Treating Acne From The Inside Out with Dr. Elizabeth Boham

Mark Hyman, MD

Full Transcript

Automatically generated. Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Dr. Elizabeth Boham: (00:00): The food that you're putting in your mouth is so much more important than what topical things you're putting on your skin. Dr. Mark Hyman: (00:09): Welcome to a special episode of The Doctor's Farmacy called House Call. I'm Dr. Mark Hyman and it's Farmacy with an F-A-R-M-A-C-Y, a place for conversations that matter. And you're going to learn about some important topics that affect millions and millions of people in this country. And it's something that we all wish we would never get, which is pimples. We have a massive acne epidemic in this country, it affects over 50 million people, which is not a small amount of people. That's more people that have diabetes or cancer or heart disease. And it's something that's incredibly treatable using the principles of functional medicine. It's the easiest thing to treat almost in functional medicine. Today I'm sitting with my colleague, my friend, my partner at the UltraWellness Center, the medical director here, who's an extraordinary physician and nutritionist, a registered dietician, exercise physiologist. And she works with us here at the UltraWellness Center, leads the team in an incredible way, which she has been doing for so long. And I'm just so grateful Liz to have you on the podcast again, and to have your wisdom to help people solve this horrible problem called acne. Dr. Elizabeth Boham: (01:20): Well, thank you, Mark. Thank you for having me. Dr. Mark Hyman: (01:23): All right. So, tell us a little bit about the scope of this problem and some of the background that we know about... How we think about it and traditional medicine and how we approach it versus how we might approach it using a functional medicine approach and how we deal with it here at the UltraWellness Center. Dr. Elizabeth Boham: (01:37): Absolutely. Acne is the number one skin condition in the United States. So it's the number one issue that people in the United States are dealing with in terms of their skin. As you mentioned, 50 million Americans are dealing with this. And we know that it's more common when we're going through puberty, when our hormones are shifting, we often will see acne in the adolescent age group, but we're seeing more and more acne in adults now as well. And that is definitely increasing. I remember I was having a conversation with my daughter about skincare products. Okay, "What's the best thing to use for my skin?" And all of a sudden I realized, even though she'd lived with me her whole life, I don't think I ever said this. I said, "What you're eating is so much more important than what you're putting on your skin. Dr. Elizabeth Boham: (02:28): The food that you're putting in your mouth is so much more important than what topical things you're putting on your skin. And so it made us start to have this conversation, which I thought I was saying all the time, but I think sometimes people don't realize or understand, or the connection is not made. How important, what you're choosing to eat every minute of the day, how much that impacts your skin? Dr. Mark Hyman: (02:50): Yeah. The traditional medicine focused on the outside in, what stuff you can slather on your face, what creams, potions, lotions, or maybe taking antibiotics, which is a whole problem. We're going to talk about it in a minute, but most of our skin health comes from the inside out. Dr. Elizabeth Boham: (03:06): Yes. Dr. Mark Hyman: (03:07): So if you want great skin, if you want glowing skin, if you want clear skin, if you want to get rid of your acne, if you want to get rid of your eczema, if you want to get rid of your psoriasis, if you want to get rid of rosacea, all these things come from the inside out and traditional dermatology focuses on the outside in. Dr. Elizabeth Boham: (03:21): Absolutely. Dr. Mark Hyman: (03:22): And it doesn't really work that way most of the time, even when you work on the outside in. And it's difficult, it's expensive, these medications are absorbed. You basically... My rule is, if you wouldn't eat it, you shouldn't put it on your skin. Dr. Elizabeth Boham: (03:36): And a lot of times with the topical treatments, whether it's steroids for eczema or topical antibiotics for acne, they can work in the short term, but in the long term, they disrupt your skin and make you more prone to getting it in the future. For example, we know both topical steroids and topical antibiotics are going to get rid of that really important layer of good bacteria that's on our skin. Dr. Mark Hyman: (04:04): So, wait, you have microbiome on your skin, that's what you are saying? Dr. Elizabeth Boham: (04:05): I know, it's cool, right? Not only in our digestive system, but lining our skin. And so those medications though, they can be helpful in the short term, in the long term, they're damaging. They're getting rid of all of those good bacteria, which are really important first line of defense. And so then you create a dysbiosis or an imbalance in the good and bad bacteria on your skin. And then that just makes you more prone to getting more acne in the future. So, it may be okay in the short term, but it's not getting to that underlying root cause. Dr. Mark Hyman: (04:38): It's true. And so we put on antibiotics on the skin, we