In this episode, guest Dr. Apple Bodemer, whose specialty is dermatology, discusses ways to improve your skin health.
Questions Answered
- (00:03) – is Dr. Apple Bodemer, could you give us a little bit of background on you, and what your specialty is, and how you got into maybe a plant-based diet?
- (04:18) – What skin problem responds the best to the plant-based diet?
- (06:33) – Do you have any suggestions for eczema?
- (10:01) – For people with acne, what do you recommend they wash their face with?
- (13:06) – Any suggestions for rosacea?
- (15:56) – What would you recommend for people who have age spots?
- (19:12) – What type or brand of sunscreens would you recommend?
- (21:54) – Any suggestions for itching skin?
- (25:17) – Any thoughts about hair loss?
- (31:36) – What about females who've suffered from acne in the past, how can they minimize or eliminate scars left behind?
- (33:14) – Do you know what causes rashes after sun exposure?
- (35:35) – When I get contact dermatitis, I get prescribed oral and topical steroids. Are there other things I should look into taking?
- (38:53) – Any suggestions on facial moisturizer specifically, any brands?
Complete Transcript
Dr. Laurie Marbas
(00:03)
Thank you, everyone, for joining us today on the Plant Based TeleHealth Live Q and A every second and fourth Thursday of the month. Today we're super excited to welcome our guest speaker, who is Dr. Apple Bodemer, she is a plant-based dermatologist, so we'll Zoom on hers. Dr. Boomer, could you give us a little bit of background on you, and what your specialty is, and how you got into maybe a plant-based diet? And we'll start accepting questions and go from there.
Dr. Apple Bodemer
(00:32)
Okay, yeah. I did my dermatology residency, and had the opportunity to travel to a couple of different places, both India and China, where I got to see how traditional healing methods and systems worked, which really got me excited and interested about other forms of healing. That led me to an integrative medicine fellowship after my dermatology residency, through the University of Arizona, and my whole career has been combining this in integrative approach for dermatologic patients. I think it was about five or … no, it's more than … COVID has me all goofed up, I think it was about seven years ago, I went to my first plant-based nutrition conference, and I went kind of consecutive years for two or three years. After that first conference, I decided to give up dairy, which was something I didn't think I would ever be able to do, but I was never a milk drinker or cheese eater, but I loved yogurt, and I didn't realize that I was bloated all the time, I just didn't know it.
Dr. Apple Bodemer
(01:34)
So slowly … I think for me, my plant-based diet has kind of been a continuing journey, I would say I'm about 98%. I do occasionally have something where … I get into situations where there … social situations or places where they might not have great options, and so every once in a while it'll happen to me, but as … The longer I've done this, the less … I seem to be able to head that off a little bit better. I'm better at predicting when those situations will come up, and I just feel better. I recommended a lot for patients, and some of my patients take me up on it, and some don't. I've talked with Laurie about this, it's hard to know who's ready, and I think for some people … like for me, it was I gave up dairy first, and I had been a vegetarian for 12 years so I already wasn't eating very many animal products, but then eggs was next. Then really focusing on the quality of the food I was eating.
Dr. Apple Bodemer
(02:31)
I know sugar still is plant-based so it's not great for me, but I probably struggle personally in that area a bit. I'm raising four kids, and that brings its own challenges in terms of navigating how much do I want to force an issue versus be a model and let them make their own choices. That's always a delicate line to walk, at least for me sometimes, but that's me in a nutshell. Like I said, I often will bring up plant-based diets for patients and put it out there pretty early. I often tell them, “I do think this is the healthiest way for you to eat.” I'll give them my reasons and just say, “And, you know, I would rather have you make small changes over time that are long-lasting,” and providing that in a nonjudgmental platform where we really can have open conversations about diet all the way along, while I'm helping work with somebody on their skin issues.
Dr. Laurie Marbas
(03:32)
Fantastic. So just to remind you, if you are in the webinar side of things, please use the Q and A box to post your questions, and we'll answer them from there. If you're on our Facebook, and you're seeing this live, you'll need to be on the Plant Based Telehealth Facebook page in order for me to see your question, so if you can go there and join us there. Then please share this with your feed, your groups, whomever you'd like, or tag someone you think would be interested in talking to a plant-based dermatologist. It's kind of a rare opportunity so I encourage people to take advantage of it. It looks like there may be some people just saying hi to us. Docs, do you guys have any questions for Dr. Bodemer?
Dr. Kim Scheuer
(04:18)
What have you found is the best skin problem … the skin problem it responds the best to the plant-based diet, to changing your diet?
Dr. Apple Bodemer
(04:29)
I think in terms of … Well, we have strong data for acne, not specifically, we have no, almost no data for specific plant-based diet alone, but when we look at the data we have on different dietary patterns, and the biochemical pathways that lead to disease, I would think acne is a really powerful one, with dairy in particular, especially things like the isolated whey and casein proteins. I see a lot of young men come in on that, and a lot of times if you just take away that dairy protein supplement they see dramatic improvements, and if you can get them off dairy altogether.
