Beyond Diet & Prescriptions to Solve Skin Conditions in Kids

Episode Transcript

Dr. Nicole Beurkens

Hi everyone, welcome to the show. I’m Dr. Nicole, and today we’re focusing on skin conditions in children and teens. Issues like eczema, psoriasis, acne and more are becoming a lot more common, and they take a physical and mental health toll on kids and parents. While conventional medicine offers some helpful tools, many families find themselves frustrated with ongoing symptoms or challenges related to these issues. There are many research-based integrative ways to understand and address what’s going on with skin issues, so kids can thrive not only physically but mentally as well. To help us understand these issues and treatment options, I’ve invited my friend and colleague Jen Fugo on the show today. Let me tell you a bit about her.

She’s a clinical nutritionist empowering people who’ve been failed by conventional medicine to beat chronic skin and unending gut challenges. She has experience working with conditions such as eczema, psoriasis, rosacea, dandruff, hives and more, with clientele ranging from regular folks to celebrities and professional athletes. She also founded her own line of skincare and supplements, available specifically for people suffering with these chronic skin issues. Jen holds a master’s degree in Human Nutrition from the University of Bridgeport and is a licensed dietitian, nutritionist and certified nutrition specialist. Her work has been featured on Dr. Oz, many podcasts, summits, and all kinds of places. She’s a faculty member of the LearnSkin platform, an Amazon Best Selling Author, and the host of the Healthy Skin Show. Jen, welcome. So great to have you here!

Jennifer Fugo

Thank you for the invitation. This is such an honor to be here.

Dr. Nicole Beurkens

We had an amazing conversation on your podcast quite a few months ago. And I said I have to get you on the show because these kinds of skin issues are becoming more and more common in kids. So many parents are trying to deal with them. And as we’re going to talk about over the course of this episode, it impacts more than just physical health for kids. And so I couldn’t think of anybody better to have talk about this than you. And I’d love to have you start by actually sharing with our listeners how you came to be focused on this specific area of practice, because obviously, as a dietician nutritionist, you had lots of options and things to specialize in. So share with everybody your story of why this particular realm of medical issues is so important to you.

Jennifer Fugo

Well, like most people, I ended up with rashes and various skin issues throughout my life. I will say that I did struggle with acne as a teen, and was obviously on a lot of antibiotics for that, and later in life especially during grad school I ended up with dyshidrotic eczema on my hands. I have had hidradenitis suppurativa, which impacted under my armpits, which is a really uncomfortable inflammatory issue. And I’ve had some other weird rashes show up here and there. I will say, and I think the one thing that really resonated when we were talking that I had shared with you as well, and at least from the childhood perspective, is that I had struggled with OCD that started when I was probably around six; I was young. And it was something that got really bad, and that is something that also we see, obsessive compulsive disorder, and then things like trichotillomania, dermatillomania, so picking at the skin. and whether you’re an adult, and this is happening to you because of these issues that you have, or maybe it’s also a bit of a coping mechanism or something else manifesting, and I’m not a psychologist, so I’m not going to try and figure out the exact things, that’s your realm. But I do see that there are people that will end up developing these things that further embarrass them and make them feel so separated from everyone else, and the common thing that we’re told is “Just use a different moisturizer, you’re using the wrong soap, stop picking at your skin, stop itching at your skin, stop, stop, stop”, and it’s not something you want to be doing. And just having someone tell you those phrases, it made me so embarrassed. I got to the point where I really struggled in school as a child, I struggled to make friends, I actually didn’t even eat lunch with my peers, I ate in a room, the art room by myself. I really pulled myself away, and I think that it’s sad that we don’t realize that there are so many other things that we can be doing. And yet, I think children, and I love the fact that you have this show that’s helping to support parents make better choices, to ask better questions, and to help support their children from the way that they really need to be supported, rather than kind of shaming or bullying or pushing them, even, into what you think should be the right thing for them. But also helping people, from that physical and nutritional space, find better balance. Maybe with some medication, maybe not, maybe you combine both, whatever your journey looks like is what it looks like. But there’s a lot of things with skin that we can do, that not only piece together clues under the surface of what could be going on, but we can make changes that go well beyond just doing topical steroids, or a biologic drug and whatnot. So I do want people to know that, and that’s one cool thing that I have, I feel really good about, and that I’ve shared a lot about on the Healthy Skin Show. So I’m sure we’ll talk a lot about that today.

