Become a Sustainavore!

Eat for your health, the planet, and your values.

Become a Sustainavore!

Eat for your health, the planet, and your values.

Sustainable Dish Episode 242: Jennifer Fugo

During the month of April, we are focusing on “Healthy Skin from the Inside Out,” and I love having experts on who specialize in topics that are different from my own.

Jennifer Fugo is a clinical nutritionist that specializes in treating the most challenging skin issues, and she’s here to dispel some of the common myths about fixing your skin. Spoiler – animal-based foods are not toxic or inflammatory!

Jennifer does not give you a one-size-fits-all protocol to fix your skin and instead uses a personalized approach to get down to the root cause. In fact, there are 16 possible causes of your particular skin flares. You can click the infographic below to find out more.

Skin Rash Root Causes

 

During this conversation, Jennifer gives breaks down the different systems involved in skin health and some quick action steps you can take today to help improve your skin. Check out this quick list of nutrients that she mentions for skin health:

  • Quercetin
  • Vitamin C
  • Immunoglobulins
  • Butyrate
  • Glycine
  • Vitamin B6
  • P5P (Pyridoxal-5-Phosphate or active vitamin B6)
  • Zinc (with copper)
  • Vitamin D
  • Vitamin A

We also chat about:

  • Why ‘dieting harder’ is not the solution
  • The one food Jennifer recommends to remove from your diet and why
  • Why eliminating foods can cause more problems
  • Histamines and why they are helpful and harmful

This episode is a great resource for anyone who has been struggling with chronic skin problems and can’t seem to find a solution. 

Rather watch this episode on YouTube? Check it out here: Episode 242: Jennifer Fugo

And be sure to check out Jennifer’s course: Skin Rash Rebuild. Use Code REGENRISING at checkout for $50 off.

 

Resources:

Institute for Functional Medicine

Dr. Alessio Fasano

Kiran Krishnan

Robyn Johnson

Skin Rash Rebuild Use code REGENRISING for $50 off

 

Connect with Jennifer:

Website: Skinterrupt | Jennifer Fugo

Podcast: The Healthy Skin Show

Instagram: @jenniferfugo 

 

Episode Credits:

Thank you to all who’ve made this show possible. Our hosts are Diana Rodgers and James Connelly. Our producer is Emily Soape. And, of course, we are grateful for our sponsors, Global Food Justice Alliance members, and listeners.

If you believe in making sure that people all over the world should have access to nutritious food, please join my mission through my non-profit, the Global Food Justice Alliance. All sustaining members get early access to ad-free podcasts plus free downloads, and you’ll be helping get healthy protein like meat, fish, and eggs to food-insecure kids. That’s sustainabledish.com/join.

 

Transcript:

Diana Rodgers, RD  

Welcome to the Sustainable Dish Podcast. I’m Diana Rodgers, a real food registered dietitian, author, and sustainability advocate. I co-host this podcast with James Connolly, who was a producer on my film Sacred Cow. I also founded the Global Food Justice Alliance, an initiative advocating for the inclusion of animal-source foods like meat, dairy, and eggs for a more nutritious, sustainable, and equitable worldwide food system. You can check it out and join me at global food justice.org. Thanks again for listening. And now, on to our show. 

Diana Rodgers, RD  

Hi, everyone. Welcome to the podcast. I’m really excited to have Jennifer Fugo with me. Welcome, Jennifer.

Jennifer Fugo  

Thank you so much for having me. 

Diana Rodgers, RD  

Yeah, so you are a nutritionist. And I’m really excited to have you. We met several years ago in Baltimore at the natural foods… natural… what is it? Natural Products Expo?

Jennifer Fugo  

Yeah, Natural Products Expo East

Diana Rodgers, RD  

Yeah, yes. And I wanted to have you on because, for the month of April, we are focusing on healthy skin from the inside out. And that is your jam. And it’s something that I really haven’t like targeted and focused on. And a lot of this has to do with gut health and liver issues. And so many people are suffering from eczema and psoriasis, and acne and so many issues. And so I’d love to kind of just take a deep dive for those, you know, everyone knows someone or has themselves issues with skin problems. And there are topical solutions that are marketed on TV. And there are other ways to deal with it. So you have multiple courses and lots of resources. And I thought we would just do a great big dive into it. Because, again, it’s not something that I’ve ever focused on like specifically,

Jennifer Fugo  

Well, and hopefully we can talk about some of the very famous, like toxic or inflammatory foods that people claim are really bad for skin conditions like eggs, butter, different animal products that oftentimes are demonized. And whether they’re actually an issue or not, this is one of my favorite conversations to have because I’ve really… I don’t know, there’s something about like, everyone was like, ‘Don’t you want to go get certified like being like IFM’? And I’m like, ‘No, I really like to think for myself when it comes to what is and is not appropriate for people based on research and clinical experience.’ And it’s not a knock at them. But I do think that they do a real disservice to chronic skin problems. And there’s also an excessive amount of demonization of certain types of food and everything being labeled toxic, bad for you, inflammatory, and the rate of orthorexia within the sort of wellness world is alarming. It’s staggering. And so I think we need to take a much more sensible approach to all of that. So hopefully, we can get into it.