put on these agents that dry it out, like benzyl peroxide, which are most of these acne products. And if that doesn't work, we get people oral antibiotics, which not only disrupts the facial microbiome, but also the gut microbiome. Dr. Elizabeth Boham: (04:56): Absolutely. Dr. Mark Hyman: (04:56): And what we know now in functional medicine and in medicine in general, if people paid attention to the research on acne, is a lot of this starts in the gut. Dr. Elizabeth Boham: (05:04): Yes. Dr. Mark Hyman: (05:05): So if I see someone with skin problems, the first thing I think of, what's going on in their gut? Dr. Elizabeth Boham: (05:08): Absolutely. Dr. Mark Hyman: (05:09): What's going on with their food that they're eating, with inflammatory foods, with food sensitivities, with foods that trigger hormonal responses, with foods that increase something causing some resistance. So, tell us about the pathology and the pathophysiology of acne, because it's very interesting. Because we often just think it's a topical thing, but it's really not. Dr. Elizabeth Boham: (05:28): Yeah. One of the things we know with foods, is that when you eat foods that are really refined and processed, foods that are high in sugar and refined carbohydrates, you'll get a spike in your blood sugar. And you'll often get that spike in insulin after you get a spike in blood sugar. So you eat food, your blood sugar goes up, the body makes a lot of insulin and that spike in insulin and blood sugar will cause a follicular hyperkeratosis. Dr. Mark Hyman: (05:54): That's a big word. Dr. Elizabeth Boham: (05:54): I know, which just means that there's extra... In the follicles of the skin, the skin's not turning over as well as it should. And so cells get stuck in the skin and then those stuck cells can get more inflamed and acne can get produced. So one of the major things we always start with is pulling away the refined and processed foods and the sugary foods. Dr. Mark Hyman: (06:22): And starchy foods. Dr. Elizabeth Boham: (06:23): And starchy foods, right? Anything that's going to cause that insulin spike. You can really see signs of insulin resistance on the skin in so many different ways. Dr. Mark Hyman: (06:31): It's like pre-diabetes, right? Dr. Elizabeth Boham: (06:32): Yes. Dr. Mark Hyman: (06:32): You eat much sugar, your blood sugar goes up, your insulin goes up and it creates this vicious cycle, we've talked about so much, which is this pre-diabetes that affects one out of every two Americans. Dr. Elizabeth Boham: (06:40): Yes. Dr. Mark Hyman: (06:41): Right? Dr. Elizabeth Boham: (06:41): Right. So their insulin is higher than somebody who doesn't have insulin resistance. And that high level of insulin causes a lot of shifts in the skin. It causes that follicular hyperkeratosis that causes the acne. It can cause more skin tags, it can cause something called acanthosis nigricans, which is this darkening of the skin folds in your neck and in your armpit. And so you can, by just examining somebody right away, you can get a sense of, do they have insulin resistance or that pre-diabetes state, because it shifts the growth factors, the high inflammation from eating these high sugary foods causes changes in your skin. Dr. Mark Hyman: (07:22): We know that, for example, PCOS, which is polycystic ovarian syndrome, it's a common condition that affects women that causes infertility. We're going to talk about that in another podcast. It causes acne, it causes really screwed up menstrual cycles and it causes hair growth. And we think of it as an ovarian problem. It's not. It's a mouth problem, it's a fork problem, it's a dietary problem. Dr. Elizabeth Boham: (07:46): Often, yeah. Dr. Mark Hyman: (07:47): Right? And so it's caused by insulin resistance. And the consequences of that are the acne and all these screwed up hormones. So when women have a lot of sugar, it actually can increase their testosterone, which causes acne and it causes hair growth and it causes infertility. So the treatment isn't heavy-duty drugs and hormones, it's actually changing your diet Dr. Elizabeth Boham: (08:12): Which is amazing to see. We know that when we pull away those refined and processed foods and the sugary foods, most of our patients, so many of our patients see great improvement in their acne right away. Dr. Mark Hyman: (08:24): Right away. Dr. Elizabeth Boham: (08:25): Right away. Dr. Mark Hyman: (08:26): So sugar, starch, processed foods, they got to go. Dr. Elizabeth Boham: (08:29): Yeah. Dr. Mark Hyman: (08:30): And then there's another food that is really common in this country. And it is a huge driver of acne. Dr. Elizabeth Boham: (08:37): Yeah, the dairy. Dr. Mark Hyman: (08:38): Yeah, dairy. Dr. Elizabeth Boham: (08:40): Dairy. Because dairy is... All of our dairy food, our milk, our cheese, our ice cream, all of that is very high in hormones- Dr. Mark Hyman: (08:49): There're 60 different hormones in milk. And these are not added like growth hormone, these are just naturally occurring hormones. Why? It's a growth food for calves. Dr. Elizabeth Boham: (08:59): It helps the calves grow- Dr. Mark Hyman: (09:00): It makes them grow. So it's got a lot of factors that are hormonally active that drive growth. Dr. Elizabeth Boham: (09:04): Yes. And we know that those growth factors can stimulate acne in some people. Not everybody, but for some people they're more sensitive to them and