Is Your Microbiome the Key to Perfect Skin? Featuring Dr. Doris Day

Hi, everyone. It's Dr. Ozzie here. Welcome to the more than a pretty face podcast. Hi, everyone. Doris Day. Hi, Dr. Day. How are you? Hi, thank you for that sweet introduction. If you guys haven't seen her on the view live with Kelly and Mark, she's all over the place. She gives a lot of lectures all over the world. And most recently, I saw that you were at the World Congress of Dermatology. That was such a fun meeting. It was in Singapore this year. It's usually every four years, but this time because of COVID, it was at five years. And so we were all ready to get back out in the world and share everything we know. So it was a packed meeting, so much great information and what a fun country. Yes. And such an international crowd of dermatologists coming all together once every four years. And I can't wait to talk to you about that. But for those of you who have not heard Dr. Day on our podcast a couple of times before, she's a board certified dermatologist practicing on the Upper East Side in New York City. And she always brings so much insight and value to the podcast. So I'm really excited to sit down with her today. Particularly, we're going to be getting into the skin's microbiome, and she has a new book on it. So let's get started. So first of all, tell me about the World Congress. What was the latest, greatest trends that you were seeing, or any interesting lectures that you may have stumbled upon? One of the things about the World Congress when it's in another country, and they're kind of the host of this Congress, you get to see the local flair. So there were a lot of Asian influencers at this meeting, which was really interesting. They were in the exhibit hall, they were at many of the booths. So it's a kind of see influencers in the wild. Like social media influencers? Yes. Not like Derms or... No, these are social media influencers. And they were walking the floors, doing their thing, talking about products, posting and live streaming. So that was different than what I see in the US. And I thought that was interesting. And they carry a lot of weight and power. Like a lot of these influencers, there was a couple that I met at some of the events, they're still in their early 20s. And their whole lives are around building these platforms that promote products. And the companies pay them a lot of money to do this. So that's a whole new area of expertise that is a certain personality type. It's kind of like hitting the NBA in sports, you have to have a knack for it and then have the patience for it. And I think in many ways, it's kind of lonely. Some of them were by themselves, some had entourages, but they carry a lot of weight in helping the public understand what products to use. So having some access to them, for me was fun and helpful for me to learn about them and to help them learn about the science behind some of the products. In terms of some of the lectures, a big focus of the ones that I went to were on eczema, childhood eczema and adult eczema, and some of the new medications that we have. It's so amazing how much we can do now to help people with these chronic skin conditions. Chronic skin conditions are a problem because you don't get a break. It's not like you say, okay, I'll do this, it'll be better. And then I'll be able to get on with my life. It's something you live with every single day. And that can be depressing because I said, you'll have something for a year and it will go away. You'd be like, okay, I'll put up with it for a year. But if it's for your whole life and you're itchy and your skin doesn't look good and it doesn't feel good, and you're self-conscious about it, to know that we have medicines that have great safety profiles that can help clear your skin and keep it clear. That was very, very encouraging. So I heard there were some great things on that. A lot on nutraceuticals. I gave a talk on that, but the idea of supplements and more holistic approaches to hair, skin, nails, that was a really important topic. There were some talks on the cosmetic side, nothing that I thought was earth shattering or groundbreaking, nothing that you don't already do. And I can see on your social media, you do very cutting edge things. You're ahead of the curve with all of that, with all you're doing. And sometimes that's comforting when you go and you see things and you go, okay, well, I'm there, I'm doing that, maybe and then some. So that makes us feel good about the work that we're doing. And then the other last part is the interactions with colleagues between the sessions. Just catching up with people and seeing how they're doing, what they're doing in their practices, the subtleties of things, what products they like, what they're using, what they've moved away from, maybe issues they're having. So those conversations... Off the record conversations, right? Yes, over a drink or dinner. So that was, I think, the best part of the whole meeting. And then just seeing the sites in Singapore. Yeah, that's awesome. Yeah. I mean, going back to the eczema, some of these skin conditions, if you have high blood pressure, nobody knows, right? Because it's not like you don't disclose that on the outside. But when you have a chronic skin condition, then it can be really distressing for people, much more so than something that you're able to sort of forget about it. When you have something like that, you can't forget about it because everybody's suffering. Even if you get a temporary rash, if you get