Diana Rodgers, RD  

And I’ll just for the folks who are listening who don’t know what IFM is, its Institute for Functional Medicine. And I too, I mean, I’ve seen they’re kind of like out of the box, like, diet plan, could, that kind of covers a wide range of everything, it just, it’s like just, you know, make them eat this. And it’s also, I’ve really struggled when I actually, many, many years ago, was going to be a nutritionist for a functional medicine practitioner, MD also who works not far from me, and she wanted me following those protocols. And it was a deal breaker for me. So yeah. So for anyone who, you know, you know, functional medicine is a great concept. But the nutrition recommendations coming from IFM are not always consistent with people who are questioners and think for themselves. Yeah, just put it that way.

Jennifer Fugo  

Yes. And the idea is that, oh, well, we’ll take out the inflammatory foods to lower your inflammation, and then everything else will be easier to correct or rebalance or fix or heal or whatever. And the reality is, and I work with people who have tried every diet, every elimination, some people are down to five foods at this point, and their skin is worse than it ever was. So how is elimination diet or ‘dieting harder’ improving people’s quality of life, their health outcomes, all of these things? And I think those are the people that are getting lost in the cracks because they don’t fit the results that the diet is supposed to obtain. And so, you know, I started asking why. 

Diana Rodgers, RD

All right, well, where shall we begin?

Jennifer Fugo

Well, I think one of the important things to definitely start with is rethinking that the fact that your gut impacts your skin. But it’s not everything, your gut. So there’s a lot of people online that will talk about how, Oh, your skin is a reflection of what’s going on in your gut. And to some degree, that’s true. But there are a lot of other factors that go on that can impact chronic skin conditions. And so there are plenty of people who do gut protocols and work on their gut and look at their stool tests and their microbiome and supplement with probiotics and prebiotics and all sorts of post-biotics now, and they don’t really get any better. And I think it’s because it’s too narrow of a focus. And it’s not, I mean, if we’re really, truly going to look at root causes of what’s driving one individual and their particular inflammatory process. Then we actually have to be serious about that and ask what’s going on under the surface. When you’ve tried all the topical things, you’ve tried all the diets, you’ve tried all of the supplements, even that you can think of or you feel comfortable trying, then what is going on? And so one of the things I realized very early on, is that while yes, there is a direct link from your skin, to your gut through the gut skin access, there are too many other connections that are impacted by it that aren’t in the GI tract, or that are sort of take the brunt of what’s going on in the GI tract in terms of dysbiosis and whatnot. And so I look at actually 16 different root causes. And what I found and what explains why what might work for you, right, but won’t work for me, and somebody else will get even worse is that if one’s root causes are different than the next, it makes sense why there’s not one cookie-cutter solution. That’s why one diet doesn’t work for everyone. And so looking at things like phase two liver detoxification, which is highly nutrient driven, most of those pathways actually require very specific nutrition in order to run, or else they really slow down. It’s not about doing a detox or some sort of cleanse. It’s about nourishing those pathways. So that they have… I liken it to, you know, and I Love Lucy, and maybe I’m dating myself that I still watch this as a kid but and I Love Lucy. Do you remember that scene where Lucy and Ethel go to the chocolate factory and they have to wrap the bonbons? And so I sort of describe phase two liver detox, like that scene where your body has to wrap or transform these particular things. And we’ll just call them toxic, because a lot of times what comes out of phase one becomes more toxic, then has to pass through phase two to be made water-soluble, and then we’re able to excrete it. But if you don’t have the wrappers available, like aka the nutrients available, you can’t do that efficiently. And so this sort of called a waiting room between phase one and phase two backs up and we start to then put too much pressure on the system. The liver starts to get bogged down because it can’t efficiently get these toxins out of the system. And so the fix is not to like run out and do this like whole detox cleanse with fasting and juicing and all of this stuff. It’s really about saying what nutrients do those pathways require, so that they can wrap the toxic bonbons to help get them out of the system. And what’s really fascinating is that when my associate and I started to employ this approach to this really super nutrient dense replenishment, not just focusing on liver detoxification pathways, but also other nutrients, especially when it comes to psoriasis. Like we have some photos, and I even was like ‘Wait, did this person, make sure to put the right date on these because like, there are some photos that are less than two weeks apart of looking at someone’s angry red plaques that now look light pink’. And I even was like wait, right? Because like, you’re like how did that happen and not short of a period of time? They didn’t start using steroid creams. They didn’t start… they literally just replenished the nutrients that their body was struggling because they needed it so badly. And now all of a sudden, it can wrap those bonbons and get them out of the system, which is really, really cool. I’m now I’m hungry for some bonbons and I’m just kidding. But it’s one of those things where when we look at this the problems in front of us, we can find creative solutions. And the way that the gut plays into liver detox is that not only is there obviously a direct line of sometimes we’re seeing toxic byproducts from gut flora like specifically benzoates actually heading to phase two liver detox, but it’s just so cool to see how all these different systems. So we’ve got the liver, we’ve got mitochondria, so the body’s ability to make energy, appropriate thyroid function, looking at adrenal health as well, because if you’ve been taking or using steroids for a long period of time, some people, their body actually becomes addicted to topical steroids and even to like prednisone and whatnot. And it suppresses cortisol production because cortisone is manmade cortisol. And so because of the feedback loop, in the HPA axis, when we keep taking in or applying cortisol topically, that’s essentially what it is, your body’s gonna need to do this. And it becomes addicted to those exterior sources. So looking at all these different factors, as well as dysbiosis on the skin, because we have a microbiome, they’re looking at histamine issues, all sorts of stuff. And diet is just one piece. That’s the big piece of the all of this. So I hope it’s a little helpful to just realize that when people say they’ve done it all for their skin a lot of times because they’re not taking a broader approach to figure out what exactly is going on. They can end up really struggling for a long time.

