Many of us think that once puberty passes, acne will be a thing of the past. Unfortunately, acne does not discriminate, and it can affect people of all ages. Today, I continue my conversation with Brie Wieselman about how PCOS can cause adult acne in women.
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This is the second part of my interview with Brie. You’ll want to check out Part 1 if you haven't already before listening this episode.
Brie Wieselman is a digestive health and hormone specialist who works with women all over the world through her online practice. She has helped thousands of people understand their health so they are empowered to live better.
Polycystic ovary syndrome (PCOS) is an often misunderstood cause of adult acne in women. Last time, Brie and I discussed PCOS, its symptoms and how to tell if you have it.
Today, we’re diving in deeper to talk about the best ways to manage PCOS using a whole range of tools and strategies. Brie shares her advice on how to manage this condition so you can have healthy skin and feel better all around.
Have you used any of Brie’s strategies to manage PCOS? Leave a comment!
In this episode
- What to do once you receive a diagnosis of PCOS
- The importance of monitoring your blood sugar in order to understand your hormonal health
- Why managing your diet and activity levels is integral to managing your hormonal health
- Some of the best therapeutic nutrients to consider to manage insulin sensitivity and PCOS including inositol, D-Pinitol, curcumin, chromium, and, in certain cases, berberine
- The most important food group to avoid if you have PCOS
- Why a healthy liver and microbiome is crucially important to healthy hormonal health
Quotes
“You’re definitely going to be better off doing more balanced meals where you’re focusing on getting a whole bunch of vegetables, ideally two cups of vegetables per meal and your plate is mostly vegetables and then maybe a palm-sized serving of protein of any kind and a tablespoon or two of really healthy fat.” [25:06]
“When a woman walks into my practice and has PCOS I want to get her hormones in balance and cycling and regulated as quickly as possible. Now that sounds very straightforward and easy. Just get the hormones to have a good feedback loop and cycle. But the thing is that this is a whole body multi-system issue, so that’s highly dependent on a couple of other really important body systems, namely our liver and detox system.” [37:19]
Links
Take Brie's Healthy Hormones Quiz here!
Watch Brie's Hormones & Skin Rash Interview during the Eczema & Psoriasis Awareness Week
Follow Brie on Facebook | Twitter | Instagram
034: Diet Solutions For Adult Acne w/ Brie Wieselman FULL TRANSCRIPT
Jennifer: All right. We are back again. This is part two with my dear friend Brie Weiselman. If you guys did not check out part one of this conversation where we talk about adult acne in its connection to PCOS which underlies it so the acne is actually a symptom of it is this greater problem. Go back and listen to that first because we're going to break that down, the symptoms and the testing and what that looks like so you can identify if maybe that's really what's going on for you. Otherwise, we are going to dive in a little bit deeper today, so if you do not recall, let me just remind you. Brie is a digestive health and hormone balance specialist. She works with women all over the world in her online practice. Besides women's health, she specializes in helping people with digestive problems such as IBS, parasitic infections, candida overgrowth, and SIBO to rebuild a bulletproof microbiome using her programs that integrate functional and Chinese medicine approaches,
Jennifer: She has worked with hundreds of clients living all around the world, empowering them with a personalized roadmap for understanding and transforming their health. Brie, I'm glad to have you back. This is great. We get part two.
Brie: Oh, I feel so honored. I get to have a part two. Thanks for having me back.
Jennifer: You know what, I feel like this conversation is so deep it wouldn't do it justice if I was like, okay, we're at time, we just need to cut it up. Like I frankly, if I was dealing with this I would be like, okay, well what's the next step? What can I do? Because if I go to my doctor, like you said, they're probably just going to put me on birth control pills and that might not be something I'm comfortable with. And you know what, for anybody out there who's not quite comfortable with that, you should do your research and understand why you might have good cause for concern aside from the fact that it increases your risk of stroke.
Jennifer: And I have actually known three women who've had strokes because of birth control pills. So you know, and there's other things that go on as well. So we're not going to go into that today, but we're going to, I think it's important for you to know, you know, a lot of times with a conventional doctor, they just don't know all the other options. And I think that's why this is a worthwhile conversation to have because the truth is you want to get rid of your acne. And I totally and completely understand that the, the acne is not actually the problem. It's the pretty carrot, you know, hanging dangling in front of you that you like, Oh, I got to get that carrot. But in actuality, the real problem is this underlying hormonal imbalance issue that is triggering the skin, so to speak, to end up in the way that it's presenting itself. So, all right, you've got the tests done, you have confirmation that you've got PCOS, what can you do about it?
