Leaky Skin & The Skin Microbiome with Dr. Raja Sivanmani

Dr. Cates: Hi there. I’m Dr Trevor Cates. Welcome to The Spa Dr. Podcast. Today we’re diving deep into the topic of the skin microbiome. If you’re not familiar with what that is we’re going to talk all about it today, but basically it’s about the micro organisms that live on your skin that keep it healthy and looking great, vibrantly healthy, and we want to talk today about what you can do to help support your skin microbiome so you can really see those results on your skin. And my guest is Dr Raja Sivanmani. He is a board certified dermatologist and Ayurvedic practitioner practicing at Pacific Skin Institute. He is an adjunct associate professor of clinical dermatology at the University of California Davis and director of clinical research and the clinical trials unit. He’s also an adjunct assistant professor in the Department of the Biological Sciences of California State University in Sacramento. He engages in clinical practice as well as both clinical and translational research that integrates bioengineering, nutrition, plant science, cosmetics and skin biology.

Dr. Cates: He has published over 100 peer reviewed journal Manuscripts and a textbook titled Cosmeceuticals and Active Cosmetics, the third edition. With training of both allopathic and Ayurvedic Medicine. He takes a holistic approach to his patients and in his research. So today we’re talking about, we’re talking about the skin microbiome, what supports at both from the inside with food and supplements and also what aspects of your skin care routine could be damaging your skin microbiome and which parts actually could be supporting and helping it. We cover research, testing, and what’s coming up on the horizon. So please enjoy this interview.

Dr. Cates: Raja, welcome. It’s great to have you on the spot on your podcast.

Dr. Raja: Oh, I’m so excited to be here with you, Trevor. It’s, it’s been fun watching all of your previous podcasts and it’s fun to now be on it too.

Dr. Cates: Yeah. Great. So we’re going to dive into the skin microbiome. I love this topic. I don’t know
if everybody else loves it as much as you and I do, but I think it’s important. I think it’s an important conversation to have. So let’s start off by like what is your definition of the skin microbiome? How do you like to describe it to people?

Dr. Raja: Yeah, talk about a trending topic, right? The microbiome and all of what it means. And I, I really appreciate you just having a slow it down and just talk about what does that mean? So the microbiome basically refers to the very fact that we have all kinds of organisms that live on our skin. We don’t live in a sterile world and all of us are covered in bacteria, we’re covered in fungi. We’re covered in believe it or not, we’re covered in mites and as what we call you carry out. So there’s all these different kinds of organisms that live in our skin. And the microbiome is the collection of those organisms altogether with all of the different secretions that they put out and all the signals that they’re sending to each others, just like this, this factory of organisms that are living on our skin. And in fact, I think they make up more cells. When you look at the our gut and also our skin, there’s more of them than there are of our own skin cells. So it’s pretty fascinating. Pretty complex.

Dr. Cates: Yeah, it is. And it’s, it’s so exciting to see all of this unfold and the research to really come to light, a lot of the things that impact the skin microbiome that we never knew before. And so it’s, it’s both internal from the gut microbiome and that gut-skin connection as well as what we’re doing externally to the skin. And we have, we’ve done a lot of damage over the years, to the skin microbiome. So first, let’s talk about what are some of the things that we’ve been doing that have really damaged the skin microbiome?

Dr. Raja: Well, the skin microbiome has a natural harmony and the natural harmony usually depends on, and it’s, you know, it’s interesting you bring this up because a lot of us are supposed to be out in nature and get a little bit of the bugs from nature on our skin and we’re not supposed to over clean it. And we’re in a culture where we really think about, you know, using soaps all the time using cleansers and we really clean the skin to the point where we’ve almost sterilized our skin. Now it’s impossible to totally sterilize your skin. But we’ve really changed the character of those bugs to some extent. And we see this actually, if you look at civilizations and you look at cultures that are much more in tune with being outdoors and having a little bit of, Oh, I mean for lack of a better word, getting a little dirty, they have less rates of conditions like Eczema. And then when you look at industrialized nations where it’s super clean, super soap culture, you’re having higher rates of things like allergies and Eczema. So it does speak to the fact that maybe those bacteria that are on our skin, those organisms in general, play an important role that we probably have underestimated with our clean culture.

Dr. Cates: Yeah. So what are some of the skin issues that you’re seeing a lot of with your patients as far as relationship to the skin microbiome. What are we seeing more of as a result of these changes and how does that show up on the skin?

