Latest / Skin Anarchy / Masterclass Monday: The New Era of Personalized Skin Science at Codex with Dr. Barbara Paldus

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Masterclass Monday: The New Era of Personalized Skin Science at Codex with Dr. Barbara Paldus · Skin Anarchy

• 0:02
  SPEAKER_00: Hey guys, welcome back to another episode of Skin Anarchy.
• 0:05
  SPEAKER_00: I have one of my favorite people with us again today for a wonderful episode in the masterclass with Codex Labs.
• 0:11
  SPEAKER_00: So please welcome back, Dr.
• 0:12
  SPEAKER_00: Barbara Paldas.
• 0:13
  SPEAKER_00: Welcome back, Barb.
• 0:14
  SPEAKER_00: I'm so excited to host you.
• 0:16
  SPEAKER_00: Thanks for having me, Acto.
• 0:17
  SPEAKER_00: It's a pleasure to be here and share my passion as usual.
• 0:21
  SPEAKER_00: Yeah, and you know, you are the smartest people I know.
• 0:23
  SPEAKER_00: And every time we talk, I walk away knowing like entire textbook worth of information.
• 0:28
  SPEAKER_00: So I'm really excited to dive in.
• 0:30
  SPEAKER_00: For our listeners who may be unfamiliar with the past episodes we've done, can you explain, dive into integrative dermatology?
• 0:37
  SPEAKER_00: Because I know that's what you're working on right now.
• 0:39
  SPEAKER_00: Can you explain that to us?
• 0:40
  SPEAKER_00: What does it mean, integrative dermatology, and how does it really differ from conventional dermatology?
• 0:46
  SPEAKER_01: So integrative dermatology is first of all patient-centered, and it looks beyond just the skin.
• 0:53
  SPEAKER_01: So while conventional dermatology often focuses on treating symptoms, for example, with topical creams or medications or procedures, integrative dermatology seeks to identify and address the underlying causes of these skin conditions.
• 1:07
  SPEAKER_01: So at CODEX, we recognize that the skin is interconnected with the rest of the body.
• 1:12
  SPEAKER_01: And this is something naturopathic doctors already know, such as the gut, the brain, the immune system.
• 1:17
  SPEAKER_01: And so that means considering factors like hormonal balance or the skin and gut microbiomes that we've talked about, or basic things like diet, lifestyle, stress when you're developing a treatment plan.
• 1:28
  SPEAKER_01: And I know the word holistic might be a little bit overused, or some people might consider it woo-woo, but it's really, we like to call it whole body.
• 1:35
  SPEAKER_01: And so it's really about finding a comprehensive and personalized approach that finds that primary driver of the skin condition, but also promotes long-term health, not just temporary relief.
• 1:46
  SPEAKER_00: Yeah, that makes a lot of sense.
• 1:47
  SPEAKER_00: So it's almost like detective work, trying to uncover the root cause rather than just patching up the symptoms, right?
• 1:53
  SPEAKER_01: Exactly.
• 1:54
  SPEAKER_01: And that's what makes it so rewarding because it's not just about addressing the skin condition, it's also about empowering patients about their long-term health and sustainable changes.
• 2:04
  SPEAKER_00: Makes sense.
• 2:04
  SPEAKER_00: So let's dive right into the connection between the skin, the gut brain, and then the microbiome.
• 2:11
  SPEAKER_00: What is this connection and why is it so important to consider all of these factors when we're treating skin conditions?
• 2:17
  SPEAKER_01: So I've been talking about this with you for the last almost two years now.
• 2:21
  SPEAKER_01: So I think we need to think of the skin, gut, brain, and microbiomes as complex and interconnected ecosystems.
• 2:27
  SPEAKER_01: So the gut microbiome, which just to define it again as the community of bacteria, fungi, and other microorganisms living in our digestive tracts or intestines, plays a crucial role also in immune function, nutrient absorption, and inflammation.
• 2:43
  SPEAKER_01: And when this gut microbiome becomes imbalanced, it can trigger inflammation throughout the body, including on the skin.
• 2:49
  SPEAKER_01: So the brain is also involved through the gut brain axis, meaning that stress and mental health can affect gut health and in turn impact skin conditions like acne, eczema, and psoriasis with flare-ups.
• 3:01
  SPEAKER_01: So we have to consider all these factors.
• 3:04
  SPEAKER_01: And the healthcare providers on Decode Me that we're launching can then create a more effective treatment plan that really goes to the root cause of the skin issue.
• 3:15
  SPEAKER_00: Yeah, sounds like a very delicate balancing act between all of these components.
• 3:19
  SPEAKER_00: What are some of the common signs that this ecosystem might be out of whack?
• 3:24
  SPEAKER_01: That's a great question, Ectus.
• 3:26
  SPEAKER_01: So common signs can include digestive issues, you know, bloating, gas, constipation, diarrhea, or mental health issues like anxiety, depression, fatigue, and of course, red skin blotches, blemishes, pimples, et cetera.
• 3:41
  SPEAKER_00: Right.
• 3:42
  SPEAKER_00: So how is an integrative approach to treating a skin condition different from standard dermatology platforms, particularly when it comes to diagnosing?
• 3:52
  SPEAKER_01: So in conventional dermatology, the practitioner often relies on a visual examination or a biopsy or standard allergy testing to diagnose the skin condition.
• 4:02
  SPEAKER_01: And while these methods are obviously helpful, they don't often provide the complete picture of what's going on internally.
• 4:09
  SPEAKER_01: And so integrated dermatology takes a more comprehensive approach and uses a wider range of diagnostic tools to assess the factors that can influence skin health.
