73: Should I cut dairy or gluten for my skin? Dr Thivi busts skin myths (Part 2)

Lyndi

Host

00:01

Hello everyone and welcome to another week of the No Wellness Wankery podcast. I'm very excited to have you back because we are joined again by Dr Thivi Maruthappu, and she is a dermatologist and nutritionist an incredible combination. She's joining us from the UK and we are very lucky to have her. If you haven't yet listened to the first part, go ahead and have a listen. It's going to be a beautiful intro to what we're about to have a conversation about. We were just having a little bit of a chat about disordered eating, how rife it is, and you were explaining about these day on the plates and wellness people telling us to cut out all these foods. Can you talk to us a little bit about that? 

Dr Thivi

Guest

00:44

So, Lyndi, one of the reasons I became interested in nutrition is my patients were coming to the clinic and saying I saw this person on YouTube or I saw this person on Instagram and they've suggested I go on this cleanse a gut cleanse to cure my eczema or to cure my acne. So I am on a juice cleanse at the moment and I'm really scared to start eating again and I mean I was just not equipped. I was shocked, I was sad for this person who was just living on juices and didn't have the skills to help them. So in those sorts of situations I always refer people on to a nutrition professional. But it really made me realise that when you have something visible on your skin, you will do anything to help to improve it, even if that means cutting out lots of different food groups. 

01:32

And it led me to do some research with my colleague, dr Alia Ahmed, who is a specialist psychodermatologist, and we surveyed dermatologists and dermatology nurses in the UK. We found that over 90% of them got asked about food. Less than 10% of them felt really confident answering those questions, and we also looked at the number of patients who were restricting their food. We asked them do you see people who restrict their food. Over 70% said yes. We have come across people who are restricting gluten, dairy sugar in all the common skin conditions, so eczema, psoriasis, acne, rosacea. We are seeing people cutting foods out to get control and remember people are doing this totally unsupervised and this is when we really start to get worried. 

Lyndi

Host

02:17

It can lead to an incredibly restrictive, limited diet that can cause a whole bunch of deficiencies elsewhere in your diet Plus. I think what we're about to talk about is where is the research? How does it stack up? What is it pointing us to? What should we be reducing? What should we be increasing? But what is actually backed with the evidence? And I know that this is a rife issue because 80% of women went surveyed and I think this is a British study of, I think it was 70,000 nurses had disordered eating in some variety, 10% of which had a diagnosable eating disorder. So this is just. Majority of women have some degree of caution around food and concerns. So let's start debunking some of these big myths, because I think it's going to be very interesting for all of us. Let's start with something I hear a lot, which is people having bone broth at the moment for skin. Can you explain where's the evidence? Is it something we should be consuming? What are your thoughts? 

Dr Thivi

Guest

03:16

So in my book Skin Food, I have a whole chapter on the gut skin connection, because gut health is really this new, exciting, fascinating area for skin health. And one of the myths I debunk is this bone broth trend. There is no evidence that bone broth can help to cure your skin, that it can be anti-aging. You know bone broth has been around for years. You could call it stock chicken soup. You know there may be lots of nutritious benefits for it, but skin there is not. One study you will find online about bone broth and skin health. 

Lyndi

Host

03:49

And also beyond that, the immune benefits that we keep hearing about bone broth. There is zero evidence to support the immune benefits of it unless we're adding in specifics like a turmeric, quite a high amount of turmeric, in order to kind of get those benefits. I know you do talk about the skin benefit from adding spices to our cooking. That is one way that we can get a bit more benefit. Can you talk to me about what should we be adding and how much do we need before we actually get a benefit? 