Dr. Apple Bodemer
(05:05)
What I'll tell people is there's a lot that goes into acne. It takes a long time to show up and it takes a long time to resolve, and diet is one piece of it, but if we can get you on a plant-based diet we're going to have an easier time managing the rest of it. It definitely will decrease the need for any oral medication, and sometimes allows us to be able to manage things topically only. Sometimes the endpoint isn't always full clearance, but definitely having a better time controlling things. I think acne is one.
Dr. Apple Bodemer
(05:38)
I think psoriasis is the other one, because while we don't have data on specific plant-based, we do have some decent data on anti-inflammatory diets, which are very similar to plant-based, but they do include some animal proteins and oils, and things like that. But when we look at the comorbidities for psoriasis, the metabolic syndrome, the depression, heart disease, the other inflammatory conditions that go along with it, diabetes, that definitely plant-based diets have strong data to be helpful for all of those comorbidities. A lot of times when I'm presenting that to patient I'll say, “Look, you know, we don't have specific studies on this, but we have all of these other things that go along with psoriasis, and if we can prove all those other things, even if we don't clear up your skin, you're in better off shape,” but their skin will clear up.
Dr. Kim Scheuer
(06:30)
That's awesome. Thank you.
Dr. Laurie Marbas
(06:33)
Great. Any other thoughts?
Dr. Niki Davis
(06:33)
I'm curious about eczema, because I know that there seems to be a link with dairy. Have you noticed people be able to clear up, especially in little kids who have eczema, with getting off of dairy? Then if you have any other suggestions for eczema for people.
Dr. Apple Bodemer
(06:52)
Yeah, eczema is really complicated. It seems kind of a simple common thing, but it is very complicated, and food triggers for eczema flares are much more common in kids than they are in adults. The two that I see the most common are dairy and then gluten, often it's not through gluten allergy. People will come in, and I find with eczema in particular, I struggle with people being too restrictive in their diets because they've read that strawberries can make it worse. They've read that nightshades can make it worse. They've read that gluten is bad. They've read that dairy is bad, eggs, and all of a sudden they're eating rice and fish, and maybe some leafy greens.
Dr. Apple Bodemer
(07:27)
So that's one thing, I think, to overcome that sort of, “That food is bad for my skin,” and shifting it more to what kinds of foods are going to be better for your … which are what kinds of foods are more likely to help your skin, and how can we go about this in a little more of a systematic way so that we're not ending up with this, with just the emotional burden that it can take, especially for kiddos. Because parents will feel incredibly guilty, they'll read somewhere that feeding your child this and it's causing the eczema. Eczema, we know is a genetic predisposition, as most things are, a predisposition paired with an environmental trigger that sets it off, and with eczema, those people have defective skin barriers. They're missing a protein called filaggrin, or their filaggrin just isn't functioning appropriately.
Dr. Apple Bodemer
(08:25)
Filaggrin is really important as part of the glue that holds skin cells together. So if you think of it kind of as a brick wall, when our skin is healthy, and we've got the fats that we need in order to help keep those cells plump, and we have the hydration that we need, and we have the antioxidants, and all of the things that we need, we have this nice tight barrier. But in eczema, even when the skin is not flared their filaggrin is deficient, and their skin is more porous, and so they're much more susceptible to irritants and allergens getting in. Then also, just inflammation coming from the inside out will affect the skin more too because of that more kind of open latticework rather than a brick wall.
Dr. Apple Bodemer
(09:07)
I think it is important to kind of … I often end up de-stigmatizing food in general, and trying to get people to replace with really healthy options. We talk a lot about the gut microbiome, and the impact that that has on inflammation in general. The skin microbiome, I think is … I think the gut microbiome is kind of a frontier still, there's a lot we don't know about it, and the skin microbiome, we're definitely behind in terms of knowledge. But, we know the gut microbiome plays a big role in inflammation, and things like increasing your fiber, increasing citrus fruits, pectin in general can help feed those healthy bacteria that help keep the gut microflora, the mucus lining thick and healthy so that we don't have these pathogenic bacterial byproducts getting into the system and triggering some of this inflammation.
Dr. Laurie Marbas
(09:57)
That's a great question, and a great answer. Any other [inaudible 00:10:01]?
Dr. Chris Miller
(10:01)
Yeah, I have one question. So for people with acne, what do you recommend they wash their face with?
Dr. Apple Bodemer
(10:08)
You want a bland cleanser, and there are a lot of good ones on the market, pH does matter. A lot of people will be using harsh cleansers, they really want things that suds up and foam, and a lot of those chemicals are really for marketing purposes. You don't need foam to get good clean skin, and so that's one of the things that I talked to you about. We want to tone things down. A lot of people feel like, “I've got oil in the skin, the oil is causing a problem, we need to strip it away and strip it away.” No, the oil under the skin is the problem, and when we take the oil off of the surface too aggressively we stimulate those oil glands to do what they're supposed to do, which is protect the skin, and they do that by making more oil.