they definitely will cause more acne. Actually, there're a lot of people. Dr. Mark Hyman: (09:16): I'm one of them. I think if I have dairy, I get pimples. So if I know I'm going on a PV, I can't eat dairy. I don't usually eat dairy, but I have sheep or goat, it's a little different, it's not as inflammatory for some reason. But if I have regular dairy, you can count on me getting pimples. And I'm 60 years old to get pimples from dairy. Dr. Elizabeth Boham: (09:32): Absolutely. And I think it depends like the question of sheep or goat. I think it depends on the person. There's some people that all types of dairy bother their skin. And for other people, there're some that is better than others. And what we know, is sometimes the testing, the food allergy testing or food sensitivity testing, doesn't always pick it up. We do it often, but there are times when we get a negative test result, but even if we still pull it away and people's skin improves. Dr. Mark Hyman: (10:00): So this isn't an allergy necessarily with dairy? Dr. Elizabeth Boham: (10:04): Not necessarily. It could be just like you said, all the hormones in dairy too. Dr. Mark Hyman: (10:06): But there's another category of things which are food sensitivities that do drive inflammation and drive leaky gut and can drive acne, that are independent. So we've got sugar, we've got dairy and we've got this other category, which is sort of amorphous, but it is a factor in a lot of people. Dr. Elizabeth Boham: (10:22): Absolutely. Absolutely. So, there're so many ways. And I always say this, there're so many ways that somebody can react to food. You can have... And people get confused all the time because they get one negative report and they say, "Oh, then I must be fine to eat that food." Right? Dr. Mark Hyman: (10:36): Yeah. Dr. Elizabeth Boham: (10:36): You can get an immediate reaction to food or an IgE, you can get a delayed reaction to food or an IgG, but you can also have a food intolerance. There're just so many ways you can react to food. So just because you have one negative food test result, doesn't necessarily mean that food is not causing you problems. Dr. Mark Hyman: (10:53): That's a whole another topic, which is, what are the many ways that we react to food? Like the 50 ways I love you, it's like, what are the 50 ways you react to food? And it's all kinds of stuff from tartrazine, which is a dye that causes asthma. It's an additive, or whether it's MSG that can cause an amino acid related cognitive effect or whether it's- Dr. Elizabeth Boham: (11:12): Glutamate, yeah. Dr. Mark Hyman: (11:13): ... or whether it's something like high fructose corn syrup, which people can have fructose intolerance, lactose intolerance. Dr. Elizabeth Boham: (11:20): Or have food changes your microbiome. And then that changes the inflammation. There's a lot. Dr. Mark Hyman: (11:26): By the way, in this age of COVID and coronavirus, it's really clear that, the more sugar we eat, it affects our immune system, but it also affects our microbiome and our gut health turns out is incredibly important for us to be resistant to the flu through many, many research studies and likely to coronavirus as well. Dr. Elizabeth Boham: (11:43): Absolutely. Absolutely. And I think that this first case that we were going to talk about this 22 year old who came to see me, she... It really pulls in the importance of the microbiome in terms of your immune system, but also in terms of your skin, right? She was a 22 year old and she started to develop acne when she was around 12. When we got more history from her, I realized she had had multiple antibiotics as a kid. She had chronic ear infections. And especially when she was getting those ear infections, they were treating most of them with antibiotics. And I think we've calmed down a lot on treating every ear infection with antibiotics, but she got a lot of antibiotics because of her ear infections. Dr. Mark Hyman: (12:26): Yeah. I was a family doctor member, it's like, "Oh, give me, I like candy, a little [inaudible 00:12:29], this and that." I was like, nothing. Dr. Elizabeth Boham: (12:31): Right. Dr. Mark Hyman: (12:32): And now I'm horrified by what I did 30 years ago. Dr. Elizabeth Boham: (12:35): So she came in to see us because she was using a lot of different topical treatments, she was also taking a low dose antibiotic and her skin was better, but she didn't want to stay on these antibiotics. And she wanted to really look at it in a different way. And when she stopped taking the oral antibiotic, which she realized she didn't want to be on forever, her acne started to get worse again. So she said, "Okay, I really want to figure out- Dr. Mark Hyman: (13:02): Which is not uncommon and then doctors say, "Oh, you need more antibiotics." Dr. Elizabeth Boham: (13:04): Right. Dr. Mark Hyman: (13:07): It's like, that's the vicious cycle. Dr. Elizabeth Boham: (13:08): It becomes a vicious cycle. We see these vicious cycles all the time with medications because they're shifting because this antibiotics, as we've mentioned are shifting the microbiome, they're shifting the microbiome in your gut, they're shifting it on your skin, they're getting rid of that first line of defense. And then they're allowing, then it's more common to get the acne again when you stop them. So just because of her history of all of those antibiotics as a kid and being on the antibiotics and