Dr Thivi

Guest

04:15

So with turmeric and cinnamon and supplements like that, it's more included in your food as an ingredient in cooking. So with cinnamon it seems like half a teaspoon to a teaspoon can help with blood sugar, particularly if you've got a background of polycystic ovarian syndrome or acne related to high blood sugar, so that can be a useful thing to add. In Turmeric the evidence isn't so great but I love it for its anti-inflammatory properties and if you're gonna have it a teaspoon and you need it with a bit of black pepper as well to help with that curcumin absorption. But if we think about gut health, which is so linked to skin health, and people boiling up vats of bones for hours, we would be so much better off supporting our gut health through food and really thinking about those probiotic foods, those prebiotic foods. We now have really good studies to show that these have anti-inflammatory effects and I think that is a much more nutritious way of doing it. 

Lyndi

Host

05:12

So can we specifically spell out some of those foods that we should be including more of? So our prebiotic foods. So, remember everyone, this is the food that the probiotics are going to be eating. So we need to give them enough food so that those good gut bacteria bugs, they can stay alive. And so what are some of the prebiotics we should be including in our diet? 

Dr Thivi

Guest

05:30

So prebiotic foods. Fiber is one of the major things that these good gut bacteria love to feast on. So people are so dismissive of grains, but whole grains are one of the favorite foods of these good gut bacteria and they help to regulate satiety, keep our bowel movements regular and have micronutrients as well. We also want that array of different fruits and vegetables, and I sometimes see people who try and cut out fruit, but I say you know, enjoy fruit, it's full of nutrients and have that rainbow of lots of different colorful fruits and vegetables. And then we have artichokes and onions and leeks and things like that, which are higher in specific prebiotics as well. 

Lyndi

Host

06:12

And something like garlic and onions. It can be quite easy to include in your cooking. I mean, try to stir some artichoke. Might be a little bit more seasonable, a bit more tricky, but including those things can be useful. If you've got FODMAPS, perhaps that's not going to be the route we go to. We'll find some different sources, but let's talk about the probiotics as well. So what are some options that we can include for those probiotics? 

Dr Thivi

Guest

06:33

Yeah, so I'm really lucky. My sister-in-law is from South Korea, so she makes kimchi and it is amazing. So I love kimchi. It's so good. Homemade is amazing, so kimchi is great. Sauerkraut of course, kombucha, but you know you have to check. Some of them have quite a lot of added sugars, so make sure you check your ingredient list. Live yogurt simple things like that has lactobacillus bulgaricus often, which is a great bacterial species, and I think you can do so much with just those easy probiotic foods. Kefir you can have it on your breakfast in the morning, so I think those are really easy options to include. That's beautiful. 

Lyndi

Host

07:11

And, practically speaking, I think that's a really easy way for us to include these foods in our diet would be, you know, some yogurt or yogurt how have you pronounced it With? Plain Greek yogurt is the one that I would personally go for. And then you can sweeten it with honey If you would like to. You can adjust the sweetness according to your palace. But then, adding in those prebiotics, you can add some seeds and nuts, you can add in whole grains it's like things like oats so that we're getting maybe some fresh berries and different kinds of colorful fruits and vegetable fruits, specifically in yogurt. But just imagining that as a meal, you can see how we're bringing together so many of those different aspects that we need to have a healthy diet. And I think that's the thing I take away is we don't need to be cutting out whole grains, and that is a huge myth I often hear. So can we talk about sugar, carbohydrates and its impact on our skin? What should we be focusing on and what shouldn't we be focusing on? 

Dr Thivi

Guest

08:02

So I think there's a lot of sort of myths around sugar and the skin, but some things are true that we need to really be mindful of. So I think some people, as I mentioned earlier, go to extremes. I think, right, I can't have any sugar in my diet. I have to. I have to basically go keto. I can't have any carbs and all of these things. Yes, they are metabolized to a sugar eventually. 

08:23

However, the sugars we need to be mindful of are those refined sugars that are added to foods or that we add to foods. We're talking about fizzy drinks and Sweetened yogurt. So, as you mentioned, sort of tailoring it yourself rather than buying that ready-made sweetened yogurt, chocolate, biscuits or sweets, candies, things like that. And what's the impact of those foods? So when we eat those foods, we see a greater rise in our blood sugar and that can impact our skin in a number of ways. There is a process called glycation, so where the sugar molecules combine with your collagen and they eventually cause it to become more stiff and we call that sugar sag. So a diet high in refined sugar can contribute to accelerated skin aging and, for some people with acne, when we get those higher sugar levels and higher insulin that can increase sebum production from the skin and contribute to breakouts. And it's not everybody without me, it's a proportion of people now. 

