Understanding the Gut-Skin Connection: Fixing your Skin From The Inside Out

Integrative dermatology is a relatively new field that combines conventional dermatology with functional medicine principals to diagnose and treat skin conditions. It takes a holistic approach to skincare and skin conditions, recognizing that the skin's health is influenced by various factors, including nutrition, stress levels, and overall well-being. Integrative dermatology focuses on treating the whole person, rather than just the skin condition, and aims to provide comprehensive and effective treatment options for patients by addressing the underlying causes of skin issues considering the physical, biological, psychological, social, and environmental factors that affect the lives of patients with dermatological diseases.

The human body is home to ecosystems of bacteria, yeast, viruses and other organisms that inhabit different regions of our body. These ecosystems are often collectively called the microbiome. While specific species and strains of organisms vary based on location in the body, imbalances of organisms in any given site play a role in the health of the body as a whole. The microbiome is a key regulator for the immune system. Hence, imbalances (also called dysbiosis) of these organisms are associated with an altered immune response, promoting inflammation in potentially multiple areas of the body. (1) A dysbiosis can occur if there are too many “bad” species, not enough “good” species, or not enough diversity of species.

The skin is the largest and most external barrier of the body with the outer environment. It is richly perfused with immune cells and heavily colonized by microbial cells. These microbes help train the body’s immune cells and help determine overall well-being. The skin has a unique microbiome that is distinct from the gut microbiome, yet scientists are learning that there is a strong bidirectional relationship between the health of these two areas of the body. The relationship is often termed the “gut-skin axis.” Skin conditions including rosacea, acne, psoriasis, atopic dermatitis, skin aging and others are often associated with altered gut microbiome health.

The gut and skin connection

The intestinal tract houses a diverse collection of bacteria, fungi, and protozoa. Many of these microorganisms are essential for metabolic and immune function. An imbalance in this microbiome can result in a breakdown of gut barrier function resulting in antigenic food proteins and bacteria components entering the body’s circulation to trigger inflammation. This inflammation can affect many organs, including the skin.

Adult Acne Vulgaris

Acne is a skin condition that occurs when your hair follicles become plugged with oil and dead skin cells. Acne can be described as whiteheads, blackheads, pimples or deep cysts. Cystic acne is linked to the health of the skin’s microbiome, in particular the balance of a bacteria called Cutibacterium acnes. In a diverse, balanced skin microbiome, this bacterium is involved in maintaining a healthy complexion. However, if there is loss of the skin microbial diversity, this bacteria can also trigger cystic acne. The microbial imbalance can lead to the activation of the immune system and a chronic inflammatory condition like acne. (2) Like in the gut, the health of the skin microbiome influences the release of chemicals triggering inflammation. Optimizing both the gut microbiome and skin microbiome are important stratagies to resolve acne by controlling inflammation both at the skin level and whole body level.

Rosacea

Rosacea is a common, chronic inflammatory skin condition that causes flushing, visible blood vessels and small, pus-filled bumps on the face. The exact cause of rosacea is debated and likely related to multiple factors. Like acne, the skin microbiome and its associated inflammatory effects plays a role in rosacea's etiology. There are also numerous studies connecting rosacea to gastrointestinal disorders including celiac disease, inflammatory bowel disease, irritable bowel syndrome, Helicobacter pylori infection and small bowel bacterial overgrowth.(3) Conventional treatment of rosacea often involves managing symptoms. Identifying and addressing potential associated gut-related illnesses is an effective tool to help support rosacea management.

Eczema

Eczema, also called atopic dermatitis, is a chronic condition that makes skin red and itchy. It is common in children but can occur at any age. Atopic dermatitis tends to flare periodically and is often associated with asthma or allergies. Atopic dermatitis is the most common inflammatory skin disease affecting 7% of adults and 15% of children.(1)

Studies have shown that atopic dermatitis is associated with lower gut microbiome diversity, lower levels of beneficial species, such as Bacteroidetes, Akkermansia, and Bifidobacterium in the gut, and higher amounts of harmful bacteria species including Staphylococcus aureus on the skin.(1) The intestinal microbiome modulates the body’s immune system and inflammatory responses and thus may play a role in the development of eczema and its treatment. Targeted probiotics can play a role in prevention and treatment of this disease.(4)

Psoriasis

Psoriasis is an inflammatory, autoimmune skin disease that causes a rash with itchy, scaly patches, most commonly on the knees, elbows, trunk and scalp. The illness is associated with an intimate interplay between genetic susceptibility, lifestyle, and environment. People with psoriasis have an increased risk to develop intestinal immune disorders, such as inflammatory bowel disease like ulcerative colitis and celiac disease.(1) A growing body of evidence highlights that intestinal dysbiosis is associated with the development of psoriasis.(5) One study showed that malabsorption of nutrients in the gut was more prevalent among patients with psoriasis. Celiac disease, bacterial overgrowth, parasitic infestations and eosinophilic gastroenteritis could be possible causes of malabsorption in these patients.(6) Addressing associated gut conditions may play a role in management of symptoms.

Skin Aging

Skin aging is associated with multiple degenerative processes including oxidation and inflammation. Multiple factors including diet, UV exposure, and environment play a role in the regulation of the aging process. New research shows that healthier diets are linked to fewer signs of skin aging.(7) Additionally, oral probiotics may play a role in regulating skin aging through influences on the gut-skin axis. In a study published in 2015, the oral probiotic Lactobacillus plantarum HY7714 was shown to improve skin hydration, skin elasticity and UV related skin changes.(8)

Skin Care may need to Start with Gut Care

Optimizing the gut microbiome has a role in addressing skin disorders. The following strategies can improve the microbiome:

• Eat better. The microbiome is influence by the food we eat. Beneficial bacteria thrive on fiber that comes from eating a variety of vegetables regularly. The growth of unfavorable bacteria is influenced by sugar, saturated fats and a lack of fiber/vegetables in the diet. To optimize your microbiome, avoid refined sugar and saturated fats like those found in sodas, breakfast cereals, candies, cakes, red meat (limit to 1 or 2 servings a week to prevent overconsumption) and what is commonly referred to as “junk food”.