Dr. Raja: Yeah, that’s a great question. I mean, first and foremost, like I was talking about, Eczema, for whatever reason, we’re seeing more and more of that, especially among kids in um, in cleaner countries. You know, I take the residents I’m at UC Davis and we take the residents on these trips and we go out to India and Nepal, really fun trips. When we go out there, we don’t see as much eczema out there and the conditions there tend to be maybe things like fungal and other sorts of issues. But when you have these chronic skin conditions that are dependent on chronic inflammation, I think what happens is when you shift the skin microbiome off of it’s whatever it should have been, it’s natural harmony, you start getting these conditions that tend to cause a bit more inflammation in the skin barrier isn’t as good either. And so, Eczema is a classic classic example. I think as we start to learn more, we’re now starting to see that maybe they also have a role in other conditions like acne and then you start then branching out to other conditions. I mean is there a role in Rosacea and could there be a gut connection? So there’s a lot more that we’re learning, but the classic example is Eczema and that we know is definitely on the rise in in the western culture and countries.

Dr. Cates: And that’s leading to what’s called leaky skin, right? We’ve been talking about leaky gut and the gut microbiome, but now we’re seeing there’s more attention talking about what’s actually happening when we damage that microbiome and just like if we damage the gut microbiome, we’re seeing that leaky gut. So leaky skin. Do you ever talk much about this with your patients?

Dr. Raja: Oh, we talk all the time about this because we know when the skin barrier isn’t working well, then it goes even beyond the microbiome. The microbiome obviously plays a role, but when the barrier starts to get leaky, now you’re letting allergens in. Sometimes you’re letting in irritants that normally wouldn’t get through. And so the whole leaky skin phenomenon is definitely a real thing. And that’s where moisturizers and using healthy moisturizers to make sure we seal that skin off, or using good practices to, you know, not over soaping to keep that skin in a healthier state is really important. And Trevor, one of the things I wanted to mention, you know we always talk about bacteria on the skin, other conditions where we have imbalances really common conditions like Tinea versicolor or if you have something like seborrheic dermatitis, the simple way we think about as Dandruff on your scalp or Dandruff of the face, that’s where you have slight imbalances in the fungi.

Dr. Raja: It’s a certain fungi, like there’s one called malassezia, and they go out of balance and then they start to create more inflammation. And so, you know, it’s not just the bacteria there, but you definitely have other organisms. And then going to what you’re saying when you have inflammation, now you’re opening up those channels on the, on the skin barrier. And then it becomes even more susceptible than inflammation. So sometimes it’s a negative. It’s, it’s a, it’s a bad feedback loop that ends up to inflammation leading to more dysbiosis and then more inflammation so it can be an issue.

Dr. Cates: Right. Absolutely. And so I’m just kind of curious what that, with leaky skin, does that make people more susceptible to toxic skincare ingredients get absorbed? I mean, is that anything you’ve heard about?

Dr. Raja: Yeah. Well, you know, what we do see is we see a condition called sensitive skin syndrome, a lot in dermatology where, you know, we don’t really have a set diagnosis. It’s, you know, maybe there’s a little overlap to really sensitive skin conditions like rosacea. But what ends up happening is the skin is, becomes so porous that irritants get in an easily inflamed the skin and that in turn makes the skin even more porous. And then anything they put on their skin becomes an issue. And, in terms of toxins getting in and getting in more easily. Um, even when you look at allergens, things where people wouldn’t get exposed to certain allergens or allergies, they start to develop them earlier when their skin becomes a little bit leakier because now they’re getting exposed to things that they weren’t supposed to be exposed to. And so that is definitely a real issue and sensitive skin syndrome is definitely a real issue. I mean, I see people coming in with all kinds of products that they’re trying to put on and sometimes you just got to clean out all of those ingredients and just like go back to basics and reset and then just pick products one at a time that are really much more, I would say not so irritating. And so there’s, you know, there’s a few ingredients that are really good about that. Like certain natural oils are not as an irritating, just like reset the palate sometimes for some folks. And, you know, it’s a challenge.

Dr. Cates: Absolutely. Yeah. So with antibiotics, we realize that antibiotic overuse has been an issue and that that has created some issues with some dysbiosis of the gut as well as using, what we put on the skin. Do you feel like there’s a change happening in medicine and dermatology have a shift away from antibiotics or do you feel like it’s still continuing? You know, it hasn’t really changed. What do you kind of see are the trends there?

Dr. Raja: It’s about time, isn’t it? Trevor? I feel like the naturopathic medical circles and Ayurvedic medical circles, have been talking about the need to get away from unnecessary antibiotics for a long time. It’s absolutely changing. There’s no question. We know antibiotics are probably one of the most commonly used medications in dermatology because they’re anti-inflammatory. And so we use them for conditions that aren’t classic infections. Things like Rosacea, acne and sometimes an Eczema too. When you’re trying to rebalance the bacteria, we’ll give antibiotics. But now we’ve really moved towards reducing these antibiotic courses and we’re definitely searching hard for alternatives, are moving towards alternatives as much as we can. And you know, the thing that we don’t understand is when you give someone a course of antibiotics, we do think that the gut microbiome, the bacteria in your gut, they shift to cause the good bacteria get affected. And then the question is how quickly can they recover? And we don’t know. We think maybe over a course of six months, maybe even the course of three months, but it might depend on the bacteria and it might also depend on the antibiotic. But there’s definitely the shift that we are now realizing that putting antibiotics out there for conditions that aren’t bonafide infections is probably not the, the long term. It’s not gonna be good in the long term.

