresh, glowing, radiant complexion, but our skin is busy doing so much more so. It regulates our temperature, preventing free radicals from entering deeper in the body, it regulates our sweating and it produces its own hormones. It's really remarkable. But even more than that and this is what I spent a lot of my research doing your skin is always talking to you. It is telling you more about what's going on inside your body, and a lot of people don't realize that your skin, your hair and your nails are often the first place you're going to see a nutrient deficiency. Isn't that amazing? I know that's something you're familiar with, but often the general population wouldn't realize that. 

Lyndi

Host

04:01

It's fascinating, and I know that for myself. I have a psoriasis stress flare up, so I kind of call it my psoriasis. My psoriasis flares up. It's my cue in my body. My body's communicating with me and telling me to slow down, to reduce my stress load, and this is the way in which it's communicating with us, right. 

Dr Thivi

Guest

04:18

Yes, it's speaking to you, so I almost think of your skin as being like another brain. You know, some people get stress flare ups, anxiety, or, if they've been under a lot of stress, they might notice hair shedding. It's trying to tell you something and a lot of us ignore it until it's too late. 

Lyndi

Host

04:35

Let's talk a little bit more about this idea about stress and about our skin. So something like acne signs of aging. Are these correlated with? 

Dr Thivi

Guest

04:45

stress as well, absolutely so. I devoted a chapter in my book to the mind-skin connection and it's even got its own name now in dermatology. We call it psychodermatology, the link between the brain and the skin. And it's remarkable because stress increases lots of different hormones. We know cortisol is the main one and that can trigger acne flare-ups. So it's not uncommon before a big occasion, before a big wedding, something like that, someone will come to clinic and say look, I need the spot treated immediately. And why does that happen? Well, we think it's because cortisol increases the amount of sebum, so oil production in the skin, and can contribute to breakouts as a result. We also know that it can flare other conditions like psoriasis, eczema. It could cause you to flush. So the skin and stress are strongly linked and studies have even shown it can accelerate premature skin aging. 

Lyndi

Host

05:36

That's fascinating and I think you know that so often we're chasing this beauty ideal and I think it can often be very stressful. I know as my work working with eating disorder patients and people with disorderly eating. Everywhere on the spectrum, as you said, those nutrient deficiencies are coming up on the skin and on the hair. We're getting hair breakage, we're getting problem areas with dry skin. Are there any other issues with skin that we might notice with someone who has disorderly eating or eating disorder? 

Dr Thivi

Guest

06:03

Yeah. So it's something I have to keep a really close eye on because people who have skin conditions, you know they affect you so deeply, they affect your mental health because it's visible and it is not uncommon for people with skin conditions to resort to restrictive eating patterns as a way of trying to control it. So it's something I have had to have extra training and eating disorders that I never knew I would need, because people with X malm will try and cut out lots of different food groups. You may have come across them in your practice, Lindi. They might start with dairy, then add gluten, then they add, add, add until they're eating a really small list of safe foods and that's when we really, you know, we really start to worry about that. 

06:44

So I do keep an eye out for those nutrient deficiencies. I think we do need to be really mindful of them. So be 12 deficiencies Sometimes you can get little cracks at the corners of your mouth. Iron deficiency, really common in women, and hair shedding, dry, itchy, flaky skin. And a patient I had who had really restrictive eating had omega three, essential fatty acid deficiency and what we thought was X malm was actually due to not having fat in her diet. 

Lyndi

Host

07:14

I think it's really important. When we talk about getting a healthy diet we're talking about. There's lots of different foods we want to be including and so often the nutrition world is telling all the wellness angry world is telling us to narrow our food choices. Yes, you're very much talking about expanding our food choices. Can you tell me a little bit about your four step skin solution, which you talk about in your book Skin Food? 

Dr Thivi

Guest

07:37

Yes. So in the book I talk about how I approach skin conditions in the clinic. So the foundation to healthy skin and what we all need to make sure that we have in our diet is a balanced diet. So that includes, you know, healthy fats, healthy carbs, good quality proteins, all those fruits and vegetables. I'm not a believer in restriction. I think we need to enjoy our food and I also think that people forget that your skin needs nutrition to function properly. Now, if you have a skin condition, that doesn't mean you're doing something wrong. Genetics plays a really big part, but whatever you're tackling and a balanced, nutritious diet is the foundation. 

