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ENCORE: A Deep Dive into Acne with Jacinta Barbagallo · Wellness by Designs - Practitioner Podcast

• 0:11
  SPEAKER_00: This is Wellness by Designs, and I'm your host, Amy Skilton, and joining us today is Jacinta Barbaghello.
• 0:20
  SPEAKER_00: Jacinta is the founder and skin specialist nutritionist of Arenda Women's Health, and having worked with hundreds of clients one-to-one as well as educating skin therapists across the world, Jacinta has worked extensively with some of the most complex skin conditions, including acne, rosacea, perioral dermatitis, melasma, psoriasis and eczema, staph infections, and so much more.
• 0:48
  SPEAKER_00: Previously working in the realm of functional pathology interpretation, the basis of Jacinta's clinical practice is helping her clients find the answers to the cause of their skin condition and provide realistic long-term solutions to achieve and manage clear skin.
• 1:05
  SPEAKER_00: And we're so honored to be chatting with Jacinta today about the naturopathic approach to treating acne from the inside out.
• 1:14
  SPEAKER_00: So, Jacinta, welcome to the podcast.
• 1:17
  SPEAKER_01: Thank you so much, Amy, for the introduction.
• 1:19
  SPEAKER_01: I'm very excited to get into everything today.
• 1:21
  SPEAKER_01: And I know that you love skin too.
• 1:23
  SPEAKER_01: So it'll be a great conversation.
• 1:25
  SPEAKER_00: I'm so excited to be speaking with you because skin is certainly a huge passion of mine as well.
• 1:30
  SPEAKER_00: And for me personally, it was born out of having chronic acne as a much younger woman, which led me to studying to be an aesthetician as well.
• 1:43
  SPEAKER_00: But I'd love to hear your story.
• 1:45
  SPEAKER_00: Like, how did you end up working in this space yourself?
• 1:50
  SPEAKER_01: So, um, as you mentioned in my little bio, so I used to previously work for a company that was a supplement company and also functional testing.
• 1:58
  SPEAKER_01: So I was really working in the space of education for quite a period of time.
• 2:04
  SPEAKER_01: And with that, involved me training a lot of different skin therapists around the benefits of essential fatty acids and how it can support their clients to be able to meet the topicals halfway and to really work on the internal drivers of a lot of most of the time acne.
• 2:20
  SPEAKER_01: And it really helped me to find my niche of an area that I wanted to really delve into in clinic because I could just see that they could really only get to this the skin so far with the type of treatments that they did.
• 2:32
  SPEAKER_01: And their their clients really required that internal support, and they just weren't feeling supported by finding a long-term solution with being given prescriptions of the pill or doxyclin or arachotane, and they really wanted to find a long-term approach.
• 2:47
  SPEAKER_01: And essentially from there, it's whole the whole of Arenda started because I was educating so many skin therapists about how they can support their clients, but they did just need somewhere to go to have someone else to really delve into all the internals with them.
• 3:04
  SPEAKER_00: And I think that's one of the challenging things because the one of the blessings of you know a skin issue, if I can call it this, is it's an organ that we can actually topically apply things to, which means we can support our skin in additional ways that we perhaps can't do topically to our liver, for example.
• 3:24
  SPEAKER_00: Um, but I do find, you know, in the general public, most people end up pursuing topical treatments over and over again, thinking the holy grail lies in a certain cream or a certain serum or a certain treatment when you know chronic skin conditions are a sign of chronic dysfunction internally.
• 3:45
  SPEAKER_00: And so the naturopathic approach is always to find those root causes and to address them.
• 3:51
  SPEAKER_00: Um, that being said, towards the end of our conversation today, I do intend to talk to you about topical support because it is one of those unique aspects of health where we can use a combination approach and enhance each of those things as well.
• 4:08
  SPEAKER_00: But looking into the internal causes, I know that taking a long-term approach is certainly what you're very passionate about.
• 4:20
  SPEAKER_00: And when I say long-term approach, I also don't want people to hear it takes a long time to fix.
• 4:26
  SPEAKER_00: Um, certainly that can be true for certain patients.
• 4:29
  SPEAKER_00: Um, but what I mean by that is the approach that Jacinta crafts is one that sets people up for good skin for life.
• 4:38
  SPEAKER_00: Um, meaning it's not like a symptomatic fix or a quick cleanup with antibiotics or, you know, something that temporarily shifts the state of the skin only for it to return to its default because the underlying drivers weren't actually addressed.
• 4:54
  SPEAKER_00: And I think, you know, again, allopathically speaking, for convenience, you know, things get pigeonholed.
• 5:01
  SPEAKER_00: And therefore, if it looks like this, you give this particular medication.
• 5:05
  SPEAKER_00: But when it comes to you know, functional and root cause medicine, you might have 10 acne clients and each one of them has a different prescription, lifestyle, nutrition, and you know, supplement-wise.
• 5:17
  SPEAKER_00: And so I'd love to hear from you your reflections on why there isn't a blanket treatment for acne and why you know different patients can present so differently.
• 5:30
  SPEAKER_01: Absolutely.
• 5:31
  SPEAKER_01: Well, I think with that, it's probably good to delve into what we define as acne and the causes of acne because it's really the causes of acne.