• 4:19
  SPEAKER_01: So those can include the gut microbiome that I mentioned, things like organic acid metabolites, inflammation levels, hormonal balance, nutrition deficiencies, as well as other factors that might be contributing to the skin condition.
• 4:33
  SPEAKER_01: And so this allows our providers a more personalized and targeted treatment plan for the patient that addresses really the root cause of the problem.
• 4:42
  SPEAKER_00: Interesting.
• 4:42
  SPEAKER_00: So it's like having a more detailed roadmap to guide the treatment process, basically.
• 4:47
  SPEAKER_01: Precisely.
• 4:48
  SPEAKER_01: And it helps us understand the unique needs of each patient and tailor the approach accordingly.
• 4:53
  SPEAKER_00: That's very interesting.
• 4:54
  SPEAKER_00: So, you know, I want to address this because we keep hearing the term microbiome, especially recently.
• 4:59
  SPEAKER_00: It feels like it's used literally everywhere from everything from skin care to oral care.
• 5:04
  SPEAKER_00: Can you describe what is the skin-gut-brain microbiome access and what is its role in maintaining overall health, especially skin health?
• 5:14
  SPEAKER_01: So this is one of my favorite topics.
• 5:15
  SPEAKER_01: So skin-gut brain microbiome access refers to the bidirectional communication network between these four systems.
• 5:23
  SPEAKER_01: So the gut microbiome influences the skin through immune signaling, inflammation, and nutrient availability.
• 5:29
  SPEAKER_01: The brain influences the gut through the genomic nervous system, which affects gut motility, secretion, and microbial composition.
• 5:36
  SPEAKER_01: And then the skin microbiome influences the immune system and can protect against pathogens like staph infections, for example.
• 5:43
  SPEAKER_01: So all these systems are constantly communicating with each other, and disruptions in one system or one area can affect the other.
• 5:50
  SPEAKER_01: So, for example, stress, which comes from the brain, can alter the gut microbiome, leading to inflammation that exacerbates skin conditions like acne and eczema and causes flare-ups.
• 6:02
  SPEAKER_00: That makes so much sense.
• 6:03
  SPEAKER_00: So basically, managing stress can literally improve your skin health, is what you're saying.
• 6:08
  SPEAKER_01: Absolutely.
• 6:09
  SPEAKER_01: I can't say how important stress management is, but again, it's another component of this integrative dermatology treatment plan to minimize future flare-ups or breakouts.
• 6:19
  SPEAKER_01: And you can apply, there's a variety of techniques, whether that's mindfulness, yoga, meditation, spending time in nature, walking in a park, all of these help reduce stress.
• 6:29
  SPEAKER_01: They improve gut health, and therefore there's fewer and less intense skin eruptions.
• 6:35
  SPEAKER_00: Interesting.
• 6:35
  SPEAKER_00: So how does the gut microbiome specifically influence the skin?
• 6:40
  SPEAKER_00: What happens when that balance is disrupted?
• 6:43
  SPEAKER_01: So, as we were saying, you know, gut microbiome plays a critical role in immune immunity, inflammation, nutrient absorption.
• 6:49
  SPEAKER_01: And so when the gut microbiome is balanced, it helps regulate the immune system, it prevents it from overreacting to substances that can penetrate through the skin and cause inflammation, but it also produces beneficial compounds like the short chain fatty acids, which help nourish the gut lining and reduce inflammation.
• 7:08
  SPEAKER_01: But when the gut microbiome is disrupted, on the other hand, it can lead to increased gut barrier inflammation, leaky gut, impaired vitamin production, and those can all manifest as skin problems like acne, eczema, psoriasis, and rosacea, kind of the core four that I always talk about.
• 7:24
  SPEAKER_00: Yeah, leaky gut is another term we're hearing more and more about.
• 7:28
  SPEAKER_00: I know this came up a few years ago, but now it's everywhere.
• 7:31
  SPEAKER_00: Can you explain that a bit more in detail?
• 7:33
  SPEAKER_00: What is leaky gut?
• 7:35
  SPEAKER_01: Absolutely.
• 7:35
  SPEAKER_01: And we're seeing more supplements, for example, on Amazon for that.
• 7:38
  SPEAKER_01: So leaky gut is essentially increased intestinal permeability.
• 7:43
  SPEAKER_01: So it's a condition where the lining of the intestines becomes more porous.
• 7:47
  SPEAKER_01: And so substances like bacteria, toxins, or undigested food particles can leak into the bloodstream.
• 7:53
  SPEAKER_01: This then triggers the immune response and inflammation throughout the body, which can then contribute to a variety of health problems, including skin conditions, but not limited to skin conditions.
• 8:05
  SPEAKER_00: Very interesting.
• 8:06
  SPEAKER_00: So then on the other end, you have your brain.
• 8:08
  SPEAKER_00: So how does the brain or the central nervous system factor into skin health?
• 8:13
  SPEAKER_00: Can you talk to us about this gut brain skin access?
• 8:16
  SPEAKER_01: Sure.
• 8:17
  SPEAKER_01: So the brain and the central nervous system have a profound impact on skin health through that gut brain axis.
• 8:23
  SPEAKER_01: So stress, anxiety, and depression that we were talking about can all disrupt that gut microbiome, leading back to the inflammation and the impaired immune function.
• 8:32
  SPEAKER_01: But also the brain influences the skin directly through the release of hormones and neurotransmitters that can affect sebum production, skin inflammation, and skin barrier function.
• 8:41
  SPEAKER_01: So, for example, stress can increase cortisol, which can then trigger acne breakouts, or chronic stress can impair the skin's ability to repair itself, leading to premature aging or psoriasis flares.