Dr. Raja: One small thing we know we have this resistant bacteria called MRSA, Methicillin-resistant Staphylococcus aureus. And it’s in the community is too, sometimes they call a community version of it and then there’s really nasty ones that are found in the hospital. But even out in the community, you know, this is something that happens with football players or like if you play a lot of sports and share a lot of gear and what we’re starting to see now is doxycyclin which is the classic classic antibiotic that is being used to treat things like acne. We’re starting to see just early signs that maybe there’s more resistance now to doxycycline, which used to be able to be used classically to treat that resistant bacteria. Now we’re starting to see that that vector is starting to become resistant to doxycycline and that might serve as an early wake up call that we need to start looking for alternatives or alternative approaches.

Dr. Cates: Yeah, I mean antibiotics and certainly have throughout history have saved lives. But we have I think became a little bit to depend on that. And there’s so many other anti-inflammatory, um, you know, supplements, nutrients, herbs that we can start incorporating to use. And then when we need antibiotics, then we can use them. And that way they work so much better. Right?

Dr. Raja: Absolutely. 100% agree with you. You want to use the antibiotics when you need them and then we need to find other ways to talk to our patients. I mean one of the things that I do, and I’m sure that you have, you’ve had your own journey with your skin about diet and we talk about nutrition and that didn’t used to be the conversation when I was in residency, but now I feel like that is really important.

Dr. Cates: Sorry you cut out there for just a moment. Um, so you were saying that you, you would, did you say something before we start to talk more about diet?

Dr. Raja: Yeah, I was going to say that antibiotics absolutely are being overused, especially in the sense that we, we’re using them for conditions that aren’t classic infections and like you said, we should save them for when they’re actual infections. And so now I’m trying to incorporate much more conversations around other features that are really important in controlling things like acne, like for example, nutrition. So I didn’t use to have these conversations around food and diet. It’s almost mind blowing that we didn’t used to have these conversations when I was a resident, but now we do and we do talk about healthy eating. We talk about healthy lifestyle in addition to whatever treatments we’re going to do to try to get the acne under control with the absolute goal of transitioning people off antibiotics and maybe even in hopes of not having to ever start antibiotics if we don’t need to.

Dr. Cates: All right, absolutely. So what are you finding in the research? Let’s talk about the research when it comes to the skin microbiome because this is fairly new, the the things that are coming out. What are you seeing as positive trends and information that’s showing up in the research now?

Dr. Raja: Yeah, so in the skin microbiome world we’re starting to understand, and I think this is really important to realize that we are a dynamic and diverse group of microbiomes that kind of traverse the entire human body. It’s like when you think about the world, you will have different sorts of climates in different regions. And the same thing happens on our skin cause we’ll have a bit more oily skin on our face, upper chest, upper back, and there’s a different kind of organism that grows there. So we’ll have dominant organisms and dominant bacteria. Then when you get into areas like the armpits or you get into, drier areas like the arms or the hands or maybe, you know, sometimes we have sweaty feet and those sweaty areas get a different group of bacteria. So we’re realizing that it’s not just one microbiome, that we have a diversity of microbiome that kind of goes from head to toe truly. And then it really depends what conditions you’re thinking about that you may have different shifts in your microbiome. You know, there’s some cool new, um, uh, antiperspirants and deodorants that are now coming out that are trying to help control the microbiome in your armpits as an example to maybe prevent odor from ever developing. Wouldn’t that be cool if you could actually have a way of controlling that so that you don’t have to necessarily try to mask the odor but just get rid of the source in the first place and make it a much more pleasant kind of a microbiome there.

Dr. Cates: Absolutely. And I saw a study looking at Anna perspirant actually creating more of the malodorous forming bacteria. So using an antiperspirant creates more of the stinky bacteria. So here you are trying to get rid of the bad smell from the armpits and you’re making it worse.

Dr. Raja: You know, there are some companies out there now that are actually looking at potentially using their mix of probiotics to try to make it so that you never have to use deodorant again. I haven’t been so brave to take that option because sometimes, you know, when I’m doing surgery I’ve got my arm right over someone and the last thing I want to do is offend someone. It’s a really interesting, it’s a really fascinating idea to think that you could deliver either a probiotic or something to the skin to then just reshift its balance. Now I don’t think the science has shown that you can do that. Absolutely. But boy, it’s interesting that we’re studying that right now.

Dr. Cates: Yeah. So let’s talk about probiotics on the skin because this is a big thing in skincare, it’s a lot of marketing and a lot of money is being spent by skincare companies to create probiotic skincare. So do they work? What do you think?

