Nutrition Essentials | How Diet Affects Your Skin and Hair with Chey Ranasinghe, MD

Podcast Transcript

John Horton:

Hello and welcome to another episode of Nutrition Essentials, an offshoot of our popular Health Essentials Podcast. I'm John Horton, your co-host with registered dietitian Julia Zumpano.

Julia Zumpano:

Hey, John. So happy to be here, and I'm very excited about our topic today, how nutrition can affect your skin.

John Horton:

Julia, I have to say, it's amazing how what we eat can have such a huge effect on your skin and your hair. There's even something I learned about called the “gut-skin axis,” which is just … not two parts of your body that you really connect together. It's just really mind-blowing.

Julia Zumpano:

It's completely fascinating and I can't wait to dig in with our guest today, Dr. Chey Ranasinghe, who's with the Cleveland Clinic Dermatology and Plastic Surgery Institute.

John Horton:

Well, we definitely have a lot to cover and we all have skin issues that we're curious about. So let's find out what we can do about them with our diet. Dr. Ranasinghe, welcome to the podcast. I got to tell you, we're so happy to have you here. Getting anybody from Dermatology to have a little spare time is usually impossible, so we really appreciate that you were able to make it in.

Dr. Chey Ranasinghe:

Thank you both so much for having me. I'm excited to be here today.

John Horton:

So what made you go into dermatology? I mean, were you just attracted to it? Because it is the largest organ in the body, so that does put it high in the pecking order, I think.

Dr. Chey Ranasinghe:

Well, I actually grew up planning to go into Ob/Gyn. And I think when I reflected on that, I think it's because I grew up with a really strong female presence. So I have an older sister, both my grandmothers lived with us while we were growing up. I went to an all-girls school. So when I went to med school, I had my blinders on. I said, "OK, I'm going to focus on women's health." And my research at the time in medical school was working with our PCOS patient population in the gynecology department and also dermatology and hair loss. So with that overlap, I was then exposed to the world of dermatology and my eyes were opened to how many things I can treat and I can help more people. So you could say I found my calling, because as you said, the skin is the largest organ on our body. So there's a lot, a lot that we need to do.

John Horton:

It does so much with just how we feel about ourselves, how your skin looks, your hair, everything. I mean, it's more than just appearance. I mean, it really does have a profound effect on us as people on just how you go about day-to-day life.

Dr. Chey Ranasinghe:

That is so true. A big portion of my clinic, actually, I focus on hair loss. And I think the reason why I'm so passionate about this condition is it's often overlooked, when the reality is, it's a sense of our identity. It affects our self-esteem, our confidence, right? Look good, feel good. So we can be the best version of ourselves.

So the health of our hair really can also be a reflection of our internal health. So that can tell us about, yes, our genetics, our biological age, our stress — those are all things that can affect our hair, but we can't always control those things. But what we can control is actually our nutrition. What we put into our body is something we can control. So we do talk actually quite a bit about nutrition and diet in my visits with my hair loss patients.

John Horton:

Well, that was a great segue. I think you're going to end up getting my job here. That was the perfect segue back into our main conversation here, which is connecting what we eat to the health of our skin and our hair. And I think when we look at our skin, hair, you just see appearance and how it looks, but it really is a ... there's a telltale sign of what's happening in our body … can show on our skin and hair, correct?

Dr. Chey Ranasinghe:

Correct. Yes. Yes. For example, if we are eating a specific diet, where it's high in sugar, high in processed foods, that's going to generate inflammation, and inflammation can manifest in so many different ways on our skin. We have acne, we have rosacea, psoriasis, eczema. And I can go into those a little bit more in detail depending on what direction we're going to go into, but exactly what we are putting in our bodies can trigger our genetics also to go in a certain direction, too, and lead to these pro-inflammatory conditions.

Julia Zumpano:

One thing I want to note is, we had a podcast on malnutrition. And when we do screen for malnutrition, I look at skin, I look at hair. Is the hair easily pluckable? Are we having hair loss? We're looking for reactions of the skin — drying, peeling skin, even the skin around your eyes, the skin around your lips. So we do really look at that and it can be a sign of malnutrition or nutritional deficiencies. And I also wanted to note, I really think something you said was very important, how much our skin affects our psychological health. And I struggled with acne as a teen and even as a young adult, and it really decreased my personal self-esteem. So I think it's also really important that we look at it from a step that someone can actually take to help improve their skin because nutrition is something, as you mentioned, they can actually change. So it gives them a little bit of ownership and ability to feel better. That's what really ... people want to feel better and really like the way they look, feel good about the way they look.