08:16

And then, on top of that, we look at the mind, skin connection and the role that stress plays, and that might be mindfulness, meditation, it could be talking therapy, it could be more than that, it could be even cognitive behavioral therapy. 

08:28

Sometimes we use that as part of managing specific skin concerns. On top of that step three, we're talking about skincare, and most people think skincare step one, but it's actually step three. We have to think about everything else on the inside before we get to skincare, because if you're not doing step one and two, step three can't do its job, so you might end up spending a fortune on face screams and not get the results that you want, and you need to go back to one and two. And finally, for many people out there, and certainly lots of people that come to see me, step four is medical treatments. That might be, if you're thinking about anti-aging, that might be Botox, you know, go for it. It might be medical treatments for eczema, psoriasis, all of those common skin concerns, but it runs the gamut of nutrition, mindfulness, skincare and in-office treatment. So it's everything and you get to choose the best of everything to really help your skin. 

Lyndi

Host

09:23

That's incredibly holistic and it's certainly not a good idea to be willing nearly be removing foods from your diet, which I think so many people are doing, as you said. That is incredibly problematic. Make an appointment with a dermatologist in Australia. We get a, we can get. You can go to your doctor. You can get a referral and then you go to a dermatologist. How does it work in the UK? 

Dr Thivi

Guest

09:42

and it's the same. But we have a really long waiting list to see a dermatologist. Or, if you want to go privately, it's really expensive. So it's not accessible for everyone. And part of that was the reason that I wrote the book, because I thought actually a lot of what I do is really easy and if people knew how to do it themselves, maybe they wouldn't need to wait for months and months to see a doctor. Maybe they wouldn't need to, you know, shed out lots of cash to get a dermatologist. Maybe there's a lot they could do for themselves well, excellent. 

Lyndi

Host

10:07

I mean, I wish everyone would get your pause on this new book skin food. Can you talk to us a little bit about sleep, the importance of sleep and the importance of high quality sleep on our skin? 

Dr Thivi

Guest

10:18

absolutely so. Sleep, beauty sleep, as it's called. It's real because when we are in deep sleep we produce melatonin. Melatonin produces growth hormone and growth hormone is like the fountain of youth. It causes ourselves to regenerate, muscles to regenerate. It's really important for skin cell turnover. So you can't really shortcut getting your good quality sleep. You do need to have it and it's worth prioritizing it how much would you recommend getting a day? 

10:45

so if you can get between seven and eight hours, that's great. I know some people on social media kind of always sleep nine to ten hours. I mean, don't we all have so many things to do in the day? I don't know that's really realistic. 

Lyndi

Host

10:56

I'm so jealous of those people I know two babies, that sounds lovely. 

Dr Thivi

Guest

11:03

I know it's hard, you know, when you have small children it's not realistic. But you know, when you get to the other side and they're sleeping better, then those are good hours to aim for. 

Lyndi

Host

11:11

What about hydration? How important is it? Is it overstated? And, ultimately, what should we be hydrating with? 

Dr Thivi

Guest

11:18

so I think hydration is important, but I think that there is a lot in the media. You have to drink gallons and gallons of water. You need your pee to be light yellow in color and if you're doing lots of exercise, that might mean more hydration. If you're doing less, that might mean less. Obviously, it could be really hot where you are. You need to drink more, but you really have to be guided by your body. It isn't one size fits all for everyone, but it does make a difference. 

Lyndi

Host

11:41

We all know when we drink plenty of water, our skin does look better so that advice to just have two liters of water is kind of silly when you consider that it can apply to a five foot human or a six foot five human. 

Dr Thivi

Guest

11:54

And so using your wee is the best barometer to work out if you're hydrated or not exactly yes, you just can't apply that as you say to you know, somebody might be working out running for an hour a day. Outside they're going to have very different hydration requirements to somebody who's indoors set at a computer all day of course, let's talk about supplements, something which also can impact the color of your urine. 

Lyndi

Host

12:14

So if you are using your wee as a test to see if you're hydrated, remember some supplements are going to turn your wee bright yellow and it's going to throw you off a little bit. 

Dr Thivi

Guest

12:23

Yeah, that's a good point. 