Diana Rodgers, RD  

So where does someone start? Let’s say, I mean, do you start with the specific skin condition? Or do you start with just assessing the person’s overall, you know, like, I know you have a self-guided course that people can take, how does one get started in all this?

Jennifer Fugo  

So the first thing is yes, to take into account what diagnosis you’ve gotten. Sometimes it’s unclear, because there are instances where, for example, psoriasis can look like eczema. And they will do usually do a biopsy to try to determine what’s going on. So misdiagnosis is possible. But I wouldn’t fixate so heavily on what particular exact skin condition that you have because like to make it even more narrowed. Like what happens if you have nummular eczema, or dyshidrotic eczema, or guttate psoriasis? Is that different from plaque psoriasis? Like we could go down rabbit holes that sometimes are actually not all that helpful. There are some times there’s like nuance to it, like guttate psoriasis is associated with a higher risk of the trigger being strep pyogenes. So a lot of people who had psoriasis show up, especially as a kid, or even adult onset will notice that it was triggered after they had strep throat. So there’s a lot of really cool… I mean, it’s not cool for that person. But it is cool. It’s research that shows these different connections of possible triggers. So yes, it’s one of the facets, but then I would say looking at the different bodily systems. So looking at your gut function. How often do you have bowel movements? Are you having digestive distress? Are you, you know, what other… what other symptoms do you have throughout your entire body that can help guide us toward those unique root causes? Right? What if, for example, you have a psoriasis diagnosis? So I had a client who had psoriasis on her hands. And when she finally got to me, she had tried every diet, she was extremely exhausted, very depressed, and she was in a lot of pain. And so as I went through and talked to her, all of her boxes, were checking off that there was clearly some possible some type of thyroid issue and testing confirmed because her TSH was 33, which is the highest I’ve ever seen in my practice. Because for those listening, if you don’t know you, you ideally should not be above 4.5 to 5 in the conventional model, one to two is generally considered more optimal. So she was like really hypothyroid. And not that it’s like we ideally want to see people end up on medication, but there can be a time and place for it. And for her getting on some thyroid medication made this huge shift because her energy improved. Her mood was like turning the light bulb on. She wasn’t in so much pain, her psoriasis lessened. So that way, we could start doing all of that other work under the surface that was driving it in the first place. So that’s why it’s important to say alright, what exactly is my diagnosis, but then what are all these other pieces, even if they’re unconnected to the skin, who cares? Your body is one connected unit, and that can help tell us what our unique root cause combo is. So out of 16 possible issues. Usually people have three to six. And I would say that most people have the liver detox that phase two liver detox overload. That’s one of the most common issues that I see. And a simple recommendation can be something like simply adding glycine, which is an amino acid to help fuel at least the glycine pathway. It’s one of the pathways in phase two detox. And for some people, it makes a huge improvement in a matter of like two to three weeks.

Diana Rodgers, RD  

Great. And so, yeah, again, just wondering, like for that person that’s listening, and they want to kind of take immediate action right now. They, maybe they’re, you know, they’re gluten free, dairy free, you know, they’ve eliminated sugar, they’re taking their probiotics, how might they know you want to like walk through maybe the different 16 issues that you’ve identified?

