A Naturopathic Approach to Skin with Dr. Pamela Langenderfer

Trevor:  Hi there, I’m Dr. Trevor Cates. Welcome to the Spa Dr. Podcast. On today’s show we’re talking about a naturopathic approach to skin health. My guest is Dr. Pamela Langerderfer. Dr. Pamela and I attended naturopathic medical school together at the National University of Natural medicine. She’s a licensed acupuncturist and naturopathic physician. Dr. Pamela is passionate about empowering patients to lead a healthy life and find the root cause of their health concerns. She realizes that the body is one integrated system, not a collection of independent organs divided up by medical specialties so she treats the whole system, not just the symptoms and she strongly believes optimal health is best achieved in partnership with her patients.

In today’s podcast we discuss root causes of skin issues. Dr. Pamela shares her own experiences with overcoming eczema with a naturopathic approach and how she helps her patients with eczema and other skin issues. We discuss specific laboratory tests and approaches to unveil and address the root cause. As you watch this interview you may wonder what your root causes for skin issues are and how to address them so I want to remind you that you can go theskinquiz.com and take my free skin quiz to find out your skin type which corresponds to your unique combination of root causes and you’ll receive customized recommendations for you. Just go to theskinquiz.com. I hope you enjoy this interview today with Dr. Pamela.

Pamela, it’s great to have you on my show.

Pamela:  Thank you, thanks for having me. I’m excited to be here.

Trevor:  You and I went to a naturopathic medical school together many years ago.

Pamela:   Yeah.

Trevor:   It’s great to hear that you’re doing well in practice, you’ve got 2 clinics running and that’s fantastic. What we’re talking about today what we wanted to talk about is eczema and skin issues and how certain factors like nutrition and hormones play a role in our skin. I know that a naturopathic physician you share a similar philosophy as I do of we need to get to the root cause of what’s going on with skin problems. Part of that, we’re going to talk about various things of that, but part of it’s nutrition right? Nutrition plays a big role despite what some conventional dermatologists say what we find as naturopathic physicians is that nutrition really important, right?

Pamela:  Yeah absolutely. I think nutrition plays a huge role and that’s essentially what can happen when people are first diagnosed with eczema they are given steroids, then they’re given medications to suppress it. I think you know part of my story and my personal journey with this is just my own experience with eczema. I don’t know even if you remember when I was in school but I think when I was in school it was like the worst it has ever been in my whole entire life, like literally covered head to toe for 6 years and just how that emotional devastation really had impacted me and impacted everything.

When I look back at that period of time you know I remember, because we started naturopathic school back in 1996 so back then people we didn’t really have an understanding yet about gluten or even grains or what those things could do to skin and autoimmune issues. Everybody had understood that wheat had an impact. I remember when I started school and one of the doctors telling me I had to give up wheat and dairy. Like a lot of people I had that skeptical look like are you kidding me? That sounds crazy. When I had stopped eating wheat I definitely saw some things improve because I always used to have chapped lips all the time, cuts all over my lips, constantly for years and years. I had seen that improve.

Then you start to take into effect that now we’re in school and we have all this stress, we’re living in Portland, Oregon where there’s tons of mold. At that period of time too I actually would have started to consume soy. Unbeknown to myself I actually have a severe sensitivity to soy and so that was just sort of adding to the whole entire thing. I think that you know when I look at this big picture when you’re dealing with autoimmunity diet is so important and of course there are other factors that play a role but if you don’t address the nutrition part you’re just going to be continually trying to cover something up that isn’t really being fixed.

Trevor:   Right and it’s great that you had that knowledge that when you went to naturopathic medical school learning about wheat and you know sort of like gluten and all of those things. Having the stress then on top of that was just another factor that you had to address. I think [inaudible 00:05:09] people ask me with the skin problem if I give up gluten will my eczema go away or will my skin issues go away? Well it might and it might get a little bit better. I mean, it’s so hard to know because there’s different factors that play a role with different people. We do certainly see a lot of how these trigger foods are common amongst people with certain issues like eczema but it’s not across the board and it’s not 1 thing. It’s important to realize that there are multi factors, right?