Dr. Nicole Beurkens

Yeah, I want to get into that, because I think there’s so many people who need to hear that. In the realm of developmental and mental health issues for kids, we talk a lot on the show about looking at kids as a whole person. And I’ve shared that part of my journey of coming into more of the holistic way of understanding and treating these things, is from seeing all the connections for all those years between physical symptoms in kids, and their brain symptoms. And even in my own children, and one of my children had eczema, chronic recurrent eczema. It was a big issue. And that was connected also then to some of the things that we were seeing from a behavioral standpoint. And I think that just making people aware of the connections between these things, especially in children, even if your child isn’t having a diagnosable, developmental or mental health issue, having a chronic skin condition, having chronic eczema that hurts or is itchy, having issues with the skin is going to impact mood, to your point, social anxiety, functioning. And I think that it’s easy to brush that off and just be like, “Oh, it’s just a skin issue.” But when I hear from kids around this, it’s much bigger for them. And so I think this is such an important conversation. I want to start by having you talk about limitations of the current, or maybe we could say the mainstream view of chronic skin conditions. You touched on it when you said, “Oh, just use a different lotion”, or “Oh, just bathe your kid and a different soap”, or “Don’t use soap.” Everybody’s got some kind of thing, right? Like, “Oh do this, don’t do that.” Just sort of that current or mainstream understanding, versus really looking at these things from a root cause type of way.

Jennifer Fugo

Yeah, so there are a lot of challenges. I will share that when I actually developed a condition called dyshidrotic eczema, it’s a specific type of eczema that impacts the palms and the bottom of the feet. And you’ll develop these little bubbles under the surface that eventually will kind of break open and ooze, the skin gets really red and super itchy and it goes through this horrible flare cycle, dries out, you have this moment of thinking that you’ve passed beyond this problem. And then it starts over again. Very vicious cycle. And so when I went originally to the dermatologist, she basically was like, “Well, use these topical steroids, and here’s another cream you can put on at night to help with the skin when it feels like it’s drying out, and then during the day maybe to hold in the moisture, you could try Vaseline”, and I’m like “Vaseline on the palms of my hands? What? How does that work?” It’s completely impractical. And so fortunately, my dad was a medical doctor, and he was like, “Look, be careful with the topical steroids.” And he never exactly explained why, though. Now I do know the reasons why, because just in case parents don’t know, long term extended use of topical steroids can actually cause addiction within the body, and at times, certain individuals — there’s no research right now to differentiate who this happens to, but your adrenal glands basically stop producing cortisol, because that’s what topical steroids are. Hydrocortisone is manmade cortisol. And so your body is like, “Oh, well, I have it coming in. Why do I need to produce it?”, and it gets confusing. And with time, you need higher potency and more and more and more, and it’s not working, and the rash spreads. And then you end up with full body eczema, which looks extremely severe, but it’s not eczema anymore. It’s now something called Topical Steroid Withdrawal, which is not recognized by conventional medicine just yet, but there are doctors working on diagnostic criteria in the US. It’s been recognized in the UK, and there are talks with the FDA about starting to actually acknowledge this. So we do want to be careful, and I don’t say that to scare parents or patients at all, but we have to be aware that there’s limitations because it’s topical steroids, antibiotics, antihistamines, maybe you get an immunosuppressant, and then there’s now this rise of biologic drugs. Dupixent is the main one for eczema, then there’s others for psoriasis. And that’s like, what else is there? And if you ask a dermatologist, most will tell you, “Well, this is it. You take the meds, and maybe it’ll get better, we don’t know. And maybe it’s genetic. We don’t know.” They just don’t know, they don’t seem to know, a lot. That’s the main problem, whereas if we were to peel this back and say, “Alright, hold the phone, let’s actually take a look from a 2000-foot perspective, what could be going on?” And not just look at the skin itself. And start saying, “Alright, do you have headaches? Do you have numbness in your fingers and toes?” Really looking at all of the symptoms together, and maybe in the case of some of your patients who are young, young children, are they having issues socializing? Are they having developmental delays? Some children have a lot of issues and anxiety around eating and food because they actually struggle with digestive issues, like “My stomach hurts”, and they get blown off as just being a difficult child or a picky eater, but they actually may have celiac disease. So we want to start looking under the surface, looking at blood work, because I have no idea if I have a vitamin D deficiency, I have no idea if I have other deficiencies. We need that data to actually look at, and then looking at what’s going on in the stool and the microbiome, and understanding that there are so many pieces to this. It’s so much more than just a skin problem. You’ve got thyroid involvement, as I mentioned already, now you have this medication involvement that can impact your adrenal glands, you have these inflammatory pieces that can be driven by things well beyond allergies. In kids, it is interesting that they have that allergic triad that we don’t see as much in adults, although some adults do start to develop allergies and eczema and things like that. But with children, there’s some really fascinating research coming out now that we may actually be developing allergies, young as a child, because of the contact with allergens through the skin, not by ingesting them. And so now they’re starting to peel back the layers and say, “Maybe we should be introducing allergens as a young at a younger age and we shouldn’t be restricting these things”, because children, their immune systems aren’t getting trained, they’re not developing any type of tolerance. Then how do you develop the allergy? Well, now the question is, is it actually happening through the skin, to the food? So there’s a lot of pieces to this. I have 16 root causes that I assess clients for, and I know that sounds like a lot. That doesn’t mean that everybody has 16 root causes. Some people usually have three, maybe you have six, it depends. And obviously adults, it can be more complex because you’ve been here longer. But it is important to consider a number of factors beyond just allergies and beyond what you’re just washing your clothes in and soaps that you’re using. There are so many factors that we’re not discussing, that we need to. And when you start to address them in a very systematic fashion, you can actually not only reintroduce foods that you have potentially avoided because you thought maybe they were a trigger food, or you read online that they were bad for eczema or bad for whatever your poor child has. And then also seeing those rashes and other symptoms start to subside in time when you do that actual work. So I think that’s one of the big differences. And you can, by the way, do them together, the conventional with the more root cause work at the same exact time.

