External and internal stressors can have a negative impact on the skin. My guest today will discuss how various stressors can lead to inflammation, which can lead to skin rash issues.
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My guest today, Brie Wieselman, is a digestive and hormonal health specialist who works with women around the world in her online practice. She also specializes in helping people with a range of digestive issues so that they can build a healthy microbiome.
Her programs integrate functional and Chinese medicinal approaches. I have personally worked with Brie several times and can vouch for her knowledge and expertise.
Join us as we discuss cortisol, the “stress hormone”: some common misconceptions, as well as how it affects the skin.
Have you tried to heal inflammation in an effort to calm your skin rash issues? Let me know in the comments!
In this episode:
- What is cortisol and where does it come from?
- Is there a relationship there between the stressors that we experience and the hormone that's released impacting the skin?
- How does inflammation affect the skin?
- Topical steroids
- How to find relief
Quotes
“In skin we know that multiple inflammatory conditions are either triggered or aggravated by stress. Psoriasis, eczema or atopic dermatitis, that same category, acne of various kinds, contact dermatitis, alopecia, and then just like itching or hives, those can all be either caused or worsened by stress and primarily elevated cortisol.” [3:57]
“Anytime that we have a suppression of immunity and an increase in inflammation and a poor barrier function, that's a bad combo. We see that all the time in the gut, but the same exact thing happens in the skin.” [7:37]
Links
Get Brie's FREE Hormone Guide HERE (scroll about halfway down the page)
Watch Brie's Hormones & Skin Rash Interview during the Eczema & Psoriasis Awareness Week
Healthy Skin Show ep. 013: What's Really Going On Behind Adult Acne? w/ Brie Wieselman
Healthy Skin Show ep. 034: Diet Solutions For Adult Acne w/ Brie Wieselman
Follow Brie on Facebook | Twitter | Instagram
130: Cortisol-Skin Connection w/ Brie Wieselman FULL TRANSCRIPT
Jennifer: Hi everyone. Welcome back. I have to tell you, I've got a recurring guest who was on Healthy Skin show two times last year. She's one of the top to downloaded podcast episodes and experts, so I invited her back for you guys. Her name's Brie Wieselman, so maybe you remember her. We talked about PCOS and diet changes for PCOS and acne last year. We're going to talk about something a little different this year, but for those of you who don't know her, Brie is a digestive health and hormone balance specialist, working with women around the world in her online practice. Besides women's health, Brie specializes in helping people with digestive problems such as IBS, parasitic infections, candida overgrowth, and [inaudible 00:00:46], to rebuild a bulletproof microbiome.
Jennifer: Using her programs that integrate functional medicine and Chinese medicine approaches, she has worked with hundreds of clients living anywhere from Dubai and New Zealand, to California, empowering them with a personalized roadmap for understanding and transforming their health. Brie, thank you so much for joining us again.
Brie: Thanks for having me. I'm excited to be here.
Jennifer: Today, we're going to be talking about some hormone things that people don't necessarily relate to skin problems. I would love to start off with cortisol, because most people only think of it as a stress hormone, but they may not fully know how it could impact their skin. Could you start off by sharing with everyone what exactly is cortisol and where does it come from?
Brie: Okay, so cortisol is basically, it gets such a bad rap because it gets nicknamed the stress hormone, but it's really our stress response hormone. It's our body's response and priming to optimize you to respond to what it perceives as stress. I guess that's the first point, is that stress is perceived in the brain. It can be mental, physical, emotional stress or inflammatory stress. The brain perceives that this is going on and then it sends signals. It sends these hormones, releasing hormones, like corticotropin releasing hormone, CRH, we'll say. Then that prompts cortisol release as well as some other hormones like adrenaline.
Brie: Mainly this is released by the adrenal glands, but what's interesting is that recently we found out that the skin is actually an extra adrenal site for the synthesis of these hormones.
Jennifer: Really?
Brie: Yeah, not only does it respond to the hormones, but actually the CRH I just mentioned, cortisol itself, another adrenal hormone called ACTH and melatonin, which is also kind of part of the regulation of our HPA axis or adrenal system, those are all produced in the skin. I mean it's crazy because we've known that the skin is endocrine organ as well. It has multiple categories it falls into. That was something that was new to me when I happened upon it a year or two ago. Like wow, it's not just the adrenals.
