S5 E02 - Rosacea Unveiled: Exploring the Gut-Skin Connection and Holistic Management

This podcast is intended as healthcare practitioner education only and is not a substitute for medical advice diagnosis or treatment It's intermittent and it's relaxing and is characterized by a lot of facial flushing erythema Talented tazia, which is just really tiny little broken blood vessels all over the central panel of the face Papuels and pastures. It's itchy and it's dry and it can also include symptoms of dry eyes and Even to the extent where some people can have blepharitis, stys and even calzians In fact dry eyes can be a precursor to acne rosacea It is a vascular inflammatory Immunition I find it really interesting because if you look in the past of the way it was looked at they used to call it an idiopathic redness of the skin for no reason It's just really interesting because I just don't think they can figure it out And very rarely does the body do something for no reason So it's complex I think a lot of the drivers behind it can be genetics which we'll probably dive into Obviously, there's an issue with food sensitivities what I consider to be pH gradient dysfunction or hypochloritria As well as of course gut issues and permeability and microbiome dysfunction as long as just it's generally an increased inflammation This is bio concepts between clinical minds The podcast that's open-minded enough to take in all sides of a clinical story You'll hear from researchers, doctors, naturopaths, nutritionists and patients We look at common clinical presentations through a different lens It's open, frank and sometimes controversial Nothing is off limits. Will it change the way you treat? We'll leave that up to you In season five of bio concepts between clinical minds we look at skin conditions We talk to experts in the field who will take you into their clinics and share their experience I'm Tony Chambers and this is bio concepts between clinical minds In this episode of between clinical minds we discuss all things rosacea with naturopath Cheryl Sevelle and clinical nutritionist Lindsey Koch Cheryl Sevelle is a naturopath with 30 years experience and says she feels like a health detective She says rosacea starts between the ages of 30 and 50 mainly in women and can be easily distinguished from other skin conditions So I guess the first thing you're looking at is the flushing like it really is a very red presentation And at some point depending on how long it's been there these tiny broken blood vessels become very obvious There almost like a purple color on the face of this red erythemic presentation The distribution is like that T zone area Well, they call it the central panel, but it comes right out onto the cheeks So when you're looking at something like seborrache dermatitis you are going to see that more around the nasal area and when you've got perioral dermatitis that's more around the mouth area And you can see perioral dermatitis and rosacea at the same time or they can actually alternate as well And then you have got the butterfly rash that you might see with lupus And if you're suspecting there's sort of a systemic picture like lupus in Obviously you want to rule that out and send them off to a GP The other thing is that they will comment that Their skin has triggers. So rosacea is triggered by sun exposure heat stress alcohol Heavy exercise. So imagine heavy exercise in hot weather not a good spicy foods And hormonal fluctuations as well as things like caffeine and and there are some food allergies along with that There's also a lesser known trigger that I want to talk about And it's the release of endotoxins during diaphrom antibiotics or antifungals So they'll often present say oh ever since I had that infection that bronchitis or ever since I had thrush My skin has been Presenting with this really weird rash and so what that actually is is it's the endotoxins crossing the gut skin access And irritating a skin that's already sensitive Compromised barrier and a pH is probably shifted from a 5.5 which is what it should be In a healthy person over into that alkaline environment which does tend to favor the Presentation and and I guess it's almost like a Dispiosis of the skin that's already there and this is just coming in now and adding insult to injury The other thing I haven't mentioned is that as a differential with acne vulgaris Somebody did present with acne vulgaris in later years You're less likely to see comodones which are those little Blackheads it would see as an anager you go and see more those harder papules and some pastules there And there's also one other skin condition worth mentioning is fungal acne because that can happen at Any age but is more common in males teenagers Their hygiene is not as good and they get that overgrowth of that yeast coming onto the skin They won't respond to over the counter acne products like rosacea But they're more likely to have an oily presentation a greasy sort of presentation There is a bit of an odor or a smell that they might have noticed like a dandruffy smell And usually they do respond once you You know put them onto some good antifungals and change their shampoos and Work out it from that direction, but definitely that's a differential as well And so do you have a combination of systemic and local treatments? Yeah, so definitely local first and then we kind of dig into that systemic work after because You know people are feeling so uncomfortable and they're so miserable with this presentation And this is where I want to talk about the Demodex mites So a lot of people don't realise rosacea