With acne affecting approximately 80% of the population at all ages, Dr. Stacey Shillington joins us to discuss ways to manage and prevent acne by healing the root cause.
Episode 33: Seeing Your Skin Clearly
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[1:35] Cassy Price: Hi, everyone. You’re listening to Supplementing Health, and today’s Dr. Stacey Shillington is joining us to discuss the ins and outs of acne. Welcome, Stacey.
[1:44] Dr. Stacey Shillington: Hello. Thank you so much for having me. I’m so excited.
[1:48] Cassy Price: Acne is something that affects many people at all ages and all stages of life. So, would you mind telling us some of the common causes that lead to acne?
[1:57] Dr. Stacey Shillington: Absolutely. In my patient population, I work a lot with adults that are experiencing acne specifically. There are always five root causes that I address with every single patient that comes to see me.
- I take a look at their insulin and their blood sugar regulation. Often, if insulin levels are not balanced properly, blood sugar levels are not balanced properly, that can be something that can lead to acne.
- Another one is core detoxification. Often, Phase 1, Phase 2, the liver is not working optimally, so I have to take a look at that. And it’s not only the liver but other organs of detoxification. And also, the lymph. When the lymph is stagnant, often, that can be an underlying cause of acne.
- Core diet: core diet is always something that needs to be looked at. There are quite a few foods that can actually aggravate acne and make it worse. So, I take a look at the diet as well.
- The gut: the gut is a huge contributor to acne. As we know, there’s such a strong connection between the gut and the skin, which is the microbiome. So, taking a look at gut health and healing the microbiome is a really important part. Stress, as well, is an underlying cause that’s often overlooked, but it’s quite significant.
- Then, core topical care: I see a lot of core topical care that aggravates acne and makes it quite a bit worse.
That’s the long answer to what some of the underlying causes of acne can be.
[3:37] Cassy Price: Okay. Awesome. When you say stress, I’ve also heard that hormones can affect it. Is that because of cortisol levels, or can all hormones and the balance of hormones play into it as well?
[3:50] Dr. Stacey Shillington: Yeah. All the underlying causes that I just mentioned, all of those can contribute to hormonal imbalance. When somebody comes to me, and they say, “I have hormonal acne,” they’re absolutely right because you need to have an imbalance in hormones for acne to happen.
[4:09] But, I don’t treat at the hormonal level. Instead, I go deeper, and I treat the major pillars of health that actually cause hormonal imbalance in the first place.
[4:21] Cassy Price: Okay. Historically, people believe that acne was due to poor hygiene. Do you know where that belief came from?
[4:31] Dr. Stacey Shillington: Well, I don’t know exactly where that belief came from. Maybe from people that want to sell a lot of topical skincare products. I don’t know; I’m just guessing. But there is some truth to that. If you are practicing poor hygiene, if you’re not taking care of your skin and cleansing it properly, and your body is overproducing sebum, and your skin sheading is not regulated properly, then yes. Poor topical care can contribute to acne.
[5:04] Cassy Price: Are there different types of acne?
[5:07] Dr. Stacey Shillington: Absolutely, there are different types. There’s the deep cystic acne that really hurts, and it actually feels like little cysts under the skin because that’s what it is. There’s more surface acne, and that acne is red; it’s inflamed; you get pustules. There’s also comedonal acne, open comedones, where those are blackheads. Then, there’s also fungal acne, and fungal acne is like white little bumps all over the face, and they tend to be itchy, and they tend to get worse with humidity and with heat.
[5:44] Cassy Price: I know I personally suffered from rosacea before, and so have some other people I know. Is that a form of acne because it can also come up with that red, bumpy, inflamed kind of presentation?
[5:57] Dr. Stacey Shillington: Yes. Absolutely. I treat a lot of people with acne rosacea as well. With acne rosacea, though, it has a very, very strong correlation with the gut. The blood vessels in the skin actually dilate, which causes the excessive redness in the face with acne rosacea. It has a lot to do with an imbalanced microbiome.
[6:23] Cassy Price: That’s super interesting. I didn’t realize that. So when you’re treating someone with that, then you focus on healing the gut and the gut lining and using probiotics, and that sort of stuff?
[6:34] Dr. Stacey Shillington: Exactly. Take a look at the microbiome. Often, doing some testing like GI Mapping is a really great tool to understand exactly what’s going on with the microbiome. It’s always my priority to take a look at the microbiome, and also take a look at any foods that are aggravating [in this way to gut 6:55] because you can’t heal the gut if you’re constantly eating foods that are inflammatory.
[7:05] So, removing foods that are inflammatory, healing the microbiome, and then, also, healing the actual gut like any leaky gut, and any inflamed [enteritis 7:13]. That also has to be addressed, as well.
[7:17] Cassy Price: And you had mentioned that poor topical care can lead to acne. Is that including certain moisturizers and makeup?