Dr. Nicole Beurkens

Yeah, absolutely. I think it’s such an important perspective, and just like so many of the developmental and behavioral types of symptoms that we talked about being actually just the red flags that something else is going on, I think the skin issues are the same, these physiological symptoms are the same. The fact that your child has chronic, scaly, dry patches of skin, that in and of itself is a problem, but it’s not the problem. It’s a symptom of whatever else is going on. Same thing with kids who have intense hyperactivity or problems with focusing, okay, that’s a symptom, that’s a red flag. Something deeper is going on that needs attention. And so I think it’s that way of understanding it, because just like in mental health, okay, we can give your kid a stimulant medication so that the time that they’re on that, maybe their hyperactivity is reduced, or they focus better, but you take it away, and the problem is still there. Same with the skin things. It’s what we found with my son when he was little with the eczema. Okay, fine. I can keep putting hydrocortisone cream, layering it with Aquaphor, wrapping it, doing all the things, but you stop doing it and it comes right back, and so savvy parents, and I think there’s more and more parents out there going, “Hmm. So what do we actually need to be doing to solve the real problem, so that we’re not constantly in this cycle?” And I’ve had teens ask me the same thing, like “Oh, I’m on these antibiotics, these medications for my acne”, or “I’m doing this for that, but is there something else I can do so that it actually solves the problem?” Ah, these are wise, smart, young people saying “I’d actually really like to understand how to not have this in the first place.” So let’s dig into that because you talk a lot about, in your work, how the gut and the health of the gut plays a role. We’ve talked about that on the show in relation to lots of other things, but not necessarily in relation to skin. So talk to us. People are going “Oh my gosh, another thing that the gut is connected to.” Yes, absolutely. So talk to us, Jen, about why the gut, and maybe even more broadly, diet issues play a role in these kinds of conditions for kids.

Jennifer Fugo

The first thing I will say, and I want to preface this, is that we blame diet too much. I do think that it is worthwhile to clean up the diet. I’m not Poo-pooing that. So if your child eats a very highly processed diet, and they’re not eating enough protein, and all sorts of things, that just is what it is. You have to work on that. Nutrient density matters. And I think that’s where we get lost, especially with all of the talk within — this is probably one area that I have a bone to pick with functional medicine, I think that they fixate so much on diet that they a lot of times don’t realize, again, if we’re looking at someone holistically, the whole person, what happens when you constantly describe foods, even healthy foods, foods that have lectins, for example, “Well, they’re toxic, this is toxic, histamine is toxic. This is toxic or inflammatory.” If you do an elimination diet, especially in children, what do you think happens? They develop a fear of these foods. They develop disordered eating patterns. And this happens in adults, and so we go to these diet books, and there’s the eczema diet, there’s the psoriasis diet, there’s all these diets, AIP, and we start layering them because the one diet didn’t work well enough. And so you think if you just take out more, they’ll somehow get better. And so I just want to highlight this upfront because this is the first tool that people think is all you got. “Okay, I have the meds, my doctor’s not sure what to do. I’m going to mess with my diet now,” and you go online and that’s all that people will generally tell you, it is “Oh, you got to go on elimination diet, you need to take out gluten, you need to get rid of sugar, no eggs, no this, no that”, and before you know it, you’re like, “What am I supposed to eat? I don’t know what to do.” And that’s really hard for children and teens because they want to be able to go out and eat with their friends. They want to be able to have some semblance of life, and I agree with them, especially if, for example, we’re now demonizing healthy foods like strawberries, and whatnot.

