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I often talk about how nutrition and digestion can play a role in our skin health. And there are many different dietary theories out there that have been used over the decades (and even centuries) that could be beneficial.
As you might already know, I don't think diet for many with chronic skin rashes is the only tool that should be used to help achieve healthier skin. It's one tool in the larger toolbox.
So today I'd like to share with you the Traditional Chinese Medicine (TCM) approach to nutrition as it could potentially relate to skin rashes.
It's honestly fascinating and this ancient method does draw some interesting conclusions about the impact of different foods on the body based on certain imbalances present.
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My guest today is Dr. Olivia Hsu Friedman, DACM, L.Ac, Dipl.OM. She is the owner of Amethyst Holistic Skin Solutions and treats eczema, TSW, psoriasis, and acne patients throughout the US in person and via video conferencing using only herbal medicine.
Dr. Olivia earned a Doctorate in Acupuncture and Chinese Medicine as well as a diploma in Traditional Chinese Medicine Dermatology.
Outside of the office, Dr. Olivia serves on the Board of Directors of the American Society of Acupuncturists, the Advisory Board of LearnSkin and the faculty of the Chicago Integrative Eczema Support Group sponsored by the National Eczema Association.
Join us as we talk about how Traditional Chinese Medicine (TCM) diets may help improve skin health.
Has a Traditional Chinese Medicine diet improved your skin rashes? Let me know in the comments!
In this episode:
- Historical context for the TCM diet (and why this is relevant to your skin)
- Understanding how different types of food affect your body
- How does TCM view digestion?
- What types of food does Dr. Friedman recommend for people with eczema and other skin conditions?
- Should your diet change with the seasons according to TCM
- Why bitter foods are important to incorporate into your diet
Quotes
“There was this understanding that there are foods that are on the colder side. There's foods that are on the cooler side. There are foods that are warm. There are foods that are hot. And then later on, they figured out obviously there's neutral foods too.” [5:25]
“In Chinese medicine, especially when we're putting together herbal formulas, we're always looking at balance. A lot of times when we put together formulas that are looking at these inflammatory conditions like TSW, like eczema, like psoriasis, we have a lot of herbs in there that are actually cooling in nature. However, we always make sure that there's something in there that balances that, so it's not ultra cold, so that your body has a better chance of actually not being wrecked by any one individual ingredient.” [16:23]
Links
The Tao of Healthy Eating by Bob Flaws
Apple Cinnamon Porridge (congee)
Follow Dr. Olivia on Facebook
218: TCM Diet To Support Skin Rashes w/ Dr. Olivia Hsu Friedman, DACM FULL TRANSCRIPT
Jennifer: Thank you so much for joining us, Dr. Friedman. I really appreciate you being here, back on the show. And today we're talking about a topic that we've actually never discussed before. You might've mentioned it previously on our other episode, but we're going to be talking about TCM dietary theory, and how you can also use this as part of your nutritional therapy in addressing various skin rashes. Maybe we can even touch on how that could be helpful with somebody who has TSW, for example. But I think let's start off with why historically has this been helpful? Where did the theory even come from? That way we can place it in the appropriate context.
Dr. Friedman: Sure. Well, thank you so much, Jennifer, for having me back again, and I'm really excited to talk about this topic. As you said, it is something that we all do every day, so it's helpful to know the different ways that we can look at it, because the TCM perspective is slightly different. And as you mentioned, there is a historical stint to this that makes it different. Right now, I think in modern times, we're starting to understand different things about nutrition and where they fall in. But what's really interesting about Chinese dietary therapy, is that it shows up in the literature at least 2,500 years ago. And I say at least only because we only had paper and pen for so long. And so before that there were bones and there were other things that people were scribing on. But these are the things that we can actually say materially we have.
Dr. Friedman: So, at least 2500 years ago, we had information that basically said that there were all these references to healthy eating and that there was this understanding that we use different parts of foods for different parts of healing. For example, there was this understanding that there were all these different pathogens and we typically use medicinals for them. However, we also understood back in as early as 200 BCE, in this book called [foreign language 00:02:06], which is where a lot of the TCM theory comes back from, that grains are used to nurse the body. We use fruits and nuts and vegetables to aid that. And we also broke that down further and understood that there is this thing called the five flavors. And it is really important to have all five of them, because they actually supplement that life force that you have as well, as that constitutional or genetic essence that you are born with.
