The Connection Between Lifestyle, Inflammation and Your Skin with Dr. Mamina Turegano

0:00Hey y 'all, welcome back to another episode of Skin Anarchy. I'm so thrilled about our guest today because she is a triple board certified dermatologist. She is an internist and a dermatopathologist. So we can basically ask her anything that we want about skin health and she will know because she has done such extensive training in this field and all related fields. So without further ado, please welcome Dr. Momina Taragano. Welcome to the show. I'm so excited to host you and I'm so excited to dive in. Thank you so much for having me. It's an honor to be here. Thank you. Oh no, the honor is truly mine.

0:32I'm really excited to chat with you. More importantly, learn from you. I mean, it's so impressive that you have board certifications, not just dermatology, but also internal medicine and dermatopathology. That's huge, you know? So like I said, I'm very, very excited that we can pretty much ask you anything. We'll get an answer. We'll see about that. We'll see about that. But thank you. I'd love to start off by learning more about you and what really got you into, you know, dermatology overall. Was there something that happened in medical school that sparked your interest or how did this all start?

1:02Yeah, it was actually medical school because I had the intention going into medical school to go into primary care. And the years leading up to me going to medical school, I've always had a passion also for integrative medicine, taking a more holistic approach to medicine. And I thought primary care was the best avenue to take to integrate this approach. And when I was doing my rheumatology rotation, which is a subset of internal medicine, rheumatology deals with a lot of autoimmune diseases. And there's a lot of overlap with autoimmune diseases and skin diseases. And I just saw that I was so drawn to the patients with autoimmune cutaneous issues, whether it is cutaneous lupus or dermatomyositis or scleroderma, and to see the skin manifestations.

1:44And some of them were very debilitating. And I had so much empathy for these patients. And I was like, wait, maybe I like derm. I didn't think that I was a derm person, but maybe I like derm. And then I also, so when I did my derm rotation, I fell more in love with derm because it just covers the whole gamut. Like you see both adults, you see kids. Cause I was torn. I was, I was really interested in both adult medicine and pediatrics. And you also do a little bit of everything. You do a little bit of surgery. I knew I couldn't be in the OR. I was not that person. I didn't want to manipulate bowel, but I loved like simple, just cutaneous surgeries.

2:20And I also loved pathology so much. I like knew I didn't want to work in a basement and be a pathologist, but you get so much pathology with derm. And I was like, okay, this is derm is where it's at. And I was so bummed because most people know early on if they want to do derm because it's such a competitive field. And I kind of decided sort of late in the game. And I feel like I barely got in by the skin of my teeth. It was, it was a lot of luck. That's so cool though. And I love that you did this integrative approach, like you said, because when I look at, especially right now because I feel like we have so many consumers that have so many new questions I feel like I don't know you see that a lot like in your practice that people are asking like just more educated questions now than definitely yeah I feel like patients are definitely keeping us on our toes because they'll sometimes bring up topics that I haven't heard about and I think I was like introduced to double cleansing I mean this was like 10 years ago by a patient and so it's just like things like that for sure and then you know they'll also ask about like what do you think about this chemical?

3:21Is this okay? Am I harming myself? Or if I'm pregnant, like, is this fine? So yeah, definitely, I have to thank my patients a lot for staying on top of some of my knowledge. Yeah, no, that's really cool. I mean, I think that's, it's really, really neat how much education is now out there, you know, for the general consumer, like, it's crazy that we can go on and they're reliable people, you know, that are telling you about actual, you know, whether it's like the the skin condition you're dealing with or even just trying to figure out what should i do routinely you know i remember when i started hierarchy like literally i was like searching right like because you look for guests and you're like i can bring on that can like educate my audience and at the time even the derms that i i invited on they were like god you know i wish there were more of us out here because there's so much misinformation you know and i remember i think one of the first questions i asked was do you really need to apply eye cream with your third finger?

4:16That's funny. Yeah, there's a lot of stuff. But I want to dive a little bit into this integrative dermatology because you have that. Yeah. And then, I mean, what really inspired you to explore the more holistic side than the traditional medicine route? Yeah, you know, I want to attribute a lot of my interest to my mom. My mom is Japanese. knees. And growing up, she would definitely incorporate alternative therapies just into any of our healing. So she was very anti Tylenol, like whenever we had a fever and she would make us sweat it out and she would make like weird concoctions. Like I remember it was sake and a raw egg and we would have to just down it and it would knock us out.