because she started we got more information. She was having a lot of digestive issues, she was having some bloating, some diarrhea, constipation, her digestion was off. Dr. Mark Hyman: (13:47): And their dermatologist is never like, "What's going on with your gut?" Right? Dr. Elizabeth Boham: (13:50): No. Right. No, we didn't ask that. Dr. Mark Hyman: (13:53): You didn't ask that. Dr. Elizabeth Boham: (13:54): So because of that, I said, "You know what? I really need to focus on the microbiome here for this woman to help improve her acne. And so we did a stool test, which is a neat way to get a sense of what's going on in the microbiome. It looks for real- Dr. Mark Hyman: (14:13): How is this different than what a traditional doctor would do with a regular stool test? Dr. Elizabeth Boham: (14:15): It looks at a lot of different biomarkers. So it's looking at all of your levels of commensal bacteria, all the good bacteria and is there an imbalance in the good and bad bacteria? So it does look for acute infections, for real infections as well, but it also is really paying attention to something we call dysbiosis, which is an imbalance in the good and bad bacteria. And trying to get a sense of, is there an overgrowth of not good bacteria or not good yeast? Or it also looks at parasites, it looks at digestion and absorption and inflammatory markers- Dr. Mark Hyman: (14:51): Yes. [inaudible 00:14:52] how your enzymes are working, how you are digesting your food or absorbing your food, is there inflammation in there? It's like a window into a dark world and we can learn so much from that through these tests, which are really not available through traditional doctors. They could order them if they wanted to, but it's just not something we're trained in, which is how do we take a deep look in the gut? We're talking about the microbiome, microbiome. But at some future state of medicine will somehow figure out what to do with it. Well, we've been doing this for 30 years in functional medicine and now we understand even more than we ever did and we're learning better and better how to actually optimize the microbiome and fix the problems of leaky gut and all these things that happen as a result of like your patient who had all these antibiotics and this crappy diet and developed overgrowth of bacteria that you found and yeast. Dr. Elizabeth Boham: (15:40): Right. When the stool test came back, we found that there was this overgrowth of unwanted bacteria. And there was an overgrowth of unwanted yeast. And so we can do tests like you said on, is there increased intestinal permeability or leaky gut? And she of course, had that because of these imbalances and the inflammation going on in her digestive system, because we know that those imbalances cause inflammation and we know inflammation causes all sorts of things, including acne, right? So we said, "Okay, we need to work to fix this imbalance. Let's work to rebalance the bacteria in her gut." And so for her, she wanted to use an herbal approach and I agreed with that. So we put her on a combination of a couple of different herbs that can work to get rid of the overgrowth of bacteria and yeast. And that worked really well. The one thing I always say about skin though, is you have to be patient sometimes. So if you are pulling away a food like dairy, which we did with her, we took her off of dairy, we took away a lot of added sugar. Dr. Elizabeth Boham: (16:46): If you're adding in something to treat the dysbiosis and we also gave her a lot of probiotics too. You got to give it some time for the skin to improve. You might see some improvement in the inflammatory acne right away, but for the skin to really improve, it takes like six weeks for the skin to turn over. So you want to give it some... We always give it some time to say, "Okay, how's this improving?" Dr. Mark Hyman: (17:09): Yeah. Dr. Elizabeth Boham: (17:11): And we also added in some nutrients that are really important for skin turnover. So we know that zinc and vitamin A, are really critical nutrients to help the skin turnover. So, you don't get so much of that hyperkeratosis that elevated levels of the skin not turning over, which can cause more acne to develop. Dr. Mark Hyman: (17:35): Yeah. And Accutane is a derivative of vitamin A, which is actually what is used for really bad acne. Dr. Elizabeth Boham: (17:41): Yeah. Dr. Mark Hyman: (17:41): And by using this comprehensive approach we use in functional medicine that we do here at the UltraWellness Center with the deep diagnostics we do and knowing how to optimize function of your skin, of your gut, et cetera. We can get better, where often they don't get better. And do it in a way that not only improves their skin, but improves their overall health. Dr. Elizabeth Boham: (18:00): Yeah. Dr. Mark Hyman: (18:01): So, really powerful. Dr. Elizabeth Boham: (18:03): So we put her on some zinc and vitamin A. Now, the both of those, I just want to caution listeners, if you're not working with a doctor, both of those, you can get too much of and they can cause imbalances in other vitamins. And vitamin A is fat-soluble. So, if you're going to use a higher dose- Dr. Mark Hyman: (18:20): You can't OD on it. Dr. Elizabeth Boham: (18:20): Yeah. I use 10,000, I use per day with her- Dr. Mark Hyman: (18:25): Of vitamin A. Dr. Elizabeth Boham: (18:26): Of vitamin A. Dr. Mark Hyman: (18:26): And you don't