Pamela:   Yeah absolutely. I think that that’s when you’re dealing with any type of chronic disease what I do is I pull out a diagram for people now and I say okay, look what we’re trying to figure out is what your trigger is. Often times it’s not 1, it’s a multitude of them. Some of the big areas that I look at are diet, which I always tell people sometimes diet will fix like 50% of what’s going on but when it doesn’t you have to address the stress because we know that high cortisol causes damage to the gut and increases gut permeability or can increase leaky gut. When you’re looking at eczema, because it is classified as autoimmune we’re trying to figure out all these autoimmune triggers.

The other thing would be medications. You know I can’t tell you how many times when I had that desperation where my skin was so bad and so inflamed and I would just break down and put a little steroid cream on it and then it would show up somewhere else. It would travel down my leg or you know it was like it wanted to come out and so the more I tried to suppress it the worse it would be. It’d almost come back with a vengeance. The other thing I think that’s really important are gut infections. Quite honestly I didn’t really realize how big of an issue that was until I started testing it on people. What we look for are different things like parasites, bacteria, yeast, these types of things and it’s actually very common. This might be why somebody tries to go in and start to heal their gut but if they’ve never identified what infection they might have going on they’re not going to really see improvements because they still have this chronic thing that the body is trying to fight off. It’s really important to just do the testing to identify what the triggers are.

Often times when people come in and we’re doing some of these more functional medicine based lab tests they’re paying out of pocket for them. You know I’ve told people I’ve kinda gotten to this point where you have to test because it gives you a road map as to what may be your triggers. Another important component of eczema can actually be your hormones and that definitely impacts mine as well where my hormones are in balance it’s kind of that other trigger that adds to it all.

Trevor:  Yeah so hormones really do play a role in our skin so let’s talk about that. How have you found hormones to be playing a particular important role in skin, in particular eczema?

Pamela:  Well one of the things that I see is that people’s hormones can change and fluctuate throughout the month, which of course we know is normal and it’s supposed to happen. But a lot of women have this issue with estrogen dominance and having too much estrogen low progesterone. The other thing is as we’ve learned more about genetics a lot of people have some genetic issues where they maybe don’t metabolize estrogen correctly. If you’re not able to metabolizable estrogen correctly and you can’t break that down and get that out of your system it’s going to trigger more of this hormonal imbalance happening and that’s where we can see sometimes just skin getting worse maybe around ovulation sometimes maybe right before somebody’s period and that’s because we’re seeing maybe those fluctuations becoming too extreme for that person.

One of the biggest things I would say that had helped my skin when it was so severe was actually Chinese herbs and Chinese medicine. That’s really the thing that turned it around. The irony of it is is that formula that helped the most is one that’s a hormonal formula. That was really what had made the biggest difference for me.

Trevor:  Yeah. What difference did you notice? Tell us more about that, what you noticed.

Pamela:   The biggest difference that I had saw was my skin becoming more softer. You know when you have eczema of course it’s extremely dry, you can have a lot of weeping skin, the itchiness, the heat that’s just so intense. One of the biggest things I noticed was that the formula that I used actually contained an herb called Dong Quai. Dong Quai as we know is a female herb but it also can be beneficial for your skin. In Chinese terms it’s in those blood tonic category and so basically I think of it as as bringing more nourishment to the whole area but especially to the skin.

After taking the herb it was actually fairly quickly, within days that I noticed that it wasn’t as hot, it wasn’t as red and then it became much softer.

Trevor:  Right and yes from a Chinese medicine perspective it’s going to be slightly a different process of what practitioner is thinking about but yeah there’s definitely different purposes for that herb. Have you had … Tell us about success that you’ve had with your patients. Since learning from your own journey I imagine you’ve been able to help a lot of your patients with eczema.

Pamela:  Yeah that’s where you think everything always happens for a reason right? Now I have to be like on my patients and be on strict diets and take supplements and figure all of these different triggers that I have out. I feel like it’s definitely a learning experience for me and it always continues to be but that’s probably some of the biggest things that I can say to my patients is that when they come in and they have something going on I encourage them to do some testing so we can figure out what the triggers are.