Lyndi

Host

09:19

So what I'm hearing is it is related to Spikes and insulin, and what we really are looking for is those lower glycemic types of foods to help moderate the spike of glucose in our Bloodstream correct exactly, and we can do that in lots of different nutritious ways. 

09:36

Yeah. So when you're thinking about, or if I am going to have something that has sugar in it, I think something that people don't quite realize is adding fat and adding protein into that meal can actually slow or, you know, totally adjust the way that that glucose spikes in your blood. So let's say, let's take something like oatmeal, for example, and that is a very nutritious food to start with. But if we want to make it add a little bit of those healthy fats we adding in that protein, we're going to totally change how it's going to spike glucose in our body so that it becomes an even better source of energy. 

Dr Thivi

Guest

10:07

Exactly, and you know even something like dark chocolate, which we you know, which has lots of health benefits because of the phytonutrients. It's actually lowering glycemic index than we often think because of the fat that's held within it. 

Lyndi

Host

10:18

So if people are eliminating carbohydrates to the extreme. Where they're going into they're going into keto diet. People can get something called keto rash. Can you talk about? What is that? And I guess it just reinforces the idea of why we shouldn't be cutting out these whole grains. 

Dr Thivi

Guest

10:35

Isn't it interesting? There is a whole rash that you can get from going keto. So keto diets I don't know if they're still as popular as they used to be, but they really had a moment where people were so into them. And there's a couple of things I'm not keen about. Number one it's a restrictive way of eating, calculating numbers all the time, thinking about the amount of carbohydrates you're having in a day. I think you need to be careful about obsessive behaviors that you're going to end up with. I also think it can take the pleasure out of food as well, but beyond that, it can result in quite dramatic loss of subcutaneous fat, particularly in the face, which can accelerate how aged you look. I often find people, if they've gone on a really strict keto rash, they can come in quite hollow cheeked and they can look older as a result. And you're going to have to think about how you want to reverse that, and some people may go down the route of fillers and things because of wanting to change that. And exactly as you mentioned, indeed, the keto rash. 

11:30

Keto rash is really unusual. It is a bright red, itchy rash. You can get it all over your chest and back. It typically happens when you drop your carbohydrate intake below about 50 grams a day. So that's not very much. I mean, that's like a banana and maybe half a bit of bread. So half a slice of bread, so it's hardly anything. So if you are cutting your carbohydrate intake down that low, you could get this rash and you will completely cure it if you just eat your carbs again. So you don't really need. You could have a bit of cream if you want to. We can give you a bit of cortisone, but the cure is changing your diet and just shows your skin needs those macronutrients. 

Lyndi

Host

12:08

We need to be fueling our skin and our entire body with those carbohydrates. Our brain very much also needs those whole grains. What are your thoughts about going on a juice cleanse? Would you recommend it? 

Dr Thivi

Guest

12:20

No. So I am really adamantly against those cleansers. I think you could definitely enjoy a juice as part of your day. You know I do love a green juice now and again, but I try to have it more with vegetables. But a juice cleanse. What is the aim of a juice cleanse? I mean, are you trying to clear your skin and what's going to happen when you start reintroducing foods, or are you going to be, like many patients I see, too scared to introduce food again when you're on a cleanse? If you see a transient improvement, maybe you see that your you know your psoriasis is a little bit less angry. What are you going to do next? Are you going to stay on your juice cleanse? You cannot stay on a juice cleanse long term. 

Lyndi

Host

12:57

It really strikes me as well in this way. Inquiry A juice cleanse? What about going gluten free? Is that something you'd recommend? What does the evidence say? 