Dr. Apple Bodemer
(10:47)
I see a lot of problems with people over-cleansing and under-moisturizing. We want to be gentle with our cleansers. There's a lot of abrasive devices out there, and abrasive like the gritty apricot kernel scrubs that I used to use when I was a teenager, because I thought they were good because they feel good. Because your skin feels tight, and it feels like you're doing something aggressive. Well, you are, and you're also damaging those oil glands, and causing them to make more oil in order to protect themselves. We really want to get away from that, using lukewarm water, a very gentle cream-based cleanser, and there are a lot on the market that are a variety of different price points. My rule of thumb is if it foams then that's probably too harsh for your skin.
Dr. Apple Bodemer
(11:28)
There are also oil-based cleansers. I'm a huge fan of the food grade oils because they are clean, there's nothing else in them. If you're using extra virgin coconut oil that you could use in your kitchen, or you're using … Apricot kernel oil is a really good one for people who have acne or blemish-prone skin. Jojoba oil is technically a wax ester, but it functions like an oil, that one has the most similar fatty acid profile to our own natural sebum, and so that's a good one. I always tell people, “Kind of just like with your food, we don't need to douse your skin. You don't need a palm full of oil, and putting all that on your face.” It's like three to four drops, two to four drops, it just takes a few drops and that can be really helpful. So having them cleanse with a gentle cleanser that's not sudsy, with just their fingers and warm water, no more than twice a day. Then make sure that they're following it with some light moisturizer, including those food grade oils I mentioned.
Dr. Apple Bodemer
(12:24)
Then a lot of the medications we end up using, or prescriptions we end up using for acne, those are really hard on the skin too, they can dry things out so we have to be careful. A Lot of times I might see somebody who's waited six to nine months to see me, in the meanwhile they've been to Target every third night and bought a new product, and it's got salicylic acid and benzo peroxide, and alpha hydroxy acids, they're just overdoing it. I think a lot of times it's really simplifying for them, for people.
Dr. Chris Miller
(12:55)
That's awesome. Thank you so much.
Dr. Laurie Marbas
(12:57)
Elizabeth.
Dr. Elisabeth Fontaine
(12:59)
You almost make me like dermatology.
Dr. Apple Bodemer
(13:04)
I love dermatology.
Dr. Elisabeth Fontaine
(13:06)
To a certain extent you're often going to have jokes from physicians saying, “You know, dermatology [inaudible 00:13:12],” listening to you it's a different story. So how about an old fart like me that has rosacea, who's on the plant-based and doesn't seem to be doing anything, so what's your suggestion?
Dr. Apple Bodemer
(13:27)
I mean, with rosacea, obviously you are plant-based already, I often will push fiber, and making sure that you're getting close to 50 grams of fiber a day. I think that … with rosacea, we do know that there's this vascular instability that happens, and we don't necessarily know all the details about why. There's so many pieces to rosacea that we have still questions about, and then there's demodex, which is a mite that lives on all of our skin. People get freaked out when I say, “There's a mite on your skin.” We usually see that more with a papulopustular variant of rosacea, and the phymatous one. So with rosacea there's just the redness and flushing type, there's the papulopustular type that's often called acne rosacea, and then there's phymatous one where people get these bulgy noses, bulgy chins and bulgy cheeks.
Dr. Apple Bodemer
(14:14)
They are kind of the same animal, but they're a little bit different, and with just that flushing, blushing type it can be really, really hard. UV radiation plays a big role, and we know that that UV radiation exposure can trigger rosacea, and it will stimulate flares. So doing the best you can to try to protect your skin. When it comes to skincare products for people with rosacea, your biggest investment should be in your sunscreen/what I call the other parts of the sun-protective things like wide-brimmed hats, wide lens sunglasses, and then being mindful of how much UV exposure you're getting. Sunscreen is kind of controversial to some degree, or some of them can be, and we often rely on that, as most people do, as their primary source of UV protection, but I really think of it as kind of a last resort. That's your backup plan. With rosacea, there are some really good tinted mineral-based sunscreens out there that are large particle size, and the tint helps prevent some of that thick white caking. There's … and I'm not sure if we're allowed to name brands.
Dr. Laurie Marbas
(15:21)
Yeah, go ahead.
Dr. Apple Bodemer
(15:22)
Well, okay. There's one that I really like called MyCHELLE, that you can find at a lot of health food stores. It definitely is not one you'd want to put on your whole body just from a cost standpoint, but that's a really good quality mineral-based screen that I think is really good for people with rosacea in particular.
Dr. Elisabeth Fontaine
(15:36)
Can you repeat the name?
Dr. Apple Bodemer
(15:41)
MyCHELLE, it's capital M-Y, capital C-H-E-L-L-E.
Dr. Elisabeth Fontaine
(15:46)
Nice, thank you.
Dr. Laurie Marbas
(15:47)
[Inaudible 00:15:47] Michelle, but MyCHELLE, got it. Okay, cool. Any other questions? Or shall I go to the audience?
Dr. Niki Davis
(15:53)
I'll ask one more.
Dr. Laurie Marbas
(15:54)
Okay.