• Use antibiotics wisely. Antibiotic treatment is necessary from time to time. However antibiotics can significantly lower microbiome diversity and the quantity of beneficial bacteria.(9) When prescribed an antibiotic, ask your health care provider if it is truly necessary. Speak with your provider about using prebiotics and probiotics to support the microbiome after the antibiotic use.

• Repair the gut flora. In addition to a fiber-rich diet, probiotics may play a role in optimizing gut function. Probiotic science is in its infancy, but there is research suggesting that certain strains may benefit certain medical conditions. Speak with your health care provider for probiotic recommendations that may best suit your medical needs.

• Identify other ways to care for your digestive system, such as repairing the wall of the small intestine which may have been irritated by a poor diet, poor digestion, medications or stress. Identifying food sensitivities, restoring nutritional deficiencies and eating adequate nutrients to support healing are important.

Many of the interventions above can be easily implemented without need for laboratory tests. There are no specific gastrointestinal lab markers that are known to directly cause skin issues. However, assessments of the GI system may reveal abnormalities indirectly impacting skin health. Relish Health relies on multiple tools such as stool microbiome testing, breath tests and food sensitivity tests to understand the health of the gut-skin axis and develop targeted interventions to address gut and skin conditions.

A PRIMER ON HISTAMINE INTOLERANCE
TESTING, TESTING... WHICH ONES MIGHT BE RIGHT FOR YOU?

References:

1. De Pessemier B, Grine L, Debaere M, Maes A, Paetzold B, Callewaert C. Gut–Skin Axis: Current Knowledge of the Interrelationship between Microbial Dysbiosis and Skin Conditions Microorganisms. 2021 Feb; 9(2): 353. doi: 10.3390/microorganisms9020353

2. Dréno B,. Pécastaings S, Corvec S, Veraldi S, Khammari S, Roques C. Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: a brief look at the latest updates. J Eur Acad Dermatol Venereol 2018 Jun;32 Suppl 2:5-14. doi: 10.1111/jdv.15043.

3. Daou H, Paradiso M, Hennessy K, Seminario-Vidal L. Rosacea and the Microbiome: A Systematic Review. Dermatol Ther. 2021 Feb;11(1):1-12. doi: 10.1007/s13555-020-00460-1.Epub 2020 Nov 10.

4. Fiocchi A, Pawankar R, Cuello-Garcia C, et. al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics World Allergy Organ J. 2015; 8(1): 4. Published online 2015 Jan 27. doi: 10.1186/s40413-015-0055-2

5. Sikora M, Stec A, Chrabaszcz M, Knot A, Waskiel-Burnat A, Rakowska A, Olszewską M, Rudnicka L. Gut Microbiome in Psoriasis: An Updated Review. Pathogens. 2020 Jun; 9(6): 463. Published online 2020 Jun 12. doi: 10.3390/pathogens9060463

6. Ojetti V, De Simone C, Sanchez J, Capizzi R, Migneco A, Guerriero C, Cazzato A, Gasbarrini G, Pierluigi A, Gasbarrini A. Malabsorption in psoriatic patients: cause or consequence? Scand J Gastroenterol. 2006 Nov;41(11):1267-71.

   doi: 10.1080/00365520600633529.

7. Katta R, Sanchez A, Tantry E. An Anti-Wrinkle Diet: Nutritional Strategies to Combat Oxidation, Inflammation and Glycation. Skin Therapy Lett. 2020 Mar;25(2):3-7.

8. Lee, D. E. et al. (2015) “Clinical Evidence of Effects of Lactobacillus plantarum HY7714 on Skin Aging: A Randomized, Double Blind, Placebo-Controlled Study,” Journal of Microbiology and Biotechnology. Journal of Microbiology and Biotechnology. https://doi.org/10.4014/jmb.1509.09021

9. Ramirez J. Guarner F, Fernandez, L, Maruy A, Sdepanian V, Cohen H. Antibiotics as Major Disruptors of Gut Microbiota. Front. Cell. Infect. Microbiol., 24 November 2020 | https://doi.org/10.3389/fcimb.2020.572912

10. Stubbe C. The Gut Microbiome in Dermatology. Anti-aging Medical News. Spring 2022. p76-80.

Boost Your Immunity with Functional Medicine

With the spread of the flu, COVID-19 coronavirus, and RSV diseases in our community, I would like to remind you that there are several steps you can take to reduce your risk of illness. Additionally, there are steps you can take to boost your immunity in the event of exposure.

The following information outlines what you can do to help keep yourself and your family safe.

Step 1: Eliminate unnecessary inflammation. 

Inflammation is the term doctors give to the immune response our body generates when it is addressing an insult. This insult can take many forms including a virus, bacteria, elevated blood sugar or even toxic food. Inflammation is not just a vague concept but can be measured through blood tests looking at various chemicals and immune cells. Even low levels can be associated with chronic medical conditions like diabetes, heart disease, autoimmune conditions and even depression.

A plausible way to optimize our immunity is to eliminate as much underlying inflammation as possible. Start with these foundational measures:

• Get your diet on point. You have heard this before, but at no other time has it felt so critical to be well nourished. This means eating a nutrient dense diet that provides us the minerals, antioxidants, adequate protein and healthy fats that make the immune system function well (translation: LOTS of veggies). This also means eliminating the foods that trigger inflammation like fried foods, sugar, highly processed junk food, excess alcohol and sweetened beverages. For many people, gluten and dairy are problematic and trigger inflammation. This is a great time to complete the Whole30 that has been on your to-do list. 