Dr. Nicole Beurkens

I want to say, too, that I have seen it be the case, because a lot of people don’t understand that children are not just miniature adults. They have their own dietary needs, caloric needs, macronutrient needs that are different at different stages of development. And I have seen kids on such restrictive diets, with the best of intentions, long term restrictive elimination diets where they are not getting what they need to fuel appropriate physical growth, brain development, so we have to be careful, there is a time and a place for removing certain types of foods from kids’ diets, I mean, celiac or non-celiac, gluten sensitivity. Your kid should not have gluten in those cases. But doing it in a way that’s not overly restrictive, and that ensures that they are getting what they need to grow. Adults are done growing. We can go on elimination diets long term and really screw ourselves up, but we’re not impairing our growth and development. In children, that is a concern. And so I’m glad you raised that.

Jennifer Fugo

Yeah. And the other concern, too, is there’s a greater risk when you eliminate foods unnecessarily in children. They see an increased risk that the child will actually develop an IgE allergy.

Dr. Nicole Beurkens

That’s right.

Jennifer Fugo

Which you all as parents don’t want. So again, just like guardrails. Guardrails are really important. So if you’re working with a practitioner, who’s like, “Oh, no, we’re just going to do a different diet”, maybe start to ask questions like: “Is there nothing else we can do here? Is there a way that we’re ever going to get Johnny or Susie, or whomever, back on at least a more whole foods, nutrient dense diet here?” If they don’t have a plan, that is a red flag. So basically, diet is really important because it’s what nourishes us, but it also nourishes our microbiome. So the more that you reduce and constrain the diet, you also reduce the diversity of your microbiome. Those bacteria and other organisms that are crucial for us to function and live. I mean, we need the short chain fatty acids, which are the waste products of gut bacteria, we need those to thrive. We don’t make them ourselves. So there is a beautiful symbiotic relationship that we have with these organisms. And when we start to take foods out, or the other thing is, I’ve seen some very young children put on a purely carnivore-based diet. And I really think if you even want to go that way because you think carnivore or vegan is the only thing that’s going to help your child, please work with a professional to make sure that that’s appropriate for them. Because we see a lot of this; my colleagues have parents, well meaning, but what happens if you put your child on a carnivore diet? You then go to work with someone like myself or my other colleagues. And now we’re like, “Okay, well, we need to use herbs.” Well, herbs aren’t carnivore. Now you have no tools left, you have no tools to help change things. And it becomes really difficult to reintroduce foods because of the shifts in the microbiome. So we want to be very cautious and thoughtful about how we do this, and so I want to explicitly say that the reason we know that there is an inflammatory component to eczema, to psoriasis, to a lot of these conditions is because of actually all the research that has been done to make biologic drugs. So biologic drugs are different from topical steroids. What they essentially do is, and maybe you’ve shared this analogy on your show before, but it’s like having a pot of boiling water on the stove, and it’s boiling over, boiling over. And so instead of turning the pot off, you put a lid on it. And so that’s essentially what biologic drugs do. They put a lid on a particular cytokine that is causing inflammation. And so I think this is where we have to say it’s not just a skin issue, because the cytokines, these inflammatory messengers, you can think of them almost as inflammatory emails. This was a really brilliant analogy. This is not my analogy, by the way. It was Dr. Heather Zwickey. She was on my show, and I was asking her, like “Please break this down, because it’s so confusing for people.” And she’s like, “Think of cytokines like emails. They’re messengers.” And so what happens is your body encounters organisms, a lot of times in the GI tract, so back to that gut piece, that are either in too large quantities, or just should not be there. And so in an effort to try to protect itself, you have some cells that are like, “Hey, we need to send emails to recruit other cells into this area to help deal with the mess that’s going on.” Well, it just so happens that those cytokines fly out into your system, just like you would send an email out into the ether. And unfortunately, they end up on your skin, or they end up in the joints, they end up in your brain and they cause inflammation someplace else. So unfortunately, what happens in the gut doesn’t stay in the gut. And this is why we know that biologic drugs like Dupixent impact interleukin four and interleukin 13. We then have psoriasis drugs that are impacting IL17, IL21, and there’s a whole host of things that can happen as a result, like with dupixent, you’re supposed to be checked for parasitic helminth infections, but nobody really checks you for that. You’re somehow supposed to tell the doctor if you have that, but no one checks.