Dr. Chey Ranasinghe:

Exactly. Yes. And just to go along with that malnutrition that you mentioned and tying it back to hair, so a lot of my patients are on these low-protein diets or they're vegetarian or vegan. So that really limits the amount of protein they're ingesting in their body. And hair is made primarily of keratin, which is a protein. So protein intake is essential for hair growth. So in those patients that we were talking about that are having a restrictive diet, if you will, or a limited diet, that can push the hair from our growth phase, which is called our anagen phase to telogen, which is our resting phase. And then, we can lead to even a condition called telogen effluvium, which is excessive shedding of the hair, and the hair is very fine and short.

So we do go into a little bit about general protein guidelines in terms of, at least what I tell my patients, is 0.8 to 1 gram of protein per pound of body weight. We tailor it to everyone's needs. But that is something that we have to try to work with our nutritionist as well, is how can we get more protein in if they are having a specific diet that we need to work with and respect?

Julia Zumpano:

Right. And we know that iron, which is found in protein-rich foods, is another common deficiency that can lead to hair loss, especially in women, because we're certainly having a menstrual cycle or menstruating women, I should say. So that is another really important reason why we want to meet our protein needs, is because we're also meeting our iron needs and some of our B vitamins that are essential, too, for cell growth.

John Horton:

Now, do you find, is it just a matter of, if you're low in protein, you end up with hair loss or maybe some thinning hair? If you then go overboard, if you get in a lot of protein, are you going to see better hair? Is it going to look fabulous if you put more protein in?

Dr. Chey Ranasinghe:

I do think everything is a balance, right? Because if we have too much protein intake, that can lead to other health conditions as well and put unnecessary stress on other organs in our body, like kidneys, for example. So that's why I do try to tailor it to their specific, for example, their body weight percentile and try to figure out, OK, for example, for women, between like 55 to 75 grams per day is what I typically tell for the average woman for hair growth. And then, for males, of course, a little higher, right? 70 to 90 grams is the typical average I have for my male patients. So we want to try to be within that range, not too low, not too high.

John Horton:

The Goldilocks rule.

Dr. Chey Ranasinghe:

Yes.

Julia Zumpano:

Another problem with consuming too much protein is that you may not be consuming enough of the other nutrient-dense foods that you do need for hair growth as well, like polyphenols and fruits and vegetables, antioxidants, which we'll discuss later. And the other concern is, most people don't recognize that their bodies can only absorb a certain amount of protein at a time. So if you're consuming twice the amount of protein that you need, you're really not absorbing all that anyway. You're putting more strain on those organs that we want to protect. And just to clarify, I think it's 0.8 to one gram of protein per kilogram body weight.

Dr. Chey Ranasinghe:

Oh yes. Did I say pound?

Julia Zumpano:

Yeah.

Dr. Chey Ranasinghe:

Thanks for [inaudible 00:09:12].

Julia Zumpano:

Sure, sure.

John Horton:

Well, I'm glad you guys brought up the protein stuff because I know I've got two young sons and they are on that protein kick because it seems like right now, the trend is just to go bonkers on protein. So I keep telling them to-

Julia Zumpano:

…protein is so hot right now. It's so hot.

John Horton:

It is. So you try to bring it down a little bit. And it sounds like when we're looking at what protein does for your hair or skin maybe, you still want to hit that. You want to get enough, but not too much.

Julia Zumpano:

Absolutely.

Dr. Chey Ranasinghe:

And I think what's also tough, too, is the forms of protein that you're also ingesting. So sometimes, patients are eating these products that are heavily processed. And I find that they also have a lot of preservatives and additives and excess sodium, too. And they're saying, "Well, I am eating a higher protein diet. I'm eating..." And they're showing me the packages and the labels of these processed foods that they're eating and they're not whole foods. They're not actual ... when they look at their plate, it's something that they had to open a package for and they can't pronounce the labels, the ingredients on the label. And that's contributing to their inflammation and their nutritional balance, too. So it's trying to shift their focus to eating more lentils or seeds, nuts, a really underutilized form of nutrient-packed protein, for example, tofu, tempeh. I'm sure Julia can tell us more examples of what to shift patients.

