Hopefully, over the last few parts of this series, I've presented the hypothesis of Oximation to you in a way that is academically cogent. That's all well and good, but the hypothesis only means something if it can help you to practice better medicine, especially in these difficult economic times.
Certainly your patients are looking for ways to get better outcomes from less expenditure—particularly those who've recently lost their insurance. To meet these needs, you'll need to acquire what computer programmers call "killer apps," that is, applications or skill-sets that give such fantastic results that it just about kills somebody.
Learning how to clear up skin problems without using toxic substances is one such medical "killer app." It's one that patients will appreciate for its own sake, but the good news is that it will also have many other health benefits, including reducing the risk of many other common chronic diseases.
Let's face it: no one really cares much about high LDL cholesterol or elevated C-reactive protein. Who would notice that at a dinner party? But no one wants to show up with a big patch of psoriasis or a face full of zits.
Skin cells reflect the overall health of the body. I have yet to see a patient with rosacea who did not go on to develop serious cardiovascular disease! So, skin problems make for excellent teaching moments that can help patients make the connection between diet and health. This is especially true for teenagers.
The Dermal Ecosystem
There is a very strong correlation between dermatologic autoimmune disease and other diseases of oximation such as diabetes, Alzheimer's, stroke, heart disease, etc. The reason is that they all share a common pathophysiology: when a tissue becomes hypoxic or there is a compromise in the process of cellular energy production, cells start to die, or they change their pattern of DNA transcription (keratoses, cancer, moles).
When this process occurs, the same thing happens in the human body as happens in any other ecosystem: saprophytic predators are attracted to the deteriorating tissue. In the human body's ecology, fungi are the saprophytic predators or recyclers. As fungi proliferate, they release mycotoxins that act as immunosuppressants. This immune suppression will open the door for other microbes to invade, and this can then lead to more salient disease.
The invasive microbes are not esoteric. Antoine Beauchamp, Louis Pasteur's contemporary (and detractor) is famously quoted as saying, "The primary cause of disease is in us, always in us." Once there is a breach in the fragile balance of the human ecosystem, microbes that are normally commensal or even symbiotic, can become pathogenic (not unlike elected officials). The manifestations can range from vaginal yeast (visit www.holisticprimarycare.net, and read "A Role for Probiotics in Preventing, Treating Bacterial Vaginosis," Vol. 10, No. 2, Summer 2009) to acne, to bladder infections, to flesh-eating streptococcus.
Prevention and reversal hinges on maintenance of immune system integrity.
Let's use acne as an example. There is controversy in the dermatology literature about exactly which microbe/s cause acne. But we know that the disease process involves proliferation of resident bacteria—microbes that are "always in us."
Why does this proliferation happen in select individuals just before a big date, an all-important exam, or a crucial business meeting? The genesis of the pimple is likely the same as the genesis of the atherogenic "fatty streak"; a nidus of compromise that presents an opportunity for ambient resident microbes to proliferate and trigger further inflammation.
Buzzards on the Highway
It is important to understand that whenever a problem begins to arise in a particular tissue, the predisposition for "compromise" is already there. It is related to generic polymorphisms, and everyone is born with some sort of inherent weakness in some part of their physiology. Think of these as weak places in the levee. For some, the weakness is in the vasculature, for others it's the mucosal lining of the GI tract. In still other's it's the skin. Problems don't necessarily manifest until there's a big hurricane, but almost everyone has certain built-in weaknesses where disease is most likely to manifest when under stress.
Consider this: there are literally miles of arteries in the body. Why does a fatty streak and then an atherosclerotic plaque develop only at specific loci? There are miles of Texas highway: Why all the buzzards at one particular spot? The answer's simple: Saprophytes and scavengers gather where there is dead or dying tissue.
When someone is under stress, there is increased adrenal output. This increases blood sugar. If there is a weakened immune system, yeast starts to proliferate. They secrete gliotoxins that compromise macrophage response. This opens the door for native bacteria to proliferate, which in turn initiates an immune cascade and we're off! The same basic sequence occurs in acne, asthma, coronary artery disease, and many others.