• Get adequate sleep. Sleep is intimately tied to our immune health. Without sufficient sleep, our body makes fewer cytokines, a type of protein that targets infection and inflammation. Getting adequate sleep reduces our risk of infection and can improve our outcomes if we do get sick. Conversely, sleep deprivation weakness our body’s defense system and makes us more vulnerable to illness. Aim for 7-9 hours of sleep each night.

• Stay moving. Join a gym, get outside for a walk, try simple homemade weights in your basement or check out the numerous classes available online. There is great data suggesting that exercise can help the immune system find and deal with pathogens.  In the long term, regular exercise slows down changes that happen to the immune system with ageing, therefore reducing the risk of infections. High intensity interval training has particularly great data but any form of movement is better than being sedentary. Aim for 150 minutes of purposeful movement per week.

• Manage your stress. Life can be stressful. How we respond can help influence our immune health. Cortisol, one of the hormones associated with stress, can suppress our immune response. This is why you may become sick after periods of stress in your past. Acknowledging our fear and frustrations is important, but embracing stress management activities like meditation, journaling, exercise, prayer and yoga can help moderate our body’s cortisol response. If these strategies are not enough, I encourage you to find a professional counselor to help you address your emotions. 

Step 2: FOLLOW THE BASICS OF GERM CONTROL.

Respiratory virus are transmitted through droplets created when you cough, sneeze or talk and possibly, when a person touches a surface or object that has a virus on it and then touches their own mouth or nose. A few basic measures can drastically reduce your risk of contracting or spreading an illness.

• Stay home when you are ill. Wait until at least 24 hours after your fever* (temperature of 100 degrees Fahrenheit or 37.8 degrees Celsius or higher) is gone. Temperature should be measured without the use of fever-reducing medicines (medicines that contains ibuprofen or acetaminophen).

  Not everyone with flu, COVID, or RSV will have a fever. Individuals with suspected or confirmed flu, who do not have a fever, should stay home from work at least 4-5 days after the onset of symptoms. Persons with the flu are most contagious during the first 3 days of their illness.

• Wear a mask when you have a cough or congestion: When in public settings or when around people outside of your household, wear a properly-fitting face covering. Wash your hands before putting on your face covering, put it over your nose and mouth and secure it under your chin, and try to fit it snugly against the sides of your face. Make sure you can still breathe easily.

• Hand washing: The most well-established way to prevent respiratory infections such as influenza and coronavirus is frequent and thorough hand washing with soap and water. Scrub your hands thoroughly with soap and water for at least 20 seconds.

• Hand sanitizer: Handwashing with soap and water is the best way to reduce germs, but if they are not available, alcohol-based hand sanitizers that contain at least 60% alcohol can help to reduce the spread of infection. Note: avoid any products containing triclosan, a known hormone-disrupting chemical.

• Covering your mouth and nose: Cover your mouth and nose with a tissue when coughing or sneezing; if your hands are not free or you don’t have a tissue, cough or sneeze into your sleeve, not your bare hands.

• Not touching your face: Avoid touching your eyes, nose, and mouth with unwashed hands, which can help provide the virus with a route of entry into the body. Since the average individual touches their face an average of 15 times per hour, remain vigilant!

• Keeping surfaces clean: Clean and disinfect frequently touched surfaces, especially when someone is ill. Surfaces to consider include doorknobs, phones, computer keyboards, remotes, and other surfaces that are frequently touched in rooms such as the bathroom and kitchen.

STEP 3: Supplement wisely. 

Supplements are just that… supplements. They support an otherwise healthy lifestyle. Many of us are tempted to look in the medicine cabinet for options that will boost our immunity. Unfortunately, there are no specific studies available to know how to prevent viruses with supplements or drugs. It is important to stay sensible and not go overboard when considering supplements. Below is a list of supplements that may be foundational for health and immunity.

Please note. This list is not meant to be a prescription. Before starting any supplement talk to Relish Health or your health care provider about which supplements are right for you.

Where to start:

• Multivitamin/Mineral - About 75% of the US population (ages ≥1 year) do not consume the recommended intake of fruit, and more than 80% do not consume the recommended intake of vegetables. Unfortunately, micronutrient insufficiencies are common in the US. A high-quality multivitamin may help minimize the risk of low vitamin and mineral levels.

• Vitamin D - Most cells of the immune system have vitamin D receptors which help regulate the immune response. Vitamin D deficiency is associated with increased susceptibility to infection, and 41% of adults in the U.S. are clinically deficient in Vitamin D while an even greater number have insufficient levels. Vitamin D is a fat-soluble vitamin. Most adults can safely supplement with 1000-2000 IU daily without monitoring vitamin levels with a blood test. Higher doses may be appropriate if indicated by blood tests. 

Consider adding 1 or more if appropriate:

• Zinc 30 mg once or twice daily - Zinc has been extensively studied as a treatment for the common cold and other similar respiratory viruses. There is no specific data about zinc use with COVID-19, however zinc has been demonstrated to decrease the replication of other viruses.

• Glutathione (GSH) or N-Acetyl Cysteine (NAC) - Glutathione is a potent antioxidant. It can be taken directly as a supplement. NAC helps support our body’s ability to make this antioxidant thereby indirectly increasing GSH. GSH effects the behavior of many cells of the immune system by enhancing their function. GSH may confer protection against microbial, viral and parasitic infections.

• Vitamin C - Vitamin C contributes to immune defense by supporting various immune cell functions. Vitamin C deficiency results in impaired immunity and higher susceptibility to infections. According to some studies, supplementation with vitamin C appears to be able to both prevent and treat respiratory and systemic infections. 