Julia Zumpano:

You're doing phenomenal. You could take over the podcast for both of us. We don't even need to be here. No, you're spot on. And one thing I always say, you want to try to limit supplemental protein and really increase real food protein, whether that comes from meats or plant-based sources or fish, of course, or dairy.

The other quick thing to note, and I think we're going to talk about this in more detail later, but some of those supplemental proteins, like whey protein powder, can actually increase your likelihood of having acne. So you want to be cautious with some of these supplements. I mean, anything and everything in moderation can fit, but it's just finding that balance. And some of those supplements can be very quick and convenient, but I really encourage my patients, use those for convenience only, not as a routine basis or a source of protein, just use it when you need it to help meet your protein needs.

John Horton:

And Julia, I'm glad you brought that up because I think, now, we should really maybe transition into some of these skin conditions that we want to spend a little bit of time on. And obviously, a big one is acne. I mean, we've all had that zit that comes out at the absolute worst time and other issues. It can be really, really tough. Is what we're eating really triggering a lot of that?

Dr. Chey Ranasinghe:

So acne is multifactorial. So yes, dietary factors are something to consider, but also environmental factors. What I mean by that is stress. So if we're coming up to a big event or I have my brides, for example, a week before their wedding, they're calling me telling me, "Oh my gosh, I'm having the worst breakout ever." And other things to consider are genetics. Some patients can be just genetically predisposed to certain forms of acne and hormones, too, closer to a female's menstrual cycle, for example, a week before that they are experiencing a bout of acne as well. So diet can influence those modifiable risk factors that we could consider, but it's not the end-all, be-all. There are certain dietary factors we consider in terms of, are they eating high glycemic index foods? So what I mean by that, I always ask, "What did you eat today?" And a lot of my patients, for example, they'll start with eating a sugary cereal or they're eating these protein bars, again, that have high sugar content in them.

Julia Zumpano:

Granola bars.

Dr. Chey Ranasinghe:

Granola bars.

Julia Zumpano:

That whole “bar” category, the whole “packaged snack food” category, right?

Dr. Chey Ranasinghe:

Yes. Exactly. And then at 10 a.m., they're drinking Coke® or something like that. So high sugary drinks as well. So what's happening then is, that's spiking our insulin, and that's spiking insulin-like growth factors, and that stimulates our sebaceous glands, our oil glands to produce more oils. And what does that do? That clogs our pores, right? So that leads to more acne.

John Horton:

Well, it's amazing how it's all connected like that. And you just wouldn't think that you eat something really sugary, it kicks off this whole process, and the end result is you have a pimple pop-up.

Julia Zumpano:

But it's not just sugary foods, too, John. You want to keep in mind it's any high glycemic index foods, which is white bread, white rice, white pasta, crackers, snacky foods like potato chips. Those are high glycemic index foods, too.

John Horton:

What about dairy? Because I feel like you hear that tied to acne a lot, too.

Dr. Chey Ranasinghe:

So dairy has been a common trigger I've seen in my clinic, and specifically, actually, skim milk is linked more to acne than whole milk. And I think it boils down to actually the skimming process in terms of when they're removing the fat from the milk.

What happens is, then we have more bioavailable hormones, specifically again, insulin-like growth factor one androgens actually. So again, those are promoting our oil production, and again, leads to inflammation and clogging our pores. So if patients find that when they're ingesting certain forms of dairy, I tell them to actually food journal and look and see, OK, this past week, what did I eat? OK, three days ago, I've been eating dairy Monday, Tuesday, Wednesday, and I had a terrible breakout on Thursday. So then, we have to try to swap that out in terms of can we find a different form of a dairy alternative that they can still enjoy that is not going to be causing them to have this inflammatory acne breakout, for example.

Julia Zumpano:

I think another reason why the skim milk could lead to an increased risk of acne would be because there's no ... fat slows down the rate of glucose going into your bloodstream. So you're getting a much less reaction of a blood sugar spike when you pair it with fat or protein. So there could be some of that fat component that's slowing down that glucose, which is then less likely to stimulate insulin, too.

John Horton:

And Dr. Ranasinghe, I know you mentioned earlier, too, but a lot of the things that people take when they're working out. If you're a big fitness buff, you might be into those like the supplements, the muscle-building things that everyone is taking. How do those then contribute to acne?

