In this week's webinar, Dr. Klaper, Dr. Miller, and Dr. Marbas answer questions about keeping your skin healthy.
Questions Answered
- (00:39) – Understanding our skin, our largest organ
- (06:18) – Our skin as a reflection of our internal health
- (10:45) – Some common causes of acne
- (13:48) – Protecting our skin from sun exposure
- (15:58) – Does the use of sunscreen diminish the absorption of Vitamin D?
- (16:55) – What can we do about dry skin?
- (26:30) – Do you advise taking oral steroids when someone gets a major case of contact dermatitis?
- (30:00) – Does gluten have a significant impact skin health?
- (34:17) – Reactivating contact dermatitis and an interesting story about Poison Oak
- (38:00) – Can you explain if whole grain pasta, chickpea pasta, edamame pasta, healthy pastas are really healthy?
- (48:10) – What makes fingernails become thin and brittle?
- (51:08) – Feed your skin like the rest of your body
Complete Transcript
Dr. Chris Miller
(00:00)
… topic. First of all, hi, everybody. Welcome again. I thought about this topic because I'm outside in the sun all the time. And I've been thinking about my skin and how I'm protecting it and how I'm moisturizing it. And how I'm preventing it, as I am getting older, how I'm maintaining it, taking good care of it. So, I just thought we would touch on skin health a little bit and what it takes to have healthy skin. And since I get to go first today, I get to explain a little bit how it all works.
Dr. Chris Miller
(00:39)
There's three layers, really, of the skin. And it's the outer epidermis layer, the middle dermis layer, and then a tissue layer underneath. And I want you to remember that the skin is the largest organ in the body, right? It covers our whole body. And it has such an important function. It's there to protect us, number one. And so, we think of that a lot right now with coronavirus, that the first line of protection is barrier, and that's our skin. So, it's really important that we have a good skin that's doing its job, actually. And hopefully, we appreciate how good it's doing for us. So, that's one, it's protection for us.
Dr. Chris Miller
(01:24)
The skin also is important in regulating body temperature. So, whether we have a fever, when we know what's going on inside of us. When we're cold, the blood vessels can dilate or constrict and regulate blood flow and help us control whether we let heat off or whether we kind of try to let heat in. Interestingly, the more I learn about the skin, now we know all about the skin bacteria, the microbiome on it, bacteria, viruses, fungus, that there's a whole population running through our whole body. And that's a whole nother set of something that we can discuss down the road a little bit in this talk later today.
Dr. Chris Miller
(02:07)
So, that's important to know. And it's important for sensory. So, the skin is right when we touch something, how do we know if it's hot and we don't harm ourselves? Or how do we touch? It's our way of communication. And it's also important as an indicator of our health. So, I use skin all the time when I'm looking at my patients. Each and every one of you guys, when I see you online, your happy little faces, I'm looking at you, if you're pale, if you're dusky, if you have a little rosacea, right? A little inflammation in your cheeks. Looking at your skin color. And so, that tells me a whole lot about you right from the get go, just taking a look right there.
Dr. Chris Miller
(02:41)
So, so many functions to the skin. And did I cover all of those? Yeah. And the last one is biosynthesis. So, the skin is important also, it helps us synthesize very important nutrients such as Vitamin D, right? Takes those UVB light and gets the process started, happens right there in our skin. So, with all that being said, it's so important that we take good care of the skin and maintain it. And I'm just going to say the one obvious is that our skin is switching over every about 28 days, I read recently. So, that's about every month. So, our whole lives, every month, we're regenerating new skin, right?
Dr. Chris Miller
(03:23)
Imagine that. So, if you're not happy in your skin, go ahead and change it, because that's what's happening. And how do we regenerate healthier skin? Well, it's the same thing, right? Skin starts from within us. So, it's what we eat, what we put into our body is what's going to be incorporated into the cells. So, that's another reason we're such big promoters of that wholefood plant based diet, putting in the best nutrients that are filled with fiber to help feed the microbiome, which is going to navigate how the skin microbiome connection. It helps with antioxidants, which are so important for our skin, such as, we all hear about carotenoids, right? And there's a reason, because carotenoid is that orange pigment found in our green, orange, yellow, and red vegetables. That orange pigment helps our skin every time it's growing, grow into healthier skin. So, really important, the antioxidants. It's also shown to prevent cancer, those colorful fruits and vegetables and all those antioxidants. So, I can't stress that enough.
Dr. Chris Miller
(04:24)
And then, omega-3 fatty acids. We want to have just a little bit that is helping to keep our skin … What's the word for it? The fat layer of our skin to keep it to its plump layer that it's supposed to be. So, again, so it functions well as a barrier for us and doesn't look wilty and dry. So, really promoting a wholefood plant based diet when I'm working with my patients with skin issues who are working on always the gut issue, because there's that connection. And we're working together on making sure they're getting the antioxidants and the fiber, and that it's low glycemic often, because high glycemic load, like sugar, can cause it also to age faster, to be inflammatory, and not grow into its healthier self. So, we'll work on low glycemic diets as well, as a part of it, avoiding known toxins and triggers. So, again, that comes in with processed foods and animal products and saturated fats and things like that.
Dr. Chris Miller
(05:23)
Just by removing that and flooding our body with the nutrients and the wholefood plant based diet, especially the green, leafy vegetables, which you know I'm always promoting, and the colorful fruits and vegetables and the fiber, skin starts to take on a great look and have more of a glow to it. And the last two more things I would say is really hydration is key to keeping your skin plump and healthy as it's turning over all the time. And exercise is key as well. So, when you exercise, you're increasing blood flow and circulating everything around. And so, it's really important too if we're exercising while we're regenerating our healthy skin every month to really help us generate our healthier self. And that's my brief overview. And I would love to hear what you guys have to contribute to today's skin health.
Dr. Laurie Marbas
(06:14)
Doctor Klaper, what would you like to add to excellent description there?