• Probiotic foods or supplements - A large percentage of the body’s immune system is located in our gastrointestinal tract. The billions of microbes collectively living in the gut are called the microbiome. The bacteria in our gut influence our immune system. We can foster a healthy microbiome by eating a fiber rich diet and fermented foods like sauerkraut or kimchee.

• Antiviral herbs - Herbs have long been recognized for their medicinal properties. Herbs have a long history of use and are well-studied in traditional Chinese medicine. There are promising results from herbs including Echinacea, Goldenseal, Astragalus, Andrographis, Quercetin, and Reishi. *Please talk to your doctor to identify which herbs may be best for you.

• Adaptogens - Also from traditional Chinese medicine, adaptogens are herbs that aid our bodies in reacting to or recovering from both short and long-term physical or mental stress. Some also boost immunity and overall well-being. 

Most of these supplements can be found at health food stores; or check out Dr. Leazenby’s curated list of supplements at Fullscripts for examples of high-quality, vetted products. Discuss all supplements with your medical provider before starting.

STEP 4: CONSIDER VACCINATION. 

Current influenza and COVID vaccinations can decrease the severity of illness if you should become ill. These vaccines help protect you by creating an antibody response without you having to experience potentially severe illness. Talk with Relish Health or your health care provider about whether a vaccine is appropriate for you.

VITAMIN D FOR COVID-19 PREVENTION AND TREATMENT
BOOST YOUR IMMUNE SYSTEM WITH ELDERBERRY SYRUP

References:

1. Features, Evaluation and Treatment Coronavirus (COVID-19) [Updated 2020 Mar 20].  https://www.ncbi.nlm.nih.gov/books/NBK554776/

2. UpToDate Coronavirus update https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19?topicRef=8350&source=related_link

3. How Sleep Affects your Immunity https://www.sleepfoundation.org/articles/how-sleep-affects-your-immunity

4. Regular exercise benefits immunity -- even in isolation  https://www.sciencedaily.com/releases/2020/03/200331162314.htm

5. Micronutrient Inadequacies in the US Population: an Overview https://lpi.oregonstate.edu/mic/micronutrient-inadequacies/overview

6. Prevalence and correlates of vitamin D deficiency in US adults. https://www.ncbi.nlm.nih.gov/pubmed/21310306

7. Vitamin D https://lpi.oregonstate.edu/mic/vitamins/vitamin-D

8. Zinc for the treatment of the common cold: a systematic review and meta-analysis of randomized controlled trials https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394849/

9. Glutathione and infection. https://www.ncbi.nlm.nih.gov/pubmed/23089304

10. Vitamin C and Immune Function. https://www.ncbi.nlm.nih.gov/pubmed/29099763

11. The No BS Guide to Adaptogens for Hormonal Balance and Stress https://www.healthline.com/health/stress/smart-girls-guide-to-adaptogens

“An ounce of prevention is worth a pound of cure.” 

Benjamin Franklin 1736

Understanding the Gut-Skin Connection: Fixing your Gut May Fix Your Skin

The human body is home to ecosystems of bacteria, yeast, viruses and other organisms that inhabit different regions of our body. These ecosystems are often collectively called the microbiome. While specific species and strains of organisms vary based on location in the body, imbalances of organisms in any given site play a role in the health of the body as a whole. The microbiome is a key regulator for the immune system. Hence, imbalances (also called dysbiosis) of these organisms are associated with an altered immune response, promoting inflammation in potentially multiple areas of the body. (1) A dysbiosis can occur if there are too many “bad” species, not enough “good” species, or not enough diversity of species.

The skin is the largest and most external barrier of the body with the outer environment. It is richly perfused with immune cells and heavily colonized by microbial cells. These microbes help train the body’s immune cells and help determine overall well-being. The skin has a unique microbiome that is distinct from the gut microbiome, yet scientists are learning that there is a strong bidirectional relationship between the health of these two areas of the body. The relationship is often termed the “gut-skin axis.” Skin conditions including rosacea, acne, psoriasis, atopic dermatitis, skin aging and others are often associated with altered gut microbiome health.

The gut and skin connection

The intestinal tract houses a diverse collection of bacteria, fungi, and protozoa. Many of these microorganisms are essential for metabolic and immune function. An imbalance in this microbiome can result in a breakdown of gut barrier function resulting in antigenic food proteins and bacteria components entering the body’s circulation to trigger inflammation. This inflammation can affect many organs, including the skin.

Adult Acne Vulgaris

Acne is a skin condition that occurs when your hair follicles become plugged with oil and dead skin cells. Acne can be described as whiteheads, blackheads, pimples or deep cysts. Cystic acne is linked to the health of the skin’s microbiome, in particular the balance of a bacteria called Cutibacterium acnes. In a diverse, balanced skin microbiome, this bacterium is involved in maintaining a healthy complexion. However, if there is loss of the skin microbial diversity, this bacteria can also trigger cystic acne. The microbial imbalance can lead to the activation of the immune system and a chronic inflammatory condition like acne. (2) Like in the gut, the health of the skin microbiome influences the release of chemicals triggering inflammation. Optimizing both the gut microbiome and skin microbiome are important stratagies to resolve acne by controlling inflammation both at the skin level and whole body level.

Rosacea

Rosacea is a common, chronic inflammatory skin condition that causes flushing, visible blood vessels and small, pus-filled bumps on the face. The exact cause of rosacea is debated and likely related to multiple factors. Like acne, the skin microbiome and its associated inflammatory effects plays a role in rosacea's etiology. There are also numerous studies connecting rosacea to gastrointestinal disorders including celiac disease, inflammatory bowel disease, irritable bowel syndrome, Helicobacter pylori infection and small bowel bacterial overgrowth.(3) Conventional treatment of rosacea often involves managing symptoms. Identifying and addressing potential associated gut-related illnesses is an effective tool to help support rosacea management.