Jennifer: Wow. That's really neat because a lot of times we think of … I don't know, you're right, there's a lot of negative things that go around. We talk about cortisol and your adrenals and everybody thinks they have adrenal fatigue. We just only think about it in terms of energy, but when it comes to the skin, boy, stress certainly impacts your skin for sure.
Brie: Oh my gosh. Yeah.
Jennifer: Is there any tie between that and cortisol? Since obviously that's a hormone that happens in response to stress. Is there a relationship there between the stressors that we experience and then the hormone that's released impacting the skin?
Brie: Absolutely. Basically the tie on here is modulation of inflammation, or in this case [inflammaging 00:03:55] also. We'll get to that in a minute. In skin we know that multiple inflammatory conditions are either triggered or aggravated by stress. Psoriasis, eczema or atopic dermatitis, that same category, acne of various kinds, contact dermatitis, alopecia, and then just like itching or hives, those can all be either caused or worsened by stress and primarily elevated cortisol. The tie in there is inflammation. What's really interesting is that cortisol's effect on skin and its relationship to inflammation can be positive or negative. Okay. Here's where it gets a little bit complicated, but we're going to break it down real, real simple.
Jennifer: Perfect.
Brie: The nitty gritty. It has to do with short term stress or longterm stress, or short term or long term exposure to cortisol and the stress hormone. In order to like start to wrap our heads around this, we just need to look at the effect of longterm, like prednisone or topical steroid creams on the skin to see evidence that long term exposure to cortisol, which is essentially the same thing, just endogenously produced, made inside our own bodies, to see evidence that that's not beneficial for the skin. Longterm glucocorticoid use as therapy for treating inflammatory disease of the skin, we know that it causes the skin to atrophy.
Brie: The epidermis gets thinner and there's other hallmarks of skin aging, like poor wound repair and less collagen and more wrinkles and things like that. Basically what happens is that the effect of the cortisol and cortisol releasing hormones in different types of skin cells is really diverse and cell specific. In some cells it inhibits cell proliferation. In others it can act like a growth factor. Then for example, in mass cells, which are present not just in the skin but in other places in the body, and we know that mass cells are related to histamine and things like hives and itching and redness and swelling, it will cause increased degranulation or breaking open of those mass cells to rupture and spill the histamine. That is kind of proinflammatory.
Brie: Then in other cells it can do things like inhibit something called NF-kappa beta, which basically helps limit inflammation. It's really interesting because it's this bi-directional thing. Why is it? It's because inflammation is an important player in restoring and maintaining the epidermis, the health of your skin. There's some levels of inflammation that can be beneficial if it's at the right time and the right amount. They can also be damaging if prolonged. Short term stress basically triggers wound repair. It can be antiinflammatory initially. Then once the inflammatory cytokines in the skin go down, it gives feedback like, hey, lower the cortisol production.
Brie: That's in the ideal situation, but in people who already have a background tone of upregulated inflammation or in situations where the stress goes on, and this is remember, both emotional, mental or physiological stress goes on and on and on, then what happens is that the prolonged cortisol exposure actually breaks down the barrier function of the skin. We basically get like leaky skin and it cause it to lose hydration. It also changes how the distribution of the immune cells, like getting from the blood to the skin. In the short term you have this enhanced immunity and in the longterm you have a suppression of the immunity.
Brie: Anytime that we have a suppression of immunity and an increase in inflammation and a poor barrier function, that's a bad combo. We see that all the time in the gut, but the same exact thing happens in the skin.
Jennifer: What's interesting that you're mentioning about the topical steroids, one of my goals this year has been to talk a bit more about topical steroid withdrawal, because there are people that have overdone it with topical steroids, not having known the appropriate way to use them, and use them a lot, all the time. Then tried to go off of them and their skin rebelled to a point that your heart breaks, understanding and listening to the stories that these folks have to tell and the journey they're walking on. One interesting thing is that, and I think a lot of people don't know this, is when you apply topical steroids, they're absorbed through the skin and those steroids impact your system. Do you have any thoughts on that that you'd like to share?
Brie: Yeah, because I see this all the time. I do a lot of work with people with skin like you do, but I also really get a lot of those real critical gut cases. For example, I'll often get people who come to me on prednisone or different kinds of steroid treatment as suppression for the inflammation, let's say for things like inflammatory bowel disease, like a colitis or Crohn's. It's really, really, really hard to taper them off of those drugs without a flare. The same exact thing is in the skin. I think part of the reason for this is that when we're using those drugs, because we just have to turn off the fire. They do what they're supposed to do and they do it really, really well, but they do it because we're basically using these super physiologic dosages of something that we would produce in our own body.