Dr. Friedman: Okay, so even as we knew that, it started to evolve in terms of what exactly does food play in our lives? And as far as 220 CE, or AD, whichever one you prefer, there was another important texts that came out called the [foreign language 00:02:52]. And in this one, it actually talks about this idea that if you combine herbs with common foods, that equals good health. And there was this sense that medicinals and foods actually share the same source. And so there's this idea that they go together. It's not something that is separate. We think of things as, we get sick, we have medicine. But we don't think of it as we need it in combination with food. But we thought about that in Chinese medicine, as far as 220 AD.
Dr. Friedman: But then things progressed. From that idea, the Chinese became very, very, I want to almost say obsessed with the idea of longevity and what exactly makes us live longer? Okay, and again, there's this idea that food is a big part of that. There's this understanding that in order to live to at least a hundred years old, which is what they believed every person was capable of doing, that it has a lot to do with what kinds of food you're actually eating. And there was also this understanding that with those different five flavors, that if you do too much of any one of them, you could actually damage different organs, or you could damage the function of your body. And we see that playing out right now in real life. But they already understood this whole idea of balance.
Jennifer: How progressive of them, by the way.
Dr. Friedman: Yeah. Right? This is so long ago, how could they possibly know this? And mind you, all of this was done without a microscope, without any technology whatsoever. This is based on just observation and just watching thousands and thousands of people. And each doctor observing more in sharing those notes with the previous doctors before them.
Dr. Friedman: So, then when we go to 420, 589 AD, there was another text by a doctor named … Well, I think it may have been a mythical person, but it's supposedly this physician. It's best known as the [foreign language 00:04:51], which is basically this book that talks a lot about more of this idea of the five flavors, more this idea of the different natures of food and how does it actually affect you. And this is where they started discussing things like the temperature of your food, not the actual degree temperature, but how does it actually affect you when you eat these foods?
Dr. Friedman: So, you can eat something that's not particularly hot in temperature, but when you eat it, it actually makes you hot. Like say for example, cayenne pepper, something like that. So there was this understanding that there are foods that are on the colder side. There's foods that are on the cooler side. There are foods that are warm. There are foods that are hot. And then later on, they figured out obviously there's neutral foods too. And this is when they started to really think about the idea that if you are pathologically hot, then doesn't it make sense to eat foods that are actually more cooling? And if you are pathologically cold, doesn't make a lot of sense to eat foods that are nurturing you to be a little bit warmer.
Dr. Friedman: So, that's when we start to see these things where eating certain foods can actually affect the different kinds of diseases that you have. But there also is this understanding, another famous doctor basically said that whenever people are sick, you need to regulate your diet and your lifestyle, but only if that's not enough, then other intervention should be considered. So again, there's this idea that yes, there's preventative help, yes, there's interventions that food can play a role in, but there's also this understanding that it can't do it all. And at a certain point, you have to realize that you might need a more invasive intervention.
Dr. Friedman: So, these are a lot of the ideas behind Chinese medicine and food therapy. I think that there's this understanding that there's a place for it, for sure. And in every single part of your disease, there's a place. But to what degree of plays a role will depend on where you are on that spectrum of your condition. So, does that make a lot of sense?
Jennifer: It does. And I actually want to say, thank you for bringing that up, because I think when we have conversations here on the Healthy Skin Show about diet, it's always so important to me to clarify that this may work, it may not work. It may support what you're doing, or it may be a foundational piece for you to build on with other tools. This diet is not always going to solve the problem.
Jennifer: And I'm sure you see that a lot in your practices I do. That there are so many people who've been failed by the promise of these different diet books. “If you just change your diet, if you do AIP, or you go …” And it's interesting, you mentioned about grains, the importance of certain grains and how we have this backlash against how grains are so bad for. You should take grains out. They wreck your gut. It's so interesting that this is such a unique journey, and it's crucial to remember that diet can be helpful. It can play a role. It can be maybe what does get some people to the finish line. But if it doesn't for you specifically, who's listening right now, it doesn't mean you failed. It just might be a piece of the puzzle and you still need to do some other things to help.