Eczema

Eczema, also called atopic dermatitis, is a chronic condition that makes skin red and itchy. It is common in children but can occur at any age. Atopic dermatitis tends to flare periodically and is often associated with asthma or allergies. Atopic dermatitis is the most common inflammatory skin disease affecting 7% of adults and 15% of children.(1)

Studies have shown that atopic dermatitis is associated with lower gut microbiome diversity, lower levels of beneficial species, such as Bacteroidetes, Akkermansia, and Bifidobacterium in the gut, and higher amounts of harmful bacteria species including Staphylococcus aureus on the skin.(1) The intestinal microbiome modulates the body’s immune system and inflammatory responses and thus may play a role in the development of eczema and its treatment. Targeted probiotics can play a role in prevention and treatment of this disease.(4)

Psoriasis

Psoriasis is an inflammatory, autoimmune skin disease that causes a rash with itchy, scaly patches, most commonly on the knees, elbows, trunk and scalp. The illness is associated with an intimate interplay between genetic susceptibility, lifestyle, and environment. People with psoriasis have an increased risk to develop intestinal immune disorders, such as inflammatory bowel disease like ulcerative colitis and celiac disease.(1) A growing body of evidence highlights that intestinal dysbiosis is associated with the development of psoriasis.(5) One study showed that malabsorption of nutrients in the gut was more prevalent among patients with psoriasis. Celiac disease, bacterial overgrowth, parasitic infestations and eosinophilic gastroenteritis could be possible causes of malabsorption in these patients.(6) Addressing associated gut conditions may play a role in management of symptoms.

Skin Aging

Skin aging is associated with multiple degenerative processes including oxidation and inflammation. Multiple factors including diet, UV exposure, and environment play a role in the regulation of the aging process. New research shows that healthier diets are linked to fewer signs of skin aging.(7) Additionally, oral probiotics may play a role in regulating skin aging through influences on the gut-skin axis. In a study published in 2015, the oral probiotic Lactobacillus plantarum HY7714 was shown to improve skin hydration, skin elasticity and UV related skin changes.(8)

Skin Care may need to Start with Gut Care

Optimizing the gut microbiome has a role in addressing skin disorders. The following strategies can improve the microbiome:

• Eat better. The microbiome is influence by the food we eat. Beneficial bacteria thrive on fiber that comes from eating a variety of vegetables regularly. The growth of unfavorable bacteria is influenced by sugar, saturated fats and a lack of fiber/vegetables in the diet. To optimize your microbiome, avoid refined sugar and saturated fats like those found in sodas, breakfast cereals, candies, cakes, red meat (limit to 1 or 2 servings a week to prevent overconsumption) and what is commonly referred to as “junk food”.

• Use antibiotics wisely. Antibiotic treatment is necessary from time to time. However antibiotics can significantly lower microbiome diversity and the quantity of beneficial bacteria.(9) When prescribed an antibiotic, ask your health care provider if it is truly necessary. Speak with your provider about using prebiotics and probiotics to support the microbiome after the antibiotic use.

• Repair the gut flora. In addition to a fiber-rich diet, probiotics may play a role in optimizing gut function. Probiotic science is in its infancy, but there is research suggesting that certain strains may benefit certain medical conditions. Speak with your health care provider for probiotic recommendations that may best suit your medical needs.

• Identify other ways to care for your digestive system, such as repairing the wall of the small intestine which may have been irritated by a poor diet, poor digestion, medications or stress. Identifying food sensitivities, restoring nutritional deficiencies and eating adequate nutrients to support healing are important.

Many of the interventions above can be easily implemented without need for laboratory tests. There are no specific gastrointestinal lab markers that are known to directly cause skin issues. However, assessments of the GI system may reveal abnormalities indirectly impacting skin health. Relish Health relies on multiple tools such as stool microbiome testing, breath tests and food sensitivity tests to understand the health of the gut-skin axis and develop targeted interventions to address gut and skin conditions.

TESTING, TESTING... WHICH ONES MIGHT BE RIGHT FOR YOU?

References:

1. De Pessemier B, Grine L, Debaere M, Maes A, Paetzold B, Callewaert C. Gut–Skin Axis: Current Knowledge of the Interrelationship between Microbial Dysbiosis and Skin Conditions Microorganisms. 2021 Feb; 9(2): 353. doi: 10.3390/microorganisms9020353

2. Dréno B,. Pécastaings S, Corvec S, Veraldi S, Khammari S, Roques C. Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: a brief look at the latest updates. J Eur Acad Dermatol Venereol 2018 Jun;32 Suppl 2:5-14. doi: 10.1111/jdv.15043.

3. Daou H, Paradiso M, Hennessy K, Seminario-Vidal L. Rosacea and the Microbiome: A Systematic Review. Dermatol Ther. 2021 Feb;11(1):1-12. doi: 10.1007/s13555-020-00460-1.Epub 2020 Nov 10.

4. Fiocchi A, Pawankar R, Cuello-Garcia C, et. al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics World Allergy Organ J. 2015; 8(1): 4. Published online 2015 Jan 27. doi: 10.1186/s40413-015-0055-2

5. Sikora M, Stec A, Chrabaszcz M, Knot A, Waskiel-Burnat A, Rakowska A, Olszewską M, Rudnicka L. Gut Microbiome in Psoriasis: An Updated Review. Pathogens. 2020 Jun; 9(6): 463. Published online 2020 Jun 12. doi: 10.3390/pathogens9060463

6. Ojetti V, De Simone C, Sanchez J, Capizzi R, Migneco A, Guerriero C, Cazzato A, Gasbarrini G, Pierluigi A, Gasbarrini A. Malabsorption in psoriatic patients: cause or consequence? Scand J Gastroenterol. 2006 Nov;41(11):1267-71.

   doi: 10.1080/00365520600633529.