Dr. Nicole Beurkens

“Hey, check me for parasites.”

Jennifer Fugo

But no one does that. And there’s reasons why for that, and then with a lot, not dupixent, specifically, but some of the psoriasis biologic drugs actually can cause issues with fungal infections, and they’re usually systemic issues. So again, this is how we know, I think it’s a blessing and a curse. I do think on one hand, I know a lot of folks are like, “I don’t want to go that route. I don’t like the biologic drugs. The side effects scare me.” But you also have to consider if it’s for you or your child. Where are they in terms of quality of life and suffering, and as I said, you can, like with eczema, I work with a lot of people who are on dupixent, we do that underlying work. And you can actually slowly taper off of dupixent under the guidance of your dermatologist and not flare again, that is possible. And so that’s why we have to do the work under the surface to address the imbalances within the GI tract, to look for organisms like H. Pylori, to look for parasites, to look for overgrowth of fungus. We need to see what’s going on in terms of gut functions. So looking at your immune response. I’m so fascinated and still fascinated by the secretory IgA response, and how immunoglobulins, I use a lot of immunoglobulins in my practice, which is so cool, especially for clients who have chronic hives, it is such a big helper for that. You wouldn’t think that you would use it for that, it really does help. And so trying to pull those parts away from one another and say, can we find balance with our diet? Let’s not be at war with food, and start looking at these other factors. Because by the way, if you have a dysbiotic or unbalanced GI tract, it will impair your liver, because the waste products of those organisms end up having to be processed down the phase 2 pathways, in order to be repackaged so that the body can excrete them. And unfortunately, those pathways require nutrients like lysine and 6 and whatnot. And so at a certain point, we can also start to see this overuse of nutrients in the system. So on one hand, we’re restricting the nutrient diversity, restricting the nutrients that are coming in, then we’re using up too much of the nutrients we have, and we end up in this place where the body is like, “I don’t have the tools”, and now you’ve got skin issues, you’ve got joint issues, you’ve got headaches, you’ve got gut problems, all sorts of things. And I also will just end it on this point. You do not have to have any gut problems to have a dysbiotic gut. Some clients have horrible skin problems, and they poop like a champ, one to three times a day, no gas, bloating, nothing, and they have some of the most messed up GI tracts. Why it does not show up in the gut, I have no idea. But I just want to put that out there for anybody who’s like, “Oh, my kid’s fine”, or “I’m fine.” You might not be fine.

Dr. Nicole Beurkens

I’m so glad you mentioned that, because we see that a lot in neurodevelopmental and mental health issues, where we’re asking about what’s going on GI wise, and it’s like, “Oh, no constipation, no history”, all these great things. And yet, their gut, when we look at it, it’s a mess, and it can cause neurological symptoms. Sometimes those are the only symptoms that you see. And so I think that’s such an important point, and what you’re getting at here is that this inflammatory process, this sort of dysregulated, immune issue that caused this inflammatory process is so key to so much of what goes on in the skin. And I want to draw the connection for all of you, all the research that we have that shows that these same inflammatory processes are a huge part of what goes on in mental health, depression being the flagship diagnosis that we have research on related to inflammation, which is why when we have a child who is showing up with mental health kinds of issues, we need to look at the physiology. And it’s why when you have a child who maybe is showing up with eczema or other types of skin things, you need to look at the bigger picture of how that inflammation is impacting them. And unfortunately, the way that our medical system is so siloed, people, parents never have the opportunity to draw these connections to understand that, oh, yeah, this chronic eczema or whatever it might be skin wise, that you’ve been trying to address with your kids since they were an infant, is actually very connected to the problems you’re seeing them now have in school or with peers or with their behavior. And so I think this connecting of the dots, and you so clearly explaining the immune and the physiological process behind that, is just so important for people to understand, because then we can advocate better.