Dr. Friedman: For sure. Yeah. And I think the other thing that's really important to stress in Chinese dietary theory is this understanding that everybody's born with a very different constitution. And your genetic being, if you want to say, is determined by your parents. And so you're coming to this world with a certain set of things that you probably have a higher propensity towards. So, certain skin conditions or whatever those other conditions possibly be. That doesn't mean it's a sentence for the rest of your life to have this. There's also this idea that you can use food to coax your function to be a little bit better, but you may not completely change it a hundred percent through food.
Dr. Friedman: So, I liken it to your microbiome is very similar to, and I do a lot of gardening, is like garden soil. You can't just put one thing into that garden soil and expect your soil to be perfect to grow all these different plants, which I'll take the plants as being all that flora that you want in your guy. To have that appropriate commensal relationship with bacterias and viruses and all those things that typically live in your gut. But, a lot of people are under the impression that if I just throw this one supplement in, or if I just eat more of that food, or if I eat a ton of this kind of thing. Good Is good, more is better. That's not really how it works. And it plays out when you look at your own garden and you try to throw one chemical in there to bring up the magnesium, or bring down the potassium or whatnot, and your plants don't grow automatically overnight like that. It's something that changes over time.
Jennifer: True.
Dr. Friedman: And so you might have to go through a few seasons of supplementing your soil and making it better, so that the next season that you actually have a planting, that you actually have healthy growing things, or maybe each year you do something more and they're better and better each year. And I would say the microbiome is the same way. It's not something that happens overnight that you can fix. It's something that you do have to work on over time. It also depends on what you're given to begin with as raw materials. And you can't change that entirely. It's like saying again with the plant analogies, if you're a chrysanthemum, you can't turn into a marigold. If I'm really, really meant to be tall, I can't make myself short. Things like that.
Jennifer: And different plants require different pHs of the soil, different nutrients. And so that's why the bio-individuality of the person must be taken into account. It's Interesting, because you were saying about the microbiome, which is so important, but the digestive process in and of itself, well at least in my practice, I consider that step one. With TCM and the way that they view digestion, at least my recollection is like, there's this digestive fire. You want to have this digestive fire. Can you talk a little bit about that?
Dr. Friedman: I'm so glad you asked me about that. So, the way that we see digestion and TCM, is that the stomach is basically seen as this organ that's helping to decompose and basically cook the food, so that it's bioavailable for the rest of your body. So, what happens is all of those pure parts of the food, which are better known as the five flavors in Chinese medicine, they're things that actually help to supplement your life energy if you will, or life force. And then all those pure parts of the liquids that you drink are what help to fortify your blood and in all the different fluids in your body as well, it's like cerebral spinal fluid, or interarticular fluids and things like that.
Dr. Friedman: Now, anything that's impure is essentially what gets pushed down to the large intestine. And that comes out in your bowel. Now, in your large intestine, there's also this other function that happens that the ancients recognized that there was even more stuff that was being taken out of whatever was left over from the stomach. And some of that stuff actually went towards what they called the life gate, which is again, this other idea of the life force within you, the essence within you and whatnot, and supplementing that. But the rest of it went out the bowel and exited the body.
Dr. Friedman: There was another sense of the impure fluids that didn't quite make it through to the blood would then move out to your small intestine. And then that would be pushed out as well as urine. So, the idea is that because the stomach is always cooking this food, it needs to be at this temperature all the time, which is around a hundred degrees. And if it's not at that temperature at all times, it's basically going to impede the way that your digestive system works.
Dr. Friedman: So, how does that play out? That means that when you're eating things that are actually cooling the system, you're actually abusing it. And so if you're continuously abusing it, you're going to make that function, not function. And over time, that's where the problems start. So, things like cooking food is a really important part of Chinese medicine, digestion and nutrition. Because if you cook food, you basically allow a lot of the nutrients to be released from the cellulose that holds it, and then your body doesn't have to work so hard to actually take those ingredients and then bring them out to the different parts of your body for nutrients. So, a lot of people are fixed on this idea of eating only raw foods. And they feel like there's more enzymes, there's more vitamins, there's more minerals available, but that's not a 100% true. Because going back to that idea of these things are locked within the cellulose and your body has to work a lot harder to break that down, whether it's by chewing, or actually in your stomach.