Dr Thivi

Guest

13:06

So there's no evidence for gluten free for acne and I often have people coming to clinic with acne saying, look, I've gone gluten free, caffeine free for my breakouts. There's no evidence for either of them. For some people with eczema, gluten can be an issue, but you would want to work with your nutritional practitioner to do a food diary to monitor your symptoms and then see if gluten is something you need to remove for a period of time whilst you monitor your symptoms, and you would have to do it in a very scientific way. You don't do it willy nilly, you don't just cut it out and just see. You've got to do it properly and I always want people to see a nutrition practitioner to do that and then reintroduce the food if it's not making any difference. People forget to reintroduce at the end. 

Lyndi

Host

13:46

That's the issue I see all the time and as you say, they become so scared to reintroduce it in case it causes a flare up. So having a practitioner hold your hand through that process is going to give you the best outcome. 

Dr Thivi

Guest

14:00

Honestly, you're speaking my language. I totally agree with that, and I think that seeing a nutrition practitioner doing it properly means you just do it once, rather than you keep trying to attempt it over months and months and then for psoriasis. There is some evidence that gluten can be a trigger for people with psoriasis, but it tends to be those who have positive blood tests against gluten. So if you think that gluten could be affecting your psoriasis, get your GP to do the blood test for celiac and if that blood test is coming positive, it is definitely worth going gluten-free for three months to see if your psoriasis improves. 

Lyndi

Host

14:33

And if you are celiac, certainly that's an essential thing to be doing. Should we be going vegan? 

Dr Thivi

Guest

14:40

So I think there are lots of reasons to support a vegan way of life and a vegan diet, but you do need to supplement it properly. So you need to think about what additional things that you need to include through supplements to maintain a complete diet, and things you need to be really mindful of B12 supplements. You do need to include B12 because it's very difficult to get that from other sources. I also recommend my vegan patients to supplement with Omega 3. And I think that people can try to get their Omega 3 from chia seeds, from walnuts. I think the conversion is not quite there and you are safer to supplement with an algae-based Omega 3. And I also think you need to be careful of your protein intake, because there are some vegan sources of complete protein, mainly tofu, but you do need to mix your lentils and your pulses to achieve all of those amino acids. So I think you've got to be really clever about a vegan diet and you've got to make sure you're very cognizant about the foods that you're eating. 

Lyndi

Host

15:43

Indeed, it does take a little bit of consciousness and prepped in order to do that, because you can eat an unhealthy vegan diet and a very nutritious vegan diet, and then the other one that comes to mind might be an iron supplement. 

Dr Thivi

Guest

15:55

Yes, that's a good, very good point. 

Lyndi

Host

15:56

It can be quite tricky to get the iron, which is so easily found in things like red meat. 

Dr Thivi

Guest

16:02

Especially if you're a woman and you're menstruating, you know, or you're perimenopausal and you're having, you know, heavier periods than you used to, then I think a really good point there to think about an iron supplement, a beautiful, segue into. 

Lyndi

Host

16:14

What I want to talk about is hormones and how they affect our skin. Can we talk firstly about our menstrual cycle and how it causes fluctuations in our acne throughout the cycle? 

Dr Thivi

Guest

16:24

Yes. So we all know that feeling. I mean you're really lucky if you haven't ever had it, but getting a spot just before your period and what happens is when your estrogen levels start to decline, your progesterone gets to have more of an effect on the skin and then you're circulating androgen. So this is testosterone, which women have, of course as well can have more an effect on the skin, and these hormones can trigger breakouts by increasing oil production and increasing congestion. So in the week leading up to your period, you can think about adjusting your skincare routine slightly to help unclog the pores. 

Lyndi

Host

16:59

And for women who are going through perimenopause menopause the skin can turn dry and apparently lose radiance. What can we do there? What should we be aware of? 