Dr. Raja: Yeah, and maybe you know, what we can do is, let me give a little primer to the three kind of main probiotics that are being used in skincare so that everybody, when you’re looking at your skincare product, you kind of have an idea of what you’re looking at. So the three main categories you have are probiotics and then you have prebiotics and then you have postbiotics and, and then sometimes you have any combination of the three and uh, and to start with probiotics or bacteria and they can be alive or dead. And there’s some controversies around should you deliver bacteria versus dead bacteria. And Trevor, we can get into that. I think that’d be really interesting conversation. And then you have prebiotics. Prebiotics are super interesting. They’re basically substances and typically sugars that help other bacteria grow. And when you think about it, a classic example of this is when you eat a lot of fiber, that fiber, even though you can’t digest it, the bacteria in your gut are able to digest it and somehow those bacteria using that as food in the same way you can give prebiotics to the skin in hopes that you can get some of the skin bacteria to take hold and use it to then selectively grow or not.

Dr. Raja: And then you have postbiotics, which is very interesting where you take bacteria, you grow them, and then you look at all the substances that they make as a byproduct. Then you collect all those substances and with the whole idea that well, bacteria know what they need to make to help themselves survive better. And they can also channel other bacteria or other organisms to survive better. And so what you can do is you can take healthy bacteria and then get their byproducts and then put that into a product and then say, hey, we’re going to deliver this directly to the skin. So that’s a postbiotic. When it comes to prebiotics, I think it’s hard to get prebiotics, even if they’re live bacteria. Of course dead bacteria won’t survive on the skin, they’re temporary. But even with live bacteria, it’s very hard to get them to stay and stick on the skin unless, and this is the coolest thing that people are doing, unless you have a way of finding a bacteria that’s already on your skin, finding a way to then make it healthier and then delivering it back to you.

Dr. Raja: That’s kind of like the new age stuff that people are doing, but the stuff that you find skin products, I’m not so sure that it’s sticking on the skin, but that still doesn’t matter because at the end of the day, even if the bacteria is alive or dead, they’re able to do surface to surface communication with the other bacteria that are on your skin and still they can modulate inflammation, they can reduce inflammation, and they may even actually stimulate other processes you’d like. They can help with facial rejuvenation too. You know, one of the studies that we’ve been working on was to look exactly at that. It’s about to publish. I can’t talk too much about it, but it’s exciting that, you know, there’s some topical cosmeceuticals that are now incorporating probiotics as part of it.

Dr. Cates: Yeah, there are so many different layers to this. I mean, one of the things that’s interesting to me is that the FDA regulations around bacteria in skincare products, that there are regulations around what can go to market with bacteria in it. And that’s kind of, you know, it’s a little bit of an outdated approach, but that’s what we’re working with right now. So that creates some limitations on the skincare manufacturing side because we can’t, we’re not supposed to be really putting in live bacteria in according to the current regulations, but that’s on the premises. That bacteria is bad. Right. But now we know we’ve got these good bacteria, so now create some confusion and some confliction about the regulations around skincare products.

Dr. Raja: Yeah. And I think the way that folks are getting a, not around it, but they’re having alternate ways of approaching this, like you’re saying, is to then focus in on these prebiotics. Or if they’re not live bacteria, they’ll, they’ll put some groups together and create sinbiotics, which is just basically when you put a pre in a probiotic together or these postbiotics. I mean there are, you know, there is no live bacteria at all and sometimes they can even be more stable in your skincare products at room temperature and whatnot. And so, you know, I think, I think companies are trying to figure out other ways to build in the beauty of the microbiome without having to deliver a live bacteria.

Dr. Cates: Right. Because then there’s also what the live bacteria can, I mean, how can they survive on the skin? Yeah, it’s hard. It is hard. You know, the skin is so bolstered in, it’s like a fortress. It has a group of bacteria that are sitting on the skin as its own biofilm is like this specialized product that bacteria make when they get into big enough groups, then that can really set the stage for how they survive and how they protect themselves. It’s really hard to crack that shell, you know, as throwing in an external bacteria. But maybe you can change the way they behave temporarily and that might be what you need on an ongoing basis to keep your skin healthier. We don’t know. We’re still working on some of that research, but you’re right, it’s hard to get an external new, it’s hard to get a new stranger to take up shop.

Dr. Cates: That’s good. Well, I mean, it’s hard enough with probiotics. Oral probiotics have been used for many years and we’re still having challenges with that. Even though those had been around for a long time of how do we keep them stable and how do we make sure that they get where they need to go and that you have find the right balance and everybody’s a little bit different. And, and with the skin microbiome, you have so many external factors. You’re just, you’ve got other people around you with their own their skin microbiome actually yours, yet your animals, your pets, you know, everything around you. It’s nothing really. Not a controlled environment.