Dr. Friedman: And so we actually have to talk more about the net gain that your body's actually getting from having this particular food in you. So if you actually cook it, your body doesn't have to work so hard for the amount of vitamins and minerals that it gets out of it. But for raw food, it has to work awful hard chewing and digesting. And by the time you take out the energy that was needed to do that, you almost have a little bit more of a deficit, not necessarily a complete deficit. I would say you're not gaining as much as you think you are. So in Chinese medicine, it's all about eating cooked foods. You hardly ever go to a Chinese restaurant and see anything raw. It's always cooked. It always comes to you warm and it always comes with tea. And that's another idea of keeping the system at that hundred degrees at all times. The other thing is [crosstalk 00:15:13] Go ahead.
Jennifer: Can I actually ask you a question? For someone with eczema, or or a TSW, where you feel really overheated and have difficulty regulating your temperature, do you generally recommend more cooked foods for those individuals? Or might sometimes cooler, or cooling type foods be beneficial?
Dr. Friedman: That's a really great question, Jennifer. And the answer is all of the above and none of the above. It really depends on the situation, because I would say that, yes, there are definitely foods that, as I mentioned before, can be categorized between hot, warm, neutral, cooling, cold. And the thought of if you're pathologically hot, wouldn't it makes sense to eat cooler foods? And the answer is yes, but if you're only eating cold foods and those cool foods are below a hundred degrees, guess what? You're probably going to do some damage to your stomach. And if you do some damage to your stomach, now, you're not able to do the work that it's meant to do in terms of digestion. So, you're substituting one thing for another and you don't necessarily want to do that.
Dr. Friedman: So, in Chinese medicine, especially when we're putting together herbal formulas, we're always looking at balance. A lot of times when we put together formulas that are looking at these inflammatory conditions like TSW, like eczema, like psoriasis, we have a lot of herbs in there that are actually cooling in nature. However, we always make sure that there's something in there that balances that, so it's not ultra cold, so that your body has a better chance of actually not being wrecked by any one individual ingredient.
Dr. Friedman: So I would say yes, I would tell my patients, “If you have a propensity to be eating a lot of these hotter foods all the time, not temperature wise [crosstalk 00:17:09], but how they actually work in your body….” Yeah, you probably want to stay away from them, or at least cut down on them, or at least balance them with some foods that are cooler. And then if you're really, really in a place where the inflammation is so out of control, it might help, but it's not going to solve the problem because now you've gone way the other side of the other spectrum. And as I mentioned before, you should try another intervention if the regular diet in the lifestyle is not enough. And that's what that famous doctor said way long ago.
Jennifer: I love that some diets are so … especially when they say, “Eat local,” you're forced to eat what's seasonally available for you. So, how does the seasonality piece to this play into TCM? Because how many people are trying to do juices in the middle of the winter and they live where it's super cold? Like you and I, we live in areas where it's cold in the winter time. The last thing I want to do is juice cucumber and spinach and all that stuff. But yet there are some people that are doing that. So how does TCM view seasonality when it comes to food and eating?
Dr. Friedman: Okay. So, it just so happens that those foods that typically grow in those particular seasons have the nature of what that season is, which in Chinese medicine, we're always trying to make sure the microcosm is in alignment with a macrocosm. So, if you think of your body as a microcosm within the earth, which is the macrocosm, we're always trying to stay in the same alignment. So if we're able to grow these foods at this time of year, those particular foods actually work really well on your body at that time of year.
Dr. Friedman: And so that's why lots of times when people are eating things that are shipped from other countries, like for example, mangoes. They come from south America and the middle of our winter, and then people are getting sicker from eating these kinds of things, because they don't really align well with the season that your body is in right now and what your body needs at that point in time.
Dr. Friedman: So the other thing is Chinese medicine really aligns with the seasons. You should be eating what your season is actually asking you to do. And there's different seasons that have different kinds of flavors and different temperatures of food. And obviously in the summertime, you probably want to eat more cooling foods overall, because you tend to be hotter because the sun is out. In the winter time, you probably find yourself gravitating to things that actually make you warmer. I know a lot of people who drink red wine and whiskey and scotches and stuff like that, and they wonder why they're gravitating towards that in the winter. It's because it's warming you.