The one thing I always emphasize is that if people don’t see results from natural medicine it’s not that it doesn’t work, it’s that we haven’t figured out your underlying cause yet and to not give up on that because figuring out the underlying cause you know is something that’s really important and is going to be helpful just in your overall future health. The biggest thing I would say that I see with patients though is that when we start to figure some of these things out and we’re making diet changes wether I’m treating eczema or if I’m treating Hashimoto’s disease the skin is kind of that immediate information so to say where you can see if things are how are things doing. If I put them on a diet and we’re seeing their skin get worse, whether it be more acne or more rashes then I would say, okay wait that’s not the right diet for you. We need to step back and figure out what might have made that worse.

Trevor:  Right okay. Let’s talk about the tests that you would typically do. Tell everybody, what are those tests?

Pamela:  Some of the tests that I’ve found the most useful hormone testing of course, so doing hormone testing so we have a complete picture of the person’s hormones, how they’re metabolizing their estrogens, what they’re doing with their cortisol. Stool testing so we can identify those infections. As I mentioned that is a huge huge thing to be able to figure that out. I feel like for me one of the things we would be told in school sometimes is that you know somebody had sometimes I feel like could be in this category of like oh it’s Candida. Okay is it really Candida? Because everyone just get puts in this category or oh it’s parasites. Is it really parasites?

Well if you do the testing then you can actually see that oh my gosh it really is those things. The other testing I’ve found really useful is the organic acid testing where we get a snapshot of that person what nutrient deficiens they have, how their liver is detoxifying and those tests I originally ran on myself probably it’s been almost 10 years ago and it really was life changing when I did that because I could see that oh my gosh I don’t detox very well and now that I’ve done all the other genetic testing and have really dived into that I can see that genetically I am set up to not detox well. That’s why when people come back in you know they get put on supplements and sometimes they’re frustrated with that because they think gosh do I have to do these forever? I tell them you know I don’t know if I don’t know your genetics I don’t really know and I just share with them my personal story that if I go off of my supplements that help with detoxification for too long my symptoms start to come back.

The reason they come back is because I’m genetically not set up to do that very well. This is where I think in this area of personalized medicine as we see what’s happening where we can start looking at peoples genetics and see if those genes are turned on and off that’s what’s really going to be helpful, that’s where you’re going to see the big changes happen because unfortunately you know this isn’t cook book medicine.  There’s not going to be one thing that works for everybody. If we can personalize it to each person then they’re going to see much better results.

Trevor:  Yeah absolutely. With people with eczema it’s not lie you’ve seen it naturopathic doctor if you have eczema and they’re going to give you one treatment like steroids. It’s not one typical thing.  I mean there are certainly certain things that that we tend to reach for and topicals as well as dietary recommendations and supplements but it’s very individualized. That’s why sometimes it’s hard to you know when people ask me so what do you for eczema? It’s like okay well it depends.

Pamela:  Yeah.

Trevor:  That’s what you were saying. I want to back up a minute and talk a little bit more about some of these tests that you mentioned because I know that people have questions about these and of course working with a naturopathic physician or functional medicine doctor in your area is going to be the best thing to do to help you really figure out the best test for your situation, right?

Pamela:  Right.

Trevor:  If you’re listening, watching, it’s important to realize that but just to help you, give you some information about what you might want to ask your doctor for, here are some of the things that we’re talking about. The first thing you mentioned is hormone testing. Are you talking about like a 24 hour urine hormone panel? Something along those lines, is that what you typically recommend?

Pamela:   No not doing the 24 hour urine panel, I had switched to people who’ve heard of the new I guess its not new it’s been out for a few years but the Dutch test. Because that is actually a urine test but you’re urinating on strips at different times throughout the day so you can still see that rhythm of cortisol but that really was a big game changer for me being able to view people’s cortisol levels from basically 3 different angles. That for me has been giving me a lot more information and then also you can see those estrogen metabolites. If you’re converting down something called a 40H pathway and you’re converting too much estrogen down that pathway that’s actually not very good and people tend to not metholate very well which ultimately means you don’t detox very well.