Jennifer Fugo

And also, with psoriasis, I was at the Integrative Dermatology Symposium in October of 2021, and one of the doctors shared a slide connecting, specifically for psoriasis, how there is a really unfortunate connection, that psoriasis, I would say it’s a metabolic, full body problem. It’s connected to depression, number one, and it’s because of the cytokines, the depression, inflammatory bowel disease, cardiovascular disease, we have issues with non-alcoholic fatty liver disease and other fibrotic issues. And so we want to look full body and say, “Alright, what’s going on?” And then also, too, as I shared in the beginning, some people will develop issues of shame, of not wanting to participate in life. I mean, one thing, Nicole, I’ll share with you in our conversation, that really hit home for me was that, and this is when you were on my podcast, you had shared that sometimes children will interpret things, we make up things to explain things, and I think in my head, I never had kids, and I always thought, “I don’t want to put on a child, the OCD and the years of all of these issues that I have had.” And I think back now, and I was like, wow, I didn’t realize that was a coping mechanism. I meant well, but it really wasn’t true, and I may have deprived myself of an opportunity in life. I mean, it is what it is, and I can’t go back. But I didn’t even see that. And I’m 42. And so we don’t realize how having these issues impacts quality of life and what we may be open or closed off to later in life because of the stories we tell ourselves as a child to explain these things, or even as an adult, and also that they’re very traumatic. I do want to very clearly state that these skin issues are traumatic. It’s not a hidden disease for most people. And even if you can hide it, because maybe it’s on your arms and your legs and you can wear pants, and long sleeve shirts. What happens in the summertime? What happens when you’re invited to a pool party? What happens when you’re supposed to be all dressed up and your skin’s not cooperating? And then people stare and kids start asking questions, and you become anxious and nervous? Or the pain and inability to sleep well at night? That goes on endlessly. These are traumatic skin issues that we discount as “just a skin problem”. And they’re not. They are really life-altering. I almost felt like I was in my own version of hell when I had dyshidrotic eczema, because the simple act of just turning a doorknob, I couldn’t do that. I couldn’t wash my hair because I couldn’t touch water, it burned so badly. So we take for granted the things that we can do on a normal day that somebody with chronic skin issues just cannot.

Dr. Nicole Beurkens

So beautifully said, such important points. I want to talk about histamine issues, because I think this is another category. So we’ve touched on things where parents may be familiar with, like using a topical steroid, a hydrocortisone, we’ve touched on those. I think the other area that this comes up either chronically for some kids, or even intermittently, rashes and things, is in the realm of histamine. People might be familiar with, “Oh my doctor, my pediatrician told me to give my kid Benadryl when they get that kind of reaction”, we’re talking about histamine issues there. So I want to touch on that, and again, circle back to why we need to be thinking about those things as more than just “Well, give your kids some Benadryl or change their diet.” So what are we talking about with histamine issues?