Jennifer Fugo  

Yeah. And I mean, I can also, we can also share our graphic in the show notes too. So that way, we’re not like rattling off a lot of things. But I do think that the one piece in terms of diet, because that’s usually what people have most of the questions around, because they’re very fed up. It’s either you’ve eliminated so many things, and you can no longer enjoy food with family going to events. And you also just don’t know what to eat because you’re so overwhelmed by like… I have seen people on Facebook groups say, So am I just supposed to eat air’? Like, they don’t know what literally what to eat anymore. Because everything has become demonized, depending on who you look, whether you go to like the carnivore side, which says that plants are bad for you. Or you go to the fully plant based and vegan side, which they’re like, oh, everything that’s at from an animal is inflammatory, and you shouldn’t have that. And so it gets to a point where you just don’t know what to do. And a lot of the diet books also push people toward being more plant-based, which I love plants. I have… I want to be very clear in all of my comments so that nobody mistakes me – I eat meat. I am an omnivore. And I also have raised bed gardens. I have fruit trees in my backyard. Like I am a big believer in that we should all to some degree be a little self-sufficient. If I could have chickens, I would. Like I would do different things. But there are laws in my town so prohibits the chickens. But yeah…

Diana Rodgers, RD  

I think we’re on the same page. But my opinion, you know, because a lot of people think that I promote carnivore just because I’m so pro-meat. And I promote meat because it’s so demonized. But my goal for everybody is to eat as many foods that don’t give them problems or stimulate over-eating as possible.

Jennifer Fugo  

100% I agree with you 100%. And I think that’s a very refreshing message in the chronic skin problem world because I want my goal for every single client is to eat the most diverse diet that works for them. And at the end of the day, I know they’re like, what does that mean? Does that mean I should go to eat at McDonald’s? I’m like, ‘No, that’s not what I’m saying’. But like, listen, if you want to go to a stop and do something like just have enjoy it and like move on with your day, but like that should not be the norm. Because I just… I worry when I have worked with so many people that are afraid to eat, they’re under eating protein, they are under eating calorically especially women who like think that if they just keep cutting, they’re going to get healthier. When in reality, their body is stuck in starvation mode because they’re just not consuming enough calories. It’s not for your thyroid, not good for all the nutrients that you need, right, for all of these pathways and the nutrient wells that are becoming incredibly dry. But also, there are some foods that they do not react to and yet they’re constantly being told that they’re bad for you. And so my thing is, look, if there’s one food and I always get asked this, is there one food that you would recommend to avoid when you’re dealing with skin issues, generally speaking, I would say gluten, but not like gluten is the devil. Gluten is the worst thing in the world. A lot… I want to try to keep what’s going on in the gut inside the gut and gut there is ample amount of research from celiac, like the celiac pioneer Dr. Alessio Fasano that shows that every single person has an increasing gut permeability when exposed to gluten. It’s just about their tolerance. I like to try and keep the chaos within the GI tract, like, somewhat contained. But at the end of working with me privately, if as long as somebody doesn’t have celiac disease, or an allergy to wheat or some other factor, that’s a problem like if they want to try to reintroduce sourdough bread or older versions of wheat, have at it and like if it works for you, awesome, I’m happy for you. And so my one of my goals is to always say like, do an assessment and especially if you took foods out that you heard or read were inflammatory, and I’m talking about whole foods, right? Not like processed sugars and candy that you buy at the grocery store. I’m not talking about that I’m talking about like, beef, eggs, dairy, etc. Right, like, we’re strawberries, spinach, like any number of things that people go down these rabbit holes of like, oh, well, that’s high oxalate that’s bad for you. Oh, that’s high salicylates. That’s bad for you like I mean, we could… at a certain point, your body has mechanisms in place that allow it to flourish on these foods. Now, granted, the landscape may have shifted over time, and you now need more support, or you need to do a little work to get back there. But at the end of the day, most people can reintroduce foods that they took out. I’ve plenty of eczema clients who eat eggs just fine. I have psoriasis clients who eat grass-fed, pasture-raised beef just fine without an issue. And so that’s why I would just caution every single person from assuming that the entire reason why their system is out of whack is because of some sort of rhetoric, like inflammatory fear-based rhetoric around the nourishment that we ultimately need. And also, sometimes when we have reactions, because we put the food in our mouth, we assume that what happens afterwards is a result of that food. But what if it’s not actually the foods fault, it’s the result of what happens once it gets down into the gut microbiome. And due to gut imbalances with digestion and absorption and the microbiome, that’s the reaction, that’s the problem. It’s not the food itself to blame. And it’s difficult for us to suss that out. And so I just… it makes me really sad when nourishment is seen as the enemy. So yeah, that’s been one of my big things. And I’ve also had the pleasure and to collaborate with a dermatologist at UC Davis. And we actually did a survey based study. For people with chronic skin conditions, we had over 600 people complete the survey. And what we found was not only that, the younger you are, the more prone you are with the use of elimination diets to develop fear of food and negative association with food, it was something like 18 to 24 year olds, I want to say it was something like 74% now had fear of food as a result of an elimination diet use. But also what was interesting was, we looked at people who had no had either a history of eating disorders, or none at all. And even about 50% of those who had no prior history of an eating disorder, also developed a fear of food. So at that point, we have to ask ourselves is the elimination diet route the best way, the most responsible way to actually support a body that needs a variety of nutrients, a variety, especially fat soluble vitamins, and all sorts of fiber and all sorts of things that help nourish all of our systems as a whole? And so yeah, so I just take a very different approach, I guess, than some of my colleagues.