This is where some of these genetic things come into play because some people have genetic issues that set them up to just not break down estrogen or catecholamines very well. They maybe have let’s just say you look at like our drinking water. There’s estrogen in our drinking water and if you’re not filtering your water or if you’re drinking out of plastic water bottles you know we have estrogen everywhere. If you’re genetically not set up to get rid of that very efficiently you’re going to have more hormonal issues than somebody else.

Trevor:  Right and the estrogens are coming from the environment, from different chemicals as well as from medications and things in the water right?

Pamela:  Yeah.

Trevor:   That don’t get filtered out so yeah it is important to filter water. I asked you about that with the which type of test you use because I think a lot of people will look at blood tests for hormones as well as salivary, testing saliva for hormones but you don’t get the metabolites that you’re talking about unless you do urine. That’s the only way to find out those metabolites.

Pamela:   Yeah the urine testing and I did used to do saliva testing in the past. I would say that’s where there would be some frustration where you get the results and then you’re going over them with the patient and then you see oh you’re dominant and you’re low progesterone and then you would think very simplistically like let’s just give that person progesterone. I can’t tell you how many times that did not work. It was not the magic cure all and it was because we were missing some of the other parts of the picture there.

Trevor:  Yeah so it’s not just a matter of estrogen being high and then you just need more progesterone to balance it out, it could be that you’re not metabolizing your hormones properly so that’s what’s creating the imbalance. Yeah I think a lot of practitioners that do bioidentical hormones will just automatically just start adding more of whatever seems to be missing rather than helping with the metabolism to help with the balance. I think it’s important to do both, right?

Pamela:   Mm-hmm

Trevor:  To really help support but also to help with that metabolism so you can naturally balance the hormones. Yeah that’s great. That’s great information. Anything else you wanted to say about the hormone testing?

Pamela:   Just more I know sometimes people will have blood testing done and for me it’s never been very useful because how many times do you have the blood tests and people are told oh you’re in range, you’re normal but they don’t feel normal at all and they’re very symptomatic and that’s where I think it’s just missing some of those key pieces there with the metabolites.

Trevor:  Yeah yeah that’s what you miss by doing the blood work. Yeah. Okay and then you also talked about doing the stool tests for looking for parasites and bacterial imbalances and Candida and that’s having to do with the gut. Anything you wanted to add about that that people what people should be looking for or talking to their doctor about with those tests?

Pamela:  I would say if you’re going to be doing those tests again working with the doctor that has experience using those tests because there are a variety of different labs out there. Sometimes people will just use their local lab just to test for parasites that can be really difficult to detect and so trying to utilize the lab that maybe does DNA testing or they’re a little bit more sensitive to be able to pick some of these things up. Also, making sure you’re’ looking at a variety of things on there so you’re checking to see if you maybe are reacting to gluten because some of these more advanced stool testing will have anti-gliadin and antibodies on there. I can’t tell you how many patients have had that they’re avoiding gluten and those antibodies are high and it’s because they’re getting cross contamination from somewhere so we have to really sit down and start looking at where could that be coming from? Is it a sauce? Is it your toothpaste? Someone had kitty litter that was made out of wheat.

Trevor:  Skin care products.

Pamela:   Yeah skin care products, even though they’re natural having wheat in them and stuff.

Trevor:    Okay what other particular labs that you like for those tests?

Pamela:   For the urine and the stool testing?

Trevor:  Stool tests

Pamela:   For the urine testing as I mentioned I usually use the Dutch test which is from Precision Analytical. Then for the stool testing I’ve been using Diagnostic Solutions. I feel like they give people a little bit more bang for their buck and can see more information there. For the organic acid testing I like Genova’s profile on that. I’ve looked at a couple other companies but I think Genova’s is kind of a nice general one to start with.

Trevor:   The organic acid test, can you explain a little bit about how that works and what we’re looking at there?

Pamela:   Yeah so organic acids, the way that I like to think about them as because I sort of think in this I guess a little bit linear way where I’m thinking of maybe a biochemistry chart and I’m trying to think if you’re trying to get from point A to point B you might need something like B vitamins or CoQ10 as that co factor to be able to get from point A to point B. If you don’t have enough B vitamins for example that pathway doesn’t happen. Think like you have a river and the river just stops and then you get these metabolites that spill out in the urine. The higher those metabolites are the more blocked that river is so that’s where we’re able to tell where some of those imbalances are coming from and if you go in and correct some of those imbalances basically you get that system working again.