• 8:53
  SPEAKER_01: So that's where the integrative dermatology also needs to address mental and emotional well-being.
• 8:59
  SPEAKER_00: Yeah, so everything you're saying, it really drives home that it's all connected.
• 9:03
  SPEAKER_00: You know, if you're stressed, it's not just in your head, it's actually going to show up on your skin.
• 9:07
  SPEAKER_01: Absolutely.
• 9:08
  SPEAKER_01: I mean, the mind-body connection is very real.
• 9:11
  SPEAKER_01: And it's essential to address both mental and physical health for optimal skin.
• 9:15
  SPEAKER_01: I mean, I have mild eczema.
• 9:16
  SPEAKER_01: When I get stressed, oh, I start itching like crazy for no reason, and then all of a sudden I have a breakout.
• 9:22
  SPEAKER_01: So it's very real.
• 9:23
  SPEAKER_00: Wow.
• 9:24
  SPEAKER_00: So given how complex this connection really is, how can telehealth platforms like Decode Me help individuals really gain insight into their skin conditions and find really effective solutions?
• 9:36
  SPEAKER_01: So telehealth platforms like our Decode Me platform are designed to bridge the gap between traditional or conventional dermatology and integrative medicine by providing patients with convenient access to comprehensive diagnostic testing, right?
• 9:50
  SPEAKER_01: All those diagnostic tests that are not normally done, as well as highly personalized treatment plans and then ongoing support because things don't clear up in a week.
• 9:59
  SPEAKER_01: There's no magical pill or magical topical.
• 10:01
  SPEAKER_01: Some of these skin conditions take three months or six months to really improve.
• 10:05
  SPEAKER_01: And so by offering these at-home tests for a gut microbiome or inflammation or hormonal balance and other factors that may contribute to skin conditions, they start connecting patients with these integrative medical practitioners for real feedback because they review their test results and they conduct virtual consultations.
• 10:24
  SPEAKER_01: And then they can develop based on the test results, personalized treatment plants, because every person is unique.
• 10:30
  SPEAKER_01: And so by combining this advanced technology and testing, but really a whole range of these tests with this integrative whole body approach, the platform DecodeMe can empower patients to essentially control their skin health, A, from the comfort of their own homes, but B by understanding the root causes and what's going on inside their body.
• 10:52
  SPEAKER_00: I love this.
• 10:53
  SPEAKER_00: I mean, this is so education-based.
• 10:55
  SPEAKER_00: It sounds like it puts a lot more power also into the hands of the patient.
• 10:59
  SPEAKER_00: So, how do you ensure that patients are properly educated about their results and the recommended treatments?
• 11:05
  SPEAKER_01: So, education, as you said, is critical.
• 11:08
  SPEAKER_01: And part of our goal is to also make more informed consumers and more informed patients.
• 11:14
  SPEAKER_01: So obviously, our providers will prioritize clear communication with detailed explanations of their test results.
• 11:21
  SPEAKER_01: It's much easier to do something about something if you understand why.
• 11:25
  SPEAKER_01: And so that's why we're going to be really supporting the healthcare providers in their efforts to truly do personalized recommendations, including diet, including lifestyle and supplementation, not just prescriptions.
• 11:38
  SPEAKER_01: We want to offer ongoing education and guidance, and we'll be developing those modules for patients and providers so that they can implement these changes and track process.
• 11:48
  SPEAKER_01: I usually find myself, I understand why I'm doing something that motivates me to actually do it.
• 11:53
  SPEAKER_01: Whereas if I don't understand, it might be like, yeah, whatever.
• 11:56
  SPEAKER_01: And then for various reasons, you know, most medical providers today require training in integrative medicine, including interpretation of tests, such as, you know, they don't teach gut microbiome or genetic testing in medical school yet.
• 12:09
  SPEAKER_01: Naturopaths who will also be on our platform understand a lot of this already.
• 12:14
  SPEAKER_01: And so with them, there won't be as much training because they actually already practice put this into practice.
• 12:20
  SPEAKER_00: That's very fascinating.
• 12:22
  SPEAKER_00: And I it's a very good point that you brought up about they don't teach this stuff.
• 12:25
  SPEAKER_00: So it's like a learning experience for everybody, kind of understanding integrative health.
• 12:29
  SPEAKER_00: Now, many people are, you know, are seeing that even the golden age of skincare did not necessarily offer the best products.
• 12:37
  SPEAKER_00: So, what standard products of dermatology do not necessarily address all parts of the issues a patient may face with skin care routine?
• 12:44
  SPEAKER_01: So I have a few pet peeves, including topical steroids and antibiotics.
• 12:49
  SPEAKER_01: Um, and while they're very effective for specific issues, such as, you know, allergy-based response rashes or infections for temporarily relieving common symptoms.
• 12:59
  SPEAKER_01: The issue I have is that they don't necessarily address the underlying cause of many chronic skin conditions.
• 13:05
  SPEAKER_01: And in fact, the biggest pet peeve I have is that the long-term use of these medications may in fact worsen the problem because there's a disruption of the skin or the gut microbiome, there's a weakening of the skin barrier or the immune system, and a contribution to antibiotic resistance if it's overused.
• 13:23
  SPEAKER_01: And so the other issue is that many conventional skincare products contain a lot of harsh chemicals and irritants that can damage the skin barrier and exacerbate skin problems.
• 13:33
  SPEAKER_01: So a lot of these um golden age, you know, everything from the retinol to benzyl peroxide, they're not exactly easy on your skin barrier for long-term use.
• 13:43
  SPEAKER_01: And I don't think we understand what happens if you use these products for 20 years yet.
• 13:48
  SPEAKER_01: Yeah.