5:02And I'd wake up the next morning feeling like a million bucks. But yeah, so she would just do these other remedies. She would massage different like acupressure points. If I was constipated, there was like a certain spot on my index finger that she would massage. Or if I had a sore throat, there was like a spot on the bottom of my foot. And I don't know if it was placebo, but I felt like some of it did help and work. And so she kind of instilled that interest in me. And then I was also exposed a lot to just Asian culture in general. I lived in Korea when I was in seventh and eighth grade. I went to boarding school there.

5:31My family was still living in New York at the time, But just living there, you also get exposed to Eastern healing modalities, things like moxibustion, and just drinking different tinctures, herbal remedies. So to me, that approach to health was normal. Of course, I saw a regular conventional doctor when I was just growing up, but I saw multiple angles of how health was approached. And in college, I also became really interested in how food can impact our health and even things like our breathing. And I was super inspired by Dr. Andrew Weil, who is an integrative medicine physician. And I feel like he was one of the biggest pioneers for this.

6:09And he was probably one of the biggest reasons why I decided to get an MD. He also has a medical degree. And so I was like, you know what, I feel like if I have an MD, I have kind of more options in front of me to be able to take an integrative approach, like I could just get the foundation in conventional or allopathic medicine. And then I I can always learn other healing modalities with that kind of basis of education. That's so cool. Yeah, I interviewed Dr. Weil and he was amazing to talk to. Oh, that's so awesome. Yeah, no, he was really cool. And there was a lot of cool stuff he brought up too.

6:40But that's really neat. Yeah, that's really neat that you did that and that you got this, you know, like different perspective because I always wonder this as well, because we're sitting in the West and I think an old mentor of mine a long time ago said the West practices with their machines and the East practices with their knowledge. And I was like, you know, it sounded very harsh at the time because you're in the West, you're learning. And then you grow into it and you start to realize like, yeah, you know, there's a lot of stuff like in Eastern philosophies and Eastern medicine that's still being employed.

7:12And it works, it genuinely works. And there's people who live and die by this stuff, you know, and it's not hocus pocus. I feel like the West kind of makes it feel like it is, you know, And we talk about it in a way where it's like, oh, yeah, those are just ancient remedies or cultural stuff. And it's like, no, there's value here. We could learn a lot in allopathic medicine. We could learn from that. Yeah, I love that you say that. I do think that there's sometimes this automatic, almost narrow-mindedness about it from the conventional group. And it's like, nope, where are the scientific studies and all this stuff?

7:44And they automatically shut it down. And one of my goals is to be that bridge to open the eyes of people in the conventional world to see these other perspectives and approaches to healing. Absolutely. I want to talk to you about two very common pathologies that people, I mean, you hear a lot about them on social media. There's a lot of stuff floating around is acne and psoriasis. Yeah. What are some conventional treatments that you could tell us about that are used? And then what are your thoughts about those treatments? Do you think we're doing it right? Yeah, when it comes to acne, so much focus is at the follicular unit.

8:18And that is where the pathology is with acne. If you just look at it kind of superficially, the follicular unit or the pore, where it gets clogged with dead skin cells, and oil and bacteria that naturally live on our skin can get trapped. And then you start off with whiteheads, blackheads, and then they can become inflamed bumps. So when we look at the conventional treatment for acne, we're addressing like those different components of the follicular unit, whether it's medicines to decrease the keratin proliferation, so you stop getting the clogged pore from the keratin or dead skin cell buildup, things like retinoids, like retin-A, tretinoin, tazeratine.

8:52There's also oral retinoids, like isotretinoin, aka accutane. We also recommend medicines that stop oil production, so things like salicylic acid, and then accutane also addresses that as well. and then like antibacterial things, whether it's topical antibiotics like clindamycin, benzoyl peroxide, or oral antibiotics, doxycycline is given out. Like candy, I think we have a little bit more stewardship now with how we're prescribing antibiotics, but people were on antibiotics for years. Like if you spoke to some derms from like 20 years ago. And so I think there's a little bit of a movement away from that.

9:28But yes, antibiotics is still part of a huge treatment regimen for people with acne and then medicines that address the inflammatory component. So I mean, retinoids are anti-inflammatory, benzoyl products that can be anti-inflammatory, things like azelaic acid and sulfur, which also can potentially also have some antimicrobial properties too. And then the other huge component too with acne is the hormonal component that drives the oil production. So the big one that is prescribed is oral spironolactone for adult female acne. It could also be given to teenage girls with acne too. We don't give it to men because it's like an androgen receptor blocker.