Dr. Michael Klaper
(06:18)
Really not much. I used to play some semi-professional baseball. And when you hit a home run, you've got to be sure you touch every base going around the diamond there. And boy, Chris, you just hit every base on that home run. You touched all of the points that I was going to raise. But a couple of things that I would add. It's so important, the skin is such a great reflector about what's happening on the inside of our body. And the old saying from the computer guys and girls, garbage in, garbage out. Well, garbage in sure comes out on the skin there. Certainly, it's pretty [inaudible 00:07:01]. And the fats in the diet certainly play a role.
Dr. Michael Klaper
(07:04)
But before I get into that, you really need those vitamins and minerals too. It's such a vital organ, there's such a great blood flow in the skin obviously. And it really needs the same vitamins and minerals that your muscles need and that your nerves need etc. So, those salads and soups and steamed veggies are really, really important for your skin, absolutely.
Dr. Michael Klaper
(07:26)
When people who've had skin problems, they chronic acne folks, etc., the psoriasis folks. When they change to a wholefood plant based diet, and really emphasizing that they leave behind the vegan junk foods with all the omega-6 oils and all that stuff. When they really adopt a wholefood plant based diet, one thing many, not all, unfortunately, but many, many, many of them report, “Gee, my skin cleared. Gee, my acne got better. Gee, my psoriasis is better.” Well, why does that happen? And these, of course, are very complex issues. But a couple of things regarding better looking skin on plant based diets. One, things that are in and things that aren't in, in your dietary stream.
Dr. Michael Klaper
(08:22)
Now, the things that are in, the major thing when you switch from an animal based diet to a plant based diet, you change the quality of the fat. You change the quality of everything, actually, of course. But certainly, the fats change. How do they change? Well, they are lighter fats. You're changing heavy, saturated fats, which are solid at room temperature, verus vegetables oils. And again, we're not talking about oil in a bottle. But we're talking about those micro droplets of flaxseed oil in the whole flaxseeds and in the walnut oil that are in the whole walnuts. We're talking about fats in wholefoods. But these fats are what your skin oils are made from.
Dr. Michael Klaper
(09:07)
And so, talking about an oil change, like your car, well there's an oil change for your skin. And the fact that the vegetable oils are just lighter and more fluid, they don't tend to clog up the pores and invite infection. And it's one reason why acne seems to get better. And at least, lighter vegetable oil, vegetable fats, I should say, they lubricate the skin better. And so, there's often just better hydration in the skin. And they are less pro-inflammatory. The heavy saturated fats, the animal fats have a particular kind of fat called arachidonic acid, which leads to inflammatory prostaglandin production. And you whip those out when you leave the animal products behind. So, that leaves the skin less in an inflammatory state.
Dr. Michael Klaper
(10:04)
Finally, we've learned the hard way, although it's pretty solidly established now, that if you've got acne issues, dairy products are not your friend. And it's turning out that there are proteins in cow's milk, whey and lactalbumin that turn on genes in the oil glands of the skin, TRAC-1 and others, that make the oil glands put out a particularly acidic oil that clogs up the glands and leads to acne production. And so, leave the dairy behind is one of the best things you could do.
Dr. Michael Klaper
(10:45)
I remember when I was a kid, and I had grammar school health class. And the gym teacher would say, “Don't eat chocolate. It gives you acne.” And we all rolled our eyes. Well, it turns out he was right, but not for the reason he thought. We assumed it was from the sugar and the cocoa. But it turns out, it's the milk in the milk chocolate actually, where it's more acnegenic. And the same thing, psoriasis is a very complex issue here. And I can't say it's only from the oils involved there. But psoriasis often gets better on a plant based diet.
Dr. Michael Klaper
(11:28)
One last thing before we leave acne. There's an excellent book that I often recommend called The Clear Skin Book for people that … This is written by the Nelson Sisters. They're twin girls who are very prominent on the internet. And they had really severe acne, facial acne. And it was very detrimental to their media careers. And they tried everything to try and get rid of it. Finally, they asked a colleague, John MacDougal. And he said, “Pull the soy out of your diet.” And they did, and boom, their acne cleared up. And it was very dramatic. And I'm thinking, “Why in the world would that happen? Why would soy play a role in acne?” And I couldn't figure that out until later when the answer presented itself to me. It turns out, and it's not a big problem for folks. But these girls were eating a lot of soy and tofu and soy milk, etc., etc.
Dr. Michael Klaper
(12:38)
And we've all heard about the phytoestrogens in soy. And they in general don't cause a problem. In general, they are protective against breast cancer, etc. But what they can do, however, is block the site where estrogens would normally exert their estrogenic activity and lock up the estrogen. And because even the female body produces some androgen, some testosterone, as you bind up the estrogen, it produces in these particular girls' bodies, a relative excess of testosterone. And the relative testosterone access was what made the acne erupt. And they stopped the soy and rebalanced their estrogen and testosterone. It turns out, their acne cleared up. So, interesting. Soy is such a wonderful product and I don't want people running the other way when they think about having some tofu. But if you're someone who's really struggling with acne, and you've already gone completely plant based, think about taking a holiday from soy products for a couple of months and see if that doesn't help with the blemishes on your skin there.
Dr. Michael Klaper
(13:48)
So, I'm sure we'll have other things to say. But be gentle with your skin. Wear those hats, wear the sunscreen. The sun isn't gentle. That said, especially in the morning hours when the sun is still low on the horizon and the sunbeams are coming at a very gentle through lots of the atmospheric air, we need some sun on our skin. I think we've become so heliophobic, we're so afraid of the sun these days, photoaging and skin cancer, etc. But I think 20 minutes of morning sun on your skin is a wonderful thing, or in the late afternoon. And as Chris says, it helps Vitamin D production. It helps our brain, helps our neurochemical all the way around. We have a relationship with the sun. And we shouldn't let modern life totally disrupt that. So, I'm a big fan of getting out in the sunshine for at least 20 or 30 minutes, won't give anybody skin cancer. I think in general, it's a beneficial thing to do.