is due to these mites that actually live on our skin They're on every one's skin, but there's 10 times higher amounts on a rosaceous skin I live in the eyelashes and our A cause of blepharitis So if you've had patients presenting with blepharitis that can also be a little indicator there The Demodex mites has a bacteria that it carries called the bacillus on Olin I can never say this word but olinus And together they excrete Basically excrement that is an irritant for the skin So step one is addressing both the Demodex and the bacillus And as soon as you do that you're going to see a calm and down of things And then that restores their confidence a little bit with you and they're happy to try Doing other things to kind of keep things going And then the other thing that's super important Is then working on restoring that skin's acid mantle So that they're not kind of Setting themselves up with more of an alkaline situation And so how do you deal with the mites? Tea tree oil is very effective In fact it can clear inlapse it can clear 100% of the mites But of course, try putting tea tree oil on a very irritated skin and that's not going to be very well There is a product that I recommend from the pharmacy It's called a zallic acid It's not as effective as tea tree oil but very effective It's extract from a grain And it basically helps to address the mites the bacillus The inflammation and the skin barrier So I'll use that very often Okay, so after that what's your next focus? So then I look at the gut skin axis And nowadays we accept that everything passes through the skin From the chemicals in our sunscreen which by the way are still present two weeks after we've applied them Through to medicinal and hormonal patches But in the same way, immune inflammatory chemicals can cross through the dermal layer from the gut Causing the skin diseases So it's you know, it does go both ways So we're really looking at You've got it basically addressing both areas And more often than not histamine is involved Hence the perimenopausal picture So this may be due to allergies from personal care products Perfumes are rather inhaled allergens Even perfumes in synthetic candles can stir trouble up You'll often see a family history of histamine presenting conditions And also a past history With the patient of hay fever, Xamamagrams And perioral dermatitis among others there may be a production of excess histamine from other cytokines. such as you would find with SIBO, including strep, that's a big histamine producer, H-pilory or Candida. There is often a history of thrush or digestive symptoms like IBS. And when you prescribe probiotics, make sure none of them are histamine producing. Is there any kind of link with hormones, given its time of presentation or age of presentation being over 35? In terms of the role hormones play in rosacea, there's a natural release of histamine that occurs at ovulation and menstruation. And this is what we were talking about earlier. So if there's already histamine load, this may cause a body to reach a critical threshold and that will trigger a flare up. So we do do the work on the hormones, but we're also being very mindful of that histamine in the treatment plan. They're probably the main ones, but definitely leaky gut plays a role. A recent history of antibiotic use and doxycycline, maybe triple antibiotic therapy for H-pilory can all sort of stir things up. And the other big one is insulin resistance and cardiometabolic disease. So you might see an underlying cause of rosacea sitting there and that's generally the male. So that odd male that presents with rosacea, he's more likely to come in with that sort of skinny legs than that big belly look about him. May or may not have elevations of his fast and glucose cholesterol and he may or may not have bipolar pressure because many men might not have even presented to a doctor at this point. So you want to get them off and checked. And if that's what's going on, it's more the ketogenic or a Mediterranean diet that will make a difference along with regular high intensity exercise, just being mindful of the heat, aggravating the skin. And one other theory that I have and I have absolutely no scientific evidence to support this but I do see it, my own confirmation bias maybe, is that if there's a high dietary sugar intake and there's an overgrowth of yeast in the gut, which you can see with cardiometabolic disease, this produces alcohol in the gut. Alcohol results in dilation of blephysus and flushing of the skin just like a glass of beer would do. So I do find that when I cut out the yeast in terms of dietary yeast, clean up the yeast in terms of what's presenting in the gut and cut down on the sugar, this flushing improves. And speaking of flushing, one other thing, menopausal hot flushing, which is trigger. And so getting on top of this is a priority. So if you've, someone's presenting menopausal hot flushes and rosacea, I'll use a skin treatment first and I'll dig straight in and try and address the hot flushes because they're affecting so many factors in a person's life apart from skin. When I had hot flushes, I learned that they always proceeded a stressful thought. So except for the night ones. So now I ask women to record what were they thinking just before that flush and then to write that down and bring it to me. And then I use a technique, a kinesiology technique called NET and another called psych. And also one of my own that I have come up with using flouricances and I teach. And basically we clear the emotional stress all. So the next time they have that thought, they