Dr. Raja: No. You know what’s very interesting, you just reminded me to talk about this. We all have a microbiome cloud around us and you know there’s a signature to your particular microbiome and they’re talking about maybe in the future and forensics when you leave a room that there’s this lingering microbiome that’s specific to you so that people can then take a snapshot of the bacteria that’s left behind and say, oh, that’s Raja’s microbiome. You know, it’s kind of really futuristic stuff, but it’s interesting to know that we all have a microbiome cloud and you know what that means? You start to share your cloud with those that you are close friends with and co-habit with and it turns out there’ve been a few studies looking at this. If you have a pet like a dog, that everyone’s petting that’s going around the house, you start to share your microbiome because of that dog. In fact, it lowers the risk for you to develop Eczema in a child because you’re helping diversify that child’s natural. I thought that was the coolest stuff when I heard about that.

Dr. Cates: Yeah, that’s really amazing. And what you said too, I want to call attention to the part about diversity. That is really one of the key aspects, right, of having a healthy skin microbiome as we don’t want it to be limited. We want diversity, right? And we want healthy diversity. But that’s a big part of what’s happening with 11 people with skin issues is they’re lacking that diversity, right?

Dr. Raja: Yeah, it’s right. You know, when you think about diversity, what that really means is that you have a breadth of organisms. Now one of the caveats there is when you get really, really, really dry skin, you can also have like, you know, if you happen to have like one bacteria of each, then you can also end up getting high diversity. But overall you want to have high diversity. Absolutely. Because if you have a very, a low diversity means you have one dominant organism and we have a word for that. It’s called infection. And usually you don’t want to do that. So you want to have a broad, a breadth of bacteria and other organisms too. Sometimes we forget about the natural fungi on our skin and I’m sure that they’re going to play an important role too. So we want to have a nice broad, diverse population as much as possible.

Dr. Cates: And there’s a lot changing when it comes to research. I know you’re big on research, there’s a lot changing and to be seen in the future of the research around skin microbiome and part of is the testing actually testing the skin microbiome. A lot of challenges with that. Just doing the research on what do we have, what do we all have and then, and you know, a treatment, what kind of change does that create? Just the testing alone is challenging.

Dr. Raja: Can I tell you, you know, this was a really fascinating outcome of something that we did with testing. First of all, the testing, it matters, like where you collected. Do you collect from the mid forehead? You get it from the side of the eye? Do you get it right here in the crease of the nose? All of these areas matter. But you know, it was really interesting. We had people that came in and we just checked their microbiome and their diversity before they started using a cleanser. And then when they used, they all started using one cleanser. It was amazing. Their diversity shifted. And in fact they became, they became more diverse after they all started using this cleanser. And it was, it didn’t have to be any specific cleanser. We actually had people in a couple of different studies use different cleansers, but it just goes to speak that sometimes the stuff that we’re putting on our face on a regular basis can sometimes lower the diversity of the bacteria. And when we just had people as part of research, we always put them on one cleanser to get everybody on the same page. But what we didn’t expect was that even just the pre study portion of the study led to people having a more diverse microbiome. And so we thought, gosh, what are we putting on our skin that might be reducing the diversity out of the gate. So that was, that was eyeopening.

Dr. Cates: Yeah. But it’s exciting. Yeah, that’s really interesting. And so it’s also exciting to see that it looks like the testing is getting more specific. We’re finding more about the different strains of bacteria and not just for example, p acne bacteria, something that’s been linked to acne for many, many years and people, but now we’re learning that there are certain strains of the p acne bacteria that are actually protective. So it’s not just p acne bacteria, but some strains are better than others. Right?

Dr. Raja: That’s right. Yeah. And going with your example with the probiotic bacteria acnes and now they’ve renamed it, actually now they called it c acnes. But you know what they, what they found is that c acnes yes, it was associated with acne, like you said, but people that didn’t have acne had it too, just like you mentioned. And so then it became this, it became this challenge then and understandable. Why were some people getting it and other people not. Then they had to really dive down into the strain, just like you said. And they’re saying, okay, these certain Ribo types, which is a different subsets of c acnes, they were linked to acne and other ones were not. And you know, in the, in the microbiome world, I’m still not, and many of my colleagues aren’t totally convinced that c acnes is the culprit. We actually think that there may be another bacteria like staff, Epidermitis, which is commonly thought to be healthy. But when you, when you, when you put it in a different environment down the hair follicle where there’s less oxygen, sometimes it can be a little bit more inflammatory. So, but I think the point being that now we’re understanding that different bacteria, it’s not just having that bacteria, but there are different subsets in there. There may be different from person to person and change how they get disease. Just like you’re saying.

Dr. Cates: Right. So I know we can probably get really granular here on people.

Dr. Raja: We can totally nerd out on this right Trevor? But we’ve got to be careful. We can go down a big down rabbit hole here.