Dr. Michael Klaper
(14:51)
And as she rightly said, drink enough water. Dehydration certainly shows up in the skin and certainly contributes to aging. And in the morning, after I come out of the shower, I'll put a little moisturizing lotion on my face. The time to apply moisturizing lotion is when you immediately come out of the shower and your skin is all full of water from the shower. That's the time to put those hydrating lotions on to lock that water into the skin, so it diffuses through the upper layers of your skin, rather than just evaporating off to the air. So, especially if you're an eczema person, you've got dry skin, get that moisturizer on as on as soon as you step out of the shower for five minutes, and you'll wind up with better hydration of the skin. Okay, I'm sure that things will present themselves. But I don't want to ravel on too long. So, with that, I will relay it back to Doctor Marbas and see what she has to continue.
Dr. Laurie Marbas
(15:58)
All right, that's excellent. So, you guys just went basically skin 101 college there. So, to add to it, we do have a question here. Does the use of sunscreen diminish the absorption of Vitamin D? So, basically, does sunscreen use lead to Vitamin D deficiency? So, basically, when you think about the high SPF sunscreens, they're designed to filter out the UVB. And that's actually what triggers the Vitamin D production in the skin. Clinical studies actually really haven't found that everyday use of sunscreen has led to Vitamin D insufficiency. So, I think you're okay. And remember that when you use an SPF of 15, that filters out like 93% of the UVB rays. SPF 30 is about 97%. SPF is about 58%, excuse me, 98% filtering out. So, that leaves anywhere like, two to seven percent of the UVB reaching your skin. And that's if you use it perfectly. So, I don't think it takes much to get that Vitamin D going.
Dr. Laurie Marbas
(16:55)
So, when you weigh the pros and cons of using sunscreen, you definitely want to weigh the sunscreen bit. But you know, Doctor Klaper was saying early morning sun, late evening. That's also going to be less harmful to the skin. So, just some thoughts there for you. So, we have a lot of questions actually also about the dry skin and psoriasis. So, I think what you said, do you have any additional, Chris or Doctor K? Anything about the dry skin, once someone goes to a plant based diet? Sometimes they do develop some dry skin, especially if you live where I live in Colorado. The environment just goes [inaudible 00:17:33]. It just sucks it out of you.
Dr. Chris Miller
(17:35)
Everybody has dry skin in Colorado though.
Dr. Laurie Marbas
(17:37)
And you're higher up.
Dr. Michael Klaper
(17:38)
It says on the license plate, the dry skin state. It says so right on the license plate, yeah. Right.
Dr. Chris Miller
(17:44)
And the altitude too, so you're closer to the sun's rays. Remember, right? Less of an ozone layer. So, it's very potent, the rays. People of Colorado, make sure you're always covering your face especially from aging and wrinkling and all that, and taking extra precautions. But I would say just a quick comment about the sunscreen is that, remember it wears off. It's supposed to be reapplied every two hours. That's how sunscreen's designed. And most of us don't do that, right? We're lucky if we get it on once in the morning, which is what I tend to do, unless I'm at a beach or something. So, it's supposed to be reapplied every two hours. So, it is fading throughout the day.
Dr. Chris Miller
(18:19)
So, especially if you're exposed to the sun, I would say to take precautions and have it on. But as far as moisture, to answer your question, yeah. No, my tips are just what I kind of said. I look at how much they're hydrating. Number one, most people are not hydrating enough in general, myself included. I carry my water to always be reminding myself I should be drinking more. But hydrating is number one. And looking into their diet in the end, as far as omega-3 fatty acids. I do want to make sure that they're getting a little bit of that in a small amount of nuts and seeds a day. And what else are they eating?
Dr. Chris Miller
(18:58)
So, if you're sneaking in a little this or that, sometimes that could be sabotaging it as well. So, also a trick that I like to do for when people have really dry skin is add those green smoothies, because it forces you to drink the water with the greens and the omega-3 fatty acids all in one. And so, I just feel like if we start our day off with that, especially if dry skin is a concern, starting the day off like that kind of can help out. But that's my little tip.
Dr. Laurie Marbas
(19:25)
Doctor K, anything?
Dr. Michael Klaper
(19:26)
Yes. Well said. I'm not a big fan of taking coconut oil or these oils orally. But one good use for that is on your skin. And I think they're a lovely lubricating agent. And as I said earlier, as soon as you get out of the shower or out of the bath, that's a good time to put a coconut oil based moisturizer on your skin to lock in the water. And if you've got a child at home with eczema, absolutely. Eczematoid skin is dry skin. And they don't have the oil that holds the moisture into our skin. So, we pull the little one out of the tub. And while they're still all wet, that's the time to rub that oil containing lubricant base on their skin and lock that water in. So, drink plenty of water, hold that water in after you bathe. And hopefully your skin should get more moist.
Dr. Laurie Marbas
(20:34)
Yeah, absolutely.
Dr. Chris Miller
(20:35)
They actually have done some research. Sorry to interrupt Doctor Marbas. But I've done, and it looks like some LDL levels in some people can go up with topical coconut oil, which I have been using it. I love it. I love how my skin feels with it. I love how it works. But I was just reading, they're small studies and so I'm not really sure what to make of that. But then there was a dermatologist I was looking into. And she was saying not to use coconut oil for kiddos, because their body surface area is so large compared to the size of a kid, the child, especially the little children. And that it's been shown to increase their LDL and their risk factor that they have higher saturated fat. And I had not seen studies, I didn't have time to research that yet. But I found that interesting and something I'm definitely going to look into, because I use it. I recommend it. But if it's not a good thing, then I should know that. So, I just thought that was interesting.