Brie: Meaning, we're using more than we could possibly ever create on our own. Those hormones are all subject to feedback loops. Meaning when we see high levels, it tells the grand central station or wherever that hormone is manufactured or the signaling centers in the brain, hey, turn down the volume. We don't need to produce them. I think there's this lag time when it's been suppressed for so long. Then we take away that supplemental source of the hormone, what happens is that all of a sudden we're left in this state where our body is a little bit confused and just goes, oh, now you want me?
Jennifer: The consequences can be pretty, I mean, physically painful. I mean for some people I've read that topical steroid withdrawal for example, can last for up to five years in some individuals and you can have long lasting impacts with this. That said, I wanted to highlight something here. As you were saying, like stressors, because what if you're not sleeping well? Every night you're waking up itching, so you're not sleeping well through the night. You get up, you're exhausted, you're super stressed out. Every time you start to itch or whatever, you're like, oh my gosh, is it another flare? Now we're experiencing this trauma of like, what could possibly happening.
Jennifer: Let's just say you do get a flare and you're itching like crazy and this horrible rash and you're dealing with it. You don't feel well, you have to go to work. People look at you funny and it's just this [crosstalk 00:11:08] cycle that you get in.
Brie: Heartbreaking. Well, it's heartbreaking because I mean the skin is like, you know they say the eyes are the window to our soul, well the skin is like the window or like the skylight or something to basically our wellness, like how resource we are. A lot of times like how it reflects our health and it's just so up front. It's like you can't hide that. If your digestion's upset or something, you might not be having a great day, but it's not like everyone just walks up to you and sees it unless you tell them.
Brie: With your skin, it's just so challenging because it can be right there, even on your face, and so of course that's so vulnerable. Yeah, like you said, there's this vicious cycle with sleep and cortisol and the itching. We know that there's an association, like for example, as you're well aware of people with eczema and other kinds of dermatitis, it's almost always worse at night. It's almost always worse at night or before bed. We know that also people with those conditions tend to see, like if we run them HPA axis or adrenal testing, we see that the stress hormones bounce higher at night. It's a little bit chicken and the egg, because both the high cortisol worsens the itching, and having the inflammation and the itching causes the cortisol to bounce high in a response, to try and help you to try and address it.
Brie: Actually both that situation and the insomnia and stress that it induces, and also what we were just talking about a minute ago with the withdrawal from some of the steroid treatments, both internal and topical, I've actually seen that those are very well facilitated. You can help with that withdrawal and help reprogram some of those hormones when you do testing and work directly with those hormones. We have some little kind of like, it's almost one of our secret sauces in my clinic, it's like yeah, that's one of the things we do when we see someone in a big flare. We'll almost always just like jump right to that, to kind of help them, especially if they're tapering from something like prednisone use or topical steroids.
Jennifer: For somebody who's listening to this going, “Oh my gosh, I can't sleep at night,” is there anything that they could try or do tonight to just see if maybe there's something that they could start to get some relief on, that you found helpful for your clients?
Brie: Yeah, that's a great question. I've had some good results with things like Ashwagandha and people who don't have like a specific reaction to that that's negative, which is rare. It's not common. Ashwagandha is one of those things that can safely help lower cortisol in people where it's elevated and it's a safer, less pushy thing where you don't really have to use testing, because it is a smart plant. It's an adaptogen. I love Ashwagandha for that. I really love magnesium because most people are deficient. I mean I could talk for an hour, we could talk about all the roles magnesium plays, so we won't do that. I will just say that energetically it's a very like, take the edge off the nerves kind of thing.
Brie: I particularly like the glycinate form or the chelates, because they tend not to have bowel activity for people. We're not looking for a laxative effect. Those two things I think are super safe and can help kind of just in this kind of very general fits the public kind of way help with the itching.
Jennifer: Yeah. Any thoughts on melatonin? Sometimes I feel like you have to be careful because you were saying there's a feedback loop and you hand your body, and melatonin is a hormone, so your hand your body melatonin and you tell your body, hey, I don't necessarily need you to produce this much. Is there any concern if someone is considered taking this or testing it out? Any thoughts on whether it was a good idea to try or maybe they should talk to their practitioner about it?