want to be on that for a long time. Dr. Elizabeth Boham: (18:28): No. Obviously, we did it for three months and then we started to spread it out and I was monitoring her levels. And the same thing with zinc. You just have to be a little bit cautious of just taking a lot of this on your own because it can throw off some of your vitamin levels or vitamin A can be toxic at high doses. But it really helped. The whole comprehensive approach really helped her skin improve and she was able to stop using both the oral antibiotics, topical antibiotics. She was able to get off of them and her skin... That dysbiosis started to rebalance and she wasn't getting all the acne all the time. Dr. Mark Hyman: (19:03): And I bet there were a lot of great side effects too. I bet she lost weight and had more energy and felt better. Right? Dr. Elizabeth Boham: (19:08): Absolutely. Dr. Mark Hyman: (19:09): Yeah. That is one of the side effects being all bad and you're all good. Dr. Elizabeth Boham: (19:12): That's true. Dr. Mark Hyman: (19:12): Right. Hey everybody, it's Dr. Hyman, thanks for tuning into The Doctor's Farmacy, I hope you're loving this podcast. It's one of my favorite things to do and introducing you to all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff. From foods, to supplements, to gadgets, to tools, to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter, I'll only send it to you once a week on Fridays, nothing else I promise. And all you do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S. And sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger, longer. Dr. Mark Hyman: (20:06): Now, back to this week's episode, just to recap, this is a really important case because it's a story we hear over and over and over again, you see someone who early on had probably sensitivities to food or maybe had antibiotics for an ear infection. And then it's this vicious cycle of things that disrupt the gut that then lead to secondary problems down the road like acne. And it leads to imbalances in the microbiome that can get treated with more antibiotics. And you're in this vicious loop and functional medicine takes you out of that loop. And we do a very deep history and we look at also tests, which are really different from what your traditional doctor will do. Food sensitivity testing, stool testing. We look at nutrient levels. We can look at vitamin A, zinc, fish oil, omega three, is that really important? And then we have a comprehensive approach, which is dietary. We take people off food sensitivity like dairy, which is a trigger. Sugar and starch, maybe other foods, gluten can be an issue for some people. And then we rebalance the gut. I call it the weeding, seeding and feeding program. Dr. Mark Hyman: (21:02): We weed out the bad guys, we seed with the good guys, the probiotics. We feed them, which is with prebiotics and the right nutrients like you said for the gut healing. And we see these remarkable turnarounds in a very short time and it's not that hard. You just have to know what to do. Sort of reminds me of that joke where this doctor sends his patient a bill for taking his appendix out and the patient got the bill, it said $1,000. And the patient writes back to the doctor, "Doctor, that's a lot of money for such a simple operation." He's like, "You're right." He says, your new bills is taking out your appendix $1, knowing that's what needs to be taken out $999. And I think that's the key of functional medicine, it's not necessarily that hard, it's just knowing what to do and what questions to ask and what test to do and what treatments to apply. Dr. Elizabeth Boham: (21:47): Because everybody's an individual. I think that's so key. Dr. Mark Hyman: (21:50): That's right. Dr. Elizabeth Boham: (21:51): So we're all individuals. So that for that patient, it was her microbiome that we needed to rebalance. But for the next person we're going to talk about it's going to be, how do we help support their detoxification system? And for somebody else, it may be just as simple as they're eating too much sugar. But I think it's important that we have to recognize that we're all individuals and the cause of acne is not just one problem, it depends on your individual story. How we treat you. Dr. Mark Hyman: (22:22): This is really. We often say in medicine that, one disease can have many causes and one cause can create many diseases. So acne can have many, many different things. There are common patterns and there are common patterns. So we know what to look for, but in each individual it might be a little bit different. And that's what we call personalized medicine, precision medicine, personalized nutrition, precision nutrition, personalized health, precision health. It's what we do. That's what functional medicine is. Dr. Elizabeth Boham: (22:43): And so for- Dr. Mark Hyman: (22:44): Tell us about the next one because it's quite a different kind of case you wouldn't expect that would relate to acne, but it... Dr. Elizabeth Boham: (22:49): Right. So she was a 44 year old woman and she had been struggling with acne her whole life. It got worse definitely before her period. So there was a hormonal connection, but she always had some acne. And we did an elimination diet with her. She had tried some on her own, but then when she came to see us, we became more strict and we pulled away really more inflammatory foods just to see. We did some