Dr. Laurie Marbas
(21:30)
That is really fascinating. I mean, it makes sense. Your skin is absorbing everything that you put onto it, so that is really interesting. Fascinating. Yeah, I'll have to definitely dig into that. So yeah, and with the eczema, I've treated so many kids with eczema. And even my little ones, when they were little had eczema. But I also was just drinking dairy and breast feeding. And then they went to cow's milk type of formula. So, oftentimes, many, many, many times, I have some dramatic stories of patients getting better when they go to a plant based diet, and especially removing the dairy, like Doctor Klaper was speaking about. So very important with little ones with eczema. But then we also have, for example, healthcare workers or others who are working with gloves, and they're constantly washing their hands, especially if you're in the OR, like Doctor Klaper was before. And they get really dry skin. They're super sensitive to hospital grade antimicrobials. So, any suggestions for someone like that who's going to be constantly being exposed to something that may be leading to cracked or dried skin? Do either of you guys have any other suggestions there?
Dr. Chris Miller
(22:35)
No. So, I have some colleagues in the emergency room who have been talking a lot about dried cracked hands. And so, several of them have been doing things like trying to wash their hands instead of always alcoholing it, using alcohol, which can be very helpful. That alcohol is so drying. And actually, we'll talk about that, because if you can wash your hands, I'm always a fan of washing your hands over using alcohol if you get the choice. And then they were doing things, like they had little coconut oils by the sink side, and it was helping them so they were protecting. And they found that to be very helpful with the dry cracks.
Dr. Chris Miller
(23:14)
And so, again, now this is something I have to look into. But that's a tool that using the oil, we'll just say oil in general, maybe a plant based oil right after washing your hands. And they have all come back to me and said, “Oh my god, that's totally working. It's really helping.” So, that's a tip that maybe we could try. Now I'm going to have to look into almond oil. I love the smell of that and see if that's a good alternative. And see if hopefully my face will look okay next week, and then you'll know it's working.
Dr. Laurie Marbas
(23:43)
That's great. Doctor Klaper, you were in the OR and maybe you've seen some things.
Dr. Michael Klaper
(23:49)
Indeed. And it comes down to using those lubricants. And just in this day of post-COVID, in the middle of COVID times now, wear your mask, keep your distance, and wash your hands, we're told. And the more you wash your hands, the more you take the skin oils out. And by the way, one phenomenon that happens as we wash our hands frequently is, it takes oils. Soap dissolves oils. It's a detergent, that's what it does. That's why you're washing your hands because it dissolves the oils that's holding the dirt onto your hands there. Now, one place it also removes the oils is from the nail plate of your fingernails. And as the months go by, if you wash your hands frequently and you're leeching the oils out of the nail plates, the actual part that grows, one way it shows up is with these longitudinal cracks that go down your nails.
Dr. Michael Klaper
(24:55)
And people go, “I must have a vitamin deficiency or my vegan diet isn't working for me.” No, it just means you're washing your hands a lot and you're taking the oil out of your nail plates and they're cracking. And so, there are ways around this. But again, comes down to replacing the oils. And there are the manicures, there are oils that you can apply right directly onto the nail plate and let them soak the oil back in. And if you have cracking nails, and again, these are the longitudinal cracks. Transverse cracks are something else. But these longitudinal ones are largely the loss of oil out of the nail plates. And so, probably almond oil or most any other oils would work. But they do have these manicures that you get online. You can see fingernail oil that you can rub in. It's probably almond oil, I suspect. So, moisturize your nails as well as the rest of your hand if those cracks are a problem. And-
Dr. Chris Miller
(25:57)
That's a good tip.
Dr. Michael Klaper
(25:58)
And, as Doctor Miller said, find some lubricant that after you wash your hands, you've lost some oils out of your skin, then replace it with some oil based lubricant, just a couple of drops is all you need. But it'll keep the skin on your hands from getting too cracked.
Dr. Laurie Marbas
(26:16)
So, that's great because we have a response here. Someone says … Her name's Marlene, says, “Really interesting. I'm a health inspector and I wash my hands constantly. I thought it was a deficiency.” So, there you go.
Dr. Chris Miller
(26:26)
That is a good tip. Yeah. That's interesting.
Dr. Laurie Marbas
(26:30)
So, we have another question. Do you advise taking oral steroids when someone gets a major case of contact dermatitis, unknown origin? So, in some cases, a short burst of steroids are needed, or if you get, for example, there's lots of lovely plants that will cause some pretty significant and terrible skin reactions. But do either of you have any thoughts or suggestions on those type of things? Especially of unknown origin, would you have a way of starting that investigation?
Dr. Michael Klaper
(27:00)
When your skin breaks out, one of the first things to ask yourself is, “What did I eat the last couple of days?” There's a good chance something that went down the pipe there is now coming out in your skin oils and in your skin circulation there. So, what we think of is called contact dermatitis is often a manifestation of something unhappy going on in the inside. And so, just notice if there's pattern, “Gee, every time I eat strawberries, the next day I've got the contact dermatitis.” Okay, well, that is something that you're consuming.
Dr. Michael Klaper
(27:37)
But assuming that this is a true contact dermatitis, find out what it is that you're contacting if it truly is there. But to get to the source of your question about whether a short course of steroids work. Yes, they do. And I don't have much hesitation in using them. They can just be … not lifesaving, but lets the person retain their sanity before they scratch off their entire epidermis because their skin is so itchy. That said, an article came out just a couple of weeks ago saying that even a short course of steroids has a not insignificant increase in GI bleeding and internal problems from steroids.
Dr. Michael Klaper
(28:18)
So, if you are on a Medrol Dosepak or your doctor gave you five days of Prednisone, that's the time to be extra nice to your stomach lining. Stop the alcohol, stop the wine at dinner, stop the high coffee, don't take any aspirin or ibuprofen. Anything that may irritate your stomach lining is not the time if you're on steroids, because they make the stomach lining extra sensitive or fryable there. So, take care of your stomach lining if you do find yourself on a short course of steroids. But they can be helpful, absolutely.