like hives or something, it can be really distressing for people. And one thing that kind of leads into our topic was that there were a good amount of conversations about the skin microbiome that were brought up. La Roche-Posay has some products that are focusing on it. So there were some posters and presentations that took into account the imbalances in the skin and how we're learning that the skin is not an isolated organ. It's not just skin cells and then the pigmented cells that lives there and the immune system that lives within it. It's actually very, very, very affected by the microbes, all the bugs, basically the bacteria that live in the skin and the ones in the gut as well. And there were conversations around that. So I found that really encouraging. You know, when I tell people on TikTok that you have mites in your pores and yeasts that normally live on the skin that love to feed on oils, they look at me like, what language are you speaking? What are you even talking about? But it's true. It's like its own little village, the microbiome and the skin. You know, everybody does their part and there's like a whole ecosystem that lives on our skin. And that's why I think people don't realize the skin is actually a living organ. It's not plastic. You can't just throw on a thousand different products and expect it to be okay. You're really going to disrupt some of the, you know, some of the work that some of these microorganisms are doing. Absolutely. That's a hundred percent spot on. And even if you had the right ingredients and they have the wrong preservatives or the wrong concentrations, and you're layering five of those things, you're knocking out the biome. So in doing the research for this book, I wrote it with a PhD, Thomas Hitchcock, who is one of the most brilliant people I know. I met him when he was working on other projects. We've known each other a very long time, but he had his own company that was looking at these things he calls zycropes, which are the microbes that live in the skin. And what he found, and I think others may have as well, but one of the things we talked about were that I thought was like earth groundbreaking was that the most common bacteria in the skin is C-acnes in healthy skin, not in acne prone skin. So C-acnes, we used to call it P-acnes, propionibacteria acnes, but now it's cutibacteria acnes. They just changed the name. It's all technical stuff, but now we call it C-acnes. That bacteria has different strains. And so there are some strains that are more inflammatory that we see more in acne, but there are some strains that are actually really good for your skin, and they do exactly what you said. They eat the oils. And that's what concerns me about some of the treatments that are out there that are lasers and devices that knock out the sebaceous glands, because you're knocking out the food supply of good bacteria that help keep your skin balanced and hydrated. So a lot of my focus now is on helping to balance the skin biome. I've stopped using about 99% of antibiotics in my acne patients and get clearer faster with longer lasting results by focusing on the skin biome's effect on the skin cells. When we put the skin back into balance, the skin does everything it needs to heal itself. We just have to rebalance it. And this can be done by understanding. So one of the stories we tell in the book is about this national park that people would go visit and it had wolves in it. And the people didn't like the wolves because once in a while they might've attacked people. So they said, okay, we'll get rid of the wolves. So they knocked the wolves out of the park, but then they realized that the wolves ate the elk. And now that there were no wolves to eat the elk, the elk population overgrew. The elk population that overgrew now ate all the foliage and the foliage that supported the birds and the other animals now were gone and you had a barren wasteland. So even with those things like the wolves that we think, you know, who needs these predators? They serve a purpose and every element serves a purpose. So whatever we do to the skin, we have to do it purposefully and help that balance and not make too many changes at once and understand that the skin can heal itself. We don't need to sterilize it and over strip it. We need to nurture it and feed it right. What about the connection of the gut, you know, what we eat and how that affects our skin's microflora? You know, a lot of doctors or dermatologists may just kind of brush that aside and say, nah, not related. What are your thoughts on it? I think they're so integrally related and they're not separable. And to not pay attention is to miss a huge opportunity to have an impact in our patient's skin health. And it's a skin, gut and brain even that are all connected. So I'm lucky enough that I'm old enough to have been around for a while in this field and to have met a lot of people. And one doctor I met, Dr. Haynes Ely, who sadly passed away a few years ago from metastatic prostate cancer, he published a really important paper called, is psoriasis a bowel disease? And what he observed was that if you have a leaky gut, and that is a real thing, it's in the small intestines, not the large intestines. So when you eat foods that are inappropriate, like sugars, pro-inflammatory foods, alcohol, spicy foods, that can create leaky gut in so many people. And when you give those up for a short period of time, just a few months, add in quercetin, which is a bioflavonoid and duozyme, which is a bile acid, which you