Diana Rodgers, RD  

Yeah. So you mentioned phase two detox, and kind of explain that really nicely. And you briefly mentioned adrenal function with cortisol. What are some of the other pathways that could be arise during, you know, people who struggle with skin issues?

Jennifer Fugo  

Yeah. So one of the interesting pathways that I definitely like to talk about is what I call histamine overload, because histamine intolerance is like exploded over the past. I mean, not that it’s exploded, but I actually don’t believe that there’s as much histamine intolerance, as people say there is. I actually think it’s histamine overload and the difference I know it’s nitpicky. But I do think it’s significant because words matter. Intolerance is very specific. It means that your body does not produce an enzyme that will appropriately break something down, right? If you’re lactose intolerant, you don’t have an efficient amount of lactase in the body. Fine. But is it really that we’re not producing enough enzymes to break down histamine? Really? I have plenty of clients that have tried DAO or diamine oxidase supplementation, because that’s the primary enzyme in the GI tract that breaks down histamines. They see no improvement at all. It’s not a DAO problem. So we have two different enzymes. HMNT is the intracellular enzyme that breaks down histamine. And it’s also through the methylation, which is associated with again, phase two detox. And so what I, my feeling and I have other colleagues that agree with me is that actually histamine intolerance for most people is actually histamine overload where the body itself is generating so much histamine, that the amount of enzymes that you have available to you cannot deal with the load, and it forgets the fact that not only can there be histamine released because of certain organisms like H. Pylori, which in most skin conditions is somewhere between 60 to I would almost say 75% of cases show that they are H. Pylori positive. And that’s on research, not what I see in my practice. But also there are organisms that directly produce histamine like Morganella, which can… I mean a histamine infection in a fish can kill it, or a Morganella infection in fish can kill it because of the production of like huge production of histamine. Also, there are certain Klebsiella species not Klebsiella pneumonia, which is most connected oftentimes in functional medicine to Hashimoto thyroiditis. But other Klebsiella species can actually produce histamine as well. And there are other organisms, there’s a whole list of them that either produce histamine or trigger the release of histamine. And then there’s also parasites, mold, exposure, fungus, etc. And so if you just have too much of that, you’re swimming in it, you can’t walk away from it, you can’t shut the door and go to bed. It’s going to bed with you. And so I think that’s one of the facets of how to rethink the way that we look at things so that we can actually get to a better resolution. And yeah, so that’s another piece to it as well. That’s one of my one of my favorite ones too. For people who are struggling with urticaria, chronic hives or dermatographia, that’s, that’s usually a big piece of their puzzle.

Diana Rodgers, RD  

Will you explain histamines, just for the folks that are maybe have heard Oh histamines, or you know, have… because this low histamine diet, I have counseled people who have asked me to help them with a low histamine diet and that is so difficult to follow. Especially for someone like me who cooks a ton of leftovers. I mean, you can’t eat a leftover, so will you explain exactly what a histamine is?