• 5:39
  SPEAKER_01: And once we truly understand that, we then know why there's no blanket treatment and why it's so different for every individual.
• 5:47
  SPEAKER_01: Um, so the way that we essentially define acne, it's an infection of the pylus herbaceous unit and it's driven by an excess proliferation of C.
• 5:56
  SPEAKER_01: acne bacteria.
• 5:58
  SPEAKER_01: And essentially that's because there's a blockage in oxygen into the hair follicle, which then creates the environment for the C acne bacteria to proliferate.
• 6:08
  SPEAKER_01: So essentially, when we're looking at our individual acne clients, we need to look at the three main causes of what allows the blockage of the oxygen flow into the hair follicle.
• 6:18
  SPEAKER_01: And each individual can then be different with the causes of what could be driving that pathophysiology to start off with.
• 6:25
  SPEAKER_01: So, one of the main causes, so we'll break it down into the three causes of what blocks the oxygen flow into the hair follicle.
• 6:32
  SPEAKER_01: One of them is retention keratosis, and that's essentially where we get the thickening of the stratum corneum, and that's that outer layer of the skin, and that blocks the hair follicle, the oxygen into their oxygen flow into the hair follicle.
• 6:47
  SPEAKER_01: And that can be driven by, from an internal perspective, dehydration of the skin, which includes things like lacking essential fatty acids.
• 6:56
  SPEAKER_01: So if the skin and the stratum corneum doesn't have enough essential fatty acids, then it'll cause basically like a buildup of these skin cells on the top of the surface that stops the oxygen flow to come into the hair follicle.
• 7:09
  SPEAKER_01: But then we also think of other naturopathic reasons that would cause retention keratosis, like thyroid dysfunction, because an underactive thyroid would cause sluggish um desclamation of the skin.
• 7:21
  SPEAKER_01: So again, you get that dryness, the buildup of the stratum corneum.
• 7:26
  SPEAKER_01: And again, we then get this blockage of hair of oxygen flow into the hair follicle as well.
• 7:32
  SPEAKER_01: Um, for other people, can also be a vitamin A deficiency as well.
• 7:37
  SPEAKER_01: And that's where, even just in that one cause, you can see that it's so different person to person because not everyone has a thyroid issue, but there might be some that have a thyroid issue and they their symptom is they present with acne.
• 7:50
  SPEAKER_01: And then we have another cause, our second cause is either hypercebum secretion, so excess sebum production, or we have an increase in the sebum viscosity.
• 8:01
  SPEAKER_01: Now, when we're thinking of hypercebum secretion, this is that classic kind of picture where everyone's like acne is driven by excess androgens because androgens are what cause excess sebum production, or they control the sebum production in the sebaceous gland.
• 8:17
  SPEAKER_01: But the sebaceous glands also react to things like well, testosterone, DHEA, cortisol as well, and also histamine.
• 8:26
  SPEAKER_01: So when we're thinking about the reason that our clients might be presenting with hypercebum secretion, it may not be testosterone and DHEA.
• 8:35
  SPEAKER_01: It could also be cortisol because they're stressed.
• 8:38
  SPEAKER_01: And just because they're stressed doesn't mean that they've got excess testosterone and excess DHEA.
• 8:45
  SPEAKER_01: And then we think about the sebum viscosity.
• 8:49
  SPEAKER_01: And this is one that we do see in a lot of acne clients, which is where the sebum viscosity is quite thick and it's congested.
• 8:56
  SPEAKER_01: And that's because they're lacking the essential fatty acids.
• 8:59
  SPEAKER_01: And we can see that there's either that excess omega-6 in the diet or that lacking of omega-3.
• 9:06
  SPEAKER_01: And so, even within that, again, the root cause of acne can be so different person to person because you can have clients that have low androgens, their testosterone is bottoming out, their DHEA is so low, but then we see them present with acne, and it doesn't necessarily mean that they're getting this hyperbum secretion because their androgens are high.
• 9:27
  SPEAKER_01: They could be very stressed, and it's the cortisol that's causing their sebum to be excess excessively produced.
• 9:34
  SPEAKER_01: And then our final cause we have is the pH balance, and that's where the skin pH and the acid mantle, which is the outer layer, that protects the it's essentially the skin barrier function.
• 9:47
  SPEAKER_01: That pH is so tightly regulated in order to protect the skin, and it has certain antimicrobial peptide um properties that are really important to try to prevent acne.
• 10:01
  SPEAKER_01: And essentially the pH balance that can be drastically impacted by the type of topical products the clients are using.
• 10:08
  SPEAKER_01: So everything from their cleansers, their moisturizers, their serums, their SPF as well.
• 10:15
  SPEAKER_01: Um, but the pH balance of the skin can also be impacted by the gut microbiome, just like we know that the gut microbiome pH can be impacted by the types of short short short-chain fatty acids that are produced within the gut.
• 10:28
  SPEAKER_01: It's very similar with the skin, that the skin pH can then be influenced by both the gut microbiome and the skin microbiome.