Dr. Niki Davis
(15:56)
What would you recommend for people who have age spots?
Dr. Apple Bodemer
(16:02)
So that's usually sun spots, 90 plus percent of what we think of as aging is actually photoaging, and once they're there it's difficult to get rid of them. It's certainly protecting yourself from getting more, so doing those things that you can do to protect yourself from UV radiation exposure. I think there's … Our face is where we tend to see the most aging, face, neck, and back of the hand, so people will tell me like, “Oh, I don't use sunscreen because I want to get my vitamin D. It's not healthy to use sunscreen.” Well, there can be some argument for that, and I think the whole Vitamin D thing gets more complicated the more you try to simplify it, but there's … Aging happens, photoaging happens, and once it's there … There's something called tranexamic acid, that we sometimes will use, that's a medication that can be used for melasma, so some sunspots are freckling. Once those are there they're not going to go away very easily, unless you're doing something like intense pulse light treatment, or a cosmetic laser resurfacing kind of thing.
Dr. Apple Bodemer
(17:06)
There aren't a lot of creams that will just magically make them disappear unfortunately. Prescription tretinoin is probably the closest thing that we have when it comes to helping kind of rejuvenate. People will say, “Well, what can I do to keep myself looking younger? What can I do to try to help my skin look younger again?” Those of us here probably eat mostly plants, drink lots of water, practice UV protection, and then use a good quality skin oil. I think rose hip seed oil is one that's got a lot of antioxidants. There's no data about preventing or taking away sunspots. There are some things, so arbutin and kojic acid, arbutin comes from really darkly colored berries, and kojic acid comes from Japanese mushrooms. Those do have some lightening properties. They can be pretty expensive, so if you're looking at over the counter products that have them in it, they can be upwards of a $100 for a 15 to 20 gram tube.
Dr. Apple Bodemer
(18:05)
I think The Ordinary is a company, it's a Canadian company, they do have an arbutin product that I have not tried, but they claim that they have 4% arbutin in it. I think it's a good quality company, from what I hear it's a really good one. So there are some things that you can find with those two, the arbutin and kojic acid, and there are some others out there as well.
Dr. Laurie Marbas
(18:27)
How do you spell arbutin and kojic acid? Because people asks.
Dr. Apple Bodemer
(18:32)
Yes, yes, A-R-B-U-T-I-N, arbutin, I-N, I think it's arbutinin. Kojic acid is K-O … you're taxing my spelling.
Dr. Laurie Marbas
(18:46)
It's okay. We'll get the right idea [inaudible 00:00:18:49].
Dr. Apple Bodemer
(18:50)
K-O-J, that's a J in there, K-O-J-I-C.
Dr. Laurie Marbas
(18:53)
Okay, cool. All right, and that was … the company in Canada was Ordinary?
Dr. Apple Bodemer
(18:57)
The Ordinary, and they're everywhere, they're at Sephora, they're at Ulta, so people can find them in lots of places. They have a really strong online presence. I think they originate out of Canada.
Dr. Laurie Marbas
(19:08)
Okay, cool. All right, any other questions?
Dr. Apple Bodemer
(19:12)
Thank you.
Dr. Laurie Marbas
(19:12)
Yes. Any other questions, or should we go to the others? Okay. Here's a simple one, I think, what type or brand of sunscreens, like bodily, I'm assuming, sunscreens would you recommend?
Dr. Apple Bodemer
(19:23)
It's tricky because this industry changes all the time, even within a season you'll see reformulations happen. So a sunscreen that you might have been really comfortable with in the past might have done something, and added something, without you being aware of it. I think the Environmental Working Group, is a group that I support, and I think they do a really wonderful job of addressing concerns with products that we have in our environment. They have a sunscreen guide that comes out every May, so you can get on a list, and they will email you that list when it comes out. They also do some promotional things where they'll put together a basket of sunscreens that they rate very highly and … or they rate low. A lower rating is better for the Environmental Working Group, but sunscreens that they endorse, and that comes out every May too as a promotional thing that they do, a fundraiser. So that's one place to get good information.
Dr. Apple Bodemer
(20:14)
When I'm advising patients I usually give guidelines and then some suggestions, because there are a lot of good products out there, there's a lot of not very good products out there, especially given the concerns that have come through the FDA in this last year and a half about two of the most common sunscreen ingredients. I generally like people to stay away from chemical sunscreens, and there are a lot of good ones out there. So zinc, zinc oxide, titanium dioxide, and iron oxide are the three things that I would look for the active ingredient list, and if there's a whole bunch of other stuff in there then I try to avoid that.
Dr. Apple Bodemer
(20:51)
The MyCHELLE that I mentioned, I really like that brand. They have a really good face product that's got a couple different levels of tint so it doesn't leave you with that ghostly white hue that some of the mineral-based sunscreens can leave you with. Clinique is actually a brand I don't usually love, but they have one called liquid minerals that I think does a good job. I actually found out about them through the Environmental Working Group. That's one that a lot of my male patients like, especially because it doesn't leave much of a heavy residue so they don't walk around feeling like they got a foundation on. The iron oxide is kind of newer to the scene in terms of a sunscreen ingredient, and I'm not as familiar with sunscreens that would have the iron oxide in it, but it does have a natural tint. It also helps block out that, it's called the HEV, the high-energy visible light, which some people can be sensitive to, especially people who have autoimmune disease, or people who have melasma, they might want to look for something that's heavier on the iron oxide.