Brie: I'm a big fan of testing prior to melatonin, but that said, I think it's very safe. Some of the liposomal forms that are like a third or one milligram, they're very, very low, I think those are pretty safe, especially when we're talking short term use. [inaudible 00:15:12]. You say, hey, I'm going to try that, and why we would say that is that melatonin and cortisol are like a seesaw. They are inversely proportionate to each other. If you have someone with really high cortisol at night and in particular if they're not sleeping, melatonin could be a useful tool and may actually be low on testing. I would say that if you decide to try out something like that and you notice, hey, that actually felt like kind of beneficial, and you want to play with, is that the right dose or would I maybe need more, then that's where I would definitely say testing is probably of service.
Jennifer: Okay. With melatonin supplementation, do you feel like people notice a difference right away? Are they going to take it once and all of a sudden have an amazing night's sleep? Or is it going to be over maybe the course of a few weeks where they need to test this out and see if like that one milligram or so would be appropriate for them?
Brie: I've seen it go both ways. I'd say more often we see the latter, because sleep is a pattern. It's about patterns and habits and our body responds the same way. There's very few things that you take that are natural that all of a sudden, bam, you're sleeping like a baby. Yeah, usually it's going to take a minimum of 10 days. Usually about three weeks is the time I would give that. That said, melatonin is pretty strong. It's kind of on the druggy, [hormony 00:16:33] end of natural agents that we can use. Some people will take melatonin and I've seen this even in people taking three milligrams, and they wake up super groggy the next day.
Brie: That was too much for that person's body to tolerate. They might've said, hey, I actually slept better, but I just felt really horrible the next morning. Okay. That's the kind of thing where you can see that immediate response. Then you want to taper that back.
Jennifer: Yeah. Do you have any suggestions or tips for anybody who is in this really bad cycle of stress and so we know that there's probably some level of cortisol dysregulation? Any lifestyle tips that you could share that they might not have thought of? I mean, everyone's like, calm down, do breathing, take a deep breath, but those are the obvious things. Maybe there's some other tips that you might have that people can [crosstalk 00:17:31].
Brie: Yeah, I mean the ones that I like are, go for a walk in nature. There's actually shown to be a balancing effect on cortisol just by basically what we would call earthing. I forget what the Japanese name for it, but it translates to forest breathing. It's essentially like go be in nature away from the sound of, if possible, cars and planes and whatnot. Literally at the very bare minimum, just go for a walk, get out of your house, breathe some fresh air, get some sunshine on your face. That's another one, is I'm a big fan of early morning sunshine exposure, which means ideally in the first 15 minutes of being awake that you get the full rays of the sun's light in your eyes without sunglasses. That's one that I like.
Brie: Another one that I like, although this may not always work out for someone who's got an acute skin flare, is a warm evening bath. Now it doesn't have to be super hot. If the hot water flares the redness of your skin, maybe a just a warm bath moderately could work. That actually has been shown to help modify a high evening cortisol and improve quality of sleep tremendously. I love a bath. Who doesn't love a bath?
Jennifer: Well, it's funny because every time people think of a solution, they think it has to cost a lot of money and it doesn't necessarily have to. You just have to create the time and do it. There are plenty of free tools that we can access that can make a big impact. It doesn't mean you have to take a bath every single day. It could be a few times a week. I mean, I know for sure that when I need to slow down, especially in the winter months, in the cooler months, it's nice to just carve out 15, 20 minutes and just sit still. It really does help. This has been so helpful.
Jennifer: I think people don't realize, again and again I'm like, oh my gosh, there's so many connections between the skin and other parts of the body that we don't often hear about, so this is great. This is the first time we're ever really talking about cortisol impacting the skin on the Healthy Skin show. You've got a great gift for everybody. What is that called?
Brie: I'm going to call it my hormone guide. It has some big long fancy name, like something kind of sassy and I apologize. I should know, it's on my website, but it's on the homepage of my website. If you scroll down about halfway and we can put the link in the show notes. It's kind of like a hormone guide, so to speak.
Jennifer: Wow, that's really perfect. For everybody who's looking to find you, they can find you over at your website, briewieselman.com. You're also on Instagram, you have a great Instagram account with lots of good information. Anything else you'd love to share with the listeners before we wrap up?
Brie: I don't think so. No, I think we hit it. I think we're good.
Jennifer: Awesome. Well, thank you so much for coming back. I really appreciate it.
Brie: Thank you. Thanks for having me. Always so much fun to come be with you.