Dr Thivi

Guest

17:09

So that a lot can happen in that perimenopausal time. We can see acne come back, acne appear that you've never had before, and it is so frustrating. You know you're already going through hot flushes, tiredness, your periods, all over the place, and then you get some spots and you think, oh, this is it. So, yeah, you can get. You can get spots again. Your collagen production declines, particularly during that time. It's not fun and you might see your hair thinning as well and you may see that loss of radiance. And I think really well, in advance of that time you need to really have a good retinol on board, because a retinol, even a prescription strength one, if you can access it, helps with that collagen production, helps with that cell turnover and radiance and can also help to tackle acne. But of course, if you're having other symptoms, then do see your GP about whether you need additional hormone support during that time as well. 

Lyndi

Host

18:01

Excellent. I have one final question and I wonder if you'll be able to help. Currently I'm going through my four month four months postpartum, which means I'm losing a whole bunch of hair. I know for women, as we age, we tend to lose hair as well. How I've heard that scalp health is incredibly important. Are there things we should be doing to help our hair stay full, to stimulate more follicules? What can we be doing? What tell me about it? 

Dr Thivi

Guest

18:30

So hair and nutrition is something that dermatologists have been obsessed with for a very long time. So if someone comes to us with hair shedding, we would do a nutrient blood profile as a matter of course, and you know there are a lot of dermatologists who don't get on board with nutrition and skin, but hair everyone's on board with hair. So what do we do? We will check vitamin D, zinc, iron, b12 and folate. So those are the blood tests we would do, and I think it is worth it. If you're shedding hair, get those blood tests done. If you've just had a baby, your baby could have taken so much of your iron, you know, and your baby could have taken lots of your vitamin D. So it's worth checking those things and either replacing them through diet or with supplements as well. Hair really is like a tree with roots and the soil needs to be right. So the soil is your scalp health, and you need to prioritize the health of your scalp in order to have good hair growth. So how do you do that? So, things that help. 

19:28

A scalp massage can help improve the circulation. You can use scalp lotions and tonics, and there's one I love for hair shedding, particularly postpartum. I hope you can get it in Australia. It's by a company called Rene Fertura and he makes these little hair tonics that you do. You apply to the scalp twice a week and they really help to stop hair shedding. I'm a big fan of those and I think they're 99% natural. I think they have Mangosteen extract in. It's a really good product I don't work for them, by the way and you can also use rosemary oil as well in their hair, and there's increasing evidence that that can help to support healthy hair growth. 

Lyndi

Host

20:04

So there are things that we can do and I also have heard that there is a medication that is available that might be able to help stimulate hair growth as well, which I assume is a bit more of a later stage option. 

Dr Thivi

Guest

20:15

Yes, so if you see a dermatologist about hair shedding, you may be offered scalp lotion called Minoxidil and that improves blood supply to the scalp. You need to check if you can use it in breastfeeding. I know you can't use it in pregnancy. That has to be used continuously in order to support hair growth and it can also be taken as a supplement, as a tablet, and we use that a lot now in dermatology and it really helps to regrow hair. But that needs to be under a medical practitioner. 

Lyndi

Host

20:41

Thank, you so much for your time. I have learned so much and I want to know if there's one thing you want people to take away from our conversations together. What would be one tip piece of advice you'd give to any listener listening today? 

Dr Thivi

Guest

20:54

Skincare starts on your plate, not on your bathroom shelf. Start with what you eat and make sure you've really got that down, and then everything else is your added extras. 

Lyndi

Host

21:03

Beautiful. This isn't about restriction. This is about adding in, crowding and more of those healthy stuff, getting a balance of all these different nutrients, not eliminating things, but instead creating that beautiful balance. Dr Thivi, thank you so much for being on the show. Thank you, lindy. Thank you so much for listening to today's episode. I hope you enjoyed it. If you would like to get a copy of Skinfood by Dr Thivi MaruthappuI think she is brilliant and I endorse the things that she is saying Then I'm going to leave a link to that in the show notes below so you can find them and grab a copy of the book. And, of course, if you like this podcast, I would be so grateful if you'd give it a review and tell your friends. It's really helpful for us. Either way, I'll see you next week. Bye.