10:02So androgens include things like testosterone. So that's not something we give to men, but definitely addressing hormonal component. And birth control pills is another treatment. I don't really do birth control pills. I actually find spironolactone to be safer, but that's another commonly prescribed treatment for people with acne. Do you think that that's an approach that we should be following more so than like and care. I mean, I feel like that's where I see a lot of misunderstanding is this idea of like, should I go to a dermatologist versus like, let me buy a bunch of products, you know, and try to treat this myself, especially with acne.

10:36Yeah. You know, with acne, it's very easy to get caught up in a rabbit hole and spend a lot of money on different products over the counter. And I think that you can save a lot of time and hassle by seeing a dermatologist who can look at your skin and tell you what products are helpful, what prescriptions are helpful. And sometimes it can be inconvenient, of course. I mean, but I think there's just like even so many that are even online that are so easily accessible. And if you want something gone quickly, a dermatologist is there to give you the tools and the guidance, which is what I really appreciate.

11:12But they're not going to get to the root cause for the most part. And so just an FYI with that. Yeah, no, I mean, that's why I asked you just to debunk anything that's floating around because right now what I see a lot of and you know, I'm just observing and that is that people are taking things like, like acne has turned into rather than a word that is indicating a pathology, it's turned into a buzzword. You know what I mean? It's turned into a word that is like, oh yeah, it's something you just get like a rash or something. No, and that's where I think there needs to be so much more education because it is something you go to a doctor for.

11:49I remember having a teenager and I got the antibiotics and, you know, but at the same time, I also discovered Proactive. At the time, Proactive worked beautifully and it worked really well for my skin. But here's the really weird part is Proactive, as much as I loved it and I'm still thankful for that skincare, it sensitized my skin to benzoyl peroxide. So now when I apply benzoyl peroxide, I turn into a lobster, even like a little dot of it. And so that's where I personally get frustrated, right? Because I'm like, you should just go to a dermatologist. Because if you don't ever go to a medical professional, you're never going to know what the right treatment is.

12:28And then you're going to overdo it, you know, with a lot of the products and create other things, you know, it's just going to turn into this mess. Yes. Yes. Having the guidance. Yeah. You bring up another interesting point is like, yeah, people will just go all out. They'll buy every active over the counter. They're like, oh, I need benzoyl peroxide. I need adapalene. I need salicylic acid. And then they'll end up ruining their skin barrier. And when your skin barrier is ruined, your acne can get worse. A lot of people don't realize like gentle cleansers, moisturization, like these are really crucial parts of having a solid acne skincare routine.

13:03Absolutely. Now, I want to talk about, because you spoke on antibiotics and that brings up gut health. Explain to us, how does gut health and diet really play a role in acne? And are there any other foods that you could recommend or tell us to avoid in that regard? Definitely. Yeah. So it's a little bit complex, but I love this topic. So we're just learning so much more about our gut and the microbiome, which is the trillions of organisms that live in our intestines. I mean, they're also in our mouth, on our skin. And these play such a huge role with inflammatory pathways in our body, our immune system.

13:38And there are multiple ways that problems in our gut can manifest as inflammatory issues like acne. So one of the ways is when you get an imbalance in your gut microbiome, aka dysbiosis, And when there's a higher population of, quote, bad bacteria, they can potentially increase more inflammatory signaling in the body, and that can create more systemic inflammation. The other potential problem is this concept called leaky gut, where you could potentially eat certain foods and usually the culprits are more, quote, processed foods. So things that have really high sugar or some people, it could be gluten that could be a trigger for leaky gut, certain processed vegetable oils, of course, things like antibiotics and whatnot.

14:25And leaky gut is essentially just a kind of a more casual term for increased gut permeability. So the damage to the gut lining causes these holes that allow larger molecules to enter your blood circulation. And that can set off also more inflammation in the body. And that can manifest in multiple ways, whether it's like joint pain or migraines or acne. So it's different in everyone. The other interesting part about gut health is that there is such a close communication with signaling in the gut and our hormones too. The gut signals very closely with your immune system. our immune system has a very close intricate relationship with our endocrine system all of our hormones so when things are thrown off in the gut indirectly our hormones can be impacted as well so things like androgen levels can be imbalanced can go higher even things like insulin and cortisol those are also considered hormones those can affect acne too so there's the hormonal component i think there's so much more to it but one other thing i do want to say is that if your gut's not working optimally, you also may not be absorbing nutrients optimally.