Dr. Laurie Marbas
(21:54)
Okay, great, and then as far as any suggestions for itching skin?
Dr. Apple Bodemer
(21:59)
Yes. The most common cause for itchy skin is dry skin. I probably say that like 20 times a day. So if you have not started moisturizing using a moisturizer, then that's the first place to start, and I love that you grabbed your water because we don't really give oral hydration enough credit. I think there's not a lot of good studies. There's like a few studies from way long time ago, that did show that oral hydration improves the skin, the microvasculature in the skin, but in terms of actual skin health, we don't have a lot of hard data. But, Christie Brinkley, and I got a blank on the other one, there was another supermodel in the day when supermodels are first becoming a big thing, that they both … I saw them interviewed multiple times, and they both would always say that the key to their skincare regimen was drinking lots of water, but we don't have the scientific data. I'll go with Christie Brinkley, her skin still looks pretty good, although I'm sure there's been a lot more to that than just drinking water and sun protection, but that will help.
Dr. Apple Bodemer
(23:04)
The moisture in our skin doesn't come from the outside, so when we talk about putting moisturizers on the skin that's really a misnomer, because our skin will only draw moisture from the environment with an ambient humidity of 70%. So if you're not living in a rainforest, all of the moisture in your skin is coming from your circulation. What we get when we use moisturizers, so we are putting on those two main classes of ingredients in standard moisturizers. There's occlusive, which basically leave a layer of occlusion on the skin, and help lock moisture in so that it can't evaporate. Then there's humectants, and humectants will draw moisture to the skin from underlying structures, so that comes from your vasculature.
Dr. Apple Bodemer
(23:52)
The food grade oils do a combination of both. Plus, they have a lot of antioxidants, so that's another reason. That's what I use, exclusively pretty much on my skin and on my kid's skin, are the food grade oils, but that's where our skin hydration is coming from. When I've got somebody coming in … We have something in our skin called natural moisturizing factor or NMF, and as we get older we lose some of that, we just don't have as much. The lipids in our skin tend to fall apart, our sebum will change, that can also be affected by skin pH.
Dr. Apple Bodemer
(24:24)
When we think about, maybe eczema patients who are living in really dry environments, and we talk about putting a humidifier in their room, there is a reason. Because when the skin is dry the pH changes, and we start to kind of have what happens when in eczema we'll have that kind of opening happen, and we'll see more evaporation, leading to more dry skin, which leads to itching. Then other irritants getting in, which can also contribute to itching. We really want to do our best to protect that skin barrier, and through oral hydration, if people live in really dry climates, like some of you, especially in Colorado up high it can be … or Arizona, it can be really, really dry, using humidifiers, especially in sleeping areas, and then using a good quality moisturizer regularly. That's usually where … usually that'll clear up a lot of mild to moderate itching in people who aren't already doing those things.
Dr. Laurie Marbas
(25:17)
Cool. Any other thoughts? Okay, excellent. Then what about hair loss?
Dr. Apple Bodemer
(25:23)
Oh, yes.
Dr. Laurie Marbas
(25:23)
I know you and I have talked about this before. We're going to do another interview about that, but please, hair loss.
Dr. Apple Bodemer
(25:28)
Yes. Hair loss is huge, it's one of my particular clinical areas of interest, and there's a lot of different types of hair loss, so you can't just say like, “Oh, what do you do about hair loss?” Because, especially with COVID, we were all seeing a lot of a type of shedding type of hair loss called telogen effluvium. That's probably one of the most common types of hair loss that would be seen in a primary care setting. That can go along with several different things, but specifically thinking about people who might be changing their diets severely rapidly that can lead to some telogen effluvium. It's just something to be on the watch for. People who might drop weight really rapidly, which we might have people who need to drop weight pretty rapidly, and we know that that can happen on a plant-based diet, so we just need to watch for that, and really it's reassuring people it's going to grow back.
Dr. Apple Bodemer
(26:15)
When we see that diffuse shedding, where people come in and they have handfuls of hair, we want to try to figure out what the trigger is. It can be physical, or psychological stress, so both types of stress can trigger it, and a lot of times it's a combination of the two. Somebody might have had a heart attack, or been diagnosed with coronary artery disease, and then there is the physical stress of that event, that cardiac event that happens, and then the emotional stress that comes up from, “How am I going to live with this new diagnosis? What can I do to kind of fix that?”
Dr. Apple Bodemer
(26:45)
We always check thyroid, iron studies, and I'd always check Vitamin D levels. Vitamin D level is rarely low enough to actually cause the telogen effluvium, but vitamin D is important in helping regulate and normalize hair growth. It's one way that we can help optimize hair growth, so when the hair does start growing back then we can make sure it's going to grow back as robustly as possible.