That has been extremely useful because you know how many time do people come in and they have a whole entire bag of supplements and then you know they have all these different pills their taking. Then I say why are you taking it? Well, I don’t know I read about it. I’m like, okay well let’s look and from the testing you can see do you truly need B vitamins? Maybe you don’t. Some people do and some people don’t or people go on these cleanses to detox their liver you don’t always need it though so some people are detoxifying just fine and doing things to help with that aren’t necessarily going to be like that game changer for them because that’s not where the problem was coming from.

Trevor:  Okay all right great. That’s helpful. Once people have those tests done … That was what I was going to ask about was the genetic testing because you mentioned that. How often do you do the genetic testing? Is that something you usually wait on? You do that pretty soon off? Which testing do you do?

Pamela:  For the genetic tests most people go to 23 and Me to get their raw data because that is the most affordable thing for people to do. With the genetic testing what I’m looking at there is I look at a couple different genes that maybe affect like hormones or detox pathways. This is an area that I feel like this is changing so fast and so rapidly and unless I sat and studied it every single day and didn’t do anything else. I feel like I’m still always trying to master it. I think if you look around there’s so many interesting programs popping up where you can take somebody’s symptoms, you take their genetics, you take some of these functional medicine tests and you plug it in and it can tell you what genes are turned on and off. Because that’s the other thing is that when you see some of these results you can look at it and get a little bit like oh my gosh am I going to die?

People have to remember the genes are not your destiny and it’s what your lifestyle. That’s where we go back to the diet and all these other things because you can impact that and turn that gene on and off by what you’re doing with your lifestyle. That’s really what you need to see is if it really is a problem or not for you. You know a good example would be I kinda go back to the hormone piece of that is you know I’ve had a few women where you’ve probably seen in some of these women you try to give them maybe bioidentical hormones because they maybe they had a hysterectomy and they really need them because the hot flashes are so bad. You give them a little bit of it and they feel worse and they’re getting worse and you’re like what is going on? When you understand some of these genetic things there you can say oh well you know you had this hysterectomy but no one ever fixed your underlying problem which set you up to have it to begin with.

That maybe was all stemming from the fact that you don’t metabolize estrogen very well. If we can fix those pathways then you’re going to tolerate some of these other things a little bit better.

Trevor:  Yeah absolutely. I think you know epigenetics is so interesting and fascinating and it’s exciting to see what’s happening with the information that we can get from our genes and what we can do with our lifestyle and supplements and diet, different things to change our genetic expression and prevent diseases, treat diseases. It’s very exciting to see that. It’s great that you’re incorporating that too. Going back to my question I was going to ask, once people do these tests and they come back what do you do next?

Pamela:   I kind of look at it as sort of like this puzzle right? Now we’re putting all these different pieces together and then now we have to prioritize what we’re going to address first. This would depend on what their symptoms are. If you see for example a patient that has eczema or they have a lot of acne happening you may not actually want to go in and start giving them a whole bunch of liver detox stuff right off the bat because you might make them worse if they have gut issue. You really need to fix that gut because otherwise you’re stirring up this pot and that if you have a lot of leaky gut or increased gut permeability now we immobilized more things in there that could definitely trigger things.  I feel like depending on the person and their sensitivity you kind of have to start slow and I feel like the foundation for everything is really making sure you have a strong gut in place. If you don’t have a strong gut then that’s really you’re first place to start to be able to fix that.

Trevor:  Mm-hmm. Yeah absolutely. I think you’re right. I totally agree with that that the gut is there’s so much associated with that and that’s where a lot of this what I call skin flammation comes from that internal inflammation that shows up on the skin as it comes from those gut issues and those are so key and I find that lot of times that’s what’s missing when people have really inflamed skin. Whether it’s eczema or acne like you mentioned, getting to that is really important. That’s great. Then what about the hormones? What do you do to address those possible hormone metabolism issues and those sorts of things?