Jennifer Fugo

So histamine issues are so much more than just an allergy, right? That’s the way that they’re treated, like, “Oh, you must have an allergy.” And again, going back to: Is it the laundry detergent? Is it the soaps or the cleaning products? Is it wool or lanolin? Different things that are in our environment. Animals, pets, etc., and food allergies. And so once you’ve really ruled that out, I would say that there’s a whole other piece to this conversation, where if you do go to a more functional route, you may be introduced to the low histamine diet, and starting to say, “Alright, maybe histamine is really a problem for my child or for myself.” And so I just want to say that, I kind of consider histamine to be more of what I call a histamine overload. And what it basically means is that you are not necessarily just dealing with this external source of something causing histamine in your system, and that includes diet. So this is much more than a dietary concern. So there are foods that are higher in histamine, there are some foods that release histamine in the GI tract. And there is a low histamine diet that, as much as I to some degree loathe elimination diets, this one, unfortunately, can be helpful while you work on things. It is something that I would suggest if you’re able to work with someone on this, then do so because you don’t want to lose that sense of joy that comes with eating food. And that’s a really big problem when you can’t get off of this diet. It’s not a long-term solution, it will not fix the underlying problem. And so a lot of times, the conventional route is “Take antihistamines of some sort”, Zyrtec or Singulair, Benadryl. Maybe you go the alternative route, and it’s like you can do Quercetin or Stinging Nettle and vitamin C, and some of these bioflavonoids and whatnot to help support your histamine response. But what is really going on? And so what I would suggest is that, again, we go back to” Is it possible that there is a sort of a histamine production factory happening in the GI tract, where you have organisms that are either triggering the release of histamine in your system, because they’re just sneaky, and I almost think of them as little spiteful — I don’t think they mean to be, but I have these funny images going on in my head of a party, I really do believe, to some degree, the best way to explain is you have these organisms in your GI tract that are partying at your expense. And then there are some organisms that outright produce histamine, and you cannot diet them away. I want to be very clear. That includes a low histamine diet. An elimination diet will not get rid of these organisms. You cannot starve them like how everybody’s like, “Oh just do any anti-Candida or a low sugar diet and the Candida will go away.” Guess what? The Candida doesn’t go away. It just comes back the moment you need more sugar. So let’s get rid of that mindset and say, “What can we do?” So number one, we want to look for those organisms. Again, that’s how we would use a stool test to identify certain organisms like Morganella, H. Pylori, parasites, for sure. There’s a lot of research demonstrating that with parasites, we’ll see this increase in total IgE, especially for parents who have tested their kids for allergies, they’ve probably had total IgE tested. And if you can’t explain why total IgE is high, it’s an immediate red flag that there could be a parasitic problem. And yes, it doesn’t matter where you live. You can live in the cleanest place on earth, and you can pick up parasites. You don’t necessarily have to eat them, though a lot of times they are consumed orally. But actually one of the most common ways to get parasites is through the bottom of your feet. So maybe you go on vacation, you’re walking on a beach, and you get a hookworm that attaches to the bottom of your feet. And that’s how you get hookworms, for example. Sushi is one aspect, or undercooked fish. Contaminated water, you have to look at well water as well, but they unfortunately don’t test very much for parasites in water. You can consume foods, maybe you got food poisoning, or you traveled to a foreign country. A lot of times, if you and your family have traveled to definitely a country that would be considered third world, there is a high likelihood that you probably picked something up and brought a friend back, and they grew in size and multiplied, and now you have a whole community that you didn’t mean to have. So that’s one reason why I would say it’s really important. We also want to consider mold, depending on where you live, mold exposure and mycotoxin exposure can definitely play a role. That will increase the level of histamine, and it will also suppress your immune system and make it more difficult for your own body’s resources to be mobilized to actually target these organisms and whatnot. So mold is definitely another factor. And we have other factors, depending on the age, like estrogen can be one factor that can make you more sensitive to histamine. But I would just say, let’s start with some things that we aren’t looking at. It can’t just be diet-focused. As I said, this is the value of having a stool test run, and looking at what the microbiome has going on. And then also looking at your environment. And I do think it is worthwhile, especially in kids or in adults to do some sort of IgE testing to just rule out any potential allergies, because you never know, you could be using, like you said, you were putting the Aquaphor on your son. There are more and more kids that are becoming allergic to lanolin. And there’s lanolin in Aquaphor. So you might not even realize that you can actually be allergic to what’s in the topical steroid. So it is important that you rule that out in this whole process. And obviously, that’s not going to impact histamine overload per se, because it’s more of an allergy, but internally, we definitely want to look into that. And then like I said, I did share that little tip. I do think those herbs that are more histamine supportive supplements are helpful, but I do think immunoglobulins, oral immunoglobulin therapy can be really helpful for kids and moms. You can take it when you’re pregnant, you can take it when you’re breastfeeding. I think they’re really, really great, so long as you aren’t allergic to mammals. So if you have an alpha-gal issue, that would be a problem. And if you’re allergic to cow’s milk, you can sometimes find them in colostrum. So it’s either colostrum or immunoglobulins, and usually they’re bovine-derived. I think colostrum, you can get goat. There’s some goat colostrum out there, but it’s harder to find. So those are some great options.

Dr. Nicole Beurkens

It’s so important, the connections you’re drawing with this, and the options that exist. I think you’ve made a great case that we need to be looking at what’s going on in the gut. And so you’ve mentioned stool testing. I can talk about this with you for hours, but I know we’re going to have to wrap up here, but I do want you to share with people, for the parents who are listening, who are like, “Oh, I get it now. This is helping me better understand what’s going on.” Where do people start with this? Are there some things that parents should start doing on their own? Are there things they should be seeking out? What are your recommendations for everybody who’s listening who’s like, “Okay, this helps me understand what’s been going on with my kid. Now, where do I start? What do I do?”