• 13:49
  SPEAKER_01: No, that's at the levels, at the levels we're using them, because there's also competition between companies.
• 13:54
  SPEAKER_01: Oh, I have 2%, now I have 5%, no, I have 10%, now I have 15%.
• 13:58
  SPEAKER_01: So there's this gamesmanship going on in the industry.
• 14:02
  SPEAKER_01: Um, and I'm not sure that it's supported by science.
• 14:05
  SPEAKER_00: Yeah, that's a really, really like solid point you made.
• 14:08
  SPEAKER_00: And I think with uh especially with retinol, I personally have had a, you know, my own pet peeve with this specifically.
• 14:14
  SPEAKER_00: So that makes sense.
• 14:15
  SPEAKER_00: It's almost like a cycle of symptom relief followed by more problems down the road.
• 14:19
  SPEAKER_00: That's what it sounds like.
• 14:20
  SPEAKER_01: That's exactly right.
• 14:22
  SPEAKER_01: And the goal for us is to break that cycle by actually addressing the underlying causes, right?
• 14:27
  SPEAKER_01: And supporting the body's natural healing abilities.
• 14:30
  SPEAKER_01: Because, I mean, and again, pet peeve of mine, loading babies and children with corticosteroid for years on end.
• 14:35
  SPEAKER_01: And some of these people have been on corticosteroids for 15, 20 years, is not helpful.
• 14:40
  SPEAKER_01: And then it can lead to conditions such as topical steroid withdrawal syndrome, which is way worse than the original eczema.
• 14:46
  SPEAKER_01: And so the goal of this modern integrated dermatology is to focus on using more gentle, typically microbiome-supporting biotech-based ingredients, which are now coming online, as well as again going back to that, you know, mantra of root cause of the skin issue by adjusting lifestyle, diet, and other interventions, including minimizing stress to help with the future skin eruptions.
• 15:09
  SPEAKER_01: So you want to minimize the number of flare-ups and the intensity of the flare-ups.
• 15:14
  SPEAKER_00: Yeah.
• 15:14
  SPEAKER_00: So you mentioned a uh a phrase, topical steroid withdrawal.
• 15:18
  SPEAKER_00: You know, I'm seeing more of this coming up on the internet, social media.
• 15:22
  SPEAKER_00: And I would love for you to tell us more about what this is and is this possibly an epidemic that we're looking at.
• 15:30
  SPEAKER_01: So, topical steroid withdrawal or TSW, also sometimes called red skin syndrome in Europe, uh, is a condition that arises from long-term topical steroid use.
• 15:40
  SPEAKER_01: And typically these people use it all over their body for, you know, five to 15 years.
• 15:44
  SPEAKER_01: And while steroids can initially help to relieve the symptoms of skin conditions like eczema, they can also lead to dependence over time.
• 15:53
  SPEAKER_01: And so we're talking about addiction, right?
• 15:55
  SPEAKER_01: Discontinuing the use of the steroid can then cause a rebound effect, resulting in symptoms that are much worse.
• 16:02
  SPEAKER_01: And so it's important to work with a doctor when you're weaning off topical steroids and supporting not just healing of your skin, but re-regulation of your immune system.
• 16:10
  SPEAKER_01: And so this is another great application for me of integrated dermatology where the providers can treat the patient internally, not just at the surface, with steroid creams that are pretty much a quick hack, but not a long-term solution.
• 16:23
  SPEAKER_01: They keep upping the potency of these corticosteroids over time because they stop working because your body adjusts around them.
• 16:29
  SPEAKER_01: So I wouldn't say it's necessarily an epidemic per se, but it's now an awareness and a growing awareness of TSW because there's overuse of corticosteroids.
• 16:41
  SPEAKER_01: And so it's my hope that we can educate both the medical community with partners like ITSAN to start taking a more integrative approach to eczema, not slot corticosteroids as the first line of defense on babies.
• 16:54
  SPEAKER_00: Yeah, no, it makes a lot of sense.
• 16:56
  SPEAKER_00: You know, for patients, you know, who haven't found success with these traditional treatments, what hope does integrative telodermatology offer them?
• 17:06
  SPEAKER_01: So I would say integrative teledermatology is a new perspective.
• 17:10
  SPEAKER_01: And because it's comprehensive, that is the key to me, in my opinion, defining this long-lasting relief.
• 17:16
  SPEAKER_01: And so by looking at this interconnectedness of the skin, the gut, the brain, the microbiomes, and identifying these root causes, again, it can lead to these personalized, individualized treatment plans for the underlying issues.
• 17:31
  SPEAKER_01: And we often find that it can be helpful for patients who've tried everything else, right?
• 17:36
  SPEAKER_01: But they're still struggling.
• 17:37
  SPEAKER_01: That skin condition is still chronic.
• 17:39
  SPEAKER_01: It's still completely destroying their life.
• 17:42
  SPEAKER_01: And so it's really about addressing things like gut microbiome imbalance or gut inflammation, these internal problems that are likely driving the externally visible skin flare-ups, and then enabling the patients to take control of their long-term health with solutions that I would say are not as unsustainable for the planet, and obviously we want it to be also sustainable for the planet, but really solutions that they can do day to day, solutions that are not so complicated, not 15-step routines, or things that they can basically do every day to improve the quality of their life.
• 18:13
  SPEAKER_00: Yes.
• 18:14
  SPEAKER_00: You know, what's one of the biggest, I guess, aha moments you've witnessed with a patient who transitioned to a more integrative approach after struggling with the traditional methods?
• 18:24
  SPEAKER_01: So there have been many, but I would say the one that stands out the most is we had well, we have a patient um with severe eczema and been using topical steroids for years, you know, with pretty much reduced success from year to year.