Jennifer: And pumpkin pie spice.
Dr. Friedman: Right, exactly. So those are all the kinds of things that typically happen. And we probably should do a better job of thinking about how do we stay in this alignment with the season that we're in, and try to give the body what it needs during that time period. People tend to be a little bit drier in the fall, so we should have more moistening foods. People tend to be sweating a lot more in the summer, so we should have foods that help keep us hydrated, like watermelon. Things like that. So, foods should always match where we are in life, where we are in season and also our age too.
Jennifer: That is so interesting. So, are there any tips that you have for how someone … so we know that there's … well, at least I see there's two types of people seem to be really reactive to food. There's those usually with eczema and they're allergic to everything and there's a lot of environmental allergies, a lot of food allergies. But then you also have the person who has TSW, or topical steroid withdrawal, where they also seem to be reactive to a lot of things. Is there any general principle that somebody who's really reactive to a lot of foods could possibly at least just from a foundational level, where would you recommend they start?
Dr. Friedman: Yeah, so that's a really interesting question as well. And I see that in my clinic as well as you do. And I would say that there are definitely people who have allergies and they are never going to get over them and they should just avoid those foods. And they're probably going to always react when they have those foods. But the other thing that happens when you have an inflammatory skin condition is that because your skin is compromised, you basically become hypersensitive to everything. And even benign ingredients become an issue. And it's random. One week you will be completely fine and you can eat these foods, or you can be in contact with certain ingredients or substances. And then a couple of weeks later, all of a sudden you can't. And that's why every eczema patient I know, every TSW patient I know, has a cabinet full of all different kinds of products because they've gone through all of them and they've had reactions to all of them.
Dr. Friedman: So I would say that you probably will have more sensitivities in general when your skin is at its height of being inflamed and having all these different issues. In terms of foods, I would say you want to stay in what Chinese medicine would probably consider those neutral foods. Those foods that are not too hot in temperature, or at least they're not making your body so hot, but they're also not cold either. They're also gentler on your stomach. One of the things that Chinese medicine really pushes hard, is this idea of congee, also known as jook.
Jennifer: I was just going to ask you about that. I'm so glad you brought that up as I have a recipe on my personal website that is based on congee.
Dr. Friedman: Yeah. And it's one of the easiest foods for the body to digest. So what it essentially is, is like a rice porridge. Rice in Chinese medicine is considered a very harmonizing food, that is really good at tonifying the system, and it's a very easy thing for a body to take. And so what they typically do is make this congee and then they mix it with different things. And a lot of those things happen to be Chinese herbs. A lot of these herbs are considered common foods in China, but in America we would probably say, “Oh, that's not something I usually eat.” But it's an herb.
Dr. Friedman: So, a lot of these things are another vehicle to actually get these appropriate things into your body, so that you can actually heal. Or it can affect your body in such a way that it's coaxing it towards that more way of being.
Jennifer: So, is rice a neutral food, generally?
Dr. Friedman: In Chinese medicine, it is considered a fairly neutral food. It's considered a sweet food if you would look at the five flavors. And sometimes we think of sweet foods as, “Oh, well, they can't be good, because that's not somehow going to be a positive thing. Too much sweetness, too much sugar, or whatnot.” And in Chinese medicine, we do also say that sometimes sweet foods can be what they call dampening and dampening is not a great thing to have too much of in the body as well. Because there's this idea, going back to the idea that the stomach is this cooking vessel for all the foods that come into your body, if you have too much dampness, it's like water on that fire, that fire that stomach is supposed to be. And if you have too much of that water, you're basically putting that fire out.
Dr. Friedman: So, you also want to be careful on everything that you take in from the Chinese perspective that you don't do anything too much, you do everything within limit. And you also are very smart about how are you combining these things, so that you're never doing too much of anything.
Jennifer: I was going to say one complaint, my sister is also an acupuncturist, and she always says that Americans, we tend to avoid bitter foods. We overcompensate with sweet and avoid bitter. There are some people that do bitter, they do a lot of coffee. Coffee, I would consider a bitter food. Are there any other bitter foods that maybe you could share that might be helpful for people to try, or to maybe integrate in? Because bitter foods are good for us.