can buy at the drugstore or online. He said that he could cure psoriasis. I was like, are you sure you mean cure psoriasis? That's a big word, cure. So I had a few patients who, so I got the article, read the article, wrote out a protocol. And then I had a few patients who had failed on a few biologics and they weren't sure about what they wanted to do next. So I said, you know what, here's a protocol, let's try this if you want to, if you're up for it. And I tell you, not a hundred percent of them, but more than 80% of those patients who did it completely cleared their psoriasis. Never seen anything like it. The gut is absolutely involved in some ways we don't understand yet, but ways that we can point to. Sugar, horrible. It knocks out the gut microbes. You have to feed those microbes well. Then the second is alcohol is also a poison. The third is giving your stomach breaks and your intestines a break. So intermittent fasting, not putting more into it so that it can rebalance, set itself and do its work. That really helps as well. So it's what you eat, when you eat, the order in which you eat your food, don't start with the sweet or starchy stuff or sodas. Start with a vegetable that's like a green leafy vegetable, something more savory, because that'll affect your insulin spike. Really easy, basic things to do. As somebody explains it, once you understand it, it's super, super easy to do. What you'll see is within a week, your skin will look better. And that's what I love about the skin is when you start making these changes, drinking more water, sleeping better, putting better foods in your body, you see the difference within a week, within even a few days to a week. The longer lasting changes of collagen improvement takes weeks to months. That's not a fast because biology is biology and collagen takes time to form. But the easy quick changes of more hydrated, plumper, firmer skin, because it's more in balance that you see quicker. Interesting. Just because you said the intermittent fasting, I think that's exactly what happens is your body sort of resets. It gives the gut time to reset, to reorganize itself. And I think that we see this in dermatology. More and more studies are coming out about how certain foods or certain things can be pro-inflammatory. And patients have been telling us this for years. And I feel like as doctors, we sort of brush them off. No, it's not about what you're eating. Let's give you minocycline for a year. And when I look back at your practices 10 years ago, we saw people on antibiotics for a decade sometimes just because we didn't really have a lot of other choices or other medications. I don't even think spironolactone really was around as much as it is today. And so I am really finding this really interesting. I think the skin microbiome is finally getting the respect it's deserved for a long time. Part of the problem is a problem and not a problem. So I think of it as part of the problem is that we're so evidence-based, which is good, but evidence-based medicine, unfortunately, is driven by research, which is driven by pharmaceuticals. So if there's no money in it, nobody's going to drive the studies to prove the point. And when you talk about things like intermittent fasting or even some of the supplements or the things we're talking about, you need such a large population over a long enough period of time to get enough evidence to point to something that we're seeing on a daily basis. You and I see our patients when they eat better and they don't eat the high processed foods, we see a difference in their skin, but we say, well, you know, we don't know. Like if it makes you feel better, do that. The reality is it absolutely works. It's just, we can't get the evidence-based data because no one will do a proper study and it's a very difficult study to do. So it's going to be anecdotal for a long period of time. But now that we have the skin biome to look at, that may make it a little bit easier, but again, it's a matter of who's going to profit off it to be willing to invest the money in doing a good study. Yeah. And nobody makes money from eating, you know, healthy green vegetables or green foods. Or not eating for a while. Exactly. So let's, for the audience, you know, let's talk about some diseases that are driven by an imbalance in yeast and in the bacteria. Well, one, you know, you talked about is acne. Certainly when you have overgrowth of this bacteria or overgrowth of Malassezia yeast, you can get different types of acne. Even they look different. Their distributions are different on the face. It would be overgrowth of the wrong strains of the bacteria. So if we actually feed it with the right strains, then you'll rebalance. And when you have the wrong strains growing, then you can have the wrong strains of staph growing because you create inflammation. And so you can get like, if you look at somebody with eczema where we started and you do a culture of their skin, you'll see staph overgrowth, but what they don't look at is what's missing. And what's missing is C. Acnes. So C. Acnes controls that staph. It goes back to our wolf in the national park. So if we fed the skin, the right C. Acnes strain, that alone would have an impact on their eczema potentially, because we're going to put it back into balance. So I think that's one area we're going to, but yeah, I agree. The Demodex, we might learn that it's the strains of Demodex that are off. And over time, we might have to start renaming some of these microorganisms because as we learn more