• 10:36
  SPEAKER_01: So that's essentially why, in a nutshell, that when we're looking at different causes of acne, no two cases are ever the same because you can even see with the definition of acne, the complexity of all the potential drivers and how no two clients have the same exact hormone history, the exact same blood sugar issues, the exact same diet, and you've got to treat them based on the individual you're seeing in front of you.
• 11:02
  SPEAKER_00: And it just, you know, it's such a domino effect when we're looking at the cause of the cause, also, you know, just thinking about retention keratosis and vitamin A deficiency.
• 11:14
  SPEAKER_00: Obviously, we've got to consider, you know, what's their retinol intake or vitamin A intake, because beta-carotene conversion is pretty low.
• 11:22
  SPEAKER_00: Um, I personally in clinic have seen, you know, high amounts of SNPs for BCMO1, meaning the conversion of beta-carotene to vitamin A is even lower than 1.5%, which is on average what gen pop will have.
• 11:38
  SPEAKER_00: But further to that, zinc deficiency is incredibly common and you need zinc for retinal binding protein to distribute vitamin A around the body.
• 11:46
  SPEAKER_00: And therefore, even if you're consuming sufficient vitamin A, a zinc deficiency will have your skin remain vitamin A deficient and fail to desclimate properly.
• 11:55
  SPEAKER_00: And you know, there's just such a flow-on effect, you know, with pH balance and antimicrobial peptides being produced at the skin.
• 12:02
  SPEAKER_00: You know, a vitamin D deficiency alone will do that.
• 12:05
  SPEAKER_00: And we know that more than half Australians are vitamin D deficient at any time of the year.
• 12:11
  SPEAKER_00: So that's exactly what I think.
• 12:13
  SPEAKER_00: Yeah, and it's so important, you know, and again, essential fatty acids.
• 12:17
  SPEAKER_00: If anyone's listening to this who is maybe struggling with their skin and like, oh, but I take essential fatty acids, you know, are you digesting and absorbing them properly?
• 12:26
  SPEAKER_00: Are they in the right ratio?
• 12:28
  SPEAKER_00: Are you taking omega-3 in plant form because alpha-linoleic acid is not the same as EPA and DHA from fish oil, or even though they remain in the same family.
• 12:39
  SPEAKER_00: So yeah, I certainly think, you know, that's just even just scratching the surface ultimately of what's behind someone's skin presentation, but I think really serves to explain why there's not a cookie-cutter approach that practitioners can take.
• 12:53
  SPEAKER_00: And that's also why if someone is struggling with acne and they try something that worked for someone, it might not necessarily work for them because it's not working on the drivers that they actually have.
• 13:04
  SPEAKER_00: Um that's exactly right.
• 13:06
  SPEAKER_01: I see that so often in clinic.
• 13:08
  SPEAKER_01: We see such an influx of you know new clients that will say, Well, you know, I've been trying this supplement that's been advertised for acne and it's, you know, it's not working, or like I've heard Vitex is really great for acne and it's flared my skin, or you know, you hear so many different things, but then you'll hear the next person say Vitex worked incredibly well for my skin.
• 13:27
  SPEAKER_01: And that's where you can't say this is the only herb you can use for premenstrual breakouts, and this is the only thing you could use for the lymphatics or anything like that, because everyone is going to respond so differently based on their own individual calls.
• 13:41
  SPEAKER_01: And that's where I think it's so important as a practitioner, we really have to understand their timeline of the client's skin, the things that they have done, they haven't done, what it responds best to, what it, you know, what it doesn't respond to at all.
• 13:56
  SPEAKER_01: Um, and also couple that with things like, you know, your testing to see your hormones, so you're not guessing.
• 14:02
  SPEAKER_01: Because I think that's a really important thing.
• 14:04
  SPEAKER_01: You can't guess a person's hormonal status unless you actually see what's going on with the bloods.
• 14:12
  SPEAKER_00: Yes, yes.
• 14:13
  SPEAKER_00: Oh my gosh.
• 14:14
  SPEAKER_00: So this is such a good segue into my next question for you because when we're looking at those root causes, like so much of what we've already mentioned can be tested, either directly or indirectly.
• 14:26
  SPEAKER_00: Um, certainly there is a time and a place for hormone testing, assuming you're testing for the right thing at the right time of the cycle to be able to actually interpret those levels properly.
• 14:37
  SPEAKER_00: But I also know from my own clinical experience and also our chat is that there's a lot you can also glean from basic pathology blood testing as well.
• 14:48
  SPEAKER_00: So I'd love if you would take me through some of the general bloods you might run and what you're looking for when you do that.
• 14:56
  SPEAKER_01: Yep, exactly.
• 14:58
  SPEAKER_01: So essentially, when it comes to looking at the bloods, the main thing that we want to try to do is rule in or out potential pathology like PCOS, for example, because we know a lot of individuals that have PCOS, they also have acne.
• 15:12
  SPEAKER_01: And a lot of clients that will come to us, they're coming with a suspicion that they think they have PCOS because of how they're presenting.
• 15:20
  SPEAKER_01: So when we're doing the bloods, we're really trying to find a specific hormonal profile that either rules in or rules out of diagnosis for PCOS, or we're trying to find a particular imbalance with the connection between the brain and the ovaries that can signal the areas that we need to optimize with their diet and the lifestyle and determine what types of herbal interventions that you need to use as well.