Dr. Laurie Marbas
(28:55)
Chris?
Dr. Chris Miller
(28:57)
Not much to add to that. So, he basically summed up. I would do the same exact thing. It's a case by case, depending on how bad your contact dermatitis is and your medical condition, what's going on. So, that would be something I would discuss with my patient based on what was there at that time. There are other things like antihistamines that you could try to use. And-
Dr. Michael Klaper
(29:22)
Topical steroids.
Dr. Chris Miller
(29:23)
Yeah, and topical. Yeah, exactly. So, those are some other ideas that you could talk about. But yeah, sure.
Dr. Laurie Marbas
(29:30)
Yeah. And there's other medications that are topical too that, if this is a chronic issue, that you can use that are out of the topical steroid or orals, because the topical steroids with chronic use can thin the skin, which is an issue, a longterm issue. And so, you've just got to be really careful. But, again, it's a matter of investigation. And sometimes, some individuals will have … They just can't figure it out. It's not the laundry detergent, they change everything. And again, it may be something in the diet that's expressing itself through the skin.
Dr. Laurie Marbas
(30:00)
We have a few other questions and I'm trying to see here. Looks like we're getting a lot of questions about gluten. And so, I'm just going to throw one of those in here. I think we got skin fairly wrapped up here, unless you guys have something in addition.
Dr. Michael Klaper
(30:17)
Well, the two meet. There is a medical condition called dermatitis herpetiformis. And that is from gluten. It's the skin complaining about gluten in the diet. And you get these snake like rows of little itchy, itchy bump papules there. And if you have those, you can talk to your doctor about it. But look up dermatitis herpetiformis and just stop the gluten for a month or two. And if it magically goes away and doesn't come back again, then you clearly have a sign of gluten sensitivity. So, yes, actually, it can show up in the skin.
Dr. Laurie Marbas
(30:54)
Yeah, so the question was about … Where is it? There we go. Any thoughts on gluten and psoriasis and specifics? And just to get … Maybe about 10% of people will show up with the rash associated with gluten sensitivity or celiac disease. But any thoughts there on gluten and basically maybe autoimmune disease? Maybe we should kind of move in that direction.
Dr. Michael Klaper
(31:20)
Nobody needs gluten. You can live a long healthy live without ever injecting that molecule in any form. So, if there's any question, stop the gluten for a month, two months, or give it 60 days to clear out of your tissue. And then have three slices of whole wheat bread one day and see what happens. If your skin is just [latiously 00:31:40] erupted the next day, that's really all you need to know.
Dr. Chris Miller
(31:43)
Maybe just have one slice.
Dr. Michael Klaper
(31:43)
Yeah, one slice. Yeah, I'm a big fan of removing all doubt. But yeah, one slice. But if you get a big reaction, then you're the ultimate lab test. You don't need to send off the gluten antibodies and all that stuff. It's obvious, if that's what's happened. And then, just don't eat gluten. You can certainly live a long, healthy life without ever eating gluten. So, if you have any question, give yourself a break from it and see what happens.
Dr. Laurie Marbas
(32:14)
Perfect.
Dr. Chris Miller
(32:15)
And I would say, just to add to all that, that there is some evidence that once you have a leaky gut. So, once your gut is disrupted, the microbiome may be out of balance, and the gut is now allowing little toxic particles and bacteria to go across where they're not supposed to, which can happen from inflammation. Once you have that inflammatory state, which we call leaky gut, in your gut, gluten is known to actually help increase … I'll call it a toxin, but it's a little chemical called zonulin. And that causes more leaky gut.
Dr. Chris Miller
(32:50)
And so, I find that when I'm working with my autoimmune people, that I take them all off gluten initially, because it can delay healing. It doesn't mean they all have celiac. I mean, hardly anyone does, although I test it in some people, but most people will not have it. But still remove it initially and help the healing. Let the gut heal, let that inflammation quiet down. And then, like Doctor Klaper said, we bring it back in and see how they do. And definitely psoriasis responds to a gluten free diet. So, I would, if you're struggling with psoriasis or someone you know is, I would take it out for a little bit and heal that inflammation in your gut. And then you could try to bring it back and see how you do.
Dr. Chris Miller
(33:28)
And even Doctor Fuhrman's actually even published some case studies about his psoriasis patients that he's followed over several years. He's had a couple of patients that he's worked with or he's followed for so many years. And gluten was one of the things he took out in them as well and found benefit. So, I've found the same thing with my patients.
Dr. Laurie Marbas
(33:46)
Yeah, that case was actually … Go ahead, Doctor Klaper.
Dr. Michael Klaper
(33:49)
No, go ahead. Go ahead.
Dr. Laurie Marbas
(33:51)
Yeah, I was just going to say that case actually republished in the IJDRP from the managing editor. So, you guys, it's a free, open source journal. All you have to do is go to ijdrp.org and register. And you'll have access to all of those. They don't charge the authors, they don't charge the audience. So, it's a great resource. And the more you share that, the more we can move forward in sharing the science of a plant based diet. But go ahead, Doctor Klaper.
Dr. Michael Klaper
(34:17)
For the person who had the question about the contact dermatitis, and that's a whole thing in itself, and you want to avoid the contacts. But just a cautionary tale that I learned about skin in general as an organ. I was working in a remote hospital at a native American Indian reservation up in the mountains of northern California. And it is poison oak country. And it was late summer, and this fellow comes into the ER and he's just miserable. And he had a classic poison oak … He was out in his backyard clearing the brush that had grown in. And he came in and he had the classic red sheen of, as the vine wrapped around his forearm there. You could see clearly where the vines wrapped around. And he had the blisters and the weepiness, the classic poison oak eruption. And so, we both knew what it was. And so, we did oral steroids and the [falical 00:35:19] steroids and compresses, etc. And eventually, it takes weeks sometimes, but it finally faded away.