• 18:38
  SPEAKER_01: And so we switched basically to an integrative approach.
• 18:41
  SPEAKER_01: We focused on healing her leaky gut, um, reducing her chronic inflammation.
• 18:45
  SPEAKER_01: That led to reducing managing stress, an appropriate diet.
• 18:49
  SPEAKER_01: Turned out that she was allergic to dairy and didn't know it.
• 18:52
  SPEAKER_01: And her eczema is now pretty much cleared up completely, and she was able to stop using steroids.
• 18:57
  SPEAKER_01: Now it was a six to nine month process.
• 18:59
  SPEAKER_01: So I'm not gonna lie and say, nope, you know, again, we snap our fingers and a week later everything's hunky-dory.
• 19:04
  SPEAKER_01: But these kinds of things, if done properly, are truly life-changing.
• 19:09
  SPEAKER_00: That's very interesting.
• 19:10
  SPEAKER_00: So, you know, I guess my next question is so, in order to like really properly use something like Decode Me, how are the healthcare providers urged to take care of their customers with all the tools provided to them?
• 19:23
  SPEAKER_01: So, first of all, I have to state that, you know, ethical and responsible application of these tools is really paramount to us.
• 19:29
  SPEAKER_01: It's of great importance at Codex.
• 19:31
  SPEAKER_01: And so the healthcare providers on the platform are encouraged not just to look at this whole body approach through assessments and systematically reviewing factors that can affect the patient health, but they're also urged to consider the patient's situation when making a diagnosis.
• 19:46
  SPEAKER_01: So, really, it's on crafting that individualized therapy plan for both internal and external factors that might contribute to the skin condition, and also to regularly monitor their patients for progress and make adjustments.
• 19:59
  SPEAKER_01: You know, no one is.
• 20:00
  SPEAKER_01: Is perfect, no one is omniscient.
• 20:02
  SPEAKER_01: And so if they need local care, like if they need, you know, be told to go get you know some other tests at hospital or other blood work, you know, to go do that.
• 20:12
  SPEAKER_01: And so, for example, if a healthcare provider suspects skin cancer or some kind of lesion from an image that's on the platform, then they need to direct the patient to have a physical checkup because you need to go and you might need to get a MOS surgeon.
• 20:26
  SPEAKER_01: Similarly, educating patients on how to take the best photographs of their skin condition to optimize the parameters such as you know, natural lighting and focus and not applying filters.
• 20:36
  SPEAKER_01: You know, you don't want to be applying social media filters when you're trying to show a skin condition to professional, you know, because what can work for Instagram posts may obfuscate the actual skin condition and also then training the providers for skin of color because many conditions look completely different, right?
• 20:58
  SPEAKER_01: Same with psoriasis, same with rosacea.
• 21:01
  SPEAKER_01: And so really being able to understand how to take the picture and then the provider how to interpret the picture for the right diagnosis.
• 21:08
  SPEAKER_00: I really love this.
• 21:09
  SPEAKER_00: And this sounds incredibly personalized and very comprehensive.
• 21:13
  SPEAKER_00: I think that's my favorite part about this.
• 21:15
  SPEAKER_00: Is that, I mean, is that how DecodeMe is different from other teledermatology platforms, you would say?
• 21:21
  SPEAKER_01: So we're hoping that our Decadme practitioners will combine modern dermatology with complementary therapies in the most complete manner.
• 21:30
  SPEAKER_01: So all of them are educated to train the body as a whole and complex system and apply techniques for long-term health.
• 21:38
  SPEAKER_01: So accounting for these physical, emotional, genetic, environmental contributing factors, then really look for that root cause.
• 21:45
  SPEAKER_01: And that's not easy.
• 21:46
  SPEAKER_01: I mean, it's not simple and it's not quick.
• 21:48
  SPEAKER_01: And so they can also, though, then draw, you know, from the latest therapies from prescription biologics to herbal supplements to probiotics to JK inhibitor topicals to compound pharmacy prescriptions, like say vitamin B12 cream, to also nutritional coaching and stress reduction.
• 22:05
  SPEAKER_01: So, you know, when you think about it, and you can also throw in allergy management or exercise.
• 22:10
  SPEAKER_01: So it really will depend on the patient and the condition and the provider, but our goal is to bring back the personalization in medicine, which I think we're losing at a very rapid rate.
• 22:21
  SPEAKER_01: The goal here is not that you submit your condition and then the platform gives you back a generic form letter or a generic email with a standardized prescription for, you know, my pet peeves, antibiotics and steroids or isotretino.
• 22:36
  SPEAKER_01: And there's a lot of platforms out there that basically are like, oh, you know, you need a standardized, you know, cookie cutter solution.
• 22:42
  SPEAKER_01: So our goal is to really understand each patient.
• 22:46
  SPEAKER_00: Wow.
• 22:47
  SPEAKER_00: So what about the testing aspect?
• 22:49
  SPEAKER_00: Will you guys be offering testing on DecodeMe?
• 22:52
  SPEAKER_00: And can you describe the types of tests you currently offer and why they're important?
• 22:57
  SPEAKER_01: Yeah, so I mentioned at-home diagnostics.
• 22:59
  SPEAKER_01: So many skin conditions, you know, the core four have genetic or hormonal or immune system contributors.
• 23:05
  SPEAKER_01: And so that onset of the flare-up can either be driven by allergies or infections or stress or that hormonal imbalance, or if you look at it, weather, pollution, irritants, certain medications, certain fragrances.
• 23:18
  SPEAKER_01: So our practitioners will start with lab results to understand this root cause.