Jennifer Fugo  

Yeah, so histamines are, they are a really important, I would almost argue like a neurotransmitter that helps keep us alert and awake. And so there are times where histamine is an end, it is important, it’s not bad. I think we get carried away with everything has to be good or bad. Like, it’s important, just too much. It’s the Goldilocks thing, right? Too much is not good. And so there are times when your body can as… so we have things called mast cells that are like little Amazon warehouses that float around the body. And when they become destabilized, because they contain histamine, they basically dump it. And so you get this huge release of histamine into the system that can cause you to have hives get itchy, in severe, really severe instances, anaphylaxis. You know, if you’re exposed to an allergen, you know, in my world, it’s mostly chronic hives. I don’t work with a lot of clients who have really, really like mast cell activation syndrome, It is beyond my scope of practice. I don’t work with individuals who are on that end but hives, dermatographia, dermal fotografias, where you could like draw a picture on your skin with your nail, and it’ll just welt up. And like, you could literally write your name on your skin, and it’ll show up as a welt. And so histamine has to be broken down. And so the enzymes break it down so that it essentially gets deactivated. But there are certain factors that can drive it higher, obviously, producing too much of it internally is a factor. It also can… so estrogen, unfortunately, makes our cells more sensitive to histamine. So that’s where pooping appropriately, one to three times a day, healthy bowel movement is really important. So that’s actually part of phase three detox, where we are eliminating toxins and whatnot. But if there also are organisms within the GI tract, typically gram negative bacteria that have the beta glucuronidation enzyme that actually – like it turns estrogen that’s been deactivated by your liver back on, so that gets reabsorbed and so you can’t get estrogen efficiently out of your body. And unfortunately, that state makes you more sensitive to histamine, more itchy. Some people, some women specifically, I do think there was a one case study I saw a man but some women can actually develop an allergy to their progesterone, their own progesterone. Yeah, it’s pretty horrifying right to think that you develop an allergy to your own hormone that your body makes. And that so usually for most women, I’ll ask them to track their flare cycles. And usually you can see a correlation of an increase when progesterone spikes. And you can also – I have actually a whole episode on the Healthy Skin Show podcast because that’s pretty serious. There’s not a ton of great options at this point in time because it’s considered such a rare situation. But I think it’s actually more like it’s undiagnosed because nobody’s looking for it. But that’s another instance and obviously having allergies to things that you don’t know you have allergies to than developing… we can actually develop allergies. Just kind of going back to food if you eliminate foods. And you really don’t need to… you can develop an actual IgE reaction to those foods when you try to reintroduce. This happened to an eczema clients of mine last fall. She had eliminated eggs because she heard they were bad for her. And so when we started working together, we went through the list of foods that she wanted to reintroduce. And when we got to eggs, her face blew up, her mouth blew up, she was having trouble breathing, her eyes got all swollen, and she was super itchy. And I heard… I told her, ‘You need to go to an allergist’. This sounds like an allergy not just like a, you know, sensitivity, right. And it turned out she needs an epi pen now because she has an egg allergy. And we are starting to see more of this unfortunately. So you know, be very cautious. I’m not trying to tell anyone that you need to be afraid to play with your diet. But I think that there should be clear guidelines for someone who doesn’t have like the training that you and I have in the experience that you and I have, you know, if you start eliminating things, and you really aren’t seeing an improvement after like, four to six weeks, I would almost argue you might want to check in with somebody else to see what’s going on the… it’s a really slippery slope to go, ‘oh, well, I’m going to take this out, I’m going to take that out. Oh, I read about this new diet, I’m just going to take all those things out’. And slowly you end up on this like really tiny island, where you’re not getting enough nutrition, not getting enough calories. Your nutrient density has plummeted. And now you’re reacting to everything and you don’t know what to eat. That’s a really dangerous place to be in. And it is happening very frequently in our community because people are overlaying these different functional diet books, and there are protocols, and they end up on such… and trying to get someone who is legitimately afraid now to reintroduce foods is a whole process. So the low histamine diet, I will be honest, I hate it. But sometimes it is necessary, unfortunately, for a period of time, but the goal should always be to try to get histamine addressed as quickly as possible. So one, a couple of tips on that. Obviously things like quercetin can be helpful, the vitamin C, those kind of things. But another thing to try is immunoglobulins. So oral immunoglobulins. And one of the reasons why is that I had tried this, I just had an idea. And I tried it with a client. And then I had a whole conversation with Kiran Krishan on on my podcast for microbiome labs. And so the reason that it can be helpful is that not only can it bind to different things in the GI tract that are causing issues, but it also helps drive down the IGE reactions to the body when it’s really struggling to deal with what’s happening in the track. If IGA plummets, IGE will rise. And so by adding in more supplemental immunoglobulins, it actually helps drop that IGE level. And so you do have to take higher doses than what are on the bottle. But it has been a game changer because then I have clients who are able to start reintroducing foods, high histamine foods, and for them, they’re like, Okay, now I’m more comfortable. I’m eating more food, I can start to do all this other work in the meantime. But yeah, it’s histamine. The diet is that’s a really hard diet and the things that you know, obviously like, okay, you know, vinegar, wine, beer, like, those are the obvious things, yogurt, but then there’s things that you wouldn’t expect, like avocado and certain types of fish. And isn’t that there’s like no rhyme or reason to it, because some foods release histamine, some foods have higher histamine content, like you said, because they’ve sat out after cooking, because all food increases in histamine content as from that point where it stops cooking. But it is a really tricky diet. And just to be very clear, not all eczema itch is driven by histamine. And so that sometimes it’s very freeing for people who’ve been on antihistamines for a long time and who have eczema, and it’s not helping them, because it’s not all driven by histamine, believe it or not. And I actually had a dermatologist that works at Johns Hopkins University on my show, who’s done research on this. And he actually said, and he’s a very conventional minded guy, he’s like, ‘Look, we’ve got the vagus nerve. It connects what’s going on in the GI tract to the brain, and sometimes your brain misread signals of distress irritation and inflammation as itch when it’s not actually itch’. So it could be a skin infection. But if it’s not, it is possible that should be another sign to you of the value of at least looking at what’s going on in the GI tract, and as well as liver detox system and all the other things that we’ve talked about today.

Diana Rodgers, RD 

Yeah, you’re covering a ton. Yeah, it’s interesting. My daughter when she was younger, she developed a rash around her mouth, and she had just been eating a ton of strawberries. And you know, like, literally laying in the strawberry patch, eating all the strawberries and like, I don’t really know if you’re allergic to strawberries, because that’s… you’ve had strawberries before. And you’re… I don’t know, it’s just not making sense. And it turned out that strawberry season coincides with when all the trees bloom here. And so she just has to lay off strawberries when they’re actually in season. Just because there is like a histamine kind of overload just in the environment.