Jennifer Fugo

Yeah, I would say the number one thing is, if you suspect an allergy, please go rule that out, because allergies aren’t something you want to mess with. So that’s kind of number one. Number two, if you’re uncomfortable with what to do with your child’s diet, or even with your own diet, depending on who’s listening to this, go seek help. There’s nothing wrong with asking for help around that, especially if you, or your child, is experiencing food fear. That is a red flag right there. You’ve gone beyond the DIY capacity. You need help because this is now verging on what we would call orthorexia, and could potentially turn it into an eating disorder. And that’s not good. Nobody goes in trying to fix their health issues to trade it for an eating disorder. So let’s be mindful of that. The second thing I would say is cast a wide net. Say, all right, let’s do a recall of everything that’s going on system-wide. What doesn’t seem right? Even if the doctor would be like, “Oh, don’t worry about it”, write it down. Write down everything. And then, you as a parent, think about: What has the child been exposed to? Did you maybe travel? Did you guys go on a trip to Thailand or to the Philippines? Or maybe you went out, you do a lot of camping? What things have you done? What has the child been exposed to? If it’s a young baby, it’s a really different story. That’s where you’re pretty much looking mostly at allergies in the gut for the most part. And then also think about mom’s gut as well. So, mom, it’s not meant to blame you or anything, but we know so much more than we did before. So you want to say, “Hmm, did I struggle with a lot of yeast infections? Did I have a lot of GI issues? What symptoms do I have that I possibly could have passed my child?”, because guess what? You do pass your microbiome to your baby, and once the child is breastfed versus formula fed — Again, this isn’t about guilting anyone into feeling bad, it’s just data, that’s all it is, to help piece together what could have happened. And then going back to the doctor, and depending on the age, asking for some labs. Now, if the child is really young and a blood draw may be traumatic, I know my colleague Jennifer Brand, she has extensive experience working with young kids. A lot of times she prefers to use an organic acid test, which is a urine test. Way less traumatic. A stool test is really easy to do, because it’s just poop, so a parent can easily access that, rather than picking a child and it just causing more anxiety, so see what is available to you, to be able to take a look under the hood. Again, that information that you and your child just can’t tell. Nobody knows if they’re deficient in B12. You might guess, but you don’t actually know. And then from there, I would start — I have a bunch of great episodes, especially for kids on the Healthy Skin show. So I can certainly share maybe a link or something for your show notes, of those that are specific for parents to listen to, because in those episodes, what I’m sharing, there’s a lot more to this. And it may be something where you will then have the tools to be able to go back and talk to your doctor, start looking for some actual help. I also have a really great root cause rash finder guide that you can download, and it is a checklist. Remember I was saying cast a wide net? You could go through this checklist. You could do it for yourself or for your child, and start to piece together whether there’s actually issues in areas you didn’t even think were a problem, and start working through it from there. But I think those are the main things that I would say. And just one last note for parents. Nicole, as you shared, kids are not adults. And so you have to be really careful when people share information, all of us functional folks, you have to ask yourself: Was this protocol, are these recommendations for an adult? And if they’re for an adult, that means that they may not be appropriate for a young child nor for a baby? There are some supplements that you should not give babies. And also mom, breastfeeding, there are a lot of herbs you cannot take. So be very cautious in asking questions. Is this appropriate for whomever you are digging into, this problem? That way you don’t ever just try all these random things, and it turns out that that particular supplement that you read about, that this person raved about, that it wasn’t really appropriate for your kid. I know everybody means well. I have a lot of parents who ask me questions. Just always ask questions before you start giving your child supplements. Is this appropriate? Check with your pediatrician, check with your other practitioners and make sure that also it doesn’t interact with any medication that they may be on.

Dr. Nicole Beurkens

Safety is so important. And I think you’re helping people have a foundation of starting to look at all of these areas so that they can advocate, go to your pediatrician or whatever healthcare practitioner and say, “Hey, here’s some additional things that I’ve been documenting and thinking about. Where do you think we should go with this?” It may require finding a different type of practitioner to help you look at that, but you’re giving people some important ways to start thinking more broadly about what might be going on, and then finding the tools and the practitioners for that. I want to make sure that you share the website. We will put the show notes for your podcast, The Healthy Skin Show. But what’s the website if people want to get that checklist or just learn more about you and the work you’re doing? Where should they go?

Jennifer Fugo

The website is skinterrupt.com, or you could go to healthyskinshow.com, and it’ll take you to the podcast page on the website, it’s so much easier to look up Healthy Skin Show. And you’ll be on the website, and there you can grab all of our different downloads and things. And I’m also on Instagram as well at @JenniferFugo. And so that’s where I am most of the time, that and the podcast. And if anybody has any questions, please feel free to reach out, and you never know, your question might spawn an episode of The Healthy Skin Show. I do take inspiration from people who are searching for answers. I learn, we all learn together, and the goal, ultimately, is to change the way that things are done in conventional dermatology. I really want to expand the toolkit, and I also want to empower patients and parents to be able to ask those better questions and to make better choices that are also in line with their own health values and that are safe. We all want to live a good quality life, and it kills me when I see the pictures of the kids who are really just miserable from rashes and up all night scratching, that’s heartbreaking.

Dr. Nicole Beurkens

We can do better.

Jennifer Fugo

We can, we should be doing better.

We can do better. We’ll make sure the links are there. Your Instagram is great. I encourage all of you if you’re on Instagram, go follow her there. You’ve got great information there. Thank you for all of this information. Thank you for being such a forward-thinking practitioner in this area, and really pushing the field forward. I very much appreciate your work and appreciate you spending time with us today.

Jennifer Fugo

Thank you for having me.

Dr. Nicole Beurkens

And thanks as always, to all of you for being here and for listening. We’ll catch you back here next time.