Lyndi

Host

12:25

Yeah, let's talk about some of those vitamins. Um, yes, it sounds like a part of your book. You talk about how you used to take a whole bunch of different vitamins to try and improve your well-being. Can you talk to me about what happened there? 

Dr Thivi

Guest

12:39

oh. So when I was a junior doctor, I, you know, I worked crazy hours. I didn't have time to cook. Most of what I ate was out of the cafeteria at the hospital or the vending machine, and I thought it doesn't matter, I'm just going to take loads of supplements, it doesn't matter, I can eat, you know, processed meat like pepper army I don't know if you guys have pepper army and you know, chocolate bars, crisps, you know whatever I need to get through my night shift or my day shift. Um, yeah, but it's fine, I'll take a handful of supplements and I'll be fine. 

13:05

Honestly, I never felt worse or looked worse in my life and I actually look more youthful now can you believe it, 20 years later than I did when I was a junior doctor? Because I realized very quickly this is not working for me and I feel exhausted all the time. And what I realize is you cannot shortcut your way to health. There is no shortcut. You have to do it properly, from the ground up. You have to do all of those things that we all know about, and supplements are exactly that. They're a supplement to a good, balanced diet. They can't replace it. 

Lyndi

Host

13:39

Loretta In my book your Weight is Not the Problem. I have this idea, which I introduce you to the hierarchy of healthy habits and the baseline habits things like getting good quality sleep, hydration is at the very bottom it's like the building blocks of our house and at the very tippy top of that pyramid is supplement taking. What I find is problematic is so many people they go for that. Supplements is the first thing and they're totally ignoring the things that are so fundamental to their well-being and wondering why they feel so awful. And it's just one way to kind of explain, and you saying it, you're saying it so eloquently. 

Dr Thivi

Guest

14:11

So we're totally on the same wavelength. And I see patients come to clinic with a bag full of supplements bag full, and you must have seen it as well and I have to go through them and say like look, you know you spend a lot of money on this, but actually I think maybe you could do with three of these rather than 20. Loretta, can I ask then? 

Lyndi

Host

14:27

which supplements you take on a daily basis, loretta? 

Dr Thivi

Guest

14:29

Vitamin D because I don't get enough sun and I have dark skin so I have to take it all year, so I take 1000. I also take an Omega 3 because I'm not so good at eating oily fish, so I take an Omega 3. I actually like collagen supplements because they work for me and I always think try them and see if they result in an improvement. I've had patients who see no improvement. I've had people who see a big improvement, so I think they're quite individual. Loretta. 

Lyndi

Host

14:54

That's an interesting idea. So I don't know if everyone's up to date with this whole idea of collagen, so it's really having a moment. What I've heard from collagen applying topically is that the particles are too large to be able to penetrate the skin barrier. Loretta, exactly, yeah collagen. 

Dr Thivi

Guest

15:08

The collagen molecule is huge and it's not like vitamin C Vitamin C tiny. 

Lyndi

Host

15:12

It will get through the layers of the skin, but we have this wall, this brick wall called our skin barrier, and the collagen is not going to be able to squeeze through that brick wall, loretta, and that maybe taking it orally might be a way in which it could have some impact, and from what I've seen with the research, it is sketchy about whether or not it can have that influence, which is why you're encouraging people to experiment. If you are curious and if you don't notice a difference, then it may not be working for you, as opposed to just blindly taking it because you saw an influencer taking it. 

Dr Thivi

Guest

15:41

Loretta, exactly, and I think they're marketed really well. So the evidence behind collagen, the reason that people put a question mark over it is because a lot of the studies were funded by the companies who make the collagen, and so there's always this question about well, is that genuine data? And when you look at the data, it does look good in terms of improving hydration and possibly reducing fine lines and wrinkles. And there have been larger studies taking an overall look at all of the collagen data out there and they seem to be beneficial. But what you want to think about is using the smaller fragments, so little fragments of collagen. 

16:18

If you're going to do it and you can use fish or bovine collagen those would be the ones if you wanted to try it and my advice is try it for three months. Keep your skincare routine consistent. Try it for three months and see if you see any improvement. If nothing happens, don't waste your money, but always remember that sunscreen so much better, is so much more important than college and supplements, so there's no point taking college and not wearing your sunscreen every day. 