don't get that chemical surge or that biochemical surge and they don't get that trigger. And so the more we can clear, the better it improves. And we know as well, don't we now, that the impact, or we're just starting to understand the widespread impact of trauma, particularly emotional trauma, on all aspects of health, but particularly on the skin. Can you kind of explain how often you find that component in these patients? Every time. And basically any emotional or stressful situation causes that sympathetic nervous system response and that triggers that biochemical cascade of your vasodilating chemicals. And that results in a flare all on its own. So I'm embarrassed that my skin's bad. I'm already been triggered. I haven't even left the house yet. Now my face is flaring. What is all released from stress shifts the skin's pH. So that's very important. So again, you're looking at a paramedical woman who's usually got little kids full-time work, stress, stress, stress. And that cortisol is just shifting the pH into that outline state. So already that natural acid mantle and that skin barrier protection is being compromised before anything happens. So then you get that surge of inflammatory chemistry and it's not going to be helpful. If the skin is more sensitive, it reacts more easily to the bacillus and the Demitex toxins. So it's almost like the higher that pH goes, the more it will actually create immune activation on its own. And that's all just from a stressful thought. Let alone all of your childhood trauma, etc., etc. Lindsay Kosh is a clinical nutritionist with a pain to purpose story of how her modality changed her life. I had just begun my undergraduate studies believe it or not in biological sciences. That's what I thought I wanted to be. And I was living in Hawaii at the time, but believe it or not, in Hawaii, certain times of the year we get snow, which a lot of people don't realize on top of. Wow. Yeah. It's very iconic to be in a tropical paradise beach and then drive a few hours of mountain and being snow. So I went up there with my roommates. And yeah, I basically hopped on a round disc sled that was very uncontrollable. And I ended up slamming into a lava rock that was buried. So I got into a critical accident at the age of 18, where I lost my spleen, severed my renal artery. He punctured lungs for a breeze. Did all the things, everything. I couldn't even know what it was. But it was the biggest blessing in my life because being in the emergency room in the hospital, they were thinking I was going to be in there for a minimum a couple months as far as the extent of injuries. And I got out in about two and a bit weeks and I really, really put it down. My mother would go, I couldn't actually stomach the hospital food. So I couldn't even swim. So my mom went out to health food stores and brought in all the beautiful organic whole foods. I genuinely, it was such an impactful moment in my life because I realized the healing was accelerated by the food that I was eating. And even my daughters were a bit shocked. So that pretty much changed my course. I had to go and do rehab and recovery for about a year. So I had to delay my university studies and then I went back and started into more nutritional medicine. [MUSIC PLAYING] When you've got someone coming in and they have a skin condition, they may not even know it's rosacea. Yeah. So how do you distinguish between rosacea and some other skin conditions? Because it can be sometimes a little bit tricky to determine the differential diagnosis. What I'm just trying to do is distinguish visually what's going on. And then of course, you get so much information from a client's intake form. I think you have a really important thing I think you have a really quality detailed intake form. You can gather all those little puzzle pieces of what's going on. So I am looking for other signs like histamine issues and allergies. I'm looking for IBS and blood team in GI dysfunction. Signs of the reflex and the hypocryhedria. I'm kind of using together all these things to try and understand what's going on. There's a very, very big link when it comes to GI dysfunction and SIBO or small intestinal bacteria overhead. And I guess that comes to the gut skin access. And can you explain that access and how imbalances in our gut can actually manifest as rosacea? Well, like I teach my clients a lot. I often grab a pen and I literally say, look, I'm going to take a pen and draw it on the surface of my skin and not lift it. What you're going to recognize is it's all one surface. It's all connected. So what goes on inside is going to present externally. You know, easement is simple as if we have microbiome and balances, which we know generally is associated with rosacea. You know, just like we have good bacteria that release short-chain fatty acids that have been featured in it, when we have microbes or pathogens in there that are presenting other secondary metabolites, whether it be LPS or others, that is going to drive up inflammatory cytokine response. That is going to drive up histamine response. That is going to drive up TNF alpha. And those are a lot of the drivers for why we get this sort of flushing and vasodilation of the skin. So it's a direct link, as we know, there's that cross-talk between our microbes, our immune system, and because rosacea is such an inflammatory condition, you can't discount the influence of the gut and the microbiome on any inflammatory condition. And do you do gut microbiome testing with anyone who comes in with rosacea? I'm probably a little bit conservative when it comes to