testing and we pulled away gluten and dairy and all the sugars and refined products and her skin got a little bit better. But only a little bit better. And we did some of the stool testing on her and it looked pretty good. So, we started to think, "Okay, we've got to look a little deeper here." And so we did some evaluation on her toxic load. We started to look at her, how she metabolized her hormones, we started to look at what levels of toxins she had in her body. We looked at things like the pesticide levels, we looked at BPA levels. We looked at- Dr. Mark Hyman: (23:51): What's BPA? Dr. Elizabeth Boham: (23:52): BPA is a bisphenol- Dr. Mark Hyman: (23:53): Bisphenol A? Dr. Elizabeth Boham: (23:55): Sorry. Dr. Mark Hyman: (23:56): Where do they- Dr. Elizabeth Boham: (23:58): I'm sorry. I got it. Dr. Mark Hyman: (23:59): Where do people that from? Dr. Elizabeth Boham: (24:00): From the hard plastic. Dr. Mark Hyman: (24:01): Yeah. Hard plastic. Also, your credit card receipts, your ATM receipts, your- Dr. Elizabeth Boham: (24:06): Lining of cans. Dr. Mark Hyman: (24:07): Your receipts from your gas station, lining of cans. Dr. Elizabeth Boham: (24:10): Lining of cans. Dr. Mark Hyman: (24:11): People say, "You want a receipt?" I'm like, "Nope." Dr. Elizabeth Boham: (24:13): Yep. I always say no. Dr. Mark Hyman: (24:14): No thanks. Dr. Elizabeth Boham: (24:15): I always say no. And then in a lot of the big containers of water that people get, those are BPA containing containers. So, you want to be drinking out of glass and- Dr. Mark Hyman: (24:29): Metal. Dr. Elizabeth Boham: (24:30): Metal, not plastic. But that can act as an... It's a xenoestrogen. So it can act as an estrogen in the body. Dr. Mark Hyman: (24:39): So it's interesting, you just said something powerful. I want to stop for a minute because most people realize these toxins are poisons, they get that, but they don't realize that the way they act in the body is hormonal. They're hormonal imposters, mimics. And there's a book I read years ago called, Our Stolen Future by Theo Colborn, where she documented the ways in which all these environmental chemicals were affecting the reproductive health of animals and humans. It was just fascinating to me. And I was just like, "Whoa!" People really want to learn about this, they should check out that book. But tell us more about how that works. Dr. Elizabeth Boham: (25:12): So they realized that BPA was an issue back in the 1970s, I think at Tufts University where they were doing research on breast cancer. And then they realized that the test tube was impacting their results. And then they were like, "Okay, we've got to figure out what's in the test tube." And that's when they realized that BPA can act like estrogen in the test tube and impact the growth of cancer that they were evaluating or studying. And that's when we started to learn more about BPA and how it can act as a xenoestrogen, or it is a xenoestrogen, which can bind to the estrogen receptor in your body and then shift your hormones. Dr. Mark Hyman: (25:51): So fascinating about the xenoestrogens or xenohormones is... Xeno means foreign, right? Dr. Elizabeth Boham: (25:57): Yep. Dr. Mark Hyman: (25:57): Is that... They're in small concentrations, right? Dr. Elizabeth Boham: (26:01): Yes. Dr. Mark Hyman: (26:02): But it turns out that they're synergistic. So we might get a little BPA here and a little folate there and a little whatever there. And they're not one plus one equals two, they're one times one equals a thousand. And so at very small amounts, are extremely potent and they bind to the receptors, they can activate them, they're linked to cancer, they're linked to insulin resistance and obesity. So BPA can cause obesity and some resistance. So you get these double mechanisms of insulin resistance of hormonal disruption. And this can cause all kinds of problems, including acne. Dr. Elizabeth Boham: (26:35): Yeah. And so we... What I realized with all of her testing is that she had a high toxic load. Just what you're saying. She had a little too high of lead and mercury, her BPA was high. Some of her pesticide levels were high and she had a high level of oxidative stress. So oxidative stress is a marker, there's multiple different markers- Dr. Mark Hyman: (26:56): What is that? Dr. Elizabeth Boham: (26:56): ... of oxidative stress. Yeah. There're excessive free radicals in the body. So when you don't have enough antioxidants, or if your body is producing too many pro-oxidants because of poor diet or toxins, you get this imbalance, you don't have enough of the good antioxidants to get rid of the too many of the pro-oxidants that are being formed, you get an imbalance called oxidative stress. And we can measure that. Dr. Mark Hyman: (27:21): And we can see it, it's something people know when your apple turns brown, that's air and oxygen interacting, or [inaudible 00:27:25]. Your skin wrinkles from the sun, that's all oxidative stress, but it's happening on the inside. Dr. Elizabeth Boham: (27:31): Yes. And we always make these free radicals, but the problem is when you make too many or you don't have enough of the antioxidants or those phytonutrients to get rid of all the too many pro-oxidants. And so you can measure that imbalance, you can look at markers of oxidative stress in somebody's body, which is associated with aging and illness. Dr. Mark Hyman: (27:53): Nicer than