Dr. Chey Ranasinghe:

Yes. So again, when I'm screening my patients with our dietary intake form, I'm asking about whey protein intake and branched-chain amino acids. And also casein, too, which is another dairy-derived protein that some patients have been taking as well. Again, they all funnel into the same mechanism of spiking our insulin, spiking our insulin-like growth factors, and overproduction of oil. So I see this a lot in my young teens and my young adult athletes as well. So then, we try to say, "OK, how can we swap that out for a plant-based alternative like pea protein or hemp protein, for example, to add that in so they can still get the protein that they wanted to try to incorporate into their diet, but hopefully in a way that's not going to produce acne."

There are also supplements, too, that I make sure I screen for patients, particularly vitamin B6 and B12. When we're having too much of that — again, too much of a good thing can cause a lot of problems. So when taken in high doses, particularly 5 to 10 milligrams per week, that can worsen acne in some individuals. The reason being, the B6 and B12 gets into our pores, localizes in the pores, and it actually acts as a nutrient source for a particular bacteria called Cutibacterium acnes, which is a bacteria that is involved in the acne formation process. So that is something, again, patients don't connect, but could be triggering their acne.

John Horton:

That's just amazing. I mean, you look at your skin and it just does not seem all that complicated, yet there's all this going on and oils being produced and the pores, and like you just said, these things in there. I don't think we think enough about how it is connected to everything in our body and that's why we see some of the issues we do.

Dr. Chey Ranasinghe:

Yeah. Another supplement I didn't want to forget to mention was iodine. So some patients take iodine supplements to optimize their thyroid health, and we have seen excessive amounts of iodine can cause irritation around the hair follicle, then leads to inflammation and then leads to red blotchy skin. So whether it be … kelp supplements is something a lot of my patients have been telling me they're taking recently or eating seaweed cracker crisps as a healthy alternative to potato chips or just eating a lot of ionized salt, for example. So just a few little things that maybe we didn't think about could, again, be contributing to your acne.

Julia Zumpano:

Do you know if there's a difference between food-specific contributors to more of that deep-rooted cystic acne versus more of those small topical pimples?

Dr. Chey Ranasinghe:

So there's two main categories of acne. So one is those superficial comedonal acne, otherwise known as the whitehead, blackheads. And then the other form of acne, or inflammatory acne, called nodulocystic acne. So I find that the more superficial acne could be due to, yes, dietary, but I will say I've seen it more due to products that patients are putting on the skin and that's causing inflammation at a superficial level. All these TikTok, Instagram trends that patients are trying out at the comfort of their home are causing these bumps versus more of what you're eating internally is causing more systemic inflammation and then that manifests as more of these deeper nodulostastic inflammatory papules or nodules on the face.

Julia Zumpano:

What about bacterial overgrowth? Do you know if there's any connections to a bacterial overgrowth, like the gut microbiome versus the skin microbiome, that could be leading to acne or any of these other conditions?

Dr. Chey Ranasinghe:

So we have seen that if there is overgrowth of our unhealthy bacteria in our gut, if there's dysregulation of the gut microbiome, that can manifest as inflammation in various forms in our body. So not just acne. Acne is one form, but also eczema and also psoriasis. So there's definitely a subsection to all of those, but if I had to keep things big picture, there's three big categories that patients can experience these skin conditions if they have dysregulation of the bad gut bacteria overgrowing.

John Horton:

Let's break some of those down then, because now, you had mentioned psoriasis. And what are the things in your diet that might contribute to that or really cause some flare-ups?

Dr. Chey Ranasinghe:

So I guess, let me take a couple steps back in terms of what is psoriasis, right? Because sometimes patients might come in-

John Horton:

…people do get it messed up. Yeah, like what it is. You've heard it, but you don't really know-

Dr. Chey Ranasinghe:

…what it is.

John Horton:

Yeah.

Dr. Chey Ranasinghe:

Yeah. So what psoriasis is, it's an autoimmune condition. It's an autoimmune skin condition where the immune system speeds up skin cell turnover and that leads to the skin’s … to build up on itself rather than shed like it normally should, every 28 days is how often our skin cells should be shedding. And then, you get these thick, red, scaly plaques coming on the scalp. It can be on the elbows, the knees, the lower back. And we're seeing more and more research actually that psoriasis actually is not just limited to the skin. It is a systemic inflammatory disease, and patients that have severe psoriasis actually have a three to four times higher risk of cardiovascular disease or a stroke.

John Horton:

Wow.