Dr. Cates: Right. But going back to probiotics and skincare products, cause I do think that this is something that we’re going to see more and more of. And people are asking me do they work? Are we, is it too soon to use probiotics in skincare? Do we need more research on this or do you think there’s enough research to show that we’re ready for prebiotics, probiotics, postbiotics or maybe just one of them?

Dr. Raja: Yeah, I think we’re there. I think that there’ve been enough studies now building showing that there are different beneficial effects that you can get out of the probiotics. What I would say is look to see if the company that you’re buying from has done a study with that product and the studies can be done robustly. I mean there’s a many companies now that are doing studies on these prebiotics postbiotics and they’re starting to incorporate them. I don’t think that is of the future. I think we already are starting to see some cosmetic benefits with some of these prebiotics and postbiotics and we also are starting to see that it can shift the way the skin is inflamed. It can shift how the skin is inflaming. It can also shift the natural tendency towards having like an imbalance in the skin. So I think that using probiotics now topically for skincare does have a role, especially from a cosmetic standpoint now does it change disease? That’s the million dollar question. And I think that we’re looking at that, especially for conditions like acne. There was a really cool study that was done for Eczema where they used a bacteria called Rosea Monez and they looked at delivering that topically and they found that that actually helped improve Eczema in the folks that received the probiotic. So I think we’re getting closer and closer and it’s, it’s an exciting time right now. And I, I don’t think that it’s a farfetched idea to think that probiotics in your skincare could have an effect.

Dr. Cates: Awesome. That’s so exciting to hear. And I think that, I mean, there’s just, there’s so many opportunities in this, but I think, you know, what do you think about this idea of people using yogurt and DIY skincare and people saying, okay, well it’s the probiotics like you find in your supplements. Like you can take those same ones that you take in supplements and put them on your skin. What do you think about that part?

Dr. Raja: Yeah, you know, this is something that comes up frequently in questions and I think it’s … first of all if the yogurt feels good, just do it cause yogurt has other, other properties like it has lactic acid has other things that might actually help brighten the skin or help exfoliate. So if you’re doing it, it’s not hurting your skin. As long as you’re not stealing from your kids’ meals, it’s fine. Go ahead and use the yogurt. In terms of the probiotics, this is a very interesting question cause you’re taking bacteria that naturally would go into the gut and you’re putting it on the skin. And I think it was a natural first step because we were thinking, okay this was good for the gut. Like bifidobacteria, it was really good to promote growth in the gut or promote certain health outcomes. But then putting that onto the skin may or may not do the same thing cause that wasn’t a bacteria that naturally was meant to be on the skin anyway, but we are seeing that there are some effects, but I guess the next question is, well, why don’t we take the bacteria that are naturally found on the skin, get them to be a healthier variant?

Dr. Raja: Just like you were saying, different strains and can we deliver that back to the skin? Will we have a larger impact? We don’t know, but right now the approach has been to take whatever would be healthy for the gut and put it on the skin. It’s not a bad approach, especially with yogurt having so many other factors that could be beneficial, but is it the best bacteria? Yeah. I’m not sure Trevor. You know, I don’t know if it’s the best bacteria. I’m actually pretty excited for these newer studies now coming out, looking at other bacteria that may actually naturally already have a house and already have a place in the skin and just making them healthier, delivering a healthier variant of it.

Dr. Cates: Great. I love that. And I agree. Like I see the lactobacillus bifidobacteria and some of these topicals and people saying that they’re getting, they’re seeing benefits from it. So I’m kind of curious of what, what part is, is it really that bacteria that’s doing or is there something else on the product? And then the other thing is taking probiotics orally, for the gut microbiome to help the skin microbiome. And there’s been some positive research on that to you and are there, so are you seeing that there are specific types of probiotics that you want to start recommending specifically for the skin to take orally?

Dr. Raja: I love, love, love this topic. I’m so happy you asked about this because I think the gu- skin access goes back to millennia of knowledge from traditional Chinese medicine and Ayurvedic medicine. And I think even, naturopathic medicine, this is whole notion of the gut being very important to heath. And I think Western medicine hadn’t looked at that so cleanly until we discovered the gut microbiome. And now all of a sudden we’re like, oh, wait a minute. We have to start paying more attention to this. Yes. In terms of looking at the effects of a probiotic for the skin, there are a few areas now we’re starting to see emerging research. For example, there was a small study done in pregnant women that had the chance of having a baby. They already had a high risk for Eczema in their kids, meaning that they had a family history of Eczema.

Dr. Raja: They had another child that already had Eczema, and so what they did was they put some of these women on a probiotic, lactobacillus rhamnosus GG, and they also compared it to a placebo, and then what they did was they supplemented them through pregnancy and then they actually followed the babies out to several years to see which of those actually went on to then develop Eczema. And it turned out the ones that got the probiotic had a 50% reduction in developing Eczema. Now it’s kind of mind blowing. We don’t know exactly the pathways that were involved. But lactobacillus, rhamnosus GG is one of those bacteria that we think maybe useful in modulating Eczema, especially in the newborn that’s going to be born. But also it seems to have a role in itch. And so that’s one, one small example of a bacteria that we’re starting to learn more about.