Dr. Friedman: Yes. And especially if you happen to have a TSW, or an eczema, or psoriasis condition that tends to be a little more oozy, or you have a little bit more exudate, things like that, bitter foods tend to dry things. And so if you have those kinds of conditions that are a little bit more on the wet side, these kinds of things can help. Again. I'm not going to say it's going to make it all better, but it will definitely move your body into coaxing it into that better situation. So, in terms of bitter foods, dandelion is something that is really great. I know the Greeks actually eat a lot of that. Parsley, collard greens, mustard greens, a lot of the greens. Arugula, kale, celery. Those are all foods that are considered bitter.
Dr. Friedman: The other thing that it does is it tends to move things down. So, if you happen to be somebody who has a lot of dampness in your body, you will notice that when you drink coffee, you usually go to the bathroom right after. So, a lot of these foods have that movement in your body. And again, in Chinese medicine, we look at foods, not just from flavor, not just from temperature, but also what direction does it move things? So bitter foods typically move things down. Foods that are sour tend to move things up. Things that are acrid, or spicy, or pungent, they tend to move things around, up and out. And then sweet foods, like I said, they tend to be nourishing, they tend to harmonize, they tend to moisten. And salty foods also tend to purge. So, you've probably noticed if you get a lot of salt, or some of these people do that salt water cleanse, what does it do? Well, it's flushes everything out and everything goes down.
Dr. Friedman: So again, there's this idea of understanding of, how does this food actually affect your body in all these different ways. And as you notice, as I'm talking, there's more and more things that are associated with each of these different types of foods, that it is a more complicated thing. It's not a, “Oh, I'll just eat this one thing and it's going to do this other thing for me.” It's like, well, you have to have a combination. Everything affects everything else. Everything affects every other part of your system too, not just your stomach. And so you have to be mindful of all those things.
Jennifer: Do you have any resources on your website about either the congee, or the dietary theory? Or do you have a book reference, or recommendation to check out?
Dr. Friedman: I do, in fact. This is a nice, simple book that everybody can take a look at. It's called the Tao of Healthy Eating by Bob Flaws. It's a really nice book, because it's made very simply, or it's written very simply so that anybody can understand it, not just somebody who studies TCM. And one of the great things about it is he actually lists every single food and talks about whether it's a sweet food, whether it's a hot food, whether it's this and how does it actually affect your body. So it's a great resource to look at. It's a quick read too.
Jennifer: Awesome. Thank you so much. And I just want to remind everyone that you do work with clients all over the US.
Dr. Friedman: I do. I even see people outside of the US too.
Jennifer: Yes. You work like I do, virtually.
Dr. Friedman: Yeah.
Jennifer: So, nobody needs to travel to Chicago in the middle of the winter.
Dr. Friedman: That's right. No one has to worry about parking, or sitting in a reception room, or whatever. Yeah. So I work with people wherever they are, however they need me. And I think because the TSW community is a really tight one, I think people have passed my name around. And that's how I've gotten to know a lot of people from other countries as well. So yeah, I'm happy to help all people from all places and at any stage of their condition.
Jennifer: Awesome. Well, we'll make sure to link up to your website and to this book in the show notes, that way it's really easy for people to not only find you, but to do a little bit more research on how they could implement it. I think it's important to say you don't have to implement this 100%. You could just start with one step. Try integrating in some foods and test them out and see how you do it. Would that be a smart way to go, Dr. Friedman?
Dr. Friedman: I would definitely agree with that. I think that we have this tendency to try to do all or nothing all the time. And I think what really works best is doing a little at a time. And so I agree with you 100%, Jennifer. Just try one different [crosstalk 00:29:59].
Jennifer: Dip your toe.
Dr. Friedman: Yeah. And again, it's all about moderation. It's all about balance. Don't jump off the deep end by just doing the one thing, and only the one thing. Really take into consideration, what is your constitution? What is your condition? And let's match the solution with the condition.
Jennifer: Perfect. Thank you so much for coming back. I really appreciate you being here.
Dr. Friedman: You're welcome, Jennifer. Thanks so much for having me again. It's always a pleasure to talk with you.
What an enlightening episode this is. It helps me understand the necessity and benefits of eating a variety of foods in moderation. Thank you!