the end. to testing. I think every single one of us is practitioners. We love ourselves a good test. Because it has more data, I try and still tap in and really listen to the client. I think sometimes is practitioners because we have such incredible technology and functional medicine testing, which I think is amazing. Sometimes we don't pause and stop and listen and pull the puzzle pieces together. So when it comes to rosacea, of course, tests that are relevant is yes, a menagenomic microbiome test. I probably are on the side of doing food antigen testing, believe it or not, with rosacea because I can anecdotally understand if someone's not microbiome or GI issues based upon symptoms that are presenting. The SIBO test is also relevant. We could use that if it's really, really presenting. But often asking the question of, "Do you get bloating us? How significant is it?" Oh, wait, I look six months pregnant. Do you get any restless legs, cramping? Do you have any issues with B12? You can kind of piece together and get evidence of whether SIBO is going on. But the one bit of information I can't get from talking to a patient is what specific foods their immune system is responding to. So when I try and discern between what test is going to give me information that I cannot otherwise get, I probably would are on the side of doing very detailed IgE, IgG4, IgG and complement testing. That's one part of the picture when it comes to this whole rosacea side. And I've had really good results with that test. And with respect to the hypochal history, do you find a lot of people coming in with low stomach acid? A lot. And I don't blame. I associate a lot of that with modern living. A lot of us were just really stressed and were really busy. In fact, I have on my intake form, I have two questions to try and get the reliance from all that. Because if you've even asked someone now, right how stressed you are from 1 to 10? They'll probably put 5 on 5. And then if you ask them, "Which is my next question? Well, how busy are you?" Oh, 10 out of 10. Okay, well, I found the true answer here what I was really looking for. Because somehow we classify stress as something that's only high panic without realizing this low-to-moderate, great, constant busyness is going to be putting you in that sympathetic nervous system far too much. And then you just get this dysregulation of GI function all the way down. So, and I think with rosacea, there is genetic links there. I've been sort of diving in and looking at research on that. And the HLA gene is quite common with people that have rosacea and that really as a role with our body distinguishing from its own proteins and from foreign proteins, particularly you know on the skin surface. So I know there is a peptide called camp, which is called catholic inside antimicrobial peptide. And it's more common on people that have rosacea. So if you have a combination of an HLA gene snip where your body's not so good at discerning between foreign and our own proteins and then you have higher levels of these antimicrobial peptides that are going to drive a immune response, you're going to see that on the skin surface. Actually, that's a question that's here about the genetic predisposition because what we're talking about with, you know, mostomic acid with a modern diet, with stress, with the high inflammation, this is common across a lot of conditions isn't it? So is it that in combination with a genetic predisposition where that kind of manifests for people as rosacea? So I think we can never outrule genetics. We know obviously we can upregulate downregulate, we can influence our genes, but I think if that's there to begin with and then they take all the other boxes of being highly stressed eating the wrong foods, maybe drinking alcohol, that's going to bring forth and present as rosacea for sure. I know there's a great paper that's in the frontiers of medicine, I think 2020, I'll try and get the the details on that in the show notes. That's really looking even to this whole DAO enzyme and mass cell and being break down and funnily enough, I've had good results with rosacea as well as even things like perioreal dermatitis by utilizing some DAO enzyme therapy with people. It's been significantly effigient. So I think in combination with that HLA gene and the DAO, I think those are definitely two genes that we need to look at in this condition and then of course address all all the other variables. And do you find, I know everyone presents differently and they'd have a raft of different food sensitivities or allergies when you do the testing, but are there any that usual that are that commonly pop up? I see a pattern. I tend to think there are foods that cause vasodilation. So a lot of the histamine foods, alcohol, cinnamon, spicy foods, things that obviously bring forth that vasodilation, I think tend to exacerbate the issue as well. And couple that if you can identify someone's individual food allergies and sensitivities, that's just the other piece of the puzzle that you can understand what's driving that inflammatory response. So we have the ones that we know we probably will take away or ask if they're having a lot of, but I always, always my mind goes back to I don't know exactly. I've just seen such variability in people's food antitesting that it actually when I started using a test, this test I use gets sent over to the United States because I find it's the only one that has enough scientific rigor. When I started doing it, it made me really rethink because when people would come in and say, "Linsey, what's the best diet for