about their structure and function, we might start having to reclassify them just like we did with P. Acnes to C. Acnes. We might have to actually call them something else because they behave so differently. So for those of you who may not know what Demodex is, and I had, I remember distinctly the minute I learned that we actually have mites in our pores, I was sitting with my dermatopathologist, you know, looking at slides and he goes, Oh, did you see that? That was a Demodex mite. I'm like, well, hold on. What? And he is, and he, you know, zoom in, we get excited when we see that looking at skin samples. There are mites that live in the pores and we see them under the microscope, but those mites, you know, are probably have a role of some sort. Like you said, the wolf, the wolf, when we see them go up in number, then depending, maybe there are different strains, then we see rosacea flare and that's a big, you know, link. And that's why a lot of the topical treatments we give people is to reduce the overgrowth perhaps of the Demodex. Yeah. It's interesting that we still argue amongst ourselves on the rosacea front. There's like, are you a Demodex rosacea person or are you not a Demodex rosacea person? And you know, are they the red herring that they, you see them more when they're there or are they the cause of it? And it's, it's, that's our controversies in dermatology. We're such nerds, but it's kind of fun, but you're, but in the end, the same medicine fixes it either way, right? All the antiparasitics, whether it's metronidazole topically or topical ivermectin, sulfa based medicines, all affect Demodex and all make rosacea better. And what about Accutane? That has nothing to do with Demodex, but why does Accutane help with rosacea? I mean, there's so much that I think we're missing. It's like, the more, you know, the more, you know, you don't know. Yes. So I think it's time to really, you know, pay attention to what patients are telling us in terms of not just their skincare, but maybe their overall lifestyle or, you know, diets and so forth. And certainly you mentioned the mind and that's huge, you know, in terms of stress and how that could certainly throw everything off. For sure. It's such a, such a stimulator of whatever you're prone to. So if it's rosacea, acne, psoriasis, eczema, ulcers, hair loss, like all of these things, I mean, I meant stomach ulcers. So whatever it is, you're prone to when you're under stress. And I like to quantify stress because stress is a part of life and actually can be a great motivator and driver. So it's, I always say, it's not about having stress or not having stress. It's really about how you manage the stress and how you perceive it. So I've kind of helped myself understand things that are stressful in my life as puzzles. And as you get older, you realize like, wait, I got here. I'm okay. I figured it out. I'll figure it out. So once you have that comfort of going, I'll figure it out, you still have the stress as the driver, but it's not the same. It's not the same anxiety about the stress. So I would kind of put anxiety and stress, try to separate them out a bit and help people manage their anxiety over the stress and change the way that they look at things. And you would say, you know, people go and they go, oh, this was like a therapy session, but in reality, it's not because it's really helping their skin and helping them solve those puzzles helps us help them address their skin issues. And it's such an important part of the work we do as dermatologists. A hundred percent. So what are three things that people can do to better care for their skin's microbiome? I mean, is there supplements, are there special diets and, you know, anything that you can name that could be helpful? Sure. I would say look for products and ingredients that are skin biome friendly, things like salicylic acid. That's really good. Interestingly, things that are natural, not always skin biome friendly, like retinols can be, but Bakuchiol, which is more natural is not necessarily skin biome friendly. And then I would try to pay attention to how many things you're layering because each thing has preservatives. And when you, when you use a lot of different preservatives, you can knock out the skin biome and you have to be careful. The other is maybe don't wash as often. So we're, we're a very clean society. We like to take many baths or showers, obviously private areas under the arms, like places that are more occluded that are blocked need to be cleansed more often. But in terms of overall washing, you are washing away a lot of the biome. It'll, it'll come back pretty much the same as it was, but you letting the biome sort of address itself and figure itself out is good. So over washing is, is a big issue. People overwash their hands. They're washing away their immunity when they do that over and over and over again. So washing your hands is important, but washing it between every single or using hand sanitizer between every single piece of gym equipment at the gym, that doesn't help. You know, if you don't want to get sick, don't touch your face. But if you knock out the stratum corneum, that outer layer of dead skin cells, then things can penetrate more. One thing that's really interesting that I heard at the world Congress that I hadn't thought about in this way was about how things can penetrate the skin. And everybody was so worried about getting sick during COVID and the virus penetrating their skin. Well, the reality is that viruses and bacteria are