Lyndi

Host

16:44

Oh, I'm such a fan of sunscreen, I'm going to applaud for that. And I found something very useful for me with applying sunscreen daily, multiple times a day, was to have tubes of it everywhere littered through my house. Where I put my toothbrush, where I get my keys in my car. It has to be absolutely everywhere, and that way it was a way for it actually to become a habit. So I think I do have multiple times a day. 

Dr Thivi

Guest

17:05

It's a really good tip and I think the spray ones are really good for top ups as well. So say, if you've got makeup on and you don't want to mess it up, you can get spray ones. Keep it in your car or your handbag. 

Lyndi

Host

17:15

I've heard that you actually require quite a bit of sunscreen, a lot more than people probably think yes, yes. And that I've heard there's like a two finger method for working out if you need how much sunscreen to apply. 

Dr Thivi

Guest

17:26

Yes, so you could do two finger lengths or half a teaspoon for your face. It's a lot. It's a lot, yeah. So you need one that you love. So you've got to find a sunscreen that you really enjoy the texture of and that you like using, because if you don't like that texture, you're not going to use it. So try lots of samples until you find the one that really works for you. 

Lyndi

Host

17:43

And I used to avoid paying more for sunscreen. I used to think it should cost a certain amount, it should be a low cost item. But then when I realized it was probably one of the most effective products I could put on my face topically to, you know, reduce the signs of aging or delay the signs of aging, and reduce, reduce my melasma appearance and all those kinds of wonderful things, I realized it was perhaps the most important ingredient in my skincare regime and therefore now I'm willing to spend more on something like that If I enjoy it. I use it every day and I kind of got over that hurdle. So if that's there for you, then that could be an idea. 

Dr Thivi

Guest

18:17

Exactly, and I think you know you don't need to spend a lot on cleansers. You don't need an expensive cleanser but when you spend a bit more in your sunscreen you get an elegant consistency that you like using and you may even get better broad spectrum protection. And there's even Lindy new data that says if you start using sunscreen now you can partially reverse some signs of skin aging. 

Lyndi

Host

18:39

All right, that's my cue to go later on some more. And just to finish off today's episode, I just want to talk about bringing it back down back to food and talk about which foods we should be including in our diet, and I know in your book you talk about foods to reduce acne. Are there certain foods to relieve a acne that we should be including or things that we should be avoiding? Can we talk about that briefly? 

Dr Thivi

Guest

19:01

Yes, so with acne, it's really a spectrum. So some people's acne is strongly influenced by food and some people much less so, and it's much more genetics and hormones. And you know, they could try removing dairy, but it might not make a difference. But the two trigger foods that we need to be mindful of are particularly low fat cow's milk but it can be other forms of cow's milk as well and high sugar, high glycemic index foods. Now, I'm always careful about this because there are people who will take it to an extreme cut out all sugar, including fruit, to clear their skin, and that's not necessary. You need to stick to your healthy guidelines, but you don't need to be extremely restrictive. And if you want to see if milk is playing a role in your acne, you would need to remove it for four weeks. So remove the cow's milk for four weeks to see if there's an improvement. You don't necessarily need to remove yogurt and cheese. The data is not so great for that, but it's milk. 

Lyndi

Host

19:53

Is it a certain volume of milk, or you know, having a glass a day, or is there a certain load which then starts to become problematic? 

Dr Thivi

Guest

20:01

So from the data it's about two glasses a day and, to be honest, not many of my patients drink that much cow's milk. But you might find it if you're having you know. If you might have it in your cereal porridge and then you have a coffee, you might be heading towards that. So it's quite easy to swap nowadays if you go for a fortified non-dairy alternative to make sure you're meeting your needs and see if that results in an improvement. But it shouldn't delay you from seeking help with your acne. 

Lyndi

Host

20:27

I think that it's a really great thing to talk about going for those fortified options, non-dairy options, if you are going to swap our cow's milk, because calcium is seriously important for women. I think in Australia it's a quarter of women have osteoporosis and we need to be looking after our bone health and get going for that. Those three serves of dairy are a great way to get that calcium needs and, if you're not having those, finding alternative sources of it, perhaps in the form of supplements or something like a fortified drink. Absolutely, Dr Thivi. Thank you so much for today's chat. I have found this so useful. I am such a skin nerd so I really enjoyed chatting to you and everyone. Please stick around, because next week we're going to be having a big conversation about food myths, skin myths and debunking all the stuff that you might need to know.