[7:25] Dr. Stacey Shillington: Absolutely. There are a lot of skincare ingredients that can be really clogging to many types of skin. You know, if you have a microbiome imbalance in your gut, chances are, you’ll have a microbiome imbalance on your skin, and your skin is going to be more vulnerable to many products. It’s going to be irritated a lot easier, so certain moisturizers can cause clog the pores. Also, what can happen is when you cleanse incorrectly and use harsh cleaners, and you exfoliate too much, that is going to be more aggravating for the skin as well.
[8:05] Cassy Price: Recent research has actually allowed us to target the microbiome in various ways to improve wound healing, restore the skin’s microbiome, etc. Can that research also be applied to healing acne and possible acne scars, as well?
[8:23] Dr. Stacey Shillington: It can be. We’re uncertain exactly what strains are the most effective at this point in time to use topically to heal acne. But I’ve been experimenting with it. I’ve experimented with various products, and I do see some really good results, so that’s definitely an option. But, there’s nothing like actually healing the microbiome from the gut because it’s the gut microbiome that is reflected in the skin’s microbiome ultimately.
[8:56] Cassy Price: Okay. I guess there are two camps of people: those that are pimple-poppers and those that are not.
[9:06] Dr. Stacey Shillington: Right. Yes.
[9:06] Cassy Price: For those that are, what can they actually be doing to their skin when they’re popping?
[9:13] Dr. Stacey Shillington: Skin picking can get really out of control. There are times when you should maybe pop a pimple, and that is when you know you have a pimple that has a whitehead and if you just gently squeeze it with barely any pressure at all, and it releases that. Of course, you need to wash your hands and your face beforehand.
[9:41] Then, there’s also the camp where you go and look in the mirror, and you just start going, and you can’t stop. I see that so often, with so many of my patients. It’s actually a deeper issue. It’s anxiety-related. It’s something that we really need to deal with on a different level. It’s more about developing self-love and listening to the talk that goes on with the inner self and how to counteract a lot of what we tell ourselves.
[10:20] Cassy Price: Along that same line, acne does influence self-confidence and self-esteem, for sure. So how do you suggest people start to confront that negative self-talk that comes up and is there any kind of initial steps that you suggest or tools that you suggest that you use to move past that?
[10:39] Dr. Stacey Shillington: Yeah. The first step is awareness. It’s always awareness; it’s always understanding – being aware that we’re saying things to ourselves that are hurtful and things that we wouldn’t accept any other person saying to us. I get all my patients to do meditation.
[11:02] I’ve developed a whole program called The Beauty Bliss program, which I walk my acne patients through. It’s all about listening to our negative self-talk, getting in touch with what we’re feeling, and allowing those feelings to be felt, and to validate ourselves, and validate our experiences, and change the conversations that we’re having with ourselves. And it’s a process. Meditation is probably my #1 tool. Also, making little notes on the mirror wherever you are saying, “I love you. You’re beautiful.” You’re really changing the story that we’re telling ourselves.
[11:47] Cassy Price: That’s fantastic. For those that have acne scars resulting from popping or sometimes just really bad acne, are there ways that they can reduce the severity or maybe entirely eliminate those scars to also help in that healing process?
[12:06] Dr. Stacey Shillington: Absolutely. There are a few steps that I always share with my patients. You have to heal the skin’s moisture barrier, and that has to be done right away because the healthier your skin is, the less it’s going to scar. And that’s the thing with your body. The less inflammation that you have in your body, the less it’s going to scar. So that’s always important to reduce scarring.
[12:32] Once my patients have actually healed their acne, and they no longer have active breakouts, the #1 thing that I see time and time again for healing acne scars is medical microneedling. It’s brilliant. This is not the same as doing dermarolling or microneedling at home because you need to have a long needle, at least one inch, to really see a lot of improvements. If you go to your medical practitioner, your doctor, your medical esthetician, they can do that medical microneedling treatment. You probably need about four to six treatments to get the results you want. That is by far the best treatment that I’ve experienced for scaring.
[13:26] Cassy Price: Very cool. For women who are using hormonal contraceptives and are dealing with menstrual breakouts, how do you treat those because that’s something that keeps coming up in a cycle? Right?
[13:39] Dr. Stacey Shillington: Right. So, they’re on the birth control pill, and they’re experiencing breakouts?
[13:44] Cassy Price: Yeah.
[13:46] Dr. Stacey Shillington: Okay. The #1 thing is that you need to reduce inflammation in the body. Once you reduce inflammation in the body, you are not going to be as triggered for breakouts. When you’re on the birth control pill, because you have a lot of breakouts, chances are that the progesterone that is part of the pill is called [dratheronon 14:11], and that progestin is actually an androgen-blocker. So it’s going to help reduce the amount of acne that you’re experiencing already. But if you’re still experiencing acne on top of that, it is very likely that your body is inflamed, and you need to bring the inflammation down.
