McAcne?

I am currently completing a dermatology rotation (last month of school  - ever!) and am constantly reminded of how much I still do not know. I recently learned about an interesting diagnosis: iododerma.  I initially had many thoughts about this diagnosis and it's relation to diet, but those kind of fizzled out with my research.  However, I thought I would take the opportunity to talk about a similar, very common diagnosis that is DEFINITELY affected by diet - acne.

Iododerma is part of a larger set of diagnoses termed halogenodermas. If you can remember way back to high school chemistry, the halogens (specific chemical elements of the periodic table) include iodide, bromide and fluoride.  Halogenodermas are skin eruptions that result from halogen containing drugs or substances.  On the face, inflammatory acne like lesions are seen while on the rest of the body large, red, raised papules are observed.

The connection to diet here is that, dating back to the 1920's, the American salt supply has been fortified with iodine. The rationale with this intervention was to reduce the incidence of goiter (thyroid disease). The fortification did its job as iodine related goiter is rarely, if ever, seen today. However, the current problem is that Americans are consuming too much salt. The recommended daily salt (sodium) intake for an average, healthy individual is 2,300mg. However, the mean intake of the average American ranges from 3,400 - 5,000mg. I found good news though - the foods typically highest in salt content (processed foods and fast food) usually contain non-iodized salt.  (However, read food labels because some companies do use still use iodinized salt and the Burger King chain does use this form in its food preparation.)  One would have to over-salt all meals with table salt for quite a while to develop the blood level of iodine to induce iododerma (eat > 20,000mg iodized salt per day).

So, what I thought was going to be a sure bet - high salt intake from processed/fast foods leads to increased skin problems - seems to not be the case at all. In fact, compared to 30 yrs ago the average consumption of iodine has fallen by about 50%.  There are now some authorities that believe that iodine deficiency could become a societal problem again due to the fact that so many individuals get their sodium fix from non-iodized sources.  Obviously Americans do not need to consume additional salt, just additional iodine.  My advice: cut back on the processed foods and lightly season fresh vegetable / pasta / fish dishes with iodized table salt.

While fast food may not lead to less than optimal skin via iodine, there are multiple other ingredients found in these foods and other staples in the American diet that likely DO increase the development and severity of acne.  There has been debate for decades about diet and acne but there is strong evidence that environment plays a large role as multiple non-Western cultures have been found to be completely free of this skin problem.  I bet most of you have heard about chocolate or carbonated beverages worsening acne. While these suggestions have been brushed aside as 'myths' by those in the dermatology field, there are underlying truths to these claims.

The development of a pimple is a process composed of 3-4 steps:
1. Keratinocyte (skin cell) proliferation
2. Androgen (male hormone) mediated sebum (oil) production
3. Inflammation
4. In some people: colonization of the skin with the bacterium Propionibacterium acnes

Steps 1-3 can all greatly be affected by diet. First, skin cell proliferation is induced by insulin and insulin-like growth factor (IGF-1), which are two pro-growth hormones. Androgens are male hormones that, among other things, bind to and activate oil glands. Androgen production is also increased by insulin and IGF-1.  Further, insulin and IGF-1 decrease the liver's synthesis of the protein that binds up androgens in the blood, resulting in higher blood levels of these male hormones and increased oil production. Insulin and IGF-1 also directly bind to oil glands and induce oil production. Finally, inflammation plays a large role in the severity of acne. The inflammatory process is why the pimples get red, swollen and painful.

What can be done to limit each of these processes?

1. Limit the amount and duration of insulin in the blood. Insulin is produced to help sugar (carbs) get into cells. More insulin is produced when more sugar is consumed.  There is tons of data that suggest that diets low in processed carbohydrates (white bread, white rice, crackers, cake, etc) improve acne. This means eating more whole grains and fresh fruits and vegetables. Not only are these items low in simple sugars, they are also high in fiber, which not only reduces overall insulin levels but also binds up and eliminates hormones in the intestine. Diets high in fiber, >30g/d, have been associated with improved acne. 

Exercise, even moderate activity such as walking, also lowers blood insulin levels. Try to get at least 30 min of moderate activity each day. This doesn't have to be all at once either. Your muscles, which use the insulin in your blood, will be just as happy with short bursts.  Three 10 min walks will lower insulin!

2. Limit dairy. Many of you may not know that dairy contains testosterone precursors, androstenedione and dehydroepiandrosterone-sulfate.  Additionally, dairy, skim milk in particular, is loaded with IGF-1. Still, for reasons beyond the scope of this blog, dairy causes an increase in insulin release far exceeding other types of foods. Finally, the animal proteins and fats in dairy are pro-inflammatory. The fats in dairy cause the body to produce prostaglandins (signaling molecules) that only potentiate inflammation and causes recruitment of inflammatory cells to damaged areas (pimples). As you can see dairy contributes to acne by muliple mechanisms.

3. Alter the types of fat you are consuming.  Omega-3 and omega-6 fatty acids (FA) compete for metabolism into signaling molecules that direct 1,000s of reactions in the body. Omega-3 FA are turned into anti-inflammatory molecules while omega-6 FA are turned into pro-inflammatory molecules.  Omega-3 fatty acids are found mainly in fish (fish oil) and their precursors are found in walnuts, flax and some green veggies.  Omega-6 FA are found in most oils, the oils used to fry, bake and cook most of the foods in our diets.  Animal proteins and animal fat are very inflammatory and contribute to the omega-6 profile of inflammatory signaling molecules.  For those who care, you can see the cascade below and the eicosanoids produced from each food product:

 There is actually evidence that those who consume moderate amounts of omega-3 FA, like 2 servings of fish per week, are less likely to have acne lesions.  Further, omega-3 FA may decrease IFG-1 which would halt the steps 1 & 2. 