• 15:44
  SPEAKER_01: But basically, we're always running a hormonal profile pretty much on every single one of our clients that come with acne because we want to rule in or out that it's you know their hormones that are impacting it.
• 15:56
  SPEAKER_01: We generally always do day two or day three T D day two or day three testing, where we would be doing things like FSH, LH, eestrogen, your prolactin, testosterone, DHEA, SHBG.
• 16:10
  SPEAKER_01: And then we're also looking in some cases that post-ovulation, estrogen, and progesterone ratio.
• 16:17
  SPEAKER_01: And I generally do that in some of my clients that may also be presenting with a little bit more PMS, or maybe they've got a bit of an endo or adenomyiosis kind of history, as well as acne.
• 16:28
  SPEAKER_01: So you can see what's going on post-ovulation.
• 16:31
  SPEAKER_01: And the main things that we're trying to look out for in that day two or day three testing is first the ratio of the FSH and the LH, because that can give us an indication if there is some kind of other blood sugar dysregulation that's associated with PCOS, and if there's that imbalance there, if there's something that's there that's connected to the androgen profile as well.
• 16:53
  SPEAKER_01: We then also like to take into consideration things like the SHBG, because the SHBG is a really great indicator if there is excess estrogen, but is actually so important when we're trying to potentially rule out cases or rule in where the client actually may be undereating and maybe it's actually insufficient nutrient intake or dietary intake in general that's impacting their skin.
• 17:20
  SPEAKER_01: So even in the hormonal profiles, we can see if a client isn't eating enough food and that if that's impacting their skin, because you can see a classic low oestrogen, low testosterone, high SHBG kind of profile, or low LH, low FSH.
• 17:37
  SPEAKER_01: And that kind of profile, you know, you're treating that client so differently to say a classic PCOS kind of case.
• 17:44
  SPEAKER_01: And that client is so it's the treatment plans really is supposed to be focused on really rebuilding their system and supporting their adrenals, supporting their reproductive system, giving them enough food in their diet, making sure they're eating enough, they're not skipping meals, they're not running off caffeine.
• 18:02
  SPEAKER_01: And then also making sure they're coupling that with rest and they're not over-training.
• 18:06
  SPEAKER_01: And that's the that's the beauty of the hormone test because it can be so easy for clients to think, okay, well, I've got breakouts in my skin and my cycle's irregular.
• 18:16
  SPEAKER_01: I must have PCOS, or I need to train more and I need to eat very low carbohydrate.
• 18:22
  SPEAKER_01: But if that's not the right profile for that type of client, they're actually really impact negatively impacting their hormones in that regard.
• 18:30
  SPEAKER_01: So we look for similar patterns, like basically trying to create a story with your hormones.
• 18:36
  SPEAKER_01: That's what we're trying to do.
• 18:37
  SPEAKER_01: So we can see how does this match the type of diet or lifestyle you're currently living, and what do we need to then change to support that profile?
• 18:45
  SPEAKER_01: The other things that we generally look at as well is of course, beyond the hormones, we're always looking at nutritional status, like your iron, your B12, your folate, your vitamin D, because especially when we're thinking about iron, that's so important for building collagen, which we need for skin repair.
• 19:02
  SPEAKER_01: So for those clients that have sluggy skin cell turnover, and that's the same as investigating their zinc as well.
• 19:08
  SPEAKER_01: And just like we all know as naturopaths, when you find specific things in the bloods that can lead you down other areas that you may not have thought of before.
• 19:16
  SPEAKER_01: Like if you can see severe iron and B12 issues, you're thinking, is there maybe something going on in terms of absorption in the gut?
• 19:23
  SPEAKER_01: Is there a digestive pathology that has been completely overlooked that maybe they have undiagnosed celiacs disease, which I can tell you I've seen so many times in clients that they've got an undiagnosed celiacs disease and that's the cause of their acne and their hormones are actually fine.
• 19:40
  SPEAKER_01: You can just see it in their nutritional profile and their digestive symptoms as well.
• 19:46
  SPEAKER_00: And if someone's looking at their bloods um while they're listening to this, I'm going, what about?
• 19:53
  SPEAKER_00: Like as far as like FSH LH ratio, and like where do you like to see SHVG sitting to kind.
• 20:00
  SPEAKER_00: To say that's not an issue.
• 20:01
  SPEAKER_00: Like, what is your framework there?
• 20:04
  SPEAKER_01: Yeah, it's really dependent because I often like to look at them all in relation to each other.
• 20:11
  SPEAKER_01: Um, but essentially the thing is with FSH and LH, I genuinely, rather than saying like I specifically want to see it in this exact ratio, because sometimes it's really difficult to get it that exact, I genuinely just don't like to see the LH sit higher than the FSH.
• 20:27
  SPEAKER_01: So as long as it's sitting below the FSH, um, even if you can see it's kind of sitting one to one with FSH, that's not ideal.
• 20:37
  SPEAKER_01: Um, and we genuinely like to see the FH, FSH sit uh below the seven to eight mark on that day two or day three.