Jennifer Fugo  

Yeah. So there’s that it’s cross reactive allergy syndrome. Oral allergies. Yeah.

Diana Rodgers, RD  

Right. So her like bucket of stress was just a little bit overwhelmed just with all the pollen and everything else that was going on. So she’s fine with strawberries any other times than when they’re actually in season.

Jennifer Fugo  

She violates the tenant of like, eat what’s in season. She legitimately… See, this is why again, there’s rules, but they’re more guidelines. Gotta you do you at the end of the day. Yeah. Because like, I would hate to deprive somebody of like, no strawberries forever, if they couldn’t like, all right, they’re out of season, but enjoy it.

Diana Rodgers, RD  

Yeah. What do you… any specific… So you know, thinking about my daughter? Because I don’t have… I’ve never really had to struggle with much skin issues. I’ve had gut issues, not skin problems. And even when I was a teenager, I didn’t really struggle with acne. And I have two kids one did not, one does. Where do you start with teenage acne?

Jennifer Fugo  

Oh, well, I can tell you first off, I don’t really work with teenagers. So I’m not the best person to ask about that. I have some colleagues that do work with acne. But I will say that part of the problem is just such a huge hormone fluctuation obviously, like the processed sugars and the processed, all the process stuff is a problem. But I would also, you know, the other thing to kind of tease out of what’s going on is it’s possible that it’s also like a possible fungal issue because you can have fungal acne, as well. So yeah, acne is not really my wheelhouse. That’s definitely not a skin topic that I focus on a lot. I usually send, like those clients to like Robin Johnson, and she’s got like a whole thing for acne, which is great for people. But it is tricky with teens, unfortunately. I would still, I don’t know if I would go out and buy like a Dutch test and spend that level. I mean, that’s like hundreds of dollars. I don’t know what I would do that. But I would probably, definitely look at their diet, liver detox. So, again, not doing a liver detox, but looking at the nutrients required for phase two detox, and then looking at their GI tract. And considering could there be something going on there that could be supportive, right because we know that when they use Accutane, it’s I mean, you’re not supposed to get pregnant when you’re using that, but also it has a huge impact on the microbiome, you know, and traditionally, they used to, I mean, when I was a kid, I had acne, and they use tetracycline, which, you know, you’re gotta be careful with but they use antibiotics. And as much as we can say, it’s for inflammatory purposes. I mean, they still do impact the gut microbiome, even like low dose doxycycline, which is oftentimes given for chronic staph infections on the skin. So I just think we have to, we have to dig a little bit deeper and be open to that rather than trying to find a bandaid for one thing. And it may be too, that they need to change their skincare routine as well, because their skin is reacting to these huge fluctuations in hormones.

Diana Rodgers, RD  

Yeah, yeah, definitely. I mean, I do think that it’s just some people just have surges in hormones and it just kind of is something that goes along with being a teenager probably. So do you want to like spitfire, you know, before we go, like a few of your favorite nutrients that you recommend to folks who are struggling?