[14:29] Cassy Price: Okay. Awesome. Does sun exposure help with healing acne, or can it make it worse?
[14:35] Dr. Stacey Shillington: Well, direct sun exposure on the face is – it can help some people, for sure. One of the reasons is because it creates natural vitamin D, which is very helpful for us. But, also exposing ourselves to direct sunlight can also create sun damage on our skin as well. It kind of helps, but then, it’s also creating another problem at the same time.
[15:08] Cassy Price: So would you suggest supplementing vitamin D instead?
[15:11] Dr. Stacey Shillington: Yes. Absolutely. Definitely supplement with vitamin D. I do love getting natural vitamin D as well, which I always get my patients to do – always put sunscreen on, cover up your face, and then 10 to 15 minutes a day, expose the rest of your body to natural sunlight, and make natural vitamin D that way because I don’t want them to get sun damage on their face. Other parts of your body, it’s okay to get a little bit, but not the face. Not the face.
[15:54] Cassy Price: One of the things that they say is a sign of ageing is the neck because a lot of people forget the neck in their skincare routine, and the neck doesn’t tend to get as much acne, but I know it can sometimes. There are other areas of the body that can get acne, so would you apply the same healing techniques to other areas, like if you’ve got chest or back acne or anything like that?
[16:18] Dr. Stacey Shillington: Yeah. And that’s a great question because when acne shows up in different parts of the body, it signals something different. So, for instance, if you get a lot of acne on your neck, then, to me, in my experience, there’s a lot of lymphatic stagnation going on in the body.
[16:41] With my patients, I’ll really target more on [healing the lymph 16:44]. If I see a lot of acne on the chest and on the back, then chances are the microbiome is really out of balance. So, I’ll take a look at that, and I’ll do healing there. I can tell. I’ve been doing this for 14 years; I’ve been looking at acne for 14 years, so I have an idea of what’s going on in the body just by looking at where the acne is appearing and what the acne looks like.
[17:12] Cassy Price: What are your thoughts on skincare products that contain acne-treating substances such as benzoyl peroxide or salicylic acid?
[17:22] Dr. Stacey Shillington: Benzoyl peroxide is incredibly drying; it’s incredibly damaging for the skin’s moisture barrier. I’m not a fan because part of what I do is I always want my patients to have healthy skin where the moisture barrier is intact; it’s not dry; it’s not irritated; it’s not peeling. It’s healthy skin. And benzoyl peroxide does not help with that at all.
[17:47] But I do like salicylic acid. Not everybody can tolerate it, so we start slowly to see what each person’s tolerability is. If you can tolerate it, it is wonderful because it’s a fat-soluble substance. It’s a beta hydroxy acid, so it’s actually able to penetrate into the pores. People that have a lot of pore-clogging, such as blackheads, salicylic acid can be very helpful for reducing that.
[18:20] Cassy Price: Interesting. I know, earlier, you had mentioned insulin levels can be a big cause for acne. Do you mind elaborating a bit on this?
[18:31] Dr. Stacey Shillington: Yeah. Absolutely. When we consume too many simple carbohydrates, they convert very quickly into glucose; that’s blood sugar. The blood sugar is elevated, and then, what happens is that the pancreas produces insulin to help get that glucose into the cells of the body.
[18:53] What the high insulin levels do is they produce a hormone called insulin-like growth factor-1. Insulin-like growth factor-1 directly increases androgen levels in the body. Androgens are the hormones that directly lead to acne. So that’s the connection, and it’s a really clear connection; it’s a strong connection. There’s so much research that’s come out over the past few years that’s shown its effect. That’s what happens.
[19:28] Cassy Price: That’s amazing. Healing acne from the inside-out, or healing our skin from the inside out is, obviously, going to take time. It’s not an instant fix. Do you have suggestions for people on ways to manage the acne in the interim while they’re doing the internal work?
[19:46] Dr. Stacey Shillington: It takes time, and I get my patients on a very gentle, nourishing skincare routine to start because we don’t want to be aggravating the skin by using the wrong skincare products. And that happens a lot, and gentle skincare is very helpful.
[20:08] But, like you said, it’s going to take time. Part of the journey is developing patience and also learning to love ourselves no matter where we are in the journey. I don’t have magical cures. I don’t have anything that’s going to eliminate all acne overnight. I think accepting that and learning to deal with that is such a big part of the healing journey, and it is part of learning to love ourselves no matter what. So, it’s valuable.
[20:45] Cassy Price: You had mentioned you have a gentle skincare routine. Do you use actual skincare products that are on the market, or do you prefer to use household items to make your own skincare products? I know some people will use, for example, coconut oil on their skin or maybe tea tree oil or things like that.