7. Katta R, Sanchez A, Tantry E. An Anti-Wrinkle Diet: Nutritional Strategies to Combat Oxidation, Inflammation and Glycation. Skin Therapy Lett. 2020 Mar;25(2):3-7.

8. Lee, D. E. et al. (2015) “Clinical Evidence of Effects of Lactobacillus plantarum HY7714 on Skin Aging: A Randomized, Double Blind, Placebo-Controlled Study,” Journal of Microbiology and Biotechnology. Journal of Microbiology and Biotechnology. https://doi.org/10.4014/jmb.1509.09021

9. Ramirez J. Guarner F, Fernandez, L, Maruy A, Sdepanian V, Cohen H. Antibiotics as Major Disruptors of Gut Microbiota. Front. Cell. Infect. Microbiol., 24 November 2020 | https://doi.org/10.3389/fcimb.2020.572912

10. Stubbe C. The Gut Microbiome in Dermatology. Anti-aging Medical News. Spring 2022. p76-80.

Boost Your Immunity with Functional Medicine

Boost Your Immunity with Functional Medicine

By now we have all heard the public health pleas to stay home and wash our hands to prevent the transmission of COVID-19 and help “flatten the curve.” This public health prescription is vitally important to keeping our communities safe and our healthcare system stable. 

While social distancing is extremely important, many of us want to take additional steps to support our immunity and resilience against this extremely contagious virus. It is estimated that 80% of people will have mild disease, but it is still important to optimize our health for illness prevention and recovery.

Step 1: Eliminate unnecessary inflammation. 

Inflammation is the term doctors give to the immune response our body generates when it is addressing an insult. This insult can take many forms including a virus, bacteria, elevated blood sugar or even toxic food. Inflammation is not just a vague concept but can be measured through blood tests looking at various chemicals and immune cells. Even low levels can be associated with chronic medical conditions like diabetes, heart disease, autoimmune conditions and even depression. In the cases of severe COVID-19 viral illness, the virus seems to be capable of producing an excessive immune reaction in the host that can cause extensive tissue damage. This is sometimes termed a “Cytokine storm.” 

While there are no specific studies on COVID-19 prevention, a plausible way to optimize our immunity is to eliminate as much underlying inflammation as possible. Start with these foundational measures:

• Get your diet on point. You have heard this before, but at no other time has it felt so critical to be well nourished. This means eating a nutrient dense diet that provides us the minerals, antioxidants, adequate protein and healthy fats that make the immune system function well (translation: LOTS of veggies). This also means eliminating the foods that trigger inflammation like fried foods, sugar, highly processed junk food, excess alcohol and sweetened beverages. For many people, gluten and dairy are problematic and trigger inflammation. This is a great time to complete the Whole30 that has been on your to-do list. 

• Get adequate sleep. Since we are working from home it is very tempting to ignore our regular bedtime routine to watch the news or binge Netflix until the wee hours of the night. Sleep is intimately tied to our immune health. Without sufficient sleep, our body makes fewer cytokines, a type of protein that targets infection and inflammation. Getting adequate sleep reduces our risk of infection and can improve our outcomes if we do get sick. Conversely, sleep deprivation weakness our body’s defense system and makes us more vulnerable to illness. Aim for 7-9 hours of sleep each night.

• Stay moving. The gyms may be closed, but there are ample opportunities to keep moving. Get outside for a walk, try simple homemade weights in your basement or check out the numerous classes available online. There is great data suggesting that exercise can help the immune system find and deal with pathogens.  In the long term, regular exercise slows down changes that happen to the immune system with ageing, therefore reducing the risk of infections. High intensity interval training has particularly great data but any form of movement is better than being sedentary. Aim for 150 minutes of purposeful movement per week. Check out some of these free online resources.

• Manage your stress. Life for all of us has been upheavaled in the past month. It is normal to feel stress and anxiety with change. How we respond can help influence our immune health. Cortisol, one of the hormones associated with stress, can suppress our immune response. This is why you may become sick after periods of stress in your past. Acknowledging our fear and frustrations is important, but embracing stress management activities like meditation, journaling, exercise, prayer and yoga can help moderate our body’s cortisol response. If these strategies are not enough, I encourage you to find a professional counselor to help you address your emotions. 

Step 2: Supplement wisely. 

Supplements are just that… supplements. They support an otherwise healthy lifestyle. In this age of uncertainty many of us are tempted to look in the medicine cabinet for options that will boost our immunity. Unfortunately, there are no specific studies available to know how to prevent COVID-19 with supplements or drugs. It is important to stay sensible and not go overboard when considering supplements. Below is a list of supplements that may be foundational for health and immunity.

Please note. This list is not meant to be a prescription. Before starting any supplement talk to Relish Health or your health care provider about which supplements are right for you.

Where to start:

• Multivitamin/Mineral - About 75% of the US population (ages ≥1 year) do not consume the recommended intake of fruit, and more than 80% do not consume the recommended intake of vegetables. Unfortunately, micronutrient insufficiencies are common in the US. A high-quality multivitamin may help minimize the risk of low vitamin and mineral levels.

• Vitamin D - Most cells of the immune system have vitamin D receptors which help regulate the immune response. Vitamin D deficiency is associated with increased susceptibility to infection, and 41% of adults in the U.S. are clinically deficient in Vitamin D while an even greater number have insufficient levels. Vitamin D is a fat-soluble vitamin. Most adults can safely supplement with 1000-2000 IU daily without monitoring vitamin levels with a blood test. Higher doses may be appropriate if indicated by blood tests. 