Jennifer Fugo  

So I would say, I love… well, I don’t know if it’s considered a nutrient but butyrate is really important. It’s produced by gut flora, when they’re exposed to short… to prebiotics and FODMAPs and that kind of thing. So FODMAPs aren’t bad for you. If you can tolerate them, they’re great. And it’s actually found in ghee, as well as pistachios. So I’m not saying you should like eat those all day. But those are… I always love to suggest those assuming that you don’t have an allergy to nuts or pistachios or cow’s milk, but I do think there’s ghee… you can get ghee from other animals as well, if you look hard enough. I also would say like most people, at least with chronic skin problems don’t eat enough protein that has been my experience from like I have a group. So the one program you were talking about the Skin Rash Rebuild, we have people track their protein intake in the beginning, and the majority of people are like, ‘Oh my gosh, I was so below what you’re suggesting, like I’m nowhere near this, I thought that protein was bad because like I have muscles, and I just can tap into that’. And you really should not. So drastically improving protein intake really helps but also glycine. So this is the deal with glycine. Yes, collagen is rich in glycine, but you can… so the suggestion of glycine that I give is usually three to five grams, which equals 3000 to 5000 milligrams, that’s on top of whatever you take in in your diet. So you cannot use collagen, where it… go by what’s on your protein powder or whatever is like oh, no, no, I’m getting like 10,000, you know, milligrams a day of glycine. I’m like, no, no, no, you’re well is dry, you need supplemental glycine. So usually we split those doses, like one to two times a day. And then vitamin B6 can be really helpful, especially for liver enzymes, you can overdo vitamin B six. So the general recommendation I feel comfortable giving is like somewhere between like 10 to 15 milligrams, but make sure to look at like your multivitamin and other things that you take that are… that have supplements in them because sometimes it’s in there, if not, you can look for a B6 or P5P supplement. They’re not usually in smaller doses. But if you maybe like you find a 30 milligram or 50 milligram, maybe you do it like twice a week, and it evens out. So those are some really easy suggestions. I would also say I love zinc, but I do think people overdo it and they don’t do it in combination with copper. So if you love zinc rich foods, like oysters – awesome. If you can’t do shellfish, or you just don’t like it like me, I would try to find something that has a good balance of copper and zinc. Usually it’s 15 milligrams to every one milligram of copper. So try to find something so they’re balanced and it balances that ratio. And then I would also argue that before you supplement things like I love vitamin D. I love vitamin A. I love the fat soluble nutrients, but get your levels checked first before you go supplementing. And a little tidbit, I don’t know if you’ve kind of saw this as well. But usually when someone has low or insufficient vitamin D, they’re usually low in vitamin A, because they’re not eating the foods that are rich in vitamin D. So I’m like, Okay, we’ll just assume you need vitamin A as well. So like liver is great if you can eat it. Awesome. If you can swallow those liver pills, awesome. I can’t do either of those things. So for me, it is a supplement. But like find what works for you. That was one reason why to like… I’m not anti dairy. If you can tolerate dairy like butter, especially as a great source for vitamin D and vitamin A. So again, it’s about what you can tolerate, what you can do and slowly building a diet as your body. And then the inflammation starts to shift, building a diet that you enjoy that you actually enjoy eating, you love food. But by finding it like I was saying, just it’s important to find those your little unique combo of root causes. And I have that one worksheet, I know we’re going to throw that into the show notes. That’s really easy for people to go through the whole process I go through with my clients to help you figure out what those root causes are for you. And then you can really hone in and I and again I have that Skin Rash Rebuild program, which is awesome. It’s eight weeks like people are like it’s like a fire hose of so much information. I never learned any of this in the last 10 years of going to the doctors I’m like well you know it’s… I’ve been in this unique position because I had eczema and I had hidradenitis suppurativa that I’m able to be to share all of that. I mean, I’ve almost 300 episodes of the Healthy Skin Show. So it boils down all of that and what I see clinically in new research to help everyone on their own unique journey. And so if you’re looking for any particular topics, I probably have it covered and then some on the show, but yeah, I that. I love nerding out about this stuff.

Diana Rodgers, RD  

Yeah, it’s awesome. Yeah. And I can mention too, I, just on the dairy end of things. When I was undiagnosed celiac, I could not do any dairy at all. And now that my gut is you know, I’ve been gluten free for so long. And I still can’t really drink milk. I don’t even like the idea of drinking milk because I never drank milk as a kid. And it just seems weird. And I don’t think it’s particularly necessary for my diet. But I do great with cheese and butter and yogurt. And so for those of you out there who think you can’t do dairy, you might be able to tolerate the fermented dairy. And I do it because of the great vitamin K2, vitamin A, like all those other great things, especially in the grass-fed dairy.

Jennifer Fugo  

Yeah, and especially like the, it makes everything richer, it tastes more rich, right? Like when we eat food that just has such amazing flavor. As opposed to bland foods, we feel satisfied. You know, flavor is just as important as the nutrients that are in it. So…

Diana Rodgers, RD  

Yeah. Awesome. So great. So we’re gonna put the link to your course in the show notes. And where can people find you if they want to learn more? How can they find you on social media and your website? Everything else.

Jennifer Fugo  

Yeah. So, my website is called Skinterrupt. I’m not going to spell that for you. So the easy way to get there is healthy skin show.com. And you’ll be able to also find all of the podcast episodes. Like I said, there’s almost 300. We have everything fully transcribed as well if you prefer to read, and then I’m over on Instagram and most social media platforms just at Jennifer Fugo. 

Diana Rodgers, RD  

FUGO 

Jennifer Fugo  

Yes. So that’s the easy way to find me and I love to… I mostly hang out on Instagram, though.

Diana Rodgers, RD  

I am with you on that Instagram is my thing. I really do dislike Twitter immensely. And Facebook just I’m actually never on my professional Facebook. I sometimes… I’m on my personal one, but…

Jennifer Fugo  

 Agreed 

Diana Rodgers, RD  

That’s usually just for professional stuff, too. It’s kind of funny, but yeah, well, it was so great to catch up. And I know this all started with you inviting me on your podcast, which, which I promise I will get around to as soon as I have a minute. But I really appreciate your time and here on ours and it’s something that I’ve never really covered before and I love having dietitians that have their own specialty that I just have never really dug into. So, I really appreciate your expertise in this.

Jennifer Fugo  

Well, thank you so much for having me. I really appreciate it.

Diana Rodgers, RD  

Awesome. Have a great day. 

Diana Rodgers, RD 

Thanks so much for listening today and for following my work. If you believe in making sure that people all over the world should have access to nutritious food, please join my mission through my non-profit, the Global Food Justice Alliance. Visit sustainabledish.com/join and become a sustaining member today. All sustaining members get early access to ad-free podcasts plus free downloads, and you’ll be helping get healthy protein like meat, fish, and eggs to food-insecure kids. That’s sustainabledish.com/join. And thank you.

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