Brie: Absolutely. So, yeah, let's talk about this and break it down a little bit because there's some things we can do, you know, right. Today at home just with our choices with diet and lifestyle, maybe even some personal supplementation. There's some really key pieces about diet I can't wait to share. And then we can talk a little bit about like, what do we do? What do I do when someone, you know, in a clinical setting when I'm working with someone just as someone can get a little peek in. So what that might look like. So, okay, always we're going to start with diet. So for PCOS and especially with all acne, actually you want to balance your blood sugar and insulin and you want those to have really optimal functions. So this goes, if you're in the category of like tending towards being overweight or struggling to keep your weight down, or even if you're underweight, even the underweight types will show some signs of insulin resistance.
Brie: And even if it's not a whole body insulin resistance, it's basically like insulin resistance of the ovary. So step one would be to optimize your carbohydrate intake for you. And there's no, I'm not going to throw out a number and say it to be like below these grams or between these number of grams because I don't believe in that. It has to do with how your body works with the carbs and that depends a lot on your genetics. It depends on your level of activity, your age, you know there's a lot of things that will influence that. So what I recommend people do is play with that and look for signs of either, you know, hypoglycemia or even do some blood glucose testing.
Jennifer: So go to buy like a go to buy a home test, from like Target, CVS whatever with a strip, and start testing.
Brie: Yeah home glucose meter. Exactly.
Jennifer: And do you have any suggestions like of how they at all, like any suggestions how they should test your blood sugar with that?
Brie: I actually, I have a handout that if anyone wants to email me through the website I'll be happy to send it to them.
Jennifer: That's awesome.
Brie: Absolutely, I didn't even think about that. Basically, you know, we don't ever want your blood sugar to rise over 140 within two hours after eating a meal. And ideally we even want it to kind of maintain a little, a lot tighter control than that. But we also don't want it to get super low. Like usually if it goes much below, you know, 65 70, then I'm gonna maybe get concerned also. So there, that would be a whole long discussion. But essentially we don't want there to be wild fluctuations and we don't want our blood glucose to trend high. In general, you know, we're going to try to eat probably slightly on the lower carbs side of things. And really it's about the choice of what kind of carbs. So eating more whole food or what we call cellular carbs, not avoiding flours, sugars, processed sugar like that.
Jennifer: So if you're eating a lot of takeout and you love your pasta like me, cause I'm Italian and bread and all sorts of stuffs.
Jennifer: And we're not even talking about like food specific food issues right now. We got a good one coming up for you, so stay tuned, but the Brie [inaudible]. I was like, what? We need to talk about that. I think that, you know, one of the biggest pieces for people as they think it doesn't really matter if they have, you know, oh well I'm going to have, you know, like a cereal for breakfast. That's probably not the best thing to have for breakfast, right?
Brie: Exactly. Yeah, it's definitely, you're definitely going to be better off doing more balanced meals where there you're focusing on getting a whole bunch of vegetables, you know, like two cups of vegetables per meal ideally. And your plate is mostly vegetables and then maybe you know, a palm size serving of protein of any kind. And then you know, a tablespoon or two of really healthy fats. For a lot of people, that's a good place to start. You know, optimizing diet can be highly personal and there's a lot of talk about different things, you know, and all that. And I don't want to go down that rabbit hole because that actually could be beneficial for some people in this situation, but not for everybody. So I think that generally focusing on eating whole foods, you know, getting your carbs from root vegetables, squashes, fruits and vegetables and possibly properly prepared legumes and occasionally whole grains in certain people.
Brie: And it all depends on your individual tolerance. So, so that would be a first step. And then the other thing about, you know, our carb tolerance is we got to move. So I don't care what you do, make sure you love it so you'll keep doing it, you know, so if it's hiking and getting out into nature, if you love going for a swim or a bike ride, if you're a dancer like me you know, if you're really into hitting the gym and doing like hit training, that's great too. And everybody should be doing some kind of strength or resistance training in addition to those things. But we just got to get moving. Even just going for a 20 minute walk after dinner increases your insulin sensitivity. So that's the best possible thing that almost everybody can do.
Jennifer: And it's free. It's free. I'm going to say that it's free. Like we do, a lot of times people think you've got to pay for all this. There are really important lifestyle things that are free that can actually make a difference. So let's let us underscore that. I think it's important. I think going out for walks and moving is such a critical piece and if you love yoga, just throw your mat out on the carpet and do like 20 minutes of a Vinyasa. It doesn't have to look pretty, it doesn't have to be perfect. There's plenty of things that you can do. We've all, we all can, can find something that we can fit into our lives to get moving.