then usual tests we do in functional medicine. We do here at the UltraWellness Center that you normally wouldn't get that tells you sort of what's going on. Dr. Elizabeth Boham: (27:58): And it's a great way. I think it's one of the best biomarkers to look at to see how is somebody improving. And so for her, she had this elevated level of oxidative stress and I'm like, "Well, that's interesting." And so then we started, that's when we looked at all these toxins, because they can be a cause of oxidative stress. There're multiple causes, but these can be one of them. And so I realized she had this elevated toxic load. She had some genes that made it harder for her to produce glutathione, which is this amazing antioxidant for the body and- Dr. Mark Hyman: (28:28): Another thing we do here, we do testing that looks at genes. We don't do your entire genome sequence, which is a thousand bucks. But we look at very specific genes that are common, that we can do something about that have some kind of clinical relevance and that we can modify through diet, lifestyle supplements, reducing toxic load, whatever. And what were the things you found on her? Dr. Elizabeth Boham: (28:49): Right. So she had a couple of variations in some of her glutathione genes, her glutathione genes, the GSTM1 gene that helps the body with production of glutathione- Dr. Mark Hyman: (28:59): What is glutathione? Dr. Elizabeth Boham: (29:00): Glutathione is this amazing antioxidant and detoxifier in the body. And so she genetically had a harder time with production and utilization of her glutathione- Dr. Mark Hyman: (29:11): I wrote an article years ago, it's called, The Mother of All Antioxidants, Glutathione. So if you want to learn more about it you check that out. Dr. Elizabeth Boham: (29:17): And it's still so relevant and so important. We know that glutathione is critical for a well-working immune system. We know it's critical for helping your body detoxify. And there's some of us that have some variations in our genes that make it a little harder for us to make and produce glutathione. Dr. Mark Hyman: (29:33): And I am one of them. And that's why I got- Dr. Elizabeth Boham: (29:33): Me too. Dr. Mark Hyman: (29:34): ... mercury toxicity. That's maybe why you got breast cancer, right? Dr. Elizabeth Boham: (29:36): Yeah. But there are things we can all do. There's a lot of people with these genetic variations. So it's not like- Dr. Mark Hyman: (29:44): Half the population. Dr. Elizabeth Boham: (29:44): Yeah. So it's not like it's a rare thing, but there are things we can do to help our body make more glutathione. And one of those things is eating a lot of cruciferous vegetables, the broccoli cauliflower, cabbage, radish, kale. All those great cruciferous vegetables that help the body with production of glutathione. We can also give things like N-Acetyl Cysteine or NAC, which helps the body make glutathione. And for- Dr. Mark Hyman: (30:07): It turns out that, that may be helpful in coronavirus and COVID-19, the N-Acetyl Cysteine because it helps in the antioxidant protection, with glutathione production, which is really important as an anti-inflammatory, it was a detoxifier and an antioxidant. Dr. Elizabeth Boham: (30:19): Yeah. And there's been some studies that it can work as an anti-viral and it's got some good lung effects. So it's really an interesting new treatment. Dr. Mark Hyman: (30:26): Exactly what we give people who have terrible lung asthma symptoms, we literally can give them inhaled Mucomyst, right? Dr. Elizabeth Boham: (30:33): Yes. NAC. Dr. Mark Hyman: (30:35): It's actually N-Acetyl Cysteine, when we were working as doctors, I was in the emergency room. I didn't know it was a supplement, I thought it was a drug because it was called Mucomyst and you'd order it and people would get this inhaled N-Acetyl Cysteine for their respiratory issues. Dr. Elizabeth Boham: (30:47): Yeah. The sulfur containing vegetables, onions, garlic, shallots, those things are really important to help the body make glutathione. And then we actually just gave her glutathione. I gave her this liposomal glutathione, you can squirt in your mouth, it gets absorbed through the cheek. You can also give IV glutathione. We do that here also at the UltraWellness Center. There's other IVs that we do for the skin too, which is interesting, zinc and B vitamins. But what was great, was that's really what helped her skin improve, was really focusing. Of course, we did the good diet and the good microbiome protection, but really helping her with her detox- Dr. Mark Hyman: (31:34): Detox her total body load of toxins. Dr. Elizabeth Boham: (31:35): Exactly. Decreasing her total body load of toxins and helping her body detoxify, that also helped her body detoxify her hormones and metabolize her hormones. You always focus on those good things with detoxification too, like drinking lots of water, having regular bowel movements, eating a lot of fiber, sweating, exercise, movement- Dr. Mark Hyman: (31:52): Sauna. Dr. Elizabeth Boham: (31:53): Sauna. Yeah. I'll help the body detoxify. But for her, that's when we started to see improvement in her skin. Dr. Mark Hyman: (31:59): This seems like a really different kind of approach. And you'd get a [inaudible 00:32:01]. You go in and you go, "Oh, I've acne take this stuff, put it on your skin." And you're saying, "Wait a minute, what could be the cause?" Typical