• 20:47
  SPEAKER_01: And with your estrogen, it's really uh depending on day two or day three.
• 20:53
  SPEAKER_01: Ideally, we like to see it between like 120 to 160.
• 20:58
  SPEAKER_01: But that can also really vary.
• 21:00
  SPEAKER_01: Like I've seen some clients that have had an ishrogen that sits at 110 and it's not a massive issue.
• 21:06
  SPEAKER_01: You've just got to take it into consideration with their testosterone levels and their SHPG as well.
• 21:11
  SPEAKER_01: But in saying that with testosterone, that's a massive one because I can tell you now the amount of clients that I've seen with testosterone that sits above the reference range, it's probably like less than five clients in total that I've seen that actually have testosterone that sits above the conventional reference range.
• 21:28
  SPEAKER_01: And generally I see testosterone that sits at 1.0 to be problematic for clients that have acne.
• 21:35
  SPEAKER_01: And there can be such a difference between, you know, a 0.7 to a 1.0.
• 21:40
  SPEAKER_01: You can actually have clients that have testosterone at 0.7.
• 21:44
  SPEAKER_01: This they're you know, they're it's not androgen dominant, for example, but then it sits at 1.0, and we can see that's a problem for them.
• 21:53
  SPEAKER_01: And that's because we're taking into consideration some of those other markers, like the DHA and the estrogen levels as well.
• 22:00
  SPEAKER_00: Yes, of course.
• 22:01
  SPEAKER_00: And SHBG, in terms of when you would think, oh, this person's under eating or over-exercising or just running themselves ragged, where do you start to get concerned on what you see?
• 22:12
  SPEAKER_01: Genuinely, if we see it above like that 90 to 100 mark, we're seeing that as a bit of a flag for our clients.
• 22:19
  SPEAKER_00: Okay, red flag, yeah.
• 22:21
  SPEAKER_00: So, from what you're saying, there is so much that can be gleaned from just standard blood tests.
• 22:27
  SPEAKER_00: Um, I'm curious to know, like when we zoom out and think about all of the ways in which we can assess someone's hormonal balance.
• 22:36
  SPEAKER_00: I'm a big fan personally of basal temperature tracking.
• 22:40
  SPEAKER_00: I can see so much based on when the thermal shift happens, the length of the cycle, all of those kinds of things.
• 22:45
  SPEAKER_00: In the past, um, I've done a bit of salivary hormonal profile testing.
• 22:50
  SPEAKER_00: I also have clients that come to me with urinary, not necessarily estrogen metabolites for like elimination, but maybe a bit more of a broader profile.
• 23:00
  SPEAKER_00: But all of these things add up either in the time it takes to track them, whether it's you know, basal temperature tracking or ordering specialized functional pathology, and you know, just in our brief conversation about what you can pick up from just a day three hormonal panel, progesterone excluded, you can tell an awful lot on basic blood testing if you know what you're looking for and you're testing it at the right time.
• 23:27
  SPEAKER_00: And how often would you then go on to, you know, functional, fancy functional testing or secondary testing?
• 23:37
  SPEAKER_00: Or maybe a better question is to ask how many clients can you just simply proceed with based on just normal standard blood pathology alone?
• 23:46
  SPEAKER_00: Yep.
• 23:46
  SPEAKER_01: I could tell you now I haven't run any other form of hormone testing for a very, very long time.
• 23:52
  SPEAKER_01: Um, when you really understand bloods and you know how to interpret them, you understand the role of FSH and LH and how that impacts the reproductive system and the connections between prolactin and androgens and thyroid function and all that that comes into it, you can get so much from your bloods.
• 24:11
  SPEAKER_01: Um, I've never done, well, I haven't done for a very long time actually, like any form of urine hormone testing.
• 24:19
  SPEAKER_01: And the reason is is because I genuinely find like one, I can get enough through bloods, um, but two, I don't particularly find that it gives me any additional information that I wouldn't be able to be able to detect from a blood panel.
• 24:36
  SPEAKER_01: The if you're trying to look at things like your estrogen detoxification capacity, that post-ovulation estrogen and progesterone ratio via blood, I tend to find can be enough.
• 24:50
  SPEAKER_01: Um, and if you have an extreme estrogen dominant case, you see it in the SHBG.
• 24:56
  SPEAKER_01: The SHBG is often well above the range in clients that you can see that that's actually a problem for them.
• 25:05
  SPEAKER_01: So I generally don't find it it adds any extra value.
• 25:08
  SPEAKER_01: And I absolutely agree with what you were saying about the the cost, because especially when you've got clients that are coming to you, they've had acne, on average, I think most people spend about$6,000 a year on acne treatments if they have acne.
• 25:23
  SPEAKER_01: And we've got to consider that those same clients that are seeing us, they're already either seeing a dermatologist or a dermal clinician or a skin therapist, and they're spending four to five hundred dollars every five to six weeks on a facial or a new range of like a change in their skincare prescription.
• 25:40
  SPEAKER_01: So if we can also meet the client halfway, especially with economic crisis at the moment, with you know clients not being able to maybe afford as much as they used to, we've really got to be cautious with where we're thinking that we need to prioritize the testing.