Dr. Chey Ranasinghe:

So in terms of the diet that we promote for our psoriasis patients, it's the same diet we promote for our patients that are at higher risk for cardiovascular diseases, which is the Mediterranean diet, is at least what I recommend for my patients to follow and look into a little bit more and do some research when they're trying to meal prep and get their grocery list in order, is Google what that means and look and see are there some foods that they want to start incorporating into their diet?

Julia Zumpano:

You could also check out our website that has really good, credible science-backed information on the Mediterranean diet. So if you're looking to look at ... and they have great recipes, so clevelandclinic.org or Health Essentials.

Dr. Chey Ranasinghe:

Well, see, this is why we do this.

Julia Zumpano:

And we can take over Google.

John Horton:

Yeah.

Dr. Chey Ranasinghe:

Yes.

John Horton:

We have talked about the Mediterranean diet once or twice, Julia.

Julia Zumpano:

Thousands of times.

John Horton:

Well, and I know, and that's always the thing that comes up. And you always get so excited talking about foods that limit inflammation. And I know the Mediterranean diet is so key for that. And it sounds like with psoriasis, you're dealing with those same inflammatory issues that can kick things off or really get things going. So what are the things that you want to really try to limit and make sure that you get in?

Julia Zumpano:

Well, so when you're talking about a general Mediterranean diet, you really want to limit what we've already addressed, simple sugars, which are also called high glycemic index foods, which are those white breads and products and bread type products, snacky foods, sugary foods, high fat foods, specifically foods that are high in saturated or trans fats, which can be processed meats, processed cheeses against some of those butter, lard, bacon fat, of course, in those animal fats, but mainly bad fats are found in processed foods again. So we're really limiting that processed category.

John Horton:

That's not a pro-salami sort of diet, it sounds like.

Julia Zumpano:

No, no, not a pro-salami type diet or pepperoni or whatever your vice might be. And that doesn't mean you can't ever have it. So again, anything in, that patients really want, I will help them work it in. There's no “no” to anything. Really, we can work anything in. It's just a matter of frequency and portion and supporting the other nutrients very positively. So we're just not going down a slippery slope when we add these other foods in, right? But high in fruits and vegetables. So when we talk about skin health, we talk about antioxidants and polyphenol-rich foods, which are found in colorful foods like berries and green tea and cocoa and grapes, et cetera. So we're looking at the colors of the rainbow, fruits and vegetables that are abundant in different colors, and that's where you're going to get the most bang for your buck because they also provide other very strong nutrients that support skin health and, of course, fiber that supports the gut microbiome and they help decrease inflammation.

So there's so many benefits to whole foods. We're looking at lean proteins and increasing fish. We've talked about plant-based sources of protein, so that's an abundant source of protein in the Mediterranean diet. So frequently eating legumes, which are dried beans and lentils, nuts and seeds are a regular consumption source of protein and healthy fat in the Mediterranean diet, extra virgin olive oil. So a lot of the stuff we've already talked about, but just reinforcing, again, one additional reason why the Mediterranean diet, or just in general, whole foods anti-inflammatory diet, can really be helpful.

John Horton:

Yeah. Now, we've mentioned this a few times here, and I don't want to forget to talk about it. So this whole idea of a gut-skin axis, which is just not something I think most of us naturally connect, that somehow your gut is connected to what's happening on the surface. So explain how this exactly works.

Dr. Chey Ranasinghe:

So there's definitely a lot of ongoing research that's still occurring with this, but what we're learning is if there is dysregulation of the gut microbiome, meaning there's overgrowth of that unhealthy bacteria compared to the good healthy bacteria, we then have patients that have an impaired skin barrier, and these patients then have cracks in their skin, and that allows for environmental allergens or something as simple as a fragrance that someone's wearing gets into our skin, and then stimulates our immune response to then create this immune cascade that leads to red, scaly, itchy rashes. I'm talking about eczema now at this point because this is the most common scenario where we see if there's [inaudible 00:26:55] of the gut microbiome, it's eczema, if I had to pick between the common conditions I see.

Now, when we have a healthy gut microbiome, which can be promoted by eating the Mediterranean diet, we have a lot of data supporting that that can regulate inflammation, and then that produces beneficial compounds, specifically called “short-chain fatty acids,” and that improves the skin barrier function. It helps retain the moisture, keep our skin barrier intact, and keep the irritants out, right? So then we don't have as severe or as frequent of these eczema flares.