• 23:22
  SPEAKER_01: Um, and then they're going to monitor the treatment efficacy with actual recurring data.
• 23:28
  SPEAKER_01: The issue is that if you don't measure it, you don't know.
• 23:31
  SPEAKER_01: And if you don't know, you can't heal the person.
• 23:33
  SPEAKER_01: And so we want to empower the patients and the providers to know.
• 23:36
  SPEAKER_01: And so our tests include tests for skin and gut microbiome, neurotransmitters, as I mentioned, hormones, heavy metal toxicity, because that can sometimes appear as a rash, metabolism, as well as inflammation.
• 23:49
  SPEAKER_01: And so these are again designed to empower this integrative dermatology approach and make it easy to have data, which then helps more concretely identify the root cause.
• 23:59
  SPEAKER_01: Like we don't want to just call it root cause practice.
• 24:03
  SPEAKER_01: We actually want to have the data.
• 24:05
  SPEAKER_00: Right, right.
• 24:06
  SPEAKER_00: And that's very important data too that you mentioned, all of those factors.
• 24:09
  SPEAKER_00: You know, can you give us some examples maybe of these tests and how they apply to something like acne or eczema?
• 24:16
  SPEAKER_01: Sure.
• 24:16
  SPEAKER_01: So I might talk for a little bit here because this is a favorite topic.
• 24:20
  SPEAKER_01: So um a lot of this might sound obvious, but for as an example, our saliva hormone test is used in managing female adult hormonal acne.
• 24:28
  SPEAKER_01: Hormones are the signaling molecules that are transported through your body, regulate your body and your behavior.
• 24:34
  SPEAKER_01: But when they're not in balance, we start feeling the effects.
• 24:37
  SPEAKER_01: So it goes back to disrupted sleep or weight changes, your body temperature feeling off, or mood dysregulation and more.
• 24:43
  SPEAKER_01: So they also affect skin processes like oil that sebum production, collagen production, and moisture levels.
• 24:50
  SPEAKER_01: So when these hormone levels fluctuate, they can lead to skin issues like acne and hormonal dysregulation, which can happen at any point through a woman's life, is a key indicator.
• 25:01
  SPEAKER_01: And so this test provides insight into any imbalances, and then the provider can help create a treatment plan.
• 25:07
  SPEAKER_01: You know, whether the woman is going through puberty or menopause or perimenopause or before and after pregnancy, the goal here is to restore hormonal balance.
• 25:17
  SPEAKER_01: Similarly for eczema, I have a huge kind of thing about the gut microbiome here and gut microbiome health playing a key role in inflammation and flare-ups.
• 25:25
  SPEAKER_01: And so the gut microbiome and gut barrier influence, again, your gut, skin, and brain.
• 25:31
  SPEAKER_01: And our test here measures the diversity, the profile of the gut microbiome, as well as the permeability, that leaky gut factor and inflammation of the gut using a fecal sample.
• 25:42
  SPEAKER_01: And so gut inflammation, why is that important?
• 25:45
  SPEAKER_01: Well, when the intestinal lining becomes irritated, you have that leaky gut because it becomes compromised, then toxins and undigested food are back in your bloodstream.
• 25:54
  SPEAKER_01: You get the immune system response.
• 25:55
  SPEAKER_01: You know that in eczema, there's a dysregulated IL-4, IL13 response, and so that's going to contribute to the flare-ups.
• 26:02
  SPEAKER_01: And what do you look for?
• 26:04
  SPEAKER_01: You look for poor diet, again, chronic stress, food intolerances, infections, possible overuse of antibiotics in kids, like her ear infections.
• 26:13
  SPEAKER_01: And then you go look at not just necessarily the biologics or the JK inhibitors, but also things like prebiotics, probiotics, diet.
• 26:22
  SPEAKER_01: And so again, preventing eczema flare ups would be the key.
• 26:26
  SPEAKER_01: You know, it's obviously a chronic condition that can't be cured, but you can improve, for example, the gut systems.
• 26:33
  SPEAKER_01: And if they persist or become worse, then again, you need a referral to a gastroenterologist for a physical exam.
• 26:39
  SPEAKER_01: There may be something more going on in the gut.
• 26:41
  SPEAKER_01: So again, it might not be just a single home test.
• 26:45
  SPEAKER_00: I love that you mentioned how it can be, you know, no matter what stage you're at in your life, like this really addresses that, you know, like you're testing specifically for where that person is at.
• 26:56
  SPEAKER_00: I mean, that's that's phenomenal.
• 26:57
  SPEAKER_00: I love that.
• 26:58
  SPEAKER_00: You know, what about metabolic testing though?
• 27:00
  SPEAKER_00: How does that relate to skin?
• 27:02
  SPEAKER_01: So organic acids, um, which are part of metabolic testing, are the products of these metabolic pathways.
• 27:08
  SPEAKER_01: And they can essentially affect your skin health and overall health through that skin gut brain biomaxis again.
• 27:15
  SPEAKER_01: So the organic acid test is a comprehensive nutritional metabolic snapshot that's derived from a urine sample.
• 27:22
  SPEAKER_01: Um, and again, the decode provider will be interpreting these results and suggesting treatment options.
• 27:29
  SPEAKER_01: And because these organics are products of the metabolic pathways in the body, they're a valuable tool for assessing things like the functional need for essential nutrients, vitamins, minerals.
• 27:39
  SPEAKER_01: You know, is your diet providing those?
• 27:41
  SPEAKER_01: Is your body transporting and absorbing those?
• 27:43
  SPEAKER_01: Diet modification, are you getting enough antioxidant protection, detoxification, and other therapies?