Dr. Apple Bodemer
(27:10)
The other most common type of hair loss we see is a genetic pattern hair loss, especially for anybody who's working in women's health, or in diabetes work. Because we do see people at younger ages come up with these genetic patterned type of hair loss, which can be hormonally driven, and we see that with metabolic syndrome, with earlier onset diabetes. We'll see a lot of issues with hormone dysregulation, and that can lead to early onset of this genetic patterned hair loss, and that really is looking at the underlying. When we're seeing at young ages, “What's going on underlying this?” When we see it in women around menopause, which is when we expect to see this to some degree, asking about other menopausal symptoms, are there things that we can do from either lifestyle modifications? There are some botanical herbs that I use in women who are perimenopausal experiencing hair loss. It will really depend on the specific symptoms that they're having.
Dr. Apple Bodemer
(28:03)
Vitex is a really pretty safe herbal medication, that if a woman's coming in with hot flashes, perimenopausal mood swings, and other perimenopausal issues, and hair loss, it's a good one to try. Pumpkin seed oil is a really interesting one, because that's come on the scene more recently. There was a study out of India that looked at about 73, I think men, who had genetic pattern hair loss. We have no studies in women. We do have some mouse studies, and then we have this decently done human study. They gave the people in this study 200 milligrams of pumpkin seed oil orally twice daily for 16 weeks, and they saw pretty significant regrowth. In the US I can't find 20 milligram supplements, they're all a 1000 milligrams, and so I have my patients take a thousand milligrams once a day of that, and I have started to see some patients back, and most of my patients are women. So this handful of women I've seen back, I think four have been really, really happy, one didn't feel like it did anything.
Dr. Apple Bodemer
(29:10)
We do know that it has 5-alpha reductase inhibition activity, which is kind of a mouthful if you're not in the medical world, but that enzyme is responsible for taking just the run of the mill general testosterone in our body, and kind of supercharging it. That enzyme is present on the hair follicles and on oil glands, and what we have happening, this testosterone will be floating around in our body, it bumps up against this enzyme, gets supercharged, and it goes right next door, and can activate the oil glands and hair follicles to go through some of these changes that we see with the genetic pattern types of hair loss. It's a really gentle 5-alpha reductase inhibitor. We do use prescription medications sometimes that have that activity as well, but I really like pumpkin seed oil because it's just gentler. There's absolutely no side effects and no interactions.
Dr. Chris Miller
(29:57)
Wow, this is so interesting, I hope everyone out there is enjoying this as much as I am. This is awesome. I have one example of this, that you brought up that just raised my ears when I heard it. We had just moved two years ago when COVID hit, and my husband was really stressed out with a new job and moving, and COVID, and he lost all the hair on both of his lower legs, from his knee down. It was so dramatic, and we tested his thyroid, and we tested his iron levels, and his Vitamin D. He's already plant-based. We couldn't figure it out, and then we figured it was stress, and since then we've moved back, and we're no longer there at that job or anything, and his hair has grown back. So, for everyone listening, it's such an example of stress, and what you said, the telogen flavum? What did you call it?
Dr. Apple Bodemer
(30:49)
Effluvium.
Dr. Chris Miller
(30:51)
Effluvium. It's so interesting that stress plays such a significant role, but it really does.
Dr. Laurie Marbas
(30:56)
Chris in Charm we have handouts, there's actually one, it talks about that, it's telogen effluvium. I've uploaded it for you. It's a really good one to have patients read, it's an article that describes it.
Dr. Chris Miller
(31:07)
Upload it to my husband now.
Dr. Apple Bodemer
(31:10)
People can lose up to 70% of the hair on their scalp. Usually it's about 10 to 25 is more common, but I have seen some pretty dramatic cases, and sometimes it's even nerve-racking for me when I'm just holding their hands being, “Just be patient, this will grow back, it will grow back.” Sometimes when I see those really extreme cases you're like, “Oh, my God, I hope it grows back.” It always does.
Dr. Chris Miller
(31:33)
So interesting. Thank you.
Dr. Laurie Marbas
(31:36)
There's a good question. What about females who've suffered from acne in the past, how can they minimize or eliminate scars left behind?
Dr. Apple Bodemer
(31:46)
The tricky thing about scars is once they're there, they're kind of there, and it depends a little bit on the stage that the scar is in. I do find that zinc, and I don't go with crazy high dosing supplements, but sometimes I will increase, just add a little bit of zinc for people who have the dark purple, kind of post-inflammatory hyperpigmentation pieces to their acne. If it's burned out, and it was acne that you had when you're a teenager, and you're now middle aged, and all you're really noticing is just the indentations there, you're really looking at cosmetic type procedures, micro dermabrasion, or dermabrasion, or some of the laser resurfacing things. Once they're there, they're really, really hard to get rid of, at least there's no creams or anything that will work for that. It's when it's still in an inflammatory stage that we can try to do things to help diminish the inflammation.