Also, when you have a healthy gut microbiome, that allows us, that good bacteria helps us to absorb those nutrients better, all the wonderful nutrients that Julia was just referencing, and that helps us to promote better building blocks, a better foundation for healthier skin and healthier hair.

Julia Zumpano:

Now, correct me if I'm wrong, there's thousands of microbes on our skin as well, correct?

Dr. Chey Ranasinghe:

Correct.

Julia Zumpano:

So we heavily focus on the gut microbiome, but the skin has its own microbiome. And if we can build the healthier bacteria on our skin, they'll be more protective against those bad invaders, just like how we view the gut, we can view the skin in the same way. And I always say, your skin is a reflection of your internal self. So we want to look at your insides, are turned on the outside. So you can see that there is some dysregulation if you're seeing signs in your skin or your scalp, as you mentioned.

Dr. Chey Ranasinghe:

Definitely.

John Horton:

And I love when you mentioned the skin barrier because it sounds so sci-fi. Somehow, we have a force field all around us. If your skin's healthy, that just protects you and wards things off. But it sounds like there really is something to that, and we contribute to the strength of that by what we eat.

Dr. Chey Ranasinghe:

Yes. So in terms of … also, I will say a supplement that I do promote is actually eating, either taking a probiotic or eating probiotic-rich foods. Because the reason is, when we're doing that, I want patients to think about that as medicine, honestly, food as medicine. I know I'm not the first person to say that. That is definitely something you all have talked about that on your podcast as well, but it's true. And an analogy that sticks with me that I tell my patients, actually, it's something that I learned when I was in training, and I'm probably going to botch it right now, but you want to think about probiotics as seeds in your garden and prebiotics as fertilizers for the seeds to grow. So whether it be patients are eating certain foods that are probiotic-rich foods, meaning those fermented foods like yogurt or sauerkraut, miso, kimchi — which I would love Julia to teach me even offline how to incorporate that more into my diet because I want to be eating these foods more rather than taking pills — by eating those types of foods though, naturally, we are going to have a healthier skin barrier and naturally, our skin's going to look better. And we won't be having to be putting all the topical steroids or putting all these other medicines in and on our body if we can just eat a more mindful diet.

Julia Zumpano:

Yeah. And you did a great job listing those probiotic foods. To add a couple more, you mentioned fermented vegetables. So you mentioned sauerkraut, but kimchi, pickles and apple cider vinegar. That's an easy one for people to add. If you do a dressing on a salad, or some people just put it in their water. So sourdough bread. So real sourdough bread that's been fermented, though. Olives, kombucha is another source. So you want to look for low-sugar kombucha, of course. But there's a lot of great opportunities to consume some of these probiotic foods. And the prebiotics that you mentioned were, again, just as essential because we need that bacteria to keep thriving and growing and prebiotic foods are essentially fiber. So resistant starch and fiber, which we've talked a ton about on this podcast.

John Horton:

Dr. Ranasinghe, you were asking earlier if I've had changes in my diet because of this podcast. I'm telling you, I drink kombucha now because of everything Julia has said about it. So that's always in my fridge.

Dr. Chey Ranasinghe:

Nice. Well, I'll need to know what brand you guys drink because I'd like to join the kombucha train as well.

John Horton:

Mine usually is whatever's on sale, but that's a whole different discussion. So we've tackled a bunch of ... you said there were five things that you wanted to make sure we hit. And we've talked about hair loss, acne, psoriasis, eczema — the last one is rosacea, which I remember when we were talking before, you said that's a little more nuanced with how diet is related to that.

Dr. Chey Ranasinghe:

Yes. So first, what is rosacea? Again, that's another condition, when I look at a patient, I tell them they have, they go, "What is that? " So let's go into that a little bit.

So rosacea is a chronic inflammatory skin condition, like everything else we've been talking about, but it's particularly affecting the central face. So what happens is these patients can have frequent facial flushing, persistent redness, sometimes these background broken blood vessels on the skin, otherwise known as telangiectasias, and they can also get papules and pustules on the skin, too. It's commonly due to just having a genetic predisposition to this condition. But there are risk factors, triggers for patients that I do have them be mindful about, meaning UV radiation. So sun exposure is a main thing. And patients will tell me, "Well, I don't go outside in the sun." And then the next question I ask a lot of my patients is, "OK, do you work from home?" And a lot of patients that work from home have big windows around them, and that can promote their rosacea flares, which people don't commonly think about.