Dr. Michael Klaper
(35:28)
End of story, I thought. The next year, who comes back in, but Cliff? And out at the same time, September the following year. “Hey, Doctor, I've got some of that on my leg this time.” And he pulls up his pants leg, and there was another chain like lesion of the poison oak blisters, etc. And yeah, we both could see it. And he said, “Funny thing, Doc. I was wearing long sleeves. I didn't touch anything. But look at this.” And he rolls up his arm. And what he had, the very same lesions from the year before had lit up on his arm once again.
Dr. Michael Klaper
(36:14)
And I realized, skin has a memory. And the tiny, tiny molecular amounts of Rhus toxin from the poison oak that got into his leg wound there, I found that when it was blistering, as it flowed through his skin up in his arm, it woke up. Those skin cells still remembered how to react to that, and it lit up. And it was quite a lesson to me about the skin and what a long memory it can have, because people … So, looping back to the contact dermatitis, if you've continually been reacting or irritated in one area of the skin, it's going to remember. It's going to take a long time for that to go away. And anything that irritates it, sometimes even in a distant part of the body, might wake that up there. So, just a point to be aware of and keep that skin well hydrated and non-irritated.
Dr. Laurie Marbas
(37:14)
Absolutely. I've seen tons of cases, poison ivy and all the poison oaks. And they may have the contact one place, but then it will spread, give it a couple of days. It's intense.
Dr. Chris Miller
(37:23)
And the oils spread too.
Dr. Michael Klaper
(37:24)
The rhus oil.
Dr. Chris Miller
(37:27)
Yeah.
Dr. Laurie Marbas
(37:27)
So, even if they've showered, they've washed. But also, check your dog. If your dog was out with you, it can stay on the fur of animals. It can stay on your shoes. So, you've got to think about all of those things. Like, who's coming in the house? And where are they jumping? Are they on the couch or on your bed? So, you've got to think about those little furry friends that are maybe bringing something too. Also, we have some other questions here. This might be interesting. Leanna says, “I have a lot of confusion about flour. Can you explain if wholegrain pasta, chickpea pasta, edamame pasta, healthy pastas are really healthy? The plant is made into flour to get into pasta form. And flour acts like sugar in the body. Correct? Or no?” So, who would like to take on the pasta question?
Dr. Chris Miller
(38:12)
I can-
Dr. Michael Klaper
(38:15)
I'll start. Yeah, go ahead Chris. [crosstalk 00:38:18] pasta.
Dr. Chris Miller
(38:19)
I can start with it and then I'll be curious to hear what Doctor Klaper has to add, because it's a great question. And it is very interesting. And I too have grappled with that just a little bit. So, that's why I think I paused is I have been thinking about that. So, you're right in everything you just said in that question. So, it is healthy and it is processed. So, it's a little bit of both. So, it's not as healthy as whole … If you're on a wholefood plant based diet to heal chronic illness, then I would say, probably no pasta. It's a little bit too processed for you at that point. And you're right, at that point, the sugar has been … The fibers have been changed to be blended down into a flour and now made into a pasta. So, it is a little bit less healthy than eating the whole [inaudible 00:39:06], edamame pasta or brown rice than brown rice pasta for sure.
Dr. Chris Miller
(39:12)
That being said, if you're not in the process of healing from a chronic illness, it actually has not been shown I believe, this is my understanding, but you guys can correct me if I'm wrong. But it has not been shown to spike your blood sugar quite as high, certainly not as a white pasta anyway. And that, with a high fiber meal that it absolutely still has benefits to it. And there's plenty of fiber and there's plenty of goodness to it still. So, a small amount with an otherwise nice, delicious plant based meal can be a part of a healthy meal and something I do include for my patients. It's a great substitute if you're getting off white pasta, helping you transition. Or even if you're already on a diet and you just start including a black bean pasta or edamame. Some are healthier than others. But yeah, I absolutely think it can be part of a healthy diet and part of your meals. So, that's my take on it. But I'd be curious to hear what your guys thoughts are.
Dr. Michael Klaper
(40:06)
Well, it's an important question. And the issue, and she's right in the spirit of her question in that when you eat a whole grain, when you eat a whole rice, whole quinoa, you hydrate it with water and then you chew it up. And it takes a half hour, hour or more for you, once you swallow it, for your digestive enzymes to work their way into the grain of rice and start digesting the starch and the protein and dismantling the very complex structure that is a grain of rice or a grain of quinoa or a kernel of corn. And as a result, even though there's sugars in the starch of the rice or the starch of the corn, it takes a long time for it to find its way into the bloodstream. And as a result from whole grains, the blood sugar rises very gently, not very high. And it's easy for the body to clear it out of there, one pass through the liver and a little bit of insulin and poof, it's usually pretty much gone.
Dr. Michael Klaper
(41:11)
But when you send that wholegrain, send that rice or wheat kernel to the miller and they grind it into powder called flour, then you're absolutely right. That changes the characteristic. That starch is now freely available to the environment, if you like, your digestive enzymes. The fiber that's been holding those starch granules is now all broken up. And as a result, when you turn that flour into a cookie and you eat it, nothing slows down the absorbs the sugar in the flour now. It's easy to turn into simple sugars, leaps into your bloodstream, sugar levels go up. And you wind up with all the problems, the high insulin and all that that comes from a lot of sugar in your blood.