• 27:49
  SPEAKER_01: Imbalances, often due again to gut issues or microbiome issues, can be triggered inflammation and disrupt, you know, the detoxification process in the body, which can then lead to, again, the core four skin problems or rashes.
• 28:04
  SPEAKER_01: Um, nutrient deficiencies and altered energy in the body can be linked to organic acid imbalances, can also impair skin health.
• 28:12
  SPEAKER_01: You know, are you not getting enough vitamin D or vitamin B?
• 28:14
  SPEAKER_01: And addressing these balances then through targeted intervention, such as supplementation, can then further improve the skin condition.
• 28:21
  SPEAKER_01: So it also complements, like we will have a vitamin genetic test.
• 28:25
  SPEAKER_01: And so the organic O test complements that genetic test.
• 28:29
  SPEAKER_01: And then you can figure out, okay, how much of that is coming from my genetics versus how much of that is coming through my diet and my lifestyle.
• 28:36
  SPEAKER_00: Wow.
• 28:37
  SPEAKER_00: Yeah, this sounds amazing.
• 28:39
  SPEAKER_00: It sounds very, very promising.
• 28:40
  SPEAKER_00: I'm just curious, are there any potential drawbacks that you see to this integrative approach to teledermatology?
• 28:47
  SPEAKER_01: So I would say, like any other approach, integrative teledermatology has its limitations.
• 28:53
  SPEAKER_01: So, for example, the at-home diagnostic tests rely on the patient doing them right, you know, complying with the instructions and accurately collecting their sample.
• 29:02
  SPEAKER_01: Similarly, interpreting the test results also requires expertise.
• 29:06
  SPEAKER_01: And not all practitioners may be equally skilled in this area.
• 29:09
  SPEAKER_01: That's where again education will play a role, and we're going to be trying to educate all of our providers.
• 29:14
  SPEAKER_01: And then the other big issue is that in telehealth, you don't have a physical exam.
• 29:19
  SPEAKER_01: So it's really not the same as being in a clinic and having a doctor physically examine your skin where they can, for example, touch the surface to see if there's any elevated regions or pick off a biopsy.
• 29:31
  SPEAKER_01: And so I would say all modes of healthcare have their own limitations.
• 29:36
  SPEAKER_01: And at the end of the day, the patient still has to remain a vigilant advocate for their own health.
• 29:40
  SPEAKER_01: And so if they're worried and they want to have a physical exam, then they should by all means go have that physical exam.
• 29:46
  SPEAKER_00: So it's really crucial to choose a provider very carefully and be active in in the participation and the whole process.
• 29:53
  SPEAKER_01: Absolutely.
• 29:54
  SPEAKER_01: It's a two-way street, right?
• 29:56
  SPEAKER_00: Yeah.
• 29:57
  SPEAKER_00: Makes sense.
• 29:58
  SPEAKER_00: No, it's easy for people, you know, to be very misguided by all the information on the internet.
• 30:03
  SPEAKER_00: I see this every day with a lot of like the skincare products people are choosing.
• 30:07
  SPEAKER_00: How can a listener determine if they should be seeking help for their ailments?
• 30:13
  SPEAKER_01: So I think if you listen to your body and seek professional help when you're concerned, it's never too early to seek professional help.
• 30:20
  SPEAKER_01: And, you know, what's the worst case?
• 30:22
  SPEAKER_01: You spend a hundred bucks and they tell you you're fine, right?
• 30:25
  SPEAKER_01: Whereas if you're experiencing persistent symptoms, call it like, you know, severe itching or pain or inflammation or you're breaking out, then it's definitely time to consult with a professional or a dermatologist.
• 30:37
  SPEAKER_01: The other thing is if you've been trying over-the-counter remedies and you're not seeing any improvement.
• 30:42
  SPEAKER_01: Or if that skin condition is really affecting the quality of life, I think it's important to deal with it and to seek some expert guidance.
• 30:49
  SPEAKER_01: And here again, trust your intuition.
• 30:52
  SPEAKER_01: So don't hesitate to reach out for help right when you need it.
• 30:56
  SPEAKER_01: And that's why we basically launched this Decode Me platform because we want something that's accessible and affordable.
• 31:02
  SPEAKER_01: It's personalized, but it's also a safe space for people with a skin condition if they have questions or they don't know where to go.
• 31:10
  SPEAKER_01: And we also want to really focus on treating skin conditions and those with skin of color.
• 31:15
  SPEAKER_01: Because again, it's an area of dermatology that's still evolving now to meet patient needs and more everything from taking the picture or the in in-office examination.
• 31:26
  SPEAKER_01: There's still a lot of ongoing training that needs to happen.
• 31:30
  SPEAKER_00: Absolutely.
• 31:30
  SPEAKER_00: Yeah, that's a very tricky area, skin of color, I think, right now, because just we know so little, like you said.
• 31:36
  SPEAKER_00: So um, what advice would you give to someone who is struggling, you know, with a chronic skin condition and they're feeling very overwhelmed about it with all the information and the all the treatment options that are available?
• 31:47
  SPEAKER_00: I mean, what would be some advice for them?
• 31:50
  SPEAKER_01: So, first of all, it is okay to feel overwhelmed.
• 31:53
  SPEAKER_01: So I think the first thing is to just not feel bad or not feel stupid.
• 31:57
  SPEAKER_01: It's okay to feel overwhelmed because there is so much information out there.
• 32:00
  SPEAKER_01: And so my advice would be just to start with a deep breath and find a qualified and compassionate healthcare provider who understands and listens to you.
• 32:11
  SPEAKER_01: And then you focus on making a series of small, again, sustainable lifestyle changes and be patient.