me?" I had to honestly say, I can't fully tell you that. What am I seeing a clinical nutrition? I'm like, I need to dive into your immune response to be able to fully help you. We can make a big difference. So you get a thorough history taking, but do you use blood pathology routinely or then how do you determine what other testing you'll do? Look, if I can get some blood tests done in combination, I always just try and say if I can do a standard routine pathology and maybe one functional testing, I'll try not to do too much because obviously some of these tests are expensive. As far as routine blood pathology, I'm looking for little bits of evidence, even on a full blood count. I'm even looking at things like easinophils. Like, what's going on there? Are we showing signs of any kind of allergy response? If I'm lucky, I can get gastrin because gastrin is a great way of testing that low stomach acid. So when we have elevated levels of gastrin, it's a bit indicative of that. I'm always looking at vitamin D. Vitamin D is huge as we know. It's an immune modulator. It's also a regulator of that camp, that antimicrobial peptide that we're talking about. So if you have someone that has rosacea and you combine that with a little vitamin D level, it's just going to accelerate the inflammatory cascade. So I think you can get a lot. I'm looking at high sensitivity CRP and getting some information there. But I think I combine that with what they're saying what they're presenting with. And then if I am lucky to get a food antigen test, we'll piece it all together. And let's talk now about the, like I'm really interested to talk about their SIBO. What about other chronic infections? Do you find a link with H. Pylori at all? Absolutely. Yeah. Obviously, having a huge effect on stomach acid regulation. There is, yeah, common. Very interesting enough, when I have been doing, this is across the board in my clinic. When I've been doing some of the metagenomic microbiome profiling, I don't know if there's other practitioners out there that are saying the same thing. I'm seeing massive increases on certain bacteria like PLEBSILA and Citrovacar. And ones that are obviously more autoimmune driving. And so I'm looking, yeah, if I could get a metagenomic microbiome test on top, that would be a well-rounded picture for really getting on top of someone's issues. And of course with the SIBO, we're seeing them, a thanavactor and the hydrogen sulfide in the, yeah, we're just, we're seeing that presenting for sure. I generally, because I will always address, got brain access first in my clinic, I was talking to Tracy about this a while ago is, you know, when we come out of university and colleges and our therapies, we tend to have protocols for certain things that you kind of, oh, comes from a thyroid, you go straight there. For me, five years into clinical practice, I just really started to see a correlation with, if I hit someone's got brain access first and I restore that, everything else works better. Any treatment we'll do afterwards will be more effective. And so when it comes to SIBO, other than making a call on whether I need to use selective antimicrobials to go in and treat, I'm kind of addressing that anyway. I want to get rid of the bloating. I want to restore the stomach acid and the microbiome, you know, so I will always kind of go there first and then just, I'm not real heavy handed when it comes to the use of antimicrobials. I do love that there's more of a trend and we're starting to reevaluate our protocols of like the week feed and going, how much do I want to go in and disturb this really important ecosystem? Can I in modulate rather than wipe out? So it's a bit conservative on that aspect because I do believe the body is designed to heal and the body lenders store balance. So can we just support it in some ways to do so? (upbeat music) Want access to exclusive clinical tools and education? Sign up for a free practitioner or student account today at bioconcepts.com.au. We create innovative health solutions to empower practitioners like you to solve complex health conditions globally. So why not join the movement? (upbeat music) (upbeat music) Cheryl Sevelle has some favorite topical go-to's. (upbeat music) I do recommend Nye Cinemide as a serum. So again, they're a couple of things you can pick up over the counter. It's anti-inflammatory strength and the skin barrier improves water retention, regulates oil production and reduces sensitivity to pollutants and irritants like the endotoxins. And it reduces papules and postules. People definitely notice less flaking of the skin and less redness and sensitivity, which is what you're wanting. You're wanting to reduce the sensitivity. So when there is both these other factors, you're not getting those flares. In a cream, I will use the teetriol unless I can't, but I can also use a wash with green tea. So just get them to make up a decoction of green tea. Put in a little spray bottle, put some teetriol in there and spray that on the face like pat down with it. And that way you can start with one drop of teetri and kind of work up on that. So green tea is an antioxidant, absorbs UV rays, radiation, reduces flares and induces cellular autophagy. So it's some pretty amazing green tea and I just love to drink it as well. Of course, cool things that does with the gut health. Never use any kind of essential oils near the eyes. If someone does also have the eye symptoms, there are a number of wipes you can get over counter or online. And these contain either manuka honey or okra. So both of those are also found to be