Brie: Absolutely. There's actually this little app that I recently started to love it. I think it's free but it's like the seven minute workout and I'm sure I'm probably the last person to know about this. It seems like one of those things everyone knows about, but it's basically a seven minute workout you can do anywhere and you go at your own like level of fitness and it's like, you know some like wall sits and some squats and some like planks and you know your basic exercises. Nothing too fancy but you get it done in seven minutes. So even if it's a day where I can't do anything else, I have seven minutes.
Brie: If i dont have seven minutes. I know something's wrong.
Jennifer: I was going to say you should tell me what that app is. We'll put it in the show notes and then my app that I downloaded. We're both looking at our phones, so like what is there on the phones. So I downloaded this app called 8fit. It's the number eight and then f i t . So it's free. They ask, they have a membership thing you can subscribe to. I just use the free thing. It works like you don't need any weights, you don't need any supplies. You can swap the exercises out and do it at your own pace. I like it. Its free.
Brie: I love that. That's like a great use of technology.
Jennifer: Exactly. Exactly.
Brie: I'm all for “Get off your phone”, but like, you know, yeah, I like that app too. So. Okay. All right. So let's say we've done these things. We've worked on the nutrition, we got moving and we're still having a hard time with our insulin sensitivity or you're trending insulin resistant. Maybe your doctor has said that. That's the time when we're going to probably add in some therapeutic nutrients. So some of the ones that I'll throw out there that are pretty safe for people to use are things like inositol, which is in the B vitamin family, d-pinitol, which is actually a version of inositol that's highly absorbable and really, really one of the best things you can take if you have PCOS to increase your,uactually your regular ovulation and your,ublood sugar, insulin sensitivity. Uand then things like curcumin and possibly chromium,uin certain cases, berberine. But I like to reserve that with a little caution just because it has effects on the microbiome too, but those are some of the natural substances that could be used.
Jennifer: Yeah. And I just want to say if anybody's like, I don't know what she said. I don't know what those are. We're going to put them in the show notes so you know, so you know how to spell them cause we both know what they are. But we also recognize that if you're not a nutritionist or a practitioner, a lot of times some of these names are tricky to spell and we'd prefer you actually find what we're talking about. So they'll be in the show notes. And then also too, I just want to say you know, part of the thing with berberine, like don't go out and just take out that is, that's literally like mother nature's version of Metformin.
Brie: Exactly.
Jennifer: So if you take too much it can cause blood sugar drops and like, yeah, you should work with someone.
Brie: Yeah. Yeah. I mentioned it because it's a tool, but no, I don't think I agree with you. I don't think people should just go out and take it. Okay.
Brie: So in the food realm, I really want one food that is like, its got to go in this situation. Like if you have acne period, if you have acne and PCOS definitely this has to go. And this part I will just put out a little warning. I'm going to mention some words that are hormones. I'm going to explain what they are, but it is going to get a little techie. So if you're not interested, that's okay. Just you know, go forward a minute or two. But basically the biggest school that's a no, no in this condition until it's under control and even possibly longterm is dairy. Now, here's why. So dairy, there's a hormone in milk that's called insulin, like growth factor one. So we call this IGF one for short because that's a mouthful. And that hormone mimics insulin in the body and it makes sense that it's there because it's a growth hormone and growth hormones increased body mass.
Brie: So if you're a baby cow, that makes sense because you want to become a big cow. But it's a problem for both PCOS and acne because women who have PCOS tend to have higher insulin levels or less sensitivity to their insulin. So we want to do everything we can to keep our insulin levels low. Now in the skin that hormone IGF one, it increases our production of sebum and it simultaneously makes you grow more new skin cells faster. And because it's a growth hormone, so as the new cells grow, the old ones die. And so that can mean there's more dead skin cells that can theoretically block the pores. And then you have the sebum trapped under it and boom, perfect storm for acne. Now the last couple of pieces in the woman with PCOS IGF one, causes your ovaries to also release too much testosterone, something we're also trying to minimize and that testosterone will promote acne. So.
Jennifer: Oh, this is like, this is just a bad storm on both sides. It's just bad.
Brie: Yeah, absolutely. Exactly. So normally people have a binding protein for clearing this and making it inactive and getting that IGF one out of the body. But women with PCOS don't have as much of that binding protein. So when we eat dairy, there's just more of it floating around, you know? And so it's just exactly, it's like this perfect storm. Now it's interesting cause you just mentioned Metformin and Metformin is a common drug that's used for diabetes or prediabetes and it's actually also prescribed in PCOS to help women ovulate. Even without over insulin resistance it'll still do that. And so interestingly one of the ways the drug Metformin works in women with PCOS is by helping to balance the ratio between IGF one and binding protein. So take one message with all of that science is that we want to do everything we can to keep our IGF one low and to keep our insulin low and dairy is going to be the biggest dietary source of that's going to promote that hormone and go the opposite direction where we want to go.