really, really big, even though they're tiny, are big in terms of their ability to penetrate. The chemicals in our skincare are tiny and they penetrate much more easily than, than any bacteria or virus. So your skin is naturally protective against bacteria and viruses just based on their molecular size. So you don't have to worry as much about that. But if you strip away your skin, then anything that touches your skin can penetrate more easily. And that can make you either have a local skin infection or even can get into the bloodstream. So I would be very protective of the skin that way. Don't overwash. Yes. I always say the key to glowing, healthy skin is a strong skin barrier because that is what keeps the bad stuff out and the good stuff in. So once you disrupt that, then, you know, all, it all, all hell breaks loose. So yeah. Yeah. So that's a good point. You know, when my kids were little, you know, they were crawling and so forth, we'd be at places and I would just let them on the ground, you know, my other son, mom, friends, you know, they'd be like, Oh my gosh, you gotta clean their hands. You gotta don't let them, you know, call over the restaurant floor. And I, and the reason I would allow them to just get dirty is because we know that there's been studies that show eczema is much less prevalent in underdeveloped countries where people, you know, are just, they're dirtier, right? Your immune system has external to attack, not you. Right. And so we see a lot more eczema in sort of developed, you know, upper socioeconomic classes of, of the population. And that's because we are a little too clean. We've got to, especially as babies and as little ones, we've got to, you know, let them get exposed. And you know, my sister, she was the extreme opposite. She would bathe her kids every night, every single night, but I would just kind of wash like kind of the dirty areas, but you do want to be careful about how much you're disrupting, you know, certainly that, that ecosystem. I'm so excited for your book. It's called rebooting the biome, how properly caring for your skin biome can do more for your health and beauty than any skincare ingredient on the market. It really goes through and talks about how to care for your skin by respecting that symbiotic nature of the skin ecosystem. That's so, so important because the skin is the largest organ and we have to maintain it and keep it healthy and happy. Thank you. So I know you have a busy day ahead, but before I let you go, I thought it would be fun to play a little game called slay or nay. Okay. Okay. So slay meaning, yes, it's a, you know, you're a hundred percent for it and nay being no, you would, you could do without. So, and these are designed to be sort of rapid fire questions. So that's it. No explanation. All right. We can, we can, we can stop if you have some things to say that would be helpful. So let's get started. Red eye flights. Nay. Nay. Absolutely nay. It's just miserable. They're always just too short to get any real sleep and then you lose the whole next day and it's, there's just no reason. Yeah. Don't know. Nay. It's always hard. Air purifiers to improve your skin. Slay. Slay. Topical antioxidants. Slay. Collagen powders. Bovine or marine. What are your thoughts on that? I'm saying slay. Slay. It's, it's neither here nor there. I have seen enough to think that theoretically they, there could be a purpose and listen, if nothing else, it's a protein. So I don't know if it does everything that it says it does, but hypothetically I've seen enough data to show that I get the theory behind it. More data would be better, but it's not a drug. So we're never going to have good enough studies, but I don't know. Right. It's a supply issue. So you feed it the supplies, but the rate limiting step is your body has to build it, right? That's, that's the, that's what really makes the collagen is your body. Right. So you can get the supply. I don't see harm in that as long as you don't overdo it. Yeah. What about buckle fat removal? Nay. Nay for the vast majority of people. There's a very small niche of people for whom it's a slay, but for everybody else, which is almost everybody else, and it's so surgeon dependent, you know, it's such a fine procedure that not everybody really has to do it. Agreed. Agreed. Agreed. Watching pimple popper videos on Tik TOK. I love her so much. She's a good, dear, dear friend of mine, Sandra Lee, but it's a huge nay for me. I can't watch them either. I mean, it's, we do this right in real life, but I like doing it. I just don't like watching it when I'm not doing it myself. Yeah, no, nay. Easy nay. That that's, I have to agree with you on that. Well, this was so fun. So tell people where they can look for your new book and we're going to link it guys in the show notes as well as in our, in the caption, but let us know where, where we can find your book. You can get it on either my website or on amazon.com. So my website is DorisDayMD and Amazon is Amazon. Yeah. Love it. And then tell us where people, where else can people find you? I know I've seen you on Instagram. I'm on Instagram, Tik TOK, Facebook, LinkedIn, everything all the same is Dr. Doris Day. Dr. Doris Day. Dr. Doris Day. I love it. Well, guys, we've been on the podcast a couple of times. So look back on the past two episodes. We're so grateful that you made time for us. I know you have a busy, busy day ahead of you. So thank you so much for being on the podcast with us again. Thank you. It's always my pleasure. I adore you. Thank you so much.