• Zinc - 30 mg once or twice daily - Zinc has been extensively studied as a treatment for the common cold and other similar respiratory viruses. There is no specific data about zinc use with COVID-19, however zinc has been demonstrated to decrease the replication of other viruses.

Consider adding 1 or more if appropriate:

• Glutathione (GSH) or N-Acetyl Cysteine (NAC) - Glutathione is a potent antioxidant. It can be taken directly as a supplement. NAC helps support our body’s ability to make this antioxidant thereby indirectly increasing GSH. GSH effects the behavior of many cells of the immune system by enhancing their function. GSH may confer protection against microbial, viral and parasitic infections.

• Vitamin C - Vitamin C contributes to immune defense by supporting various immune cell functions. Vitamin C deficiency results in impaired immunity and higher susceptibility to infections. According to some studies, supplementation with vitamin C appears to be able to both prevent and treat respiratory and systemic infections. 

• Probiotic foods or supplements - A large percentage of the body’s immune system is located in our gastrointestinal tract. The billions of microbes collectively living in the gut are called the microbiome. The bacteria in our gut influence our immune system. We can foster a healthy microbiome by eating a fiber rich diet and fermented foods like sauerkraut or kimchee.

• Antiviral herbs - Herbs have long been recognized for their medicinal properties. Herbs have a long history of use and are well-studied in traditional Chinese medicine. There are promising results from herbs including Echinacea, Goldenseal, Astragalus, Andrographis, Quercetin, and Reishi. *Please talk to your doctor to identify which herbs may be best for you.

• Adaptogens - Also from traditional Chinese medicine, adaptogens are herbs that aid our bodies in reacting to or recovering from both short and long-term physical or mental stress. Some also boost immunity and overall well-being. 

Most of these supplements can be found at health food stores; or check out Dr. Leazenby’s curated list of supplements at Fullscripts for examples of high-quality, vetted products. Discuss all supplements with your medical provider before starting.

A phased functional medicine supplement approach to COVID-19 provided by the Institute for Functional Medicine. May 2020. * Always consult your healthcare provider before starting supplements.

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References:

1. Features, Evaluation and Treatment Coronavirus (COVID-19) [Updated 2020 Mar 20].  https://www.ncbi.nlm.nih.gov/books/NBK554776/

2. UpToDate Coronavirus update https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19?topicRef=8350&source=related_link

3. How Sleep Affects your Immunity https://www.sleepfoundation.org/articles/how-sleep-affects-your-immunity

4. Regular exercise benefits immunity -- even in isolation  https://www.sciencedaily.com/releases/2020/03/200331162314.htm

5. Micronutrient Inadequacies in the US Population: an Overview https://lpi.oregonstate.edu/mic/micronutrient-inadequacies/overview

6. Prevalence and correlates of vitamin D deficiency in US adults. https://www.ncbi.nlm.nih.gov/pubmed/21310306

7. Vitamin D https://lpi.oregonstate.edu/mic/vitamins/vitamin-D

8. Zinc for the treatment of the common cold: a systematic review and meta-analysis of randomized controlled trials https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394849/

9. Glutathione and infection. https://www.ncbi.nlm.nih.gov/pubmed/23089304

10. Vitamin C and Immune Function. https://www.ncbi.nlm.nih.gov/pubmed/29099763

11. The No BS Guide to Adaptogens for Hormonal Balance and Stress https://www.healthline.com/health/stress/smart-girls-guide-to-adaptogens

“An ounce of prevention is worth a pound of cure.” 

Benjamin Franklin 1736

Homemade Coconut Yogurt

Homemade 2-ingredient Coconut Yogurt

Probiotics are all the rage in the wellness community. And for good reason, there is very interesting science about their effectiveness. Probiotics, however, are nothing new. Our grandparents and great-grandparents enjoyed them regularly as part of a common, non-industrialized diet. Making foods like yogurt and sauerkraut were simply tasty ways to preserve food. 

I recommend getting as many nutrients as possible through food, even probiotics. Yogurt is found in nearly every grocery, but few people realize how easy it is to make at home. Often the commercially available products include sugar and stabilizers that can be avoided with this DIY approach. Not everyone tolerates cow’s milk, so I’ve written a recipe below for a coconut milk alternative that I make at home.

Enjoy!

Coconut Yogurt

Ingredients:

• 1 can full fat coconut milk (Choose a brand without fillers or stabilizers in a BPA-free can.)

• 1 probiotic capsule containing lactobacillus OR ¼ cup of a prior batch of yogurt (store bought or homemade)

• 1 sterilized glass jar (I use a Ball jar that I first run through the dishwasher to sterilize.)

Directions:

1. Add the coconut milk and probiotic (or yogurt) to the clean glass jar. Stir to combine.

2. Loosely cover the jar with the lid and place the jar in the oven near the oven light. 

3. Turn on the oven light and let the jar sit overnight, but do not turn the oven on. The very low heat from the lamp is all that is necessary.

4. In the morning stir the coconut yogurt as separation is natural. Place the yogurt in the refrigerator to firm. Stir again just before using. 

Notes:

• Be sure to start with clean utensils and hands. 

• Choose a probiotic that includes lactobacillus somewhere in the range of 10-50 billion CFU. You do not want it to contain prebiotics. I use whatever I have on hand, but these are examples: Flora Advanced Adult Formula, Renew life Ultra Flora, Jarrow probiotic.

• The yogurt should have a sweet tangy smell. If it smells off or you see colored bacteria or mold on the surface, then discard it. 

• Low fat coconut can be used, however the consistency will be thin and pourable like kefir.

Check out these additional probiotic foods.

Should you be taking a probiotic?

(This blog post is not sponsored by any manufacturer. However, Relish Health may receive a commission on purchases made through an Amazon link.)