Dr. Michael Klaper
(41:57)
So, flour products absolutely are not good for you as far as blood sugar levels and all of that applies. And so, I'm not a big fan of flour products for that reason and a few others as well. So, where do pastas fit in there? They're a bit of a different beast because a couple of things. There's different types of flour. If you're making cookies or cakes, you want flour that's mostly sugar, mostly starchy. And so, those are the pastry flours. And you find they grow wheat that is especially high in starches in terms of the pastry flour. But those are the soft wheats. But there's a whole other strain of wheat called hard winter wheat. And hard winter wheat, this is high gluten wheat. This is high … It is pasta flour, and it is a very high protein content because you're going to be making pasta out of it. And they want that protein to maintain the shape of the noodle. And so, pasta flour is a high protein flour, much lower carbohydrates.
Dr. Michael Klaper
(43:14)
And when they turn it, when they do the pasta thing, they cook it, they add the water, they extrude it through the machine, etc. The protein combines with the starches, with the flour. And as the pasta cools and sets and dries, the starch grains are incorporated into the protein fibers of the pasta. And that's what gives the pasta its al dente chewy flavor. And as a result, when you eat it, a lot of the starchy carbohydrate is locked up with the protein. And as a result, pasta is digested over a longer period of time. And the blood sugar, as Doctor Miller has suggested, rises much more slowly. It's a gentler form of carbohydrate, to say the least.
Dr. Michael Klaper
(44:05)
And so, unless you're frankly diabetic where sugar is an issue, pastas, depending on the kind of pasta, is often very gentle with the blood sugar. And finally, as your question, nowadays, it used to only just be wheat flour, as what you get in past days gone. But nowadays, you get pasta now made out of edamame flour and soy flour and rice flour and all these different flours that are higher in protein. So, especially the legumes, the bean flour, so the lentil pastas, the bean pastas are very low glycemic indices. And so, if it's an issue, go with the leguminous protein and the particular pastas you're choosing. But by and large, long answer, but pastas are more of a whole food than both flour products are. And they're generally much gentler with the blood sugar issues.
Dr. Laurie Marbas
(45:04)
Yep, great. Excellent.
Dr. Chris Miller
(45:05)
Love that. Yeah. I was wondering, as I'm listening to you talk, Doctor Klaper, this is a question I'm going to put out there for you and for everyone, but if you know that … You know how when you cook potatoes and then you cool them, it increases the resistant starch, so it's a great prebiotic. It's good for microbiomes. So, as I'm listening to you talk, is it a similar thing?
Dr. Michael Klaper
(45:22)
Absolutely.
Dr. Chris Miller
(45:22)
Interesting.
Dr. Michael Klaper
(45:24)
Absolutely, that's what happens, right. The starch reconstitutes itself and it then becomes a more resistant starch and much slower absorbed, just like … Yeah, that's a good point. Thank you for adding that.
Dr. Chris Miller
(45:36)
That's interesting for bringing that up. Yeah, wow. See what we're all learning today.
Dr. Laurie Marbas
(45:42)
That's excellent. So, exactly. So, we do work a lot with diabetics. And I tend to remove any of the pastas and the flours in the very beginning at least until we see what they do, because I like to experiment on myself. So, I've used a few continuous glucose monitors over the course of time, just to see what a normal … I don't have diabetes, but I just would like to see what's happening, because there's not a whole lot of studies on the normal response to blood sugars on people without diabetes. And it was interesting. I ate rolled oats, which I've done for years, and the berries and the bananas and soy milk and pumpkin seeds with it every morning for like a decade. And my sugar went up to like 163. And I was like, “Wow.” And so, then I went to the steel-cut oats from those roll cut oats, and it barely hit 130.
Dr. Laurie Marbas
(46:27)
So, it was just really interesting, even in someone who doesn't have diabetes, but your body still, it's an example of that processing. That processing does allow that absorption to be much faster. And what I think I've found with cooking, just kind of a cooking tip is, when you have like it call for, let's say a white flour or something in a recipe that you want to make, I use chickpea flour. And I try to do half of whole wheat flour and then maybe half of the chickpea flour and that works really well. So, I don't know if you have any other maybe cooking tips, Chris or Doctor K., as far as it might be helpful in replacements?
Dr. Chris Miller
(47:02)
One of the replacements I use for my people with a lot of food sensitivities, once they've healed the initial part. This is not phase one, but a little bit further along. I like the green banana flour. Mostly, I first chose it because it's not gluten, it's not a green. It's just sort of out there and people weren't reacting to it. So, I just kind of chose it for that reason. But then as I learned more about it, it's also prebiotic fiber. So, it's filled with resistant starch and it's a good one. But that's one that I like when I'm baking. And again, like Laurie, I like to mix a couple different ones. So, a little bit of bean flour with the banana flour, and then possibly an almond flour if I need it to be a little fatty or something. So, I play around with that. I don't do a lot of baking, so it's not something I play around with too much, but every now and then.
Dr. Laurie Marbas
(47:53)
Yeah, the cassava flours are very interesting too. But every one's a little different, the density and stuff. But it's a whole nother topic. But I do have one other question. I know Doctor Klaper, you have a meeting in 10 minutes. But I think this would be a great final question from Brian. He says, “Since eating a plant based diet, started five years ago, my fingernails have become thin and brittle. For my whole life until then, I had thick, strong fingernails. Any thoughts or suggestions?”
Dr. Michael Klaper
(48:23)
Get the oils back into your nail plates there. But make sure that … The other issue is, make sure you're getting enough zinc into your diet. And all the more reason to eat whole grains, legumes, and root vegetables, beets and carrots and potatoes, things that suck the minerals out of the soil. But the grains and legumes also have zinc. So, make sure that it's not a zinc deficiency. But, have you changed your job or your position that makes you wash your hands more? If you're now a nurse in the ER, you may have a reason why you're losing oil there.
Dr. Laurie Marbas
(49:08)
Exactly. Chris, any thoughts?