• 25:55
  SPEAKER_01: And I'm I I absolutely think that we can you can just do it with bloods.
• 25:59
  SPEAKER_01: Even the whole, our whole team at a render, every single practitioner that we have in the team when we onboard them, we all go through hormone training together.
• 26:08
  SPEAKER_01: Like I'll go through like hormone assessment and how to do it with them.
• 26:12
  SPEAKER_01: And no one is doing your own testing for hormones.
• 26:17
  SPEAKER_00: So, Jacinta, you've mentioned PCOS a couple of times, and we're going to talk about diet in just a minute.
• 26:23
  SPEAKER_00: But in terms of people assuming PCOS means that they need to go on a low-carb diet or they necessarily have blood sugar or insulin problems, I think it's important to point out there are different kinds of PCOS.
• 26:36
  SPEAKER_00: Not all of them are related to insulin and blood sugar metabolism issues, but by the same token, you could have someone with acne who doesn't have PCOS but who does also have some sort of metabolic dysfunction there where it comes to insulin sensitivity and blood sugar balance.
• 26:54
  SPEAKER_00: Do you have any further insights on what we're looking for when looking at blood sugar insulin and determining that if that's an issue?
• 27:03
  SPEAKER_01: Yeah, absolutely.
• 27:04
  SPEAKER_01: So one standard test that I always do for every client is a fasting glucose test and generally a fasting insulin as well.
• 27:13
  SPEAKER_01: The reason being because we want to be able to see if there is hyperinsulin secretion and whether that might be associated with the cause of, let's say, if there is an androgen-dominant acne, we want to see is that stemming from too much like excessive insulin secretion.
• 27:31
  SPEAKER_01: And generally, what we're looking for, ideally, we want the insulin to be less than nine if it's fasted.
• 27:37
  SPEAKER_01: And if we're looking at a fasting blood glucose, I find it gives me so much information.
• 27:43
  SPEAKER_01: Ideally, we want a fasting blood glucose around 4.6 to 5.0.
• 27:49
  SPEAKER_01: Generally, anything from 5.0 plus is a flag that there's something going on in terms of blood sugar regulation.
• 27:56
  SPEAKER_01: And anything less than 4.6, I'm questioning if they're actually eating enough food.
• 28:02
  SPEAKER_01: And that's where I'm also making sure that when I'm looking at a client's test results, you've got to be so specific.
• 28:07
  SPEAKER_01: Look at the time that they got the test, because they could have got that test in the afternoon and they fasted all the way until two o'clock, and then that's an inaccurate result.
• 28:16
  SPEAKER_01: Um, but also questioning, well, what time was the meal the night before?
• 28:20
  SPEAKER_01: And what kind of meal did you eat the night before?
• 28:23
  SPEAKER_01: Because if it was a night that they've had more sugar, then that could be an inaccurate reading just based off the consumption of what they've eaten, or if they didn't eat enough the night before, is their fasting glucose just low because of that?
• 28:36
  SPEAKER_01: But that's where I find the insulin doesn't generally lie all that much.
• 28:42
  SPEAKER_01: Um, but the fasting glucose can give us plenty of information.
• 28:46
  SPEAKER_01: And in some clients that have PCOS, or that I can see that they've just got metabolic dysfunction, I generally get them to track their blood sugar response.
• 28:55
  SPEAKER_01: Um, I often get them to do like the blood sugar, the finger brick test, where they can, you know, do a fasting test in the morning, eat their breakfast, track their blood sugar two hours later, and continuously do that throughout the day, especially with those clients that I can see have a major blood sugar dysregulation issue, because I want to actually see what is their body doing when they eat oats, rather than just because the internet says you can't eat oats if you've got blood sugar issues.
• 29:20
  SPEAKER_01: I want to see how your body actually handles oats when it's coupled with the protein and a fat.
• 29:25
  SPEAKER_01: Or I want to see how your body handles potatoes with dinner, but potatoes with dinner, then you go for a walk and let's see how your body handles that.
• 29:33
  SPEAKER_01: And I find that's such an incredible clinical tool because I'm not just giving my clients blanket treatments in terms of diet and lifestyle advice.
• 29:40
  SPEAKER_01: You're actually being able to tailor the advice according to the way that they live their life already and then and the factors that we can see impacting their blood sugar based on actual data.
• 29:52
  SPEAKER_00: Yes, I think that's so important because you know, bioindividuality, we we preach it, but sometimes I think clinically you can fall back on protocols without thinking about how to apply that.
• 30:06
  SPEAKER_00: I've got a couple of questions for you on that.
• 30:08
  SPEAKER_00: Um, in terms of monitoring blood sugar, you sort of mentioned the finger prick.
• 30:14
  SPEAKER_00: Do you have a reason you prefer that over a CGM, or is it more just a price accessibility thing?
• 30:21
  SPEAKER_01: Yeah, so I'm actually starting to move more over to doing the CGMs.
• 30:25
  SPEAKER_01: Um I've personally actually recently just did it over the summer and actually chose the Christmas period of time to do it, which was kind of fun because obviously lots of different foods.
• 30:33
  SPEAKER_01: Um and the only reason I hadn't up until that point was because I just thought it would be a barrier for me to confidently explain to my clients this is how we can use it, this is how we can interpret the data, if I hadn't had the experience myself doing it.