[21:05] Dr. Stacey Shillington: Yeah. I do a combination. I actually have a combination of products that I share with my patients. Some of the homemade kitchen items that I do love, though – I love manuka honey. Manuka honey is one of the most healing things you can put on your skin. It’s incredibly antimicrobial, and it’s very calming. It reduces inflammation.
[21:32] I also love green tea. Green tea is an ingredient that’s been clinically proven to actually reduce [inaudible 21:38] production on the skin. So if you have very oily skin, spritzing some green tea on it is really, really helpful. Those are probably my two favourite kinds of homemade things. I also love using a lot of aloe vera gel. That’s fantastic.
[21:59] Tea tree oil – it depends. People that have very sensitive skin, often, tea tree oil is just too harsh for them. It’s not going to work and increase irritation, so you have to be very careful with essential oils.
[22:17] Cassy Price: For diet and gut health overall, do you look at food sensitivities and allergies, as well, when you’re looking at causes of the inflammation?
[22:28] Dr. Stacey Shillington: You know, I don’t as much as I used to. The reason being is when you’re looking at food sensitivities when you do an IGG Food Sensitivity Test, it measures foods that your immune system is having a reaction to. But I find that many acne patients actually have good intolerances. They have difficulty breaking down certain foods in the digestive tract. So I now do an elimination diet instead of doing an IGG blood test to determine food sensitivities and intolerances.
[23:06] Cassy Price: What are some of the best foods for clearing the skin?
[23:10] Dr. Stacey Shillington: My #1 favourite food for clearing skin is blueberries. I love blueberries. They naturally help to balance insulin blood sugar levels, so that’s one reason I love it – so many amazing antioxidants. That’s one of my favourite foods. Another food that I love is cruciferous vegetables. Cruciferous vegetables are fantastic to help the body detoxify.
[23:39] There are so many of them. Avocado is another fantastic food because it’s so high in vitamin D and fatty acids that really help the skin be moist and healthy. Nuts and seeds are also fantastic. I love having my patients consume a lot of those as well. Those are just a few. I have so many I could talk about them all day long. [Laughter] You just stop me.
[24:05] Cassy Price: Do you ever use supplements, as well, to help with patients’ diets, or do you prefer to go the whole food kind of route?
[24:16] Dr. Stacey Shillington: No. Absolutely, I love diet, and diet is absolutely the foundation of the work that I do with my patients, but often diets can only go so far, and there are organ systems that need to be balanced in the body. That’s when certain supplements are really important.
[24:40] Cassy Price: For dealing with lymphatic stagnation, do you do lymph node messages or do you prefer acupuncture or do you have certain treatments that you find work well to get those moving again?
[24:56] Dr. Stacey Shillington: Yeah. I love those treatments that you just mentioned. They’re fantastic, but my favourite that I use with my patient population is complex homeopathy. I find that complex homeopathy is so amazing to help move and cleanse the lymph. But, dry-brushing, we do a lot of that. We do a lot of castor oil packs. We also do some acupuncture. I love doing acupuncture, and massage is fantastic too.
[25:27] Cassy Price: Awesome. Do any other lifestyle changes, such as exercise and sleep, influence acne?
[25:34] Dr. Stacey Shillington: Yes. Absolutely. Without proper sleep, our bodies are not operating at their optimal – they’re not as vital at all, so we need proper sleep. It’s essential. It’s the foundation of health. And exercise, too. We need to move our bodies, and that’s part of keeping our lymph’s healthy, but – and this is interesting.
[25:58] I find that overexercising can be an issue when it comes to acne. When we overexercise, sometimes, we produce even more cortisol, and chronically, high levels of cortisol can be very triggering when it comes to acne. So, exercise is important, but overexercising can be an issue.
[26:21] Cassy Price: Do you see a lot of patients with HPA axis dysfunction?
[26:26] Dr. Stacey Shillington: Many. Many, many patients have HPA axis dysfunction. We are working to heal the adrenal glands, to reduce chronic cortisol levels all the time. I would say it’s very rare to actually see a person with chronic acne without having some type of dysregulation in their HPA axis.
[26:51] Cassy Price: On average, how long does it tend to take for people to notice a difference from their acne treatments?
[27:00] Dr. Stacey Shillington: It varies – what’s the underlying cause of their acne and how severe their acne is. Some patients get complete clearing within two weeks. Other patients, it can take three to four months to get complete clearing. It definitely varies, but it takes time to heal properly. Right?
[27:25] Cassy Price: Absolutely. Do you believe that we can prevent acne by preemptively following some of these steps?
[27:35] Dr. Stacey Shillington: Absolutely. Absolutely. Acne is a sign that there’s an imbalance in the body. If we keep our bodies balanced, and we support the organs that can be implicated in acne, then absolutely, we can avoid acne. I 100% believe that.
[End of interview 27:54]
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