Brie: So a lot of my people say, okay well is it just cow dairy or?
Jennifer: I want to ask you this. I'm like okay let's do fine dairy cause people, I guarantee you somebody is going to go well does that include eggs cause they're in the dairy section and that's the right question. A lot of people have asked me that. The answer would be no, it is not include eggs. So what, what would you define as dairy?
Brie: Yeah, so this is only milk milk that came out of mammals. So goat, sheep, milk and camel milk. All do have this hormone. Anything that's basically milk by a mama that is going to a little baby to make them grow bigger is going to have it. But things like grass fed butter or ghee are mostly okay because those are fat. And this IGF one that's a protein, so it's going to be bound to the protein part of the milk. So really what we're talking about is like dairy fat. Should be. Okay. so I mean, I, I'm not somebody who just in general in my practice, I don't like to like wholesale remove foods because I'm like you, I come from a food family. I love to eat. Like it gives me a lot of joy. You know, and we can talk about that for days, but I don't think that this means like, okay, you, it's not an allergy. Like, it's not like I can never touch dairy again. It's just kind of taking this into perspective like, okay, maybe I'm going to have a bite of that cheese, but I'm not going to have cheese every day, or I'm not going to like drink milk every day or have milk in my tea or coffee or whatever it is I'm having, you know? So it just kind of modifying our total intake of those things.
Jennifer: I think that's a really important perspective because a lot of times people become so afraid. Then they're like, oh, I don't know if there's butter in this. I don't know if they put this in this and, and they're freaking out because they don't know how something was made, or the right questions to ask. And it's important to have a common sense approach, especially because you're right, this is not a food allergy and it's who's to say that if say in a number of months or a year or something like that, you get your health in a better spot, then maybe you have more leeway. And I found that with clients, even when they have a food sensitivity, typically the exception is when you have like high sensitivities, moderate sensitivities or gluten, those usually you don't always get to enjoy those again. But I think in this case, because there's, that's the point here, if you guys are like IGF one sounds so like sciency thing is there is science behind this.
Jennifer: So when you're sitting there going, well it's, it's maybe that's like a woo woo thing. You know, a lot of doctors, they'll be like, they'll blow us off. And the things that we say is like, oh that's woo woo, that's nonsense. But there's actual science behind this. These are scientific reasons for why these specific [inaudible] and by the way taking dairy out free. That's another free thing you can do.
Brie: Yeah.
Jennifer: So Brie, when people come to you when clients and women with this problem come to you, it sounds to me, so I can, we'll help to recap this here. It sounds like the first thing you're going to say is, all right, we've got to manage the carbs, we've got to be responsible with that. And Hey, there is a lot of resources out there on how to meal plan. If you need help with that, we can put a link in the show notes.
Jennifer: Because you don't have to figure it all out on your own in this day and age. But then two, you've got to move. You've got to make time to do that. Even if it means you do it at home or you get to the gym or you join a intermural league of some sort, you just do something a number of times a week. I like to shoot for like three to four, but you know and then it also sounds like you got to get, you got to break up with dairy for a while. The milk you got, you just got to. You're just not friend's.
Brie: At least for the most part.
Jennifer: Yeah, yeah,
Brie: Yeah. I agree.
Jennifer: And if they, if they've done those things, let's say this is somebody, somebody is listening to this and they're like, you know, I have PCOS, I watch my carbs, I know what I can tolerate.
Jennifer: I've used the glucose meter. If anyone doesn't know about that, listen to part one. And you know, let's, let's really, let's give them some good directions of what to do next because I have a feeling when they go to the gynecologist or the dermatologist, they're not gonna have the greatest suggestions. So what should somebody look for if they're like, hey, you know what? I want to find the underlying reasons for what's going on here. I want to address them appropriately and move. I don't want this whole thing to consume the rest of my adult life. I'd like to move forward. What's the best thing for somebody in that boat to do?
Brie: Absolutely. Well, okay, speaking from experience, and I wish I had done this, and this is part of why I help people with this condition because I just want to save them the, the tears and frustration and time and money that it took me to figure it out on my own. So, so basically I would definitely recommend that this is, these are the pieces where you probably want to work with somebody who practices functional medicine and who has a good background in hormones and microbiome. And here's why. So from the like 30,000 foot view, when, when someone, when a woman walked into my practice and has PCOS, you know, I want to get her hormones in balance and cycling and regulated as quickly as possible. No, that sounds very straightforward and easy. Like, hey, just get the hormones to have a good feedback loop and cycle.