• 30:46
  SPEAKER_01: Um so now that I have, then I can easily guide my clients through it.
• 30:49
  SPEAKER_01: Whereas I know with the thing, I know the ins and outs of the finger prick test.
• 30:52
  SPEAKER_01: So it was more just being able to know that if a client had a question, I wasn't stuck with how to respond to it.
• 30:58
  SPEAKER_01: I knew exactly how they could, you know, navigate.
• 31:01
  SPEAKER_01: But yeah, um, when I did it the CGM recently, I actually um I had this in the finger prick test at my parents' house and I did the finger prick test at the exact same time that I've obviously had the CGM so I could see the accuracy, and it was probably a 0.1 or 0.2 difference, so it's very close in terms of like the accuracy of the CGM.
• 31:24
  SPEAKER_01: So I would absolutely still use the CGM with clients.
• 31:28
  SPEAKER_01: Yeah, it's just that I haven't done it just yet.
• 31:31
  SPEAKER_00: Yeah, yeah, great.
• 31:32
  SPEAKER_00: I mean, that makes perfect sense.
• 31:33
  SPEAKER_00: You want to be have that lived experience, so if you can troubleshoot with them, you know, having actually done it yourself.
• 31:40
  SPEAKER_00: And I think it's nice to hear that given you've done it for so often already, we're using another method that they dovetail really nicely in terms of data.
• 31:50
  SPEAKER_00: Um, one last question on the blood sugar thing before we move on to diet, but you mentioned obviously low blood sugar potentially indicating undereating.
• 32:01
  SPEAKER_00: What about low insulin?
• 32:02
  SPEAKER_00: What's your read on that?
• 32:04
  SPEAKER_01: Yeah, I generally see it as the same as well.
• 32:07
  SPEAKER_01: I often see if clients have a low insulin reading, it's that there's there's no demand to have to increase insulin because there's low intake of the carbohydrates as well.
• 32:17
  SPEAKER_01: So I kind of couple the both the same.
• 32:20
  SPEAKER_01: Um but I guess, yeah, yeah.
• 32:22
  SPEAKER_01: And you can also see in some other markers as well, if the clients are under-eating as well.
• 32:28
  SPEAKER_01: Like in some cases, if you can see that there's low blood sugar, low insulin, but a high cholesterol profile, you're questioning, well, what's going on here?
• 32:37
  SPEAKER_01: Because we know that we can see high cholesterol even in the individuals that have anorexia.
• 32:42
  SPEAKER_01: So we have, and if you had that plus an elevated SHBG, you've got a whole story there telling you that the client may not be eating enough food.
• 32:52
  SPEAKER_00: Yeah, yeah, brilliant.
• 32:53
  SPEAKER_00: Well, speaking of food, I know um, again, coming back to bioindividuality, that there might be some nuances for people as far as macronutrient, you know, ratios, micronutrient profiles, but can you walk us through what you find to be time and again applicable in acne patients, maybe more across the board than otherwise?
• 33:18
  SPEAKER_01: Yeah, absolutely.
• 33:19
  SPEAKER_01: Um, I generally try to educate my clients on diet in three kinds of categories.
• 33:25
  SPEAKER_01: So one is making sure that we're actually correcting like nutritional deficiencies in the diet.
• 33:32
  SPEAKER_01: So making sure that they're actually eating enough antioxidants and such to be able to support their skin whilst also correcting deficiencies we can see in the bloods.
• 33:40
  SPEAKER_01: And the reason that I go through that is, of course, because the skin is the last place to get our nutrients.
• 33:44
  SPEAKER_01: And if we're nutrient deficient, our skin cells every single day they're developing new DNA and they're growing, and they're the skin cells we're gonna see on the surface in six weeks' time.
• 33:55
  SPEAKER_01: So if there's insufficiencies in things like your B vitamins, vitamin A, your zinc, even calcium, that's all going to significantly impact the health and the function of that skin.
• 34:05
  SPEAKER_01: So I'm often working with clients to try to increase diversity in the diet and to make sure that they've got enough fuel nutritionally to be able to support the function of the skin cell.
• 34:16
  SPEAKER_01: The second aspect is, of course, optimizing blood sugar regulation.
• 34:20
  SPEAKER_01: And I find that that's just crucial, even if it isn't an insulin resistance PCOS kind of case, because let's say, for example, it's a client that's got a very stress-driven acne.
• 34:30
  SPEAKER_01: We all know naturopathically that a healthy, stable blood sugar helps to support the nervous system to feel calm and feel safe.
• 34:36
  SPEAKER_01: And you're supporting the adrenals in that way as well.
• 34:40
  SPEAKER_01: Um, and with that, optimizing the blood sugar, that's where I have a very big emphasis on clients making sure they're having at least 30 grams of protein with every meal, particularly making sure breakfast is a priority as well.
• 34:54
  SPEAKER_01: Um, I know that there's a lot of um individuals that will educate on making sure every meal and every snack is protein-rich, which I understand because it's so important because we need protein to synthesize new skin cells and so on.