John Horton:

Yeah. You don't think of being inside, you're going to end up with that.

Dr. Chey Ranasinghe:

No, yes. So that's something to consider. Another one is excessive caffeine intake, spicy food, red wine and alcohol. What all these triggers are doing, it's again, dilating those blood vessels and creating inflammation at the center of the face … dark chocolate, and then also emotional stress. So those are the main factors that patients need to consider about trying to mitigate and decrease so that they don't get as many flares on the center of their face with the rosacea.

Julia Zumpano:

Doesn't it flare also if you're in heat, like if you're in a sun or hot yoga or exercising in a hot room or running outside where you're just promoting that your body's really sweating and very hot?

Dr. Chey Ranasinghe:

Yes. Is in violation. Mm-hmm. Exactly. So when patients are on vacation, that's when they come back to see me and say, "Can you help me fix what happened to my face?" Because we're outside in a different environment versus our cooler climate here in Cleveland. That's something for their body to adjust to and that can trigger inflammation.

John Horton:

Okay. So we've tackled all these issues and what's causing them a little bit. I want to make sure that we focus and really break down what people can do to resolve some of these issues, how we can adjust our diet to lessen some of these skin issues. And I know it's all over the board here, but let's just try to break down some of them. It looks like one, you said probiotics, prebiotics, get them in your cart when you're at the store.

Dr. Chey Ranasinghe:

Yes. Get those types of foods in your cart when you're at the store. With rosacea, it’s trying to avoid those triggers that we've already reviewed. With psoriasis, actually, yes, going along the lines of the Mediterranean diet, but also out of all the conditions that we talked about, I will actually say weight loss has been shown to actually improve the severity of psoriasis. And the reason is, actually, our fat cells are producing poor inflammatory hormones that can lead to whole-body inflammation and lead to worsening psoriasis. So weight loss, as little as 5% of someone's total body weight, has been shown to reduce the psoriasis severity. So what I mean by that, for example, if we have a 200-pound patient and they lose 10 pounds, they can experience improvement in the severity of their psoriasis.

So out of all the conditions, having structured nutrition counseling is something I do tell patients to do as part of their adjunctive therapy, as part of their psoriasis treatment plan, because it really can help make a difference.

Julia Zumpano:

Well, another bonus to that is, most chronic conditions can be improved significantly with a weight loss of 5 to 10%. So not only are you improving your psoriasis, but any chronic condition or risk factors surrounding that chronic condition can really be improved, too.

John Horton:

Dr. Ranasinghe, how often do you pair one of your patients with a dietitian to try to work through some nutritional things they can do to maybe make a difference?

Dr. Chey Ranasinghe:

Daily.

John Horton:

Wow.

Julia Zumpano:

That's great to hear. Yay. Thank you.

Dr. Chey Ranasinghe:

I don't know how many of them have seen Julia in particular, but I really do treat patients holistically. And I think I already brushed on it earlier. Yes, I'm a physician, but I don't like patients to have to use medicines. I don't like patients to have to be putting a topical steroid twice a day, every day for six months. If we can just do minor lifestyle changes, they can make drastic results in living, like I said earlier, living our best life. So having the help of a skilled nutritionist to work together to try to figure out what are the dietary changes that we can swap out for. Instead of eating this highly processed chicken sausage every morning, what's a different alternative to try to get that high protein and take in that's a whole-food-based product.

John Horton:

How often do you see them when you talk to your patients about this and they meet with a dietitian, that they have that light bulb moment, that they really just see the results take hold?

Dr. Chey Ranasinghe:

So I will say the most obvious changes have been in my hair loss patients. I think that's just because what I see the most is, I see them after about four to five months. That's how often our follow-up is on average. And they'll come back and they'll say, "Dr. Ranasinghe, I started eating Greek yogurt every morning. I'm adding my chia seeds and flax seeds and hemp seeds." Little things on top of their yogurt, but they have a big impact on the amount of protein they're having in the morning. And yes, they're also doing the other changes that we talked about medically-wise, but we have the photos. That's what I love to see, is we have the before and after photos. And they're telling me that they're using apps on their phone, for example, to track how much protein intake they're having, too. And they're telling me also they're feeling better, right? They're feeling better, not just because of their hair, but they're feeling better because they're feeling more satisfied with actually nourishing themselves more adequately. But like I said, yes, going with the photos, having them side by side, patients can really see that what they're doing, the changes that they're making are really making a difference. So that's like the best feeling to see.