Dr. Apple Bodemer
(32:42)
Certainly when people have scarring and active acne we need to address the active acne before we could go into any sort of treatment for the scars specifically. It's a tough one, and it's another reason to really take it seriously. When we see teens come in with acne, we kind of expect it, and you're a teen, that's part of being a teen, but when I see anybody with really significant severe scarring acne, I really want to work fast to try to avoid that.
Dr. Laurie Marbas
(33:14)
Okay, very good. Do you know what causes rashes after sun exposure?
Dr. Apple Bodemer
(33:21)
Yeah, there's a couple of things. People can be allergic to sunscreens. That's not that uncommon, especially the chemical sunscreens, some of the ingredients have really high rates of allergenicity. So that's one thing to pay attention to, is it, “Are you going out in the sun with sunscreen on then coming in with a rash?” You might want to just try switching to a mineral-based sunscreen, those are much less likely to cause allergic reactions, but there are some people who have true sun allergy, and for those people you can try to use good moisturizers. Sometimes people need topical steroids or other topical anti-inflammatories. I like licorice root extract as a topical anti-inflammatory, it can help with mild inflammatory issues. But for really severe people that I've seen who have really bad sun allergies, a lot of times it's really hard to get it calmed down once it's flared up, and then it's just really … Those UPF protective clothing is your best friend, really trying to minimize exposure to UV radiation for those people who have that true sun allergy.
Dr. Apple Bodemer
(34:22)
There are also some interesting situations where people can end up with UV-induced itch, they don't actually end up with a blistering or bumpy rash, but they'll just get itchy, and that seems to be dysregulation of nerves, and that's something that is … It can be really hard to navigate when people have those types of allergic reactions to the sun. I would say if you're in that category, probably getting the help from a dermatologist would be useful, because a lot of times we do need to think about some prescription medications to help navigate that. I use a lot of low dose naltrexone in those patients, and while that is an FDA approved drug at high doses, it's off-label in really low doses.
Dr. Apple Bodemer
(35:02)
In the low doses, the goal for it is really not to shut down any pathways that your body needs to go through, but help augment your body's ability to respond appropriately. That can help with nerves in particular. It's used a lot for neuropathies, for certain types of neuropathies in particular. So if you are somebody who has that sort of you go out in the sun and you just get itchy with no rash, then that would be something that, at least as a provider, I would be considering that as a … and that is a prescription.
Dr. Laurie Marbas
(35:35)
Great, that's fantastic. Here's some interesting questions. This patient, when she gets a contact dermatitis she says she's prescribed oral and topical steroids, “Are there other things I should look into taking?”
Dr. Apple Bodemer
(35:48)
Yeah. Well, for … I try to stay away from oral steroids when we can because they have a lot of side effects, and if you are somebody that ends up repeatedly on even short courses, that can have negative impacts on your health long-term. Topical steroids, I think are good for short-term use, and if you're having a bad flare sometimes we need to use something prescription to calm things down. That said, I try to shift people to other things that aren't going to have risks with thinning of the skin over time, there are some products out there.
Dr. Apple Bodemer
(36:20)
There's an Ayurvedic turmeric-based cream called Vicco or Vicco, V-I-C-C-O, and that can be found online. Amazon carries it. You can also find it at a lot of Indian grocery stores, they might carry it, or ethnic grocery stores may have it. In India, they use it a ton, and I think they can buy huge vats of it for pretty inexpensive. I have some patients who are like, “Oh, Vicco, I'll just wait till I go home to India and get some,” But that's something that's … Sandalwood oil is one of the main ingredients, so it does have a smell that some people love, and some people seem really turned off by. I kind of like it, but that's got a nice, gentle kind of anti-inflammatory.
Dr. Apple Bodemer
(37:00)
There are also over the counter creams that contain licorice root extract, and one of my favorite is called Look-No-E-X-Ma. It's Look-No-E-X-Ma, so it's a funny little twist on that. It's made by a Wisconsin company called Four Elements, and that has a combination of botanicals including licorice root extract in it. I think for some mild cases of eczema that can be really helpful. I'll also use topical B12, which is from a plant-based group, is an interesting one. There are some studies, and my clinical experience has shown that topical B12 cream can be really helpful, especially for mild/moderate flares of eczema or inflammatory skin conditions. That's something you can make on your own, or you can get it compounded by a compounding pharmacy. I can give the recipe here.
Dr. Laurie Marbas
(37:54)
Yes, how do you do it? Yes, I was just about to ask.
Dr. Apple Bodemer
(37:57)
A 100 grams of a bland cream, so a thick white cream. You could use coconut oil or shea butter, they're just going to be a little bit harder, make sure that you get it mixed in well. So a 100 grams of your cream, and 70 milligrams of B12 powder, which you can pick up in health food store. It comes in little jars, and it's a bright pink color. You just need a kitchen scale to be able to measure out the amounts that you need, and you would just make as much as you want to make with that ratio of 70 milligrams to a 100 grams, and mix it up really well. It's bright pink. One of my colleagues calls it pink magic. It's great for kids. It's great for kids with mild to moderate eczema. Sometimes we need to use a topical steroids for a week or two to calm things down, and then kind of kick in with other things.