An anti-acne diet consists of:

Few simple carbs: white bread, white rice, cookies, cake, pie

Very little dairy: cow milk, ice cream, yogurt  (soy / almond milk and other products are great substitutes)

Very little amounts of animal protein (besides fish): red meat, poultry, pork

More high fiber foods: whole wheat products, oats, beans, vegetables, seeds, high fiber breakfast cereals

More omega 3 FA: salmon, herring, shrimp, cod, ground flax seed.
Ground flax seed can be put into oatmeal, smoothies, baked products and can be used as a thickner in any recipe.  If you don't like fish you can take fish, try fish oil supplements. The trick with the supplements is to make sure you are getting 1g of EPA+DHA oil/day (which is also cardioprotective). Look at the back of the bottle to make sure there is at least 1g per serving. Some people complain of fishy tasting burps taking these pills, but stored in the freezer this side effect seems to disappear.

P.S. I am not suggesting taking up wine drinking but there is evidence that the resveratrol phytochemical in wine is an anti-oxidant that actually helps improve acne! 

All these ingredients are found in the Mediterranean diet, the diet pattern found in populations that border the Mediterranean Sea.  This diet has proven to be helpful in almost all inflammatory conditions and also promotes cardiovascular health and protect against multiple forms of cancer.  So, even if acne is your main concern now when you are young by adopting this diet profile you will be able to protect yourself from various more serious diseases in the future!

Happy eating for happy skin!

‘‘Let food be your medicine and let your medicine be food"

The title of this post is one of my favorite quotes. Hippocrates, the father of medicine, stated this back when little, if any, scientific evidence existed on the link between diet and health. I want to use this quote to help explain the title of my blog and provide background information for future postings.

People eat for many reasons: to satisfy a primal need, when they are happy, when they are sad, etc. But, how many of you eat to turn on or turn off your DNA? That's right, whether you carefully chose every ingredient you put in your mouth or don't give a second thought to what's filling your belly, the food you ingest today will have a profound impact on thousands of aspects of your health, both immediately and in the distant future. We know this because of a newer field of research called epigenomics.

Since this about food I will use this analogy: your epigenome is like a thin layer of icing on your DNA cake. Epigenomics is the study of this icing. The epigenome is made up of various chemical compounds that tell your DNA what, where and when to make a genetic product. It holds the switch to turn various genes on and off. Here's the exciting part - while you can't change your DNA, the epigenome is consistently changing from influences inside your body's cells (the environment), from choices you make! While there is still much research to be done, some evidence suggests that you, by your daily choices, can turn off various 'bad' genes that promote the development of cancer, autoimmune diseases and many other chronic diseases and turn on 'good' genes that protect against these conditions.

Now, for more specifics. The chemical compounds that make up the epigenome come from various sources including natural things, like nutrients from food, or from synthetic things like medications, tobacoo byproducts or pesticides.  This means that what you put in your mouth intimately interacts with your DNA, manipulating it and flipping the 'on' and 'off' switches of your genes. I don't know about you, but I would rather have my DNA bathing in an anti-inflammatory, anti-oxidant glaze rather than being slathered in a fatty, toxic film. What's more intriguing is that we know that these epigenetic changes to DNA can be passed down through generations.  What you eat today could impact your grandchildren's health! 

So, what can you do to make a happy epigenome that stays busy flipping off all the 'bad' genes?  Let food be your medicine!  Of course there are other improtant things like avoiding tobacco and exercising (exercise has also been shown to positively modify the epigenome!), but since we all need to eat to live changing our eating habits is a sure way that we can have some control over our DNA and our health destiny!

Future posts will provide some specific examples how various foods impact your DNA and promote or prevent various health conditions. 

For specific recipes that will make your epigenome happy I want to direct you to my friend's blog: http://munchkieandme.blogspot.com/. She is a nurse and a mommy who is devoted to making healthy meals for her family. We both share the same views on nutrition and I would recommend all her recipes. They will all feed your genes right!

In the beginning....

Welcome! I am currently a 4th year medical student (two months until I graduate!), but medicine is actually just how I plan to practice my passion. My passion is nutrition and the intricate workings of food and health - physical, psychological and emotional. Before I went to medical school I earned a B.S. and M.S. degree in nutrition. Throughout the past decade of education I have learned so much more than what we should eat and what defines “health.” Some of my biggest revelations have focused around just how much many health professionals DON’T know about how to promote whole person health.

I am going to begin a family practice residency in a few months, but my eventual goal is to practice a combination of integrative medicine and lifestyle medicine. The objective of these two fields is to actively promote cost-effective, evidence-based changes in diet, physical activity, sleep hygiene, and stress reduction while also placing increased emphasis on interpersonal relationships and spirituality to improve overall wellness. The practice is distinct in that it places a larger emphasis on identifying and overcoming individual patient barriers to health and fosters whole-person health – body, mind and spirit. This approach to patient care so strongly attracts me because I have witnessed the importance of addressing these areas, not only in the lives of patients, but in my personal life as well.

I'm so excited to finally be at the point where my knowledge and credentials will allow me to help others prevent, manage and reverse (yes, reverse) some of the most common serious diseases plaguing our country. Besides writing about the major health problems like cancer, diabetes and heart disease, I will be posting on how you can use diet and other non-conventional therapies to potentially help treat other various conditions such as acne or asthma.

Unfortunately, with the life I will be living over the next few years I cannot promise regular posts but I hope you enjoy following me during the next chapter in my life. As I continue to learn how we can all improve all aspects of our health through our own daily choices, I will pass this knowledge on to all of you!