Pamela:   That’s where I do use supplements for that. I use a lot of herbal therapies and even Chinese herbal therapies. Sometimes acupuncture as well. Basically trying to if the skin is really inflamed my goal is trying to get that calmed down and then to get the hormones balanced. That I approach with a lot of the nutritional supplemental things that we have available.

Trevor:  Great great. Fantastic. Then I guess you’re seeing great results with patients that they come back. How quickly do you tend to see changes in peoples skins?

Pamela:   The skin, that’s one of the things I tell people. It can take a little bit of time but what I don’t think has to happen is that you know sometimes I feel like what we got taught in the school is that when you’re on the right track you’re going to have this big healing crisis. The healing crisis does not need to last for 6 months. A healing crisis can be quick and you move through it and again we’re stirring up this pot and then making the person so much worse that now we have to spend all this time trying to rebuild them.

When I start a treatment protocol there should be some shift happen in the first 30 days. They may not be perfect, they may still have some issues going on but they should see something improve and you should see something be better. You should see these small steps you know that you’re going up kind of a little stairway here and you’re seeing it slowly improve to know that you’re on the right track but I think your skin, at least for me my skin is like my most immediate feedback as to if I’m eating something that’s not good for me, because I will react within 24 hours. My eczema starts to come back and for me it’s right on my face for everybody to see so everyone can look at me and go, oh so what have you been eating that’s not good for you?

That’s where if you give supplements and things flare up the person should not continue to be that flared and worse over a 30 and 60 day period. You should start to see it calm down and if you don’t, stepping back, revaluate what am I missing? What’s the picture here? Because there’s some trigger that you’re not identifying.

Trevor:  Yeah absolutely. I agree. We want to be moving in the right direction. Sometimes what I’ll see with patients is we’ll see an improvement and then it stops. Whatever we’re doing it’s like we hit kind of a plateau and like okay we’ve got another layer of something we need to work here so maybe we’ve worked on some of the gut stuff and now we need to really focus on balancing the hormones more. Then you know it can be a cycle that can take some time but I do like to see people have really … I mean I like to see people in 2 weeks to see some sort of shift, especially if we’re making major dietary changes. If they are big changes that they’ve made in 2 weeks I feel like people should notice something improving. The first week though you actually might feel worse sometimes especially if you’re having to give up foods that you’ve become very dependent upon and you’re not used to having those. Sometimes you could feel worse but within 2 weeks and certainly 30 days that’s when the skin cells start to turn over and we can really see what the skin is going to be doing.

Pamela:   Mm-hmm (affirmative). I think people keeping in mind you know your skin is your largest organ of detoxification so if you’re seeing things getting more flared then looking at those other areas. Like are you having bowel movements everyday? Because if you’re not then that might be why you’re seeing some of those things flare up more in the beginning time and you want to make sure you have all those organs of elimination optimized.

Trevor:  Yeah absolutely. Okay well Pamela this has been fantastic. Really great information. I know we’re on the same page with all this stuff so it’s fantastic to talk to you. Tell people about how they can find you, about your website and your clinics.

Pamela:   Okay. You can find me at www.lakesideholistic.com. That’s our business page and then you can find me on Facebook at Dr. Pamela Langerderfer on my public figure page on Facebook is just devoted to all things hormones. If you want to know more about hormone issues and how they impact other things you’re going to find that on my page there. We have offices in both Liberty Lake, Washington and Crotaline, Idaho. We have people from a variety of different areas.

Trevor:    Fantastic. Well thank you again for all your help. I appreciate it.

Pamela:   Yeah thank you.

Trevor:  I hope you enjoyed this interview today with Dr. Pamela Langerderfer. To find out more about Dr. Pamela you can to my website thespadr.com. Go to the podcast page with our interview and you’ll find the information about her and her clinics there. Also while you’re there I invite you to join the Spa Dr. Community so you can stay in touch with us and as I mentioned earlier don’t forget to take the skin quiz because that’s going to give you great information about your root causes and how to address those. Just go to theskinquiz.com. It’s free, it only takes a few moments to answer the 10 questions and get your own customized information. Theskinquiz.com. Also I invite you to join me on social media, on Facebook, Pinterest, Twitter, Instagram, YouTube and join the conversation. I’ll see you next time on The Spa Dr. podcast.