Dr. Laurie Marbas
(38:53)
Great, that's fantastic. We have another question about any suggestions on facial moisturizer specifically, any brands?
Dr. Apple Bodemer
(39:01)
Yes. Well, I am partial to the food grade oils, as I mentioned before. For facial, for aging skin, rosehip seed oil or carrot seed oil are really good. Carrot seed oil is pretty pricey, and you'll see it combined with other oils. Typically, not usually used on its own, but rosehip seed oil is one that's easy to find. For heavier oils, the jojoba or apricot kernel oil. Some people, especially people who are older, have really dry, flaky skin, the rosacea. Because even people with the redness, like the flushing, blushing type of rosacea, they tend to have dry flaky skin, coconut oil is a really good one for that.
Dr. Apple Bodemer
(39:38)
In terms of other moisturizers, basic drugstore brands, and I like to recommend a range because we all have different price points that we're comfortable with, or that is in our budgets. Even things like Cetaphil, Curel, those are really good basic drugstore brands, Vanicream, those are really good basic, kind of easily accessible drugstore brands that anybody can access. There is a company I really like called Pipette, it's a French company, and they use a plant-based squalene, which is another compound that we have in our natural sebum. I don't know of anybody locally that carries Pipette, I think it's mainly online, at least where I'm at, but that's a really good brand. Avalon Organics, I like. Weleda is a Swiss company, they have something called Weleda Skin Food, it's probably a little heavy for facial moisturizers, but that's also a really good one.
Dr. Apple Bodemer
(40:32)
I'm just thinking off the top of my head. Alba is a pretty good brand overall. They do have some products that the Environmental Working Group doesn't rate very highly, but that's one that you can find in a lot of natural organic health food type stores. I talked about the sunscreen guide, but there is a database that the Environmental Working Group has called The Skin Deep Database. It's great because they also have an app that you can download, and then you can just scan the barcode if you're at Target, or a grocery store, or Walgreens, or Walmart, wherever you are, you can scan the code, and it will bring up … if that happens to be in their database, if that product is in their database, then it will bring up their ratings. So that can be a really helpful way if you're looking for ways to identify safe, kind of other personal care product type things.
Dr. Laurie Marbas
(41:25)
Cool. That was pretty awesome. One last question. This one's been on here for a bit. Have you heard of anything, or problems with skin allergies, or triggers in gluten-free products? Is there anything that maybe someone should be watching for that you're aware of?
Dr. Apple Bodemer
(41:42)
Does that mean that people … like using these gluten-free products, that there might be something else that could be concerning, I think so. For people that have celiac disease that's really essential that they use gluten-free skincare products, for the rest of us, I don't know that it is. For celiac, patients with celiac, it is kind of a life or death thing because their immune system triggers really bad things when they get exposed to gluten. For most people with gluten sensitivity, I rarely see topical gluten sensitivity, maybe once, maybe once, but for the most part, that's kind of a marketing thing that companies will use.
Dr. Apple Bodemer
(42:19)
In terms of other things that would go along in a gluten-free product, coconut oil is gluten-free, most of the things that go into skincare products would be gluten-free. Sometimes they'll use starch as fillers, so that might be something that they're identifying, but they can still have all kinds of crap in them. I'm very simplistic and minimalistic when it comes to my skincare regimen, and why I'm such a heavy proponent of the food grade oils, because there's one ingredient, I know what it is, and I don't have to worry about that. I would say if you have sensitivity, chemical sensitivities, you just have to read those labels, and then also recognize that these chemicals can be hidden in all kinds of different ways.
Dr. Laurie Marbas
(42:59)
That was amazing. Thank you, Dr. Bodemer, that was absolutely amazing. By far, one of the best we've had, so thank you, thank you, thank you.
Dr. Apple Bodemer
(43:09)
Well, thank you for letting me, thank you for letting me spend this time with you all, and I really enjoyed getting to meet you, and I hope you got something out of it, and I would love to chat again.
Dr. Laurie Marbas
(43:18)
Yeah, absolutely. I'm talking to you later, we're going to talk about that hair loss. We had talked all about that before, but maybe we include some other things too. So thanks again, guys. This will be available as a recording on Facebook, it stays there, it's forever. Then we'll move this to YouTube within a week or so, and then eventually over to the website, so if you want to rewatch it or send someone, please put them to the Plant Based TeleHealth Facebook page. Then like I said, if you want to speak to any of our docs on Plant Based TeleHealth, we're up to nine now. We cover all 50 states and DC, so please, and that includes internationally, we are happy to speak to you as well. Go to plantbasedtelehealth.com, you can schedule an appointment right away. We have some incredible doctors who are willing and waiting to help you. Thanks again for tuning in, and we'll see you next time. Thanks again, Dr. Bodemer, we really appreciate it.
Dr. Kim Scheuer
(44:10)
It was awesome.
*Recorded on 9.23.21