Preventing colds is easier than you think

Fall often marks the start of cold and flu season. The weather is changing, the kids are back in school sharing germs, and life continues to move at a fast and often stressed pace. Colds often feel an inevitable part of the winter months, but with a little attention and support to our immune system we can prevent sick days, sleepless nights and chapped noses. 

Staying healthy is all about giving our immune system the support it needs to do its job. Try some of these tips:

• Optimize your diet. Your body needs a ready source of antioxidants, vitamins and minerals to function well. To ensure a nutrient dense diet, aim to eat two vegetables and one fruit at each meal. Eliminating foods that can trigger inflammation, especially excessive sugar and dairy, is also helpful.

• Get your beauty rest. Sleep is a restorative process that is important for proper functioning of the immune system. Studies have shown that sleep deprivation weakens immune health, making you more susceptible to colds and other bacterial infections. The goal is to aim for 7-8 hours of sleep a night.

• Manage your stress. Stress hormones, especially if chronic, can suppress the effectiveness of the immune system. A little self-care with meditation, exercise and mindfulness can go a long way. 

• Hygiene is key. Wash your hands regularly and avoid touching your face. These are simple and effective stratagies to minimize your exposure to potential cold causing germs. 

• Supplement wisely. If you happen to be one of those people that gets ill easily despite a healthy lifestyle, targeted supplements may be helpful. The following immune-boosters have quality evidence to support their use. 

  • Vitamin D can help support the immune system and is important for overall health. The dosing of vitamin D varies widely among individuals. Adults can safely take 1000-2000 IU daily. Only use a higher dose if the results of your blood-test suggests a need. Talk to Relish Health about vitamin D testing.

  • Zinc is an immune boosting mineral found in oysters, beef, and lamb, and to a lesser degree in pumpkin seeds, cashews, and beans. Taken daily for a few weeks to a few months can help reduce the likelihood of viral infections. The prevention dose of zinc for adults is 10-15 mg. Note: Zinc can be nauseating for some people.

  • Studies have shown that probiotics improve the body's immune response. Supplementation can reduce frequency and duration of colds. Look for a brand that contains lactobacillus with or without bifidobacterial. Check out the brands listed in the Relish Health fullscripts formulary for examples. 

  • Elderberry extract can significantly lower duration of cold  and flu symptoms while lowering the need for medication. Follow the dosing recommendation of the particular type or preparation being used. This herb should be started at the earliest signs of illness.

Natural Foods for Gut Health

It is true that we are what we eat, but it is more accurate to say that we are what we absorb. Our overall health is intimately tied to the health of our digestive system. Our digestive system is a complex organ that contains trillions of bacteria. This bacterial community, called the microbiome, is responsible for helping absorb our nutrients, manufacture some of our vitamins and help regulate our immune system. Keeping this bacterial community happy, healthy and diverse is vitally important for ensuring proper absorption and optimal health.

Fermented foods have been a part of cultures for thousands of years. Historically, fermentation was a way to preserve food, but as we are now learning, it is also a way to ensure a healthy microbiome. Fermented foods include live cultures that make them natural probiotics and aid our digestive and immune systems. Modern practices like refrigeration and pasteurization have made these traditional foods less common in our culture today. Reintroducing these delicious and natural solutions can help give your gut a health boost.

Try some of these favorites:

1. Kefir is a fermented dairy drink similar to yogurt. The term originated in Russia and Turkey and is translated to mean “feels good.” It has a mildly acidic, tart flavor and contains many more strains as well as higher levels of beneficial bacteria than standard yogurt. When purchasing, choose kefir with minimal amounts of added sugar. Enjoy as a drink, in a smoothie, or with granola.

2. Sauerkraut is made from fermented cabbage and other vegetables. Artisanal varieties are often flavored with beets, apples or carrots. Sauerkraut is fermented by wild strains of the beneficial bacteria, lactobacillus. It has a pleasant sour flavor that is excellent as a condiment for entrées, salads and savory toasts. When purchasing, be sure to find the product in the refrigerated section of the grocery. (The other version on the aisle shelves has been pasteurized and no longer contains the desired beneficial bacteria.) Sauerkraut can be made easily at home. 

3. Kimchi is similar to sauerkraut, but is often made with napa cabbage and radishes. It is Korean in origin and is often spicy.

4. Kombucha is made from fermented sweet tea and is thought to originate from Japan. Kombucha is made by adding a symbiotic colony of bacteria and yeast (SCOBY) into tea and allowing the tea to ferment for a few days to a week. The resulting product is effervescent and has a tangy flavor.

5. Coconut kefir is made by fermenting the water of young coconuts in a similar manner to making dairy kefir. It is not as high in probiotics as its dairy cousin, but it is very refreshing.

6. Yogurt can be an excellent probiotic food, but only if chosen wisely. Many commercially available yogurts can contain high amounts of added sugar and dyes. The quality of dairy is important to consider.

7. Raw apple cider vinegar contains the acetobacter that is responsible for making the acetic acid that gives vinegar its characteristic flavor. Research has demonstrated that apple cider vinegar can help control blood pressure, cholesterol and blood sugar. Enjoy raw apple cider vinegar in salad dressings or as a diluted beverage.

8. Miso is a traditional Japanese product. It is created by fermenting soy beans or chickpeas with a yeast called koji. Miso can be made into a soup but is also delicious enjoyed as a condiment in salad dressings, sauces or marinades.

9. Pickles made by fermenting cucumbers with salt and water are also a source of beneficial lactobacillus. They are low in calories, but eat in moderation as they may contain a fair amount of salt. Make them at home or find in a specialty grocery in the refrigerated section. (The other pickles located in the aisle shelves are made with vinegar and do not contain the necessary live cultures.) 

HOMEMADE SAUERKRAUT