Dr. Raja: There are some other bacteria too, like we’ve done our own research now and we’re starting to see that there are some, there are some blends. There’s a, there’s a blend of bifidobacteria and lactobacillus that was compared against an antibiotic. Going back to this whole antibiotic thing that we’re talking about for acne and what they found was … are we okay talking about brands here? If I mentioned a brand? Yeah, well it’s called healthy trinity from nature and I have no conflict of interest with the company, but I just think it was a really interesting study. What they did was they compared it against minocycline that was dosed as a hundred milligrams once a day. And they found that it was just as effective for acne, it was a small study. And when they use them together, it was synergistic. And here’s the coolest part, well I think this is the coolest part. The people that were in the antibiotic group, some of the women in there, they developed vaginal candidiasis, basically Candida infections in the vaginal area. We know that’s a problem when we give people antibiotics. What was really cool was the folks that were in the Combo group or in the probiotic group, they didn’t have any instances of vaginal candidiasis. So obviously when you take something for the gut, it’s not just impacting the skin, but you’re probably going to impact other features. Like here, the gut vagina axis was impacted as well. And so I think that’s the most interesting thing about thinking about the gut skin access cause it’s not just about the skin at that point. It’s the gut skin, gut brain, gut vagina, gut body axis, which I think now you’re really talking about holistic care. So that’s why I’m really interested and excited about this area of research.

Dr. Cates: Yeah. Yeah. I think there’s so much coming up on this. And really I, it seems like a lot of this is about building the right environment, both internally and externally to support the healthy growth, the healthy balance. So homeostasis in our body. I mean, let’s just get back to the foundation of this and both internally and externally. And so when you think about the things that feed the skin microbiome from the gut skin access, what are some of the tips that you recommend for people’s Diet in general?

Dr. Raja: Yeah. Well, you know, when it comes to diet, I think it’s really important that people move towards the plant based Diet. I think that we’ve shown that it doesn’t mean you have to cut out all the meat. I’m vegetarian as a disclaimer, but it doesn’t mean you have to cut out all the meat. But we know that a plant based Diet tends to diversify the microbiome much more. And we, we tried to get people to think about getting up to, if you can get up to double digit servings of fruits and vegetables a week, that’s amazing because, and the more colorful fruits that you eat, that’s really important. But we’re also finding that some of these herbs that we have taken for, you know, that have been used for millennia, they may be shifting the microbiome as well. We did a study ourselves looking at turmeric and curcumin and curcumin being the, one of the, one of the chemicals that’s found natural, you know, phytochemicals found within turmeric that that can shift the microbiome, the gut microbiome in a healthier way.

Dr. Raja: And then we’re doing some studies now with Ayurvedic herbs and we’re finding that there are some shifts that are healthy as well. And so I think when it comes to diet, really trying to understand that having whole foods does have a bigger impact. Um, incorporating herbs has a role. As we start to learn more and more, we’ll start to see the, those herbs aren’t just being absorbed, but they do something at the gut level. They, they do impact the bacteria and then making sure that you know, if you’re going to eat your fruits, wash them off well, but try to, if you can, as long as you’re getting them locally sourced, not full of pesticides, keep the skin on them. I’m not saying you need to eat your orange with the skin on though. I don’t know how palatable that would be. I don’t know if any of you tried eating mangoes with the skin on them, but you know, some of them aren’t so bad and I’ve done that before and that’s something to think about. Definitely with apples. Keep the peel on. There’s so much goodness in the pill that might be affecting your microbiome as well.

Dr. Cates: Right, right. And so, so we talked about nourishment from the inside out, now nourishing the skin on the outside and providing the right environment for a healthy skin microbiome. What are some of the things that the skin just needs and basic daily care to help support a good skin microbiome?

Dr. Raja: I think this is a fantastic conversation. First and foremost, your skin has a healthy zone that it wants to be in your skin, wants to be slightly acidic. And that’s important because not only does it control how your skin functions, but the bacteria that stay on your skin are also dependent on you having that slightly acidic environment. And so when you start to use things like soap or you start to use things that are very caustic to the skin, you literally strip the skin’s natural environment away and that is going to shift your microbiome and not only your microbiome, your skin barrier, and all the natural functioning enzymes out of whack. And that’s something that we have to be careful about. So what you want to do is you want to use products that are really focused in on one supporting the hydration in the skin barrier.