• 35:08
  SPEAKER_01: Um, but I think if we can really aim for getting three protein-rich meals in a day, at least 30 grams each, then that's um that's a really great goal to aim towards.
• 35:18
  SPEAKER_01: And of course, trying to optimize if it is a blood sugar issue, to focus on those low glycemic carbohydrates as well.
• 35:26
  SPEAKER_01: And generally with that, I'm often advising if they're gonna be eating sweets, have a sweet after a meal to try to optimize that blood sugar response.
• 35:36
  SPEAKER_01: If you're gonna be having a larger carbohydrate meal and you've got blood sugar issues, to go for a stroll or something afterwards to help with the metabolism of the glucose.
• 35:45
  SPEAKER_01: Um, from a blood sugar perspective, that's generally the factors of what we're looking at.
• 35:49
  SPEAKER_01: And then finally, there's the whole inflammatory aspect of it.
• 35:53
  SPEAKER_01: So trying to rebalance the omega-3 to the omega-6, which is where, of course, we're looking at increasing essential fatty acids, omega-3, so like your sardines and mackerel, herring, anchovies, and so on.
• 36:03
  SPEAKER_01: And then also looking at reducing omega-6, which is going to be from canola oil, sunflower oil.
• 36:09
  SPEAKER_01: Um, I know a lot of a lot of individuals then start to become have a have a fear around food, and they're like, well, that means I can't eat nuts and I can't eat this, I can't eat that.
• 36:20
  SPEAKER_01: But it's all just about the balance and the quality in the source that you're getting from as well.
• 36:26
  SPEAKER_00: Yeah, I think that's important because it can feel a bit overwhelming um looking at it all, which is why you put together the Clear Skin Blueprint masterclass, which I just want to quickly mention.
• 36:37
  SPEAKER_00: It's something that Gacinta created for clients.
• 36:40
  SPEAKER_00: It's a 90-minute masterclass, I think it was, and um really just summarizes all of those key principles and provides that information to clients outside of the one-to-one setting.
• 36:53
  SPEAKER_00: And you can actually access that straight off Gacinta's website, which we have in the show notes.
• 36:58
  SPEAKER_00: And although it is for clients, if you are a practitioner who is looking to learn more in the space, um, Gacinta welcomes you signing up for that too to learn a bit more.
• 37:08
  SPEAKER_00: Um but the other, I guess, important thing to share here is there is going to be practitioner training later in the year from Jacinta on Acne specifically.
• 37:17
  SPEAKER_00: So if you do want to sign up to be notified about that, the link in our show notes to sign up to her newsletter will give you access to that.
• 37:26
  SPEAKER_00: Um, and the only other thing I just want to share from my own clinical experience is circadian eating as well, which is like just a whole other layer of blood sugar balance.
• 37:38
  SPEAKER_00: But our insulin sensitivity is also dictated to by light and dark environments, and eating the mere one particular meal under blue light and the same meal outside and sunlight has quite different and profound effects on blood sugar as well.
• 37:55
  SPEAKER_00: And that's probably really like a phase two thing, like getting those um core elements right is always the place to start.
• 38:03
  SPEAKER_00: But I think because so many of us work indoors and we have we spend 95% of our time indoors, you know, I'm noticing that some of that uncoupling of blood sugar and insulin sensitivity is partly a result of non-native EMF and blue light exposure too.
• 38:22
  SPEAKER_00: So if anyone's listening to this and they're like tick, tick, tick, tick, tick, I've done everything you've just mentioned, then I would be starting to go a bit deeper and looking at your circadian biology, timing of eating, you know, that kind of thing as well.
• 38:38
  SPEAKER_00: But once you get those core basics right, that's when we can look at how do we support those really important like dietary elements with, you know, this the judicious use of supplements.
• 38:50
  SPEAKER_00: And my gosh, we're so lucky to have so much to choose from.
• 38:54
  SPEAKER_00: Um and I know at Arenda Health you've got your own compounding dispensary, which means you're in a you know a wonderful position to actually customize formulas for clients on site, which I just think is so brilliant.
• 39:08
  SPEAKER_00: And I'd love it if you would take me through maybe some of your favorite ingredients and like where you see those applied.
• 39:16
  SPEAKER_00: And a few that I would love to hear you riff on are you know, myoinositol, PHG, where you might use broccoli sprout or glycine or calcium deglucurate.
• 39:28
  SPEAKER_00: What are your what are your favorite favorite children?
• 39:31
  SPEAKER_01: Yeah.
• 39:32
  SPEAKER_01: So we, I guess a lot of the the practice the clients of what we see, if they're presenting with more of like a hormone, a hormonal kind of acne, a classic formula of what we would put together would be kind of similar ingredients, like you said, and nostalgia, we would use broccoli sprouts, we'd use calcium deglucurate, we'd also add in some zinc, we'd also add in some dim.
• 39:54
  SPEAKER_01: And that's essentially because we're we're trying to work on all those specific areas of optimizing in.
• 40:00
  SPEAKER_01: insulin receptor sensitivity with the insulin that's sorry, with the emocitol that really helps to get that glucose into the cell.
• 40:07
  SPEAKER_01: And then we're working on things like supporting those phase two detoxification pathways and sulfation space.