15:29And so if you're not absorbing nutrients optimally, then that can have a whole downstream effect of skin issues. Yeah. Yeah. No, that's huge. It's absolutely huge. I love what you said. And one thing that came to mind when you were talking about hormones are also very tied. So are neuroendocrine modulators like serotonin. And I think nobody even talks about stuff like that. You know, the serotonin pathway always blows my mind in the gut. Like it's like, you only hear about it in the brain, but one of the most regulatory molecules in our body is serotonin and that's health. And it's like, we have all this complexity, right.

16:04To like unwrap. And, but you know, I think people are starting to get behind it where they're like, you know what? Yeah, there is something to this because I mean, just look at how many people have vitamin D deficiencies now. Like it's insane. It's like, it's crazy. Every single person I personally know in my life has a vitamin D deficiency. Like it's crazy. Oh yeah. It's almost abnormal. Like I'm shocked when I'm checking vitamin D on someone and it's normal. And I'm like, okay, you have to be like, you have to be taking like high amounts, like what's going on. And if it is normal, they usually are on like a really high dose supplement.

16:39Exactly. And like, and it's exactly what you said it's also affecting how you absorb things definitely and people now like you know it used to be where it was like someone has celiacs and then that's when you suspect that they're not absorbing their vitamins or something you know but now it's like no it's pretty much everybody you got to check everybody now because we're all not absorbing something exactly it's such a thing yeah yeah it's turned into a whole thing but you know i really think that that whole axis the gut skin access is something that is so worth exploring. So I want to talk about, you know, you have a whole book on this.

17:16Your new book is The Holistic Psoriasis Management Nutrition Guide, and it introduces a very different perspective. I mean, what do you think, what should people know about managing psoriasis beyond just prescriptions? Yeah, I know such a common condition that is potentially very debilitating. So beyond the conventional therapies, which oftentimes is things like topical steroids, or there's like oral anti-inflammatories and things like biologics. But psoriasis, I kind of tell people, maybe just to kind of look at it more positively. So having psoriasis is kind of like having a canary in the coal mine.

17:52It's like your body's way of telling you that there's something going on internally that's deeper. We're having so many more publications and literature coming out. I I mean, it's very well established that there's a strong connection between psoriasis and underlying chronic diseases, mainly cardiovascular diseases. But there's also a lot of association with other chronic illnesses, whether it's diabetes and even things like hypothyroidism. And so it's like if you have a little bit of psoriasis, it can help you kind of relook at your overall health and realize, okay, maybe I need to do something.

18:28Maybe I need to like look at what's affecting my cholesterol, or maybe I need to make sure I'm going on a certain exercise regimen. So for me, when it comes to counseling patients with psoriasis beyond the conventional treatments, it's looking so much at lifestyle. And there is a lot of established research that definitely shows connection between certain factors in people's environments that can trigger psoriasis. Alcohol and cigarettes, we 100 % know that those can certainly trigger psoriasis. And, you know, those are huge players too with cardiovascular disease. Like it's just very overall helpful to minimize those things.

19:03It's hard for people to give some of these things up. And, you know, obviously I tell people, you don't want to be so hard on yourself because then that creates stress. And stress also is huge when it comes to psoriasis. It's like having people kind of stop and reevaluating their lives. You know, a lot of people deal with stress and the way that they cope with it is going out and partying and staying out all night, drinking lots of alcohol. And I also say staying out all night because it's interesting, a pattern that I have noticed in my patients with psoriasis, a lot of them were doing stuff at night, whether they were students partying at night or staying up doing all-nighters, they would notice flares or even like my night shift workers, like nurses who did night shifts.

19:39For some reason, I just had a higher proportion of night shift female nurses with psoriasis. And then I also had like a stripper. She would just drink and be up all night. And so it's interesting, I looked up, there was an interesting article that talked about how disruption in your circadian rhythm plays a huge role in psoriasis in women. So sleep, and these are all such basic things, managing stress, sleeping at normal times, minimizing alcohol and cigarettes. But these are all huge players with psoriasis. And then the other huge component too with the book, because I would say the last 25 % of the book is on kind of meal plans is also looking at food.

20:21We've seen just that ultra processed diet play a really big role. So things that are high in like processed sugars, processed vegetable oils, the most consistent evidence that we have in terms of a diet that's helpful for psoriasis is the Mediterranean diet. So focusing more on like whole foods, increased fiber, increased plants and vegetables, healthy fats. And I do recommend that people supplement with omega threes as well as vitamin D. Yeah, that's really, that's really fascinating, though, that there's such a tie-in with stress. And, you know, huge. So I'm interested, like, how these people certain, I mean, I guess you could measure certain markers, right?