things aren't working dairy and sugar elimination. So you went deeper and you said, "Well, maybe there's environmental toxins." So you looked at tests that helped her identify what was going on. Heavy metals, petrochemical byproducts, we call them persistent organic pollutants, BPA and pesticides. And then you helped her with diet, actually up regulate these pathways that actually helped her detoxify. You reduced her load by identifying where the sources were in her environment, her diet and her lifestyle and got rid of those. Dr. Mark Hyman: (32:35): And environmental working group, ewg.org has a great list of resources of how you reduce your exposures, whether it's household cleaning products, skin products, your diet, vegetables, what animal product, whatever you're doing, how do you reduce your body burden of toxins? And then you gave her certain supplements that helped her to up regulate the pathways and the result was her acne got better. Dr. Elizabeth Boham: (32:57): It's phenomenal. Dr. Mark Hyman: (32:57): But that's such a different approach, you wouldn't normally see when you go to the doctor and dermatologist and they had pimples, right? Dr. Elizabeth Boham: (33:05): Yeah, because I think that the way that we're trained in conventional medicine is to quickly identify and then find the medication to suppress the illness or the symptoms. And we all know that works well in acute care, right? When somebody has an acute issue, you want to be able to quickly identify and suppress the issue. But with chronic issues, we know that that way of treating is not the best. Dr. Mark Hyman: (33:32): No. Dr. Elizabeth Boham: (33:32): But that's how we were all trained in conventional medicine. You were trained with that same model. So we have to work to change that because we know for chronic issues and things, even like acne, that just doesn't... It's not getting to that underlying root cause. Dr. Mark Hyman: (33:45): That's the thing, that the doctor gives you a label. Say, "Oh, you've got these little white things on your face or it's inflamed. I know what you got, you got acne." But acne isn't the cause of the problem, it's the name of the problem? Dr. Elizabeth Boham: (33:55): Yes. Dr. Mark Hyman: (33:56): So in functional medicine, we focus on the cause not just the name. Dr. Elizabeth Boham: (33:59): Absolutely. Dr. Mark Hyman: (34:00): It's important to know what it is, but you acne rosacea is another kind of acne, which is really problematic. A lot of people have it. It's where they get red nose and red face. And that often is treated in a similar way. The gut is a huge factor. It's used as a big factor. Dr. Elizabeth Boham: (34:14): It's such a huge factor, the gut. I have patients where it's dysbiosis until proven otherwise. Dr. Mark Hyman: (34:22): Pretty much. Dr. Elizabeth Boham: (34:22): You see so much of it is dysbiosis. And we treat the dysbiosis, the acne rosacea gets better. And when it starts to come back, we go, "Okay, that dysbiosis is coming back." Dr. Mark Hyman: (34:30): So Liz, this is an incredible podcast. I think it's going to help so many people who suffer with skin problem, not just acne, but all skin problems. And we talked about some other ones in other podcasts, but this is a problem that affects 50 million people. And like I said, that's more people that have cancer, diabetes and heart disease, right? Dr. Elizabeth Boham: (34:48): Yes. Dr. Mark Hyman: (34:49): Autoimmune disease affects more people, but that means all the autoimmune disease. So this is such a common issue, it's so poorly treated with traditional medicine in ways that are actually harmful, like oral antibiotics or Accutane can be hard on the liver. Dr. Elizabeth Boham: (35:03): Yes. Dr. Mark Hyman: (35:03): And that is relatively simple to treat using functional medicine, using a different set of questions, a different set of tests, a different set of dietary interventions, specific supplements that can help. And we talked about things like zinc and vitamin A, fish oil, even premazol is another one that's great. So it's just such a refreshing story to hear these patients who recovered from a problem that creates so much problem for people. It creates so much emotional distress, it creates so much psychological distress and it's just a pain to pimples. So I'm just really grateful for the work you do and work we do here at the UltraWellness Center to bring these kinds of approaches to so many people who really are struggling with these issues and we provide a real simple way for people to access this. People go to ultrawellnesscenter.com, learn more about our practice. They click on the get started tab to actually register, to become a patient. Dr. Mark Hyman: (35:58): And I think that if we just go that little bit extra and little bit more thorough, comprehensive evaluation based on this new model of functional medicine, which is treating the cause and treating the system, not just the symptoms, we can help so many people. So Liz, thank you so much for joining us on The Doctor's Farmacy, special episode of The House Call. And if you've been listening to his podcast and you love what you heard, please share with your friends and family on social media, leave a comment, I'd love to hear from you and subscribe wherever you get your podcasts. And we'll see you next time on The Doctor's Farmacy. Dr. Elizabeth Boham: (36:36): Thank you, Mark.