Brie: But the thing is that, like we mentioned, this is a whole body multi-system issue. And so that's highly dependent on a couple of other really important body system, namely our liver and detox system. So how well is our detox working? And then our microbiome, who is living in our gut and are they helping us or hurting us? And so and then also of course, looking directly at the hormones and maybe using things to help regulate hormones. So I'll talk just briefly about why are these important. So the reason they're important is that we make hormones in our ovaries primarily, but other places in the body. But we're talking about reproductive hormones. So we make these hormones and then they go into our bloodstream and they circulate through the body and do their job. They ask them different tissues and then they go to the liver to be kind of broken down once they're not new and fresh.
Brie: And then they are dumped from the liver into our intestines to clear. And the urine actually also clear through the kidneys and clear with the bowel movement. And that's how they leave the body. And that's in an ideal world. And then we make new fresh ones and those go circulation and everything's happy. But if you have liver detox that's kind of backed up or traffic jam, that's not going to happen as efficiently. And we're not going to break down those hormones leaving room for fresh new ones. So that's something I'm always checking in to see if a person has signs of, you know, overburdened to detox. And then the other thing is what's going on with their gut, how's their gut health. So what happens is that both for hormone health and for lowering overall inflammation, we need to have a good, strong, healthy microbiome with as much diversity as possible.
Brie: You know, diversity is strength everywhere in the gut, in the world and politics. So I, when I, what I do is I wind up testing people's guts for infections and also looking for imbalances in their good bacteria too. So I'll feel a lot of things like infections such as H pylori or candida is a big one with acne. Bacteria like staph and strep or also there's a huge connection between SIBO, small intestinal bacterial overgrowth and acne. So any of those, you could have any of those going on. And those can basically do two things. One is that they create a bunch of toxins. We call these endotoxins and those are inflammatory and our connective tissue is especially sensitive and the skin is a connective tissue so that can promote acne. And then also we have to have tons of good gut flora because they're our main player in regulating our hormones, especially estrogen levels.
Brie: And if you remember back in part one, I mentioned that women with PCOS tend to build up excess estrogen and they don't have enough progesterone to balance it. So we want everything working to clear our estrogen and keep us in a happy, healthy range. So we need to have the right bacteria so that we don't re circulate our estrogen. So again, liver, I look at the liver, I look at the gut and then a lot. And then last but not least, we work with the hormones to promote ovulation and proper signaling. And so sometimes we'll use things to help clear excess estrogen. And you know, even at home that's like putting ground flaxseed in your smoothie. Sometimes where there's a lot of other herbs that can come into play. And one of the really common herbs that people may have heard of is called Vitex or Chasteberry that are in certain people can be really, really helpful.
Brie: So in one study of about 120 women, they had four different types of acne and they took Chasteberry or Vitex for one to two years. And by three months, 70% of the women were free from acne. Just from that step. Like without.
Jennifer: Wow. That's huge.
Brie: Yeah.It's huge. That's a huge, there's very few things in the world that are that effective. And that's a pretty safe one for people. You know, that's a herb that's been used in just folk medicine for, you know, millennia. So it's not something that people can mess themselves up too bad with. So anyway those are some of the steps that I'll look at kind of clinically with testing.
Jennifer: And think it's important. Like I said, this is important. If you're going to be serious about it, you cannot go, okay, we're talking hormones. You gotta work with a practitioner that is trained in hormones. I cannot stress that anymore. If, and not like training like I did an online course. No, you gotta work with somebody that really has a lot of schooling because they're, if you're messing around with hormone pathways and all these other more complicated areas, you've got to work with somebody that really knows what they are doing because everything affects something else. And when you start to mess with different things, especially these critical hormones, it can cause other issues. So that's why I say this with love and care. Find someone like Brie is an amazing person. She's got a private practice and she sees clients. You see clients virtually. Correct?
Brie: I do video consult. Yeah.
Jennifer: So there you go. It doesn't matter where you live. You can see Brie.
Jennifer: Well great. Thank you so much for joining us. I'm going to put all of your links below and again you've got that free hormone quiz. We'll put a link to that. So if anybody's interested in seeing what their hormone balance is like, especially if you're dealing with all sorts of skin issues. So again, hormone issues can show up on the skin in a myriad of ways. Doesn't just have to be acne, but that's what we're talking about today. Brie, thank you so much. I promise you guys, we are going to have Brie back. Brie and I were brainstorming on other ideas. Brie going to be back, but thank you so much for joining us. I really appreciate it.
Brie: Jen, thank you so much for having me. This has been great.