Julia Zumpano:

I would agree with you completely. And you mentioned one thing about using an app or food journaling. I think that's one thing we didn't mention, and I think it's a phenomenal way to really troubleshoot if there is a connection to what you're eating with your skin condition. And I think it also helps you make sure you're meeting your protein needs, make sure you're getting in that fiber, which is, again, a prebiotic, making sure you're getting those polyphenol-rich foods and those fruits and vegetables. It gives you real accountability. So you can look every day and see what you're getting. If you choose to use an app, the app's like the Cleveland Clinic Diet app, will track all of these nutrients for you. They'll track your protein, your fiber, your vitamins, minerals, et cetera, and they'll tell you if you're on target or not.

If you choose to use a journal, great. You can just note that yourself, like if you have a skin reaction after a certain food or if you even can calculate your protein grams. So there's so many benefits to just writing down. And I usually tell patients, "You don't have to do it forever." I say, "Commit to two weeks. Most of us recycle the same foods within two weeks. So commit to two weeks of journaling and you'll probably get a good understanding on where you fall with nutrients or with any triggers." So I think that's one big piece to consider.

And I also think just looking at simple changes, too. So I think some of this can be very overwhelming. There's a lot to change, but just starting with one step, you know your body well, one step that you think that will make the biggest impact, such as maybe we start with cutting out sugary foods or processed meats, or maybe we start with adding something like a probiotic food.

John Horton:

Well, and we've covered so much here today. And so I'd like to, as we wrap things up, if you guys could just maybe summarize key points you want people to walk away from this discussion with, maybe some best practices they can adapt, and maybe some resources that they can use to get their diet squared away and get their skin and hair at the best it can be.

Dr. Chey Ranasinghe:

So I think what I would say is the bottom line is a balance. We need to enjoy our life, but we also need to consume things in moderation, like we started talking about. We don't want too much protein, too little protein, with our hair loss patients right in the middle, with the guidelines that we provided earlier today. With our acne patients, trying to step away from our heavily processed, highly, very … let's see, pro-inflammatory foods that have a high glycemic index or our skim milk, or considering swapping out that whey protein for a plant-based protein.

With our eczema patients, reaching for more probiotic-rich foods or foods that are prebiotics that are going to promote those probiotics.

And with our rosacea patients, being aware of our triggers and making intentional choices that support your skin health and learning more about the Mediterranean diet using our Cleveland Clinic resources that Julia has so nicely laid out for us too is something that I also am going to do a better job about linking my patients to, instead of going on Google, look and see what our wonderful institution has been able to compile.

Julia Zumpano:

Yeah. Just to second that, I think everything you said was spot on, but I would reinforce, again, educating yourself. It's always a key for me. I always try to empower my patients to educate themselves. Education is your key to success, right? It's your key to resolving whatever health issue you may have. You can take a little bit of ownership and get a little bit closer to where you want to be. So looking at the Cleveland Clinic website, the Cleveland Clinic Diet app, looking at the resources we have, the recipes we have, we have meal plan options. We have many, many dietitians that you can see if you want more individualized help. But if that's not the path for you, we have free information that you can access at any time that has been written and developed by registered dietitians. So just really educating yourself is key.

John Horton:

Well, folks certainly got an education with us here today. So I want to thank both of you for just sharing so much great info and really helping people see that connection between what they eat and how their skin and hair look. So thank you very much.

Julia Zumpano:

Thanks, John.

Dr. Chey Ranasinghe:

Thank you both.

John Horton:

So Julia, I have to tell you, that conversation, we hit so many things that I think affect people in their day-to-day life, because, I mean, we all have skin issues that we deal with.

Julia Zumpano:

I completely agree. I learned so much about the specific different kinds of skin issues. I didn't realize they were all influenced by so many factors, and really reinforcing the fact that diet and nutrition can play such an integral role in treating these skin conditions.

John Horton:

I always love hearing just how much of a difference it makes and that she sees that in the patients that she's working with.

Julia Zumpano:

It's great to see the visual changes. I've seen that as well with my patients, and it's really encouraging.

John Horton:

Agreed.

So if you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. And until next time, eat well.

Speaker 4:

Thank you for listening to Nutrition Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.