• 32:21
  SPEAKER_01: I think patients with skin conditions, again, we expect immediate results and yet, you know, skin barrier turns over in about 28 days, you know, so and you need at least a couple of skin barrier turnover cycles.
• 32:31
  SPEAKER_01: So that means you're looking at three months for significant improvement.
• 32:35
  SPEAKER_01: Um, obviously, you know, if you have, for example, a serious depletion of a keystone bacteria in your gut microbiome or other issues, you know, such as very serious bloating or gas or gastric issues like diarrhea or red patches on your body, then you might need a more aggressive intervention.
• 32:50
  SPEAKER_01: And again, as a patient, you will need to understand your diagnosis.
• 32:54
  SPEAKER_01: So don't feel afraid to ask the provider question.
• 32:57
  SPEAKER_01: But then once you agree to that treatment plan, you need to follow it diligently because there's a lot of people who don't get better because they simply don't follow the treatment plan.
• 33:06
  SPEAKER_01: They kind of fall off that ledge.
• 33:08
  SPEAKER_01: And, you know, I would say once that initial situation that brought you to the provider in the first place is under control, then that's when you start with those one or two small lifestyle changes, whether that's adding more color to your plate, eating more fruit and vegetables, or practicing mindfulness for 10 minutes a day or trying to sleep better, putting your phone away half an hour before you go to bed.
• 33:30
  SPEAKER_01: And so, because the small changes will add up for bigger results and long-term relief.
• 33:35
  SPEAKER_01: But obviously, if you're suffering or you have a massive breakout, you need to deal with that immediately.
• 33:39
  SPEAKER_01: So I would say just bite-sized chunks, but mostly find a provider that you feel you can really communicate with and you can honestly communicate with.
• 33:50
  SPEAKER_00: So, and how can listeners find a qualified and reputable integrative dermatologist who offers telehealth services?
• 33:58
  SPEAKER_01: So I would say finding the right practitioner is really important.
• 34:02
  SPEAKER_01: It's key, but it also depends on budget.
• 34:05
  SPEAKER_01: And so I would say whether it's a dermatologist, a naturopathic doctor, a physician assistant, a nurse practitioner with experience in integrative medicine, um, or these naturopathic doctors who are specialized in dermatology.
• 34:18
  SPEAKER_01: And so that's why we're going to have a Decode Me online directory in your state.
• 34:23
  SPEAKER_01: You'll be able to look and see where they got their education, what languages they speak, if they have any specializations, because all of our providers will post their credentials and their specialties.
• 34:32
  SPEAKER_01: We're also going to have them post their practice philosophy so you can actually see if they're a good fit, like if their philosophy matches your philosophy of life.
• 34:42
  SPEAKER_01: And next year we're going to also implement reviews so you'll be able to see what other people have to say about the practitioners.
• 34:48
  SPEAKER_01: And it then boils down to, I mean, bad pun here, but trusting your gut, right?
• 34:53
  SPEAKER_01: And so you again, you want to find someone with whom you feel comfortable and who you believe actually truly cares about your well-being because you will work far better with them and your compliance will be far better if you feel like you can't communicate honestly.
• 35:09
  SPEAKER_01: And then if you can't communicate honestly, the physician doesn't have all the information that they need in order to create a proper treatment plan.
• 35:16
  SPEAKER_00: Yeah, no, that makes a lot of sense.
• 35:17
  SPEAKER_00: And you know, I I love that.
• 35:19
  SPEAKER_00: I love this approach because I think that is where healthcare is kind of headed, right?
• 35:23
  SPEAKER_00: Is this more like you have to find trust in who you're going to for medical advice and for real treatment.
• 35:29
  SPEAKER_00: So I I love what you're doing.
• 35:31
  SPEAKER_00: Where can our listeners find you and learn more about your work?
• 35:34
  SPEAKER_01: Um, so obviously our website.
• 35:36
  SPEAKER_01: So www.codexlabscorp co-rp.com.
• 35:41
  SPEAKER_01: And you can also find a link on that website to the decode me platform.
• 35:46
  SPEAKER_01: Um, and then on social media at Codex Labs.
• 35:49
  SPEAKER_01: Um, same at TikTok, same for TikTok.
• 35:52
  SPEAKER_01: And um feel free also to write us at support at codexlabscorp.com.
• 35:58
  SPEAKER_01: Uh, we're there to answer questions.
• 36:00
  SPEAKER_00: I love that.
• 36:01
  SPEAKER_00: Thank you so much, Barb, for sharing your expertise with us today.
• 36:04
  SPEAKER_00: This has been so educational for me, and I know for all of the listeners.
• 36:08
  SPEAKER_00: Um, the conversation was really insightful, you know, for many, many reasons, but also because we don't get to hear about this stuff.
• 36:15
  SPEAKER_00: You know, the real integrative dermatology, the real way, you know, the way that I feel as well as a consumer that we should be approaching it.
• 36:21
  SPEAKER_00: So it's very fascinating.
• 36:23
  SPEAKER_00: But to all of our listeners, be sure to check out the show notes for all the links to Codex website and all of the other helpful resources.
• 36:30
  SPEAKER_00: And also remember that skin health is a lot more about what you put on your you know, a lot more than just what you put on top of your skin.
• 36:37
  SPEAKER_00: It's more integrative.
• 36:38
  SPEAKER_00: It's it's a lot more than what I think most of us realize initially when we're trying to treat skin conditions.
• 36:43
  SPEAKER_00: So that's very important to understand that and to approach it from this mindset.
• 36:47
  SPEAKER_00: But thank you so much, Barb.
• 36:48
  SPEAKER_00: This has been wonderful to chat with you.
• 36:51
  SPEAKER_00: Thank you.