Dr. Chris Miller
(49:10)
Yeah, I don't have much more to add to that. I would agree with Doctor Klaper. I'd just say, that's a tough one. So, I would want to take a look at what you're eating, make sure you have a balanced diet, make sure you're getting enough of everything. And we are all different. Some people aren't absorbing as well. So, if you're having some malabsorption, you may be deficient in some of your vitamins and minerals. And I see that even in people if they have IBS symptoms or gas or bloating or indigestion, or even just the mildest little … You know? Their gut's not functioning perfectly 100% normal, they could have vitamin deficiencies. So, Vitamin D, and like Doctor Klaper said, the zinc and the B vitamins, magnesium, calcium. These are absorbed in healthy small intestines. So, anyone who's having issues with that may be a little bit deficient. And sometimes I put them on a … I would maybe consider a good multivitamin, at least for a short time, see if that can help too. So, just some extra thoughts.
Dr. Laurie Marbas
(50:10)
I think that's a really good point, Chris. Several there. One, when you see someone who they're like, “I went on a plant based diet and I just didn't do well. I didn't thrive, I had stomach issues.” So, that's where you're talking about the IBS SIBO issues. And we have a really nice way of looking and working patients through that. And it's been very successful. The other thing is, if you are on a wholefood plant based diet, the beautiful thing is that we can check those levels.
Dr. Laurie Marbas
(50:36)
So, it would be a good thing to make sure that you are getting everything that you need. If you have any questions, if you're having these odd things like thinning nails, that's the other thing that we can do is we can see people who are healthy, just do a once over, see how you're eating, let us check some vitamin levels, make sure everything's on par. And it's a great way to just kind of reassure yourself that everything that you're doing is to the utmost ability to continue being healthy. But Doctor Klaper, any final words before … I know you have to check off before your next meeting?
Dr. Michael Klaper
(51:08)
Right. No, feed your skin like you feed the rest of your body. And your skin is never not looking. It knows what you're eating, just like your arteries and your liver and everything else. To thy own skin be true. And keep it hydrated, and be cautious with the sun. That's all. Yeah.
Dr. Laurie Marbas
(51:36)
Absolutely. And you know, it's like the canary in the coalmine, right? So, it's a sign. So, it's maybe an early indicator that something else is going on in the body, a lot of inflammation. So, if your skin's erupting, there's an inflammation occurring somewhere. Like, Chris was saying, the gut and some other places. But Chris, any other final words of wisdom?
Dr. Chris Miller
(51:55)
No. Well, I guess, yes. That was a fun talk, so I have been thinking about the skin. So, thank you everyone for agreeing to do that. And there's one other thought that I'm going to leave us all with. And that is, with coronavirus, we're all using a ton of the alcohol. And before coronavirus, I was trying to not use as much of it, especially for autoimmune people or higher risk people, because some of the chemicals in it, like triclosan, have been shown to disrupt hormones. So, some people with hypothyroid, it could be an issue. And it's known to change the bacterial count, right? Because it's bacteriocidal, it's killing bacteria. It kills both good and bad, harmful and non-harmful microbiome on our hands. And it's leading to an increase in bacteria resistance to the antibiotics. And so, this is a real problem.
Dr. Chris Miller
(52:49)
And so, even things like what we call MRSA, we see a lot of this, this is methicillin resistant. It's a resistant type of bacteria. And there's also the non-resistant form, which is [staphorias 00:52:58]. And so, people who just had staph used this alcohol all the time, and they were showing an increase now in MRSA. And this was in hospital workers. So, I have been very aware of this for many years. And I work in the ER. And I would always try to find a sink and soap and water as much as possible. Sometimes you can't, you just use alcohol. I do it, I do. I use alcohol too. But when I could find soap and water, plain old soap, non bacteriocidal soap, just regular soap and water, that alone kills viruses and bacteria. So, I was encouraging my patients to use soap and water and using it myself and my colleagues and people I was working with for those reasons.
Dr. Chris Miller
(53:38)
And I was talking to hospitals saying, “Let's take out this, these bad chemicals that we are exposing all the hospital workers to.” And then this happens, COVID-19. And now we have alcohol everywhere. And I agree, I'm using it too because I'm scared, right? You don't want to die or get really, really sick from COVID-19 or spread it. So, it is important. But at the same time, I just wonder what it's doing to our hand microbiomes and what's going to look in the future. Like, what's going to happen because of this? And so, I'm curious. I'm looking for data. I'm just kind of watching it. And I'm still doing my best to use soap and water, 20 seconds, whenever I can. And try to avoid a little bit extra alcohol if possible. So, I don't know. That's my thought that I'm going to leave with.
Dr. Laurie Marbas
(54:22)
And one thing too is, when you do wash with soap and water, you don't … 20 seconds or so, if you sing the alphabet, that's typical. And then, just hydrate right afterwards with a really good hydrating lotion too and that will help. It's like, every time I walk by the sink or wherever, I just grab some lotion and rub it on. Again, I'm in Colorado and things kind of suck you dry. Feel like a prune some days. But hydrate after you wash your hands too and that may help alleviate some of the dryness. But it does make you wonder about the microbiome on our skin and everything else, 100%. And the longterm effects of the COVID-19 are a bit frightening as well. Like, what are people going to be dealing with for years after having an illness? But anyway, that was an amazing talk, guys. Thank you so much.
Dr. Laurie Marbas
(55:04)
And if you'd like to see myself, Doctor Miller, or the amazing Doctor Klaper as well, and Doctor Miller is my own doctor because I have hyperthyroidism, so she's brilliant. You guys, check her out at plantbasedtelehealth.com. And we'd be happy to serve you the best we can. We're in 40 states. We're working on the last 50. I'm trying to be the last doc in the country to be licensed in all 50 in the plant based sphere. So, we're working on that. And we also can consult with folks outside of the country as well. So, we hope you will come see us there. And have a great day. Thank you.
Dr. Chris Miller
(55:36)
Thanks everyone.
Dr. Michael Klaper
(55:37)
Bye, everybody.
Dr. Chris Miller
(55:37)
Bye.
Dr. Michael Klaper
(55:37)
Bye.