Dr. Raja: I think that’s really important. That’s where I really think natural oils, essential oils have to be used in the right sort of way. They have to be used with the carrier oil, finding things that aren’t too chemically just drying. I think that that’s also important. And I think what’s most important is knowing your skin type. I mean if you have really dry skin, you might not be able to get away with using something that has drying alcohols in it or drying emulsifiers. If you have really oily skin, maybe you can put straight coconut oil on your on your face and you might start clogging those poor so know your skin type too. I think that matters a lot and then you can start tailoring your skincare to that.

Dr. Cates: Right. I think, I think that’s so important because I mean that’s one of the reasons why I created my skin care line, the spa doctor skin care line is because you know a lot of the natural skincare lines out there, they were going free of paraben-free and taking a lot of toxins out, which was great, but they weren’t looking at how do you help support healthy skin. It’s not just about taking the ingredients that we don’t want out, but it’s also putting the right ingredients and the right, like you said, the Ph of the products. We don’t want to strip the skin. We don’t want to throw off the Ph of the skin. If we’re using, it’s getting care products, we’re spending all this money and time to put it on. We wanted to help the skin. Right? And so using, you know, the cleanser is one of the key things I think is that so many of these facial cleansers just strip the skin right away and then then you’re doing everything. You got to got to rebuild it.

Dr. Raja: I know that’s the problem. Once you fall behind, you’re always playing catch up. And that’s the, that’s a struggle. And I think that’s what happens even in some of these situations where you end up getting sensitive skin, it’s just you are using the wrong skin care items. And then the problem is you’re always playing catch up and then you kind of have to reset the pallet. So it’s true, Trevor, it’s not just about paraben-free and all those marketing things that you say. I think supporting the skin means you’re thinking ahead of how can I keep the skin healthy? So that doesn’t go out of balance. And I think that’s really important too.

Dr. Cates: Right? And so it’s not just about using a skincare product also that says it’s a probiotic skincare line, but then it has some fetish fragrance and it doesn’t have a plan mineral oil or that doesn’t have plant based oils. Right. So it’s looking at all of that, that combination. So, well Roger, it’s been so fascinating. Interesting. I know you and I could just keep talking totally nerd out. Right, right. But I’m, I want to give you time to tell everybody where they can learn more about you and all the educational opportunities that you have.

Dr. Raja: Yeah, I’m really excited about some of the programs that we’re building. So we are building a, an integrative database that’s really focused on education for practitioners and for the general public, for the practitioners. It’s something called learnskin.com but anyone can come in, many of the articles are free. We’re building different summits. You know, we have one on sun protection coming up. We’re going to have one on herbs and supplements coming up and another one on women’s health. And then I’m going to be doing an eight part series and Ayurvedic. And the part that’s for the general public is called dermveda. And that’s really where you learn about ingredients and skin types. We don’t do a lot of diseases, but just what are good ingredients and what are good skin types. And if you come there, you can take this free quiz, learn about your skin type and then start to learn what things would be good for my skin and not. And then what I’m really excited about is we’re putting together the innovative dermatology symposium and that’s coming up and that’s where we get an in person conference and we’re hoping to really grow this bigger and bigger because we get all different kinds of viewpoints together. And I’m really excited about that because I think at the end of the day, my internal goal is that we dropped this word integrative medicine and just truly becomes medicine where we, it’s actually integrated and not just, you know, one segment of medicine that’s been called medicine.

Dr. Cates: Yeah, I love that. That’s fantastic. Yeah. I was there last year and last year you had a public day. Are you doing that again this year? Cause I was one of the speakers at the public day last year.

Dr. Raja: Yes. You were on your awesome. We loved it. It was such a fun event this year. We moved it to San Diego. We’re not going to have that public event the same way this time around, but maybe in future years to come we’ll do that.

Dr. Cates: I know a lot of work to put all that together so I’m glad for doctors growing that part and you still offer a lot for the public and education like you’re talking about. Again, thank you Raja for coming on and sharing all this valuable information with us today. Thank you.

Dr. Raja: I appreciate it. And it was fun having a chance to chat about this stuff with you Trevor.

Dr. Cates: I hope you enjoyed this interview today with Dr Raja. To learn more about him. You can go to TheSpaDr.com, go to the podcast page with his interview and you’ll find in the show notes you’ll find the link to his website and his information. And also while you’re at TheSpaDr.com, I encourage you to join our community so you don’t miss any of our upcoming shows and information, and if you’re curious about your skin and your skin type, you can go to theskinquiz.com it’s a free skin quiz. We created this, at The Spa Dr to help you figure out what your skin might be trying to tell you about your overall health as well as your skin and all the recommendations that you get from taking the skin quiz at theskinquiz.com are good for your skin microbiome, both internally and externally. So again, theskinquiz.com is where you can find that free online quiz. You can also join the spa doctor on social media, on Facebook, Instagram, Twitter, youtube, Pinterest, where we’re all over the place. You could join us there and join the conversation and I’ll see you next time on The Spa Dr. Podcast.