effective against Demidex mites. So they might be advertised under blepharitis, but they're treating the Demidex. The other essential oils that I will use, or you'll see me using, are lavender, German chamomile, it's the blue chamomile with the Agilin in it, not the Roman chamomile. It's very effective at calming and soothing. It is expensive. So when you're putting that in your cream, be mindful of that. So good. Infuse collendular oil, because it's antibacterial, anti-inflammatory. And it's really good when you're seeing that burnt face look appearance, it's that more of a burnt appearance. And carrot oil for the beta carotene and the vitamin A. I also like to use clove oil. You can use clove extract, but it does have alcohol in it, so that might not suit everyone. But within the cream it can work. And geranium oil, because it's antiblimatine, it actually helps reduce the broken capillaries. So you may use that early on, or you may bring that in to later creams, but that's something to think of. Vitamin K does a similar thing, but the other big hero, apart from orally taking quesitan, which I do use, islipazone quesitan. It promotes the recovery of the skin barrier. It's anti-inflammatory and antioxidant. And I will sometimes, or quite often, use it with zinc sulfate, which has been shown to reduce the severity of rosacea. And it helps to form a protective barrier against irritants and pollutants, which is what we want. Zinc sulfate is anti-inflammatory and photoprotective, all on its own, which I guess is the old zinc cream, isn't it? Absolutely. The last couple of topics that I use, and there are quite a few I've written down here, licorice, of course, that anti-inflammatory action, aloe vera. When it's that burnt erythema-looking skin, and the alan-toyne that will help increase cellular turnover. And so does Centella. That will do a similar thing. And Centella's good for that thickening of the tissue around the nose. You see that in the men with that presentation. They kind of thickening there. And also for scarring. And there's a couple of other things that I love to do. And their quite impressive all on their own is an infused oil of hypericum with a little bit of rosemary in it, in a basing virgin pressed olive oil. That you can use almost as a serum when they've got that dry, irritated picture with the papules that really seem to stand out down quite nicely. And I use French green clay. And using that helps to kind of draw out a lot of things. And I really got interested in it again. But using it for the face with rosacea it definitely takes a lot of the redness down. It does draw out a lot of the toxins. And you can combine it with some of those essential oils with a little bit of warm water. So you can use it as a mask or a polter's. What is in supplements you use regularly in these patients? So I've noticed that several patients have seen improvements when they've been prescribed beta blockers for the flushing component with that stress response. So I like to use Hawthorne berries. And when you think about it, you know, they've got flavonoids in there. We know that they help with vascular strength and they've got that property. So that's why I will often consider. Garlic is also a beta blocker. It lowers cholesterol as effective against gram negative bacteria like the bacillus oloranus. And it also has been shown to be effective against the dermotox might itself. It's also effective against methane producing bacteria in cybo. So it can be a magic bullet for some people. Cousete, which I mentioned early and the benefits of it locally is actually well researched for rosacea. It does reduce that redness within weeks. It's anti-inflammatory and it directly targets a lot of the inflammatory cascade that happens with rosacea. And it's antioxidant. And it reduces angiogenesis, which of course, you know, when you see those really advanced rosacea cases, literally the capillaries are taking on a life. I think it's very suitable there. Saccharomyces, balardi, is always in the prescription. Because I think, you know, I'm not exactly sure, but it could be it's addressing leaky gut. It's increasing that secretory IgAs. So the allergy component is reduced. It does inhibit growth of candida in the gut. And it modulates the release of cytokines in the body by improving gut health, which then has a positive effect on that gut skin access. Vitamin K, which I mentioned, can help with flushing redness the talinject azure and the dryness. And probiotics for the gut, or ones that are supportive for histamine breakdown, along with a diet in many different foods to ensure that varied gut flora. I always recommend green smoothies and green soup for skin diseases, because they help improve gut immune and skin health. And when I'm doing a lot of gut work, I'll ask them to put into that green soup, a big scoop of bone broth. And, you know, about five grams of glutamine are served. So they're kind of having their food, food is medicine. [MUSIC PLAYING] Linsy Kosh goes back to the foundations of sleep, adequate hydration, and nutritional foundations without the overwhelm. [MUSIC PLAYING] Look, always back again, divide them in D. Absolutely need it from any response and flammatory response. Zinc as well, just to calm down some of the inflammatory cascade, big fan of omega-3 fatty acids when it comes to skin conditions. Again, another test that would be great to get would obviously be that omega-3 omega-6 ratio. But I pretty much assume that most people's ratio is going to be often a modern world anyway. So I pretty much get in there and work on that from a nutritional