1. Tell us a little about yourself.
I’m a dermatologist based in Houston Texas, and I’ve been practicing for over 20 years now. I began my career as a professor of dermatology at the Baylor College of Medicine, where I was heavily involved in medical student education and began writing books. About five years ago I started my own private practice.
2. What interested you in diet and dermatology?
When I was at Baylor, I founded the contact dermatitis clinic, and I've patch tested thousands of patients over the years. Because I saw so many patients with chronic dermatitis, I fielded many (many!) questions about their diet. I realized I was tired of telling patients to talk to their nutritionist or allergist about their questions, and I decided that I needed to be the expert in this area.
As I started diving into the literature, I was surprised to find how much research had been done about diet and dermatology, but which I had never even heard about. Writing with my medical students, we’ve been attacking different facets of diet and dermatology through review articles, all of which we make sure to publish open access. [Here's a running list of these publications.] In writing these articles, I was surprised by some of the research that we found relating to diet and rosacea, diet and skin cancer, diet and chronic idiopathic urticaria, and more.
3. Discuss the role of Vitamin D and atopic dermatitis.
The question of using vitamin D in atopic dermatitis is a really interesting one, and it’s been studied in multiple research studies. These have provided conflicting results, however. My conclusion from looking at the literature is that certain patients with atopic dermatitis are more likely to have a vitamin D deficiency, and therefore more likely to benefit from supplementation. These are patients who have frequent skin infections or who have food or airborne allergies. Anecdotally and from some of the research studies, some patients with atopic dermatitis and vitamin D deficiency have responded very well to supplementation.
What about patients with atopic dermatitis who do not have a vitamin D deficiency? I haven’t seen any convincing evidence yet that those patients would be helped by vitamin D supplements.
4. Describe a few of your favorite best practices for using diet to promote skin health.
I think about the link between diet and skin health as falling into three main categories.
· First, if you’re talking about a specific skin condition, is there a higher risk of comorbidities with that skin condition?
· Second, are there any “triggers“? In other words, are there any eating patterns, foods, nutrients, or compounds that may act to worsen skin disease?
· Finally, are there any "helpers"? Are there any eating patterns, foods, nutrients, or compounds that may help skin disease?
Practically speaking, that means that for patients with psoriasis, we would think about eating patterns that protect against heart disease and diabetes. In rosacea, we would talk about food triggers that make rosacea worse. In acne, we might talk about the benefits of a low glycemic index diet.
One point I want to emphasize though (and I realized this when I was giving a talk on diet and dermatology to a group of residents and they seemed alarmed) is that our goal is not necessarily to undertake this counseling ourselves. I don’t think it is feasible for most of us in a busy dermatology clinic to do intensive dietary counseling. Instead, I think our goal should be to inform, to inspire, and to refer.
Inform: "That’s a good question. Here’s a handout about some of the foods that might trigger rosacea."
Inspire: "I'm so glad you asked that, because I have had a few patients who noticed an improvement in their acne when they cut out sugary beverages."
Refer: "That’s an excellent question, and it is really important for patients with psoriasis to pay attention to their diet. Here is the name of a nutritionist who my patients have worked with in the past."
Refer: "Your blood testing has shown that you have prediabetes. Here are the names of three diabetes prevention programs, and each of these programs would be covered by your insurance."
5. Any healthy eating tips, or recipe, you can share?
One of my key eating mantras is "eat power". In other words, eat foods that are rich in powerful nutrients. I like making a veggie chili, because it's such an easy way to add in phytonutrients and prebiotic fiber. My other two skin and diet mantras are "stop sugar spikes" and "stop skin sabotage", and recipes like this one accomplish both of those as well. The high dose of fiber helps stabilize blood glucose levels, and there's no added sugar or skin-sabotaging ingredients in recipes like this one.
6. What foods should everyone include in his or her diet?
Many of the foods that are great for skin health are the ones that are great for overall health and that we’re all familiar with, like fruits and vegetables. I also add spices and herbs to my list of skin saving foods, because they are such a concentrated source of antioxidants and anti-inflammatory powers. We all need to be focusing on prebiotic foods as well. These are foods that are naturally rich in fiber and that have shown benefits to the gut microbiome. Personally, I’m also trying to add a lot more probiotic foods to my diet, especially with recent research showing benefits in reducing inflammation. Probiotic foods are those with live active cultures, such as yogurt, miso, sauerkraut, and others.
8. Does diet affect acne?
The evidence is strong that diet does impact acne. I find this fascinating, because when I started practicing, the belief was that it didn’t at all, and that’s actually what I told my patients early in my career. Now we have strong evidence that eating patterns that lead to increases in blood sugar levels can trigger a cascade of hormonal effects that ultimately can make acne worse.
· There have been a number of randomized controlled trials of a specific dietary intervention. Instead of studying a medication, the intervention has been a low glycemic index diet, which focuses on foods that avoid spikes in blood sugar levels. Studies have shown that this results in a reduction in acne lesion counts, and by skin biopsy, a reduction in inflammation and even size of sebaceous glands.
· The issue of dairy is more complex, but it does seem to play a role in some patients.
· We also recently wrote a review article about dietary supplements that may trigger acne. I now recommend asking all of your acne patients about any supplements that they have been taking. Especially be on the lookout for whey protein supplements, muscle-building supplements (because so many of these are adulterated with anabolic steroids), and high-dose vitamin B6 and B12 supplements.
9. What should we look forward to in your talk at our upcoming conference?
I’m going to be speaking about obesity and dermatology, as well as pruritus and paresthesias.
· Obesity can definitely trigger skin conditions, but I also think it’s important for us to consider that treatment of obesity may improve skin disease as well, which has led to recent recommendations that patients with psoriasis who are overweight and obese may benefit from weight loss.
· As a specialist in chronic dermatitis, I have seen a lot of patients with challenging pruritus and paresthesias, and some of these are very challenging, such as "burning scalp." I'll be discussing potential treatments for these challenging cases.