Plaques and Plaques
I'm certainly not the only one who believes there is a connection between inflammatory skin disorders and cardiometabolic disease. Researchers first posited a correlation between psoriasis and diabetes in 1908! Over 100 years later, Abrar A. Qureshi, MD, MPH, and colleagues at Brigham and Women's Hospital and Harvard Medical School, Boston have corroborated this link.
Dr. Qureshi's group studied 78,061 women involved in the Nurses' Health Study II. The women ranged in age from 27 to 44 years in 1991 at the outset of the study, and all were free of diabetes or hypertension. In 2005, they were given a survey that included a question about lifetime history of psoriasis. They were also evaluated for diabetes and hypertension during the 14-year follow-up.
A total of 1,813 subjects (2.3%) reported having psoriasis; 1,560 (2%) developed diabetes, and 15,724 (20%) developed hypertension over the 14-year period. Those with psoriasis were 63% more likely to develop diabetes and 17% more likely to develop hypertension than women without psoriasis. The associations remained strong even after controlling for age, body mass index, and smoking (Qureshi AA, et al. Arch Dermatol. 2009; 145(4): 379–382).
The authors posit chronic systemic inflammation as the common factor underlying all three conditions. "These data illustrate the importance of considering psoriasis a systemic disorder rather than simply a skin disease," they conclude. I couldn't agree more heartily. And isn't it curious that both psoriasis and atherosclerosis are characterized by plaque formation?
Callin' Quits on Zits
|Before and after photos of a patient with severe acne. Photo courtesy of Dr. Roby Mitchell. |
Acne is certainly more common than psoriasis, and while I won't go so far as to say all teens with acne are at risk for heart disease, it is important to realize that the zits reflect an inflammatory process that could pose more serious problems later in life. Bear in mind that the atherosclerotic process begins relatively early in life, many years before it manifests as overt heart disease.
When teens come to see me for treatment of acne, I take that opportunity to make the connection with them between diet and disease. I promise them that we can make the acne go away if we work as a team. My job is to make sure that any hormonal or nutritional deficiencies are addressed. Immune system function can be compromised by deficiencies of thyroid hormone, zinc, selenium, vitamin D3, iodine/iodide, essential fatty acids, stomach acid, and beneficial gut flora.
Suboptimal levels of thyroid hormone, which can occur in teenagers, will impair conversion of β-carotene to vitamin. This may manifest as carotenemia in palmar and/or plantar surfaces. Adequate levels of vitamin A are critical for optimal immune function. If a patient has been chronically hypothyroid and manifests carotenemia, I will usually recommend 100,000 IU of micellized vitamin A (American Biologics) for 1 month.
I put the onus on the patient to not throw gasoline on the fire—and remember that "inflammation" is derived from the Latin word meaning "on fire"—by eating foods that promote fungal overgrowth.
Native, benign yeast such as Candida albicans and C. glabrata can, given the right conditions, pleomorph into filamentous, migrating, pathogenic fungi. As they proliferate, these organisms produce immunosuppressants that then pave the way for other microbes that can then cause acne, or set up the cascade for an atheromatous plaque.
I encourage my patients to get off high glycemic foods such as sugar, grains, cow's milk, sodas, fruit juice and other sweetened beverages. I advise them to eat more blue, purple and dark red fruits and vegetables that are imbued with phytochemicals that inhibit fungal overgrowth. Regular consumption of these healthful foods helps maintain a homeostatic microbe balance in the skin and internally.
To get immediate resolution of the acne (or rosacea, for that matter), I have patients start using my "Touch My Face Masque," a combination of natural plant antifungals, cell nutrients, and collagen promoters.
The Masque is very simple to use: patients simply apply a few fingertip-fuls after washing their faces with a mild soap and hot water. The masque will need to set for 2 hours, and it is easily removed with a mild soap. It can be worn overnight, but make sure patients know to rub it into the skin completely so that it does not stain fabrics. After washing off the masque, patients should apply a healing oil, such as castor oil (my personal choice), organic coconut or extra virgin olive oil.
These topical treatments are not a cure, but they will clear up acne break-outs pretty quickly. The effect will not last, however, unless the patient continues the immune-system augmenting protocol discussed above. It took awhile, but the patient shown in the accompanying pictures went through enough cycles of recurring acne that she finally cleaned up her diet. Now she only has to use the Touch My Face Masque before dates.