perspective. So really, really key ones. Look, just focusing on the nutrition in general, which people don't do too bad of a job. They're trying. Because of the busyness of the world, it's just not on their priority list. And so sometimes, in the past, probably 10 years ago, I used to do the whole shabang. I used to do all the meal planning and everything for them. If you had someone a meal plan today, that's just going to spike their stress levels. Because they've got it and just don't even know how they're going to do it. So often, when I'm trying to get in and work on someone's nutrition from a clinical intervention perspective, I will ask them just to focus on breakfast. And I'll give them leeway. And I say, look, if you don't want to eat straightaway, that's okay. But if you can promise me to eat roughly before 10 a.m., even just from an adrenal and lean muscle mass perspective, I just want you to make your breakfast the best meal. Because believe it or not, dinner normally is pretty good for people. And I will ask them to get a meal three fatty acids and zinc-based foods and lots of colorful vegetables in the breakfast meal. Because believe it or not, I feel that's where you can make the most impact on cell nutrition is the first one. Does anyone come in with, I don't know, some misconceptions about their skin and particularly if they've got rosacea, obviously, or about the skin treatments or topical treatments that they're using. Is there anything that you find that people don't understand or they've been told something that's not correct? Yeah, look, I found a lot of. My clients will come in and they've spent thousands and thousands and thousands of dollars on heals and skin treatments and A lot of times it can make it worse because what we're dealing with is a disturbed immune response on the skin And so it's worth continuing to disturb this interface of you know our immune system response and our skin microbiome It's continually stripping what we may not realize we're probably driving that further even more So I really just encourage them it's it's about restoring balance We really need to restore the balance and I think some I think again going back to that emotionality of it is I think there is a misconception that it's you know hygiene issues It's not about hygiene and I think one of the big things too is alcohol is something that we know Genuinely drives this condition But not everyone who has rosacea drinks a lot of alcohol so I think when you do have it People probably feel self-conscious. They think they probably think other people think that they drink alcohol often And it's not almost the case common, but it's not always the case Is there anything else Lindsey that I have an osteo that you've got to add? We have this capability of an hour consult or an hour and a half and I think it's really important to listen In the listening that you're gonna find out exactly what it is that you need to do and then on the flip side in that I guess one of the approaches I was taking my clinic is very much also about education is you know How many people will come into the clinic and they may have rosacea? They may have diverticulitis They may have reflex and I'll ask them the question have you ever been explained what this condition means? I don't think anyone has ever said yes if I think that no No one has had the time To explain to them what it actually means and so often I will use you know diagrams that are fairly scientific I think we underestimate our clients capability to understand medical terminology if you frame it the right way They'll get it so I often will just take a huge portion of time and listen and Look at their intake form and then the good half of any kind of appointment with me is I'm like, okay I always say hope you love science Don't share the ways but I want to show you I'm bringing up diagrams I'm literally looking at the lemon appropriate and I'm showing them where all the inflammatory regulation actually I'm in how important that little epithelial barrier is and when it comes to their autoimmune type response and I find that if you bring someone into their own health journey and get them to truly understand their condition they will be a Better client. They'll be more committed Because they understand they get it. I always say you can't fix something really properly Unless you understand it and then and also that you understand what variables contribute to you getting there in the first place If you teach your client those things it's incredible because they will They'll do most of the things that you suggest because they understand why In the next episode of between clinical minds we continue the conversation this time on X-MA and Dermatitis Hepatiformis or X-MA associated with celiac disease with naturopath through a becker hues and naturopath and soffara Katie weeks Thanks for tuning in to buy concepts between clinical minds if you enjoyed today's episode Leave us a quick review and hit subscribe so you never miss a moment of clinical insight Want to dive deeper join our practitioner education platform by our concepts engage where you'll find exclusive clinical guides key takeaways from the latest research and Practical tools to support your clinical practice for regular updates on our podcast industry events and practitioner education Be sure to follow us on Facebook and Instagram at bio concepts underscore a you And don't worry the next episode is just around the corner where we'll be unpacking fresh perspectives and practical gems Until then stay curious stay inspired and keep thinking outside the lines