20:59You could look at cortisol and all that. But did you see that? Like, there was certain other, you know, comorbidities also tied to it? Because if they're so stressed out, I would think that there's some other indicator also that goes with psoriasis. Yeah, definitely. I would say the majority of my patients with psoriasis, over 90 % of them are overweight or obese. Oftentimes we'll have at least one other chronic disease, whether it is diabetes or high blood pressure or high cholesterol. So it's like a full, it's yeah, just taking that whole picture into consideration. And then something else that's interesting, you know, GLP-1 drugs are becoming such a huge thing in so many ways and like in such amazing ways to like helping so many people who have obesity and obesity related illnesses.

21:46And we're seeing promise with GLP ones in the setting of psoriasis. Interestingly, even if people are not overweight or obese, we're seeing that there's like some kind of anti inflammatory component from GLP when I think it was trisopatide specifically that was looked at. So more to come with that. But I think that that potentially could be a promising therapy because I say all of these things. I say like all of these lifestyle changes that are helpful, but it's so much easier said than done. It's hard. Sometimes stress is unavoidable, but people need to put food on the table and like there's only certain jobs that they can have to do that.

22:21It's very difficult. It's hard. It's hard in our society and also just the inundation of like these processed foods. It's like an uphill battle as doctors trying to counsel patients. yeah you know it's crazy i think about our ancestors so much i've said this so many times on the show where it's like i literally i think people know more about my grandparents at this point than myself because i bring them up like every episode but my grandparents on my mother's side both lived to be centennials and yeah and they lived in rural india lived in india haryana they never went to the city they never lived in the city they had their own land they would grow their food they would grind their grains they would make their yeah and that's how they lived And that's how they raised seven children.

23:03And even in their last days, I think they were the healthiest people I've ever seen in that situation where, you know, you're coming to the end. And it was just, I mean, I think about that and I'm like, how the heck did we go from that to this society where we're all basically eating plastic, you know, like, yeah. No, it's wild. Yeah. And then you have all these crazy health conditions popping up. I mean, you had brought up autoimmune earlier and I wanted to say something because I have Hashimoto's. I got diagnosed with Hashimoto's when I was like, you know, late 20s or something like that. And at the same time, you won't believe it, you know, at the same time, my mom was diagnosed, my friend was diagnosed, my dad was diagnosed, and my brother was diagnosed.

23:47And I was like, how the heck do we all have? we all yeah and i was like and it really made you think like you know what it's not about just genetics and it's really about our lifestyle in america west and definitely you know and and we're eating all this stuff and even today you know you go to the grocery store you're trying to eat healthy you're trying to do better for yourself and all you ever see are options that are just riddled and in something or other you know whether it's like you're not really buying products that are truly cleaned when it comes from the angle of pesticides or whatever is being used to preserve them or like you know you can't get away from it anymore and just the other day i was having a conversation about nanoplastics now in our water supply you know and how big it is i'm actually working on a manuscript right now about nanoplastics because they're starting to deposit in the liver and they're starting to deposit kidneys and it's a whole thing it's a whole thing like yeah the rates of like thyroid issues are skyrocketing the rates of infertility is skyrocketing.

24:49The rates of acne is skyrocketing. There's like something going on. Yeah. There's a common denominator in this. And that's where it's so frustrating because people ask you questions. I mean, do you get the questions of like, how can I detox? Because I get them sometimes. Yes. Yes. And it's just kind of like, what do you say to that patient? It's like, you can't detox. I don't know how to tell you how to flush out nanoplastics. I don't know. Yeah. What I tell patients is that our bodies naturally know how to detox, but you just want to minimize the things that are interfering with the detoxification pathways.

25:23Yes, you want to minimize the use of plastics, you want to minimize alcohol, you want to minimize like processed foods, because like all of these are interfering with your natural detoxification pathways. But yeah, no, I do get that question too. And I'm like, they're actually expecting to go on a specific cleanse or something. Yeah, exactly. There's no cleanse. Like that's, that was my point. There's no cleanse, there's no beet juice that you can drink that's gonna you know unfortunately so it is very important I think more than ever right now to be very mindful of nutrition and really where we're getting it I mean I genuinely think everyone should have a home garden at this point oh my god seriously you know like just something small but like you know that you're getting all your veggies from this something that grew out of the ground and you know you know the fact that it was grown out of the ground.