Season 2 Episode 4 Full Transcript: Nutrition, Nutraceuticals and your skin health with insights from board-certified dermatologist and dermatopathologist Dr. Mamina Turegano

[Amy Gordinier] Total skin nerds is brought to you by Skinfix. We're clean, clinically active, and on a mission to deliver healthy skin.

Welcome to total skin nerds. I'm Amy Gordinier, founder of Skinfix. Total skin nerds is where I get to nerd out with some of the world's foremost experts in skin. We deep dive into issues related to skin disease, skin care ingredients, diet and lifestyle modifications to support skin health, and even spiritual practices and their skin benefits. I'm especially excited for this episode today. In season two, episode four, I'm chatting with triple board certified dermatologist, Dr. Mamina Turegano about nutrition, nutraceuticals, and your skin health. And specifically, we'll explore the emerging science linking nutraceuticals in our food and nutrition with common skin issues we all face every day. Dr. Turegano's insights into the role of nutrition and the foods we eat and the health of our skin are invaluable and I think particularly relevant today.

You may know that at Skinfix we're hyper focused on skin barrier health and the causes and cures for some of the most vexing skin conditions including acne, eczema, rosacea, and psoriasis. So this conversation really resonated with me, and I know it will for you too. Stay tuned skin nerds. Get ready to hear how what you're eating and not eating is having an effect not only on how you feel but how you look each day.

So welcome Dr. Turegano to total skin nerds. It's so fantastic to have you. We really appreciate you joining the podcast.

[Dr. Mamina Turegano] Thank you so much for having me. I'm definitely a fan.

[Amy Gordinier] Well, we are a huge fan of yours as well. And the subject that we want to talk about today is nutrition and nutraceuticals and skin health. I've been listening to a lot of content on your social media and on YouTube, and it's just absolutely fascinating and really surprising in a way that there's so much scientific efficacy linking nutraceuticals and our food and nutrition with skin issues. So I'm excited to dive in with you and learn more.

[Dr. Mamina Turegano] Yeah, same. Excited to talk about it.

[Amy Gordinier] So let's start a little bit of talking about the Western diet, which I know we hear a lot about. But tell us a little bit about sort of why, perhaps, the Western diet is causing some issues.

[Dr. Mamina Turegano] Yeah. And the Western diet is so normalized that people just think that it's okay to eat these foods. But the Western diet is composed of just more of a high caloric, high glycemic index diet. It's heavy on dairy. It’s heavy with saturated fats. That's kind of the basic gist of it.

[Amy Gordinier] And explain a little bit about something that I just learned about from your content, MTOR. What is MTOR, and why is it not a good thing?

[Dr. Mamina Turegano] Yes. So MTOR stands for mammalian target of rapamycin. You don't have to know what that is, you don't have to memorize the name of that. But what MTOR is, it's composed of two complexes. There's MTOR one and MTOR two, and MTOR one is kind of what we talk about more, but we just call it MTOR, but that it's more sensitive to nutrition. But in general, yeah, MTOR responds to various environmental signals, whether it is nutrition, hormones, growth factors, and then takes those signals into account and responds with some type of protective reaction with the body. When there's certain foods that are consumed, for example, if there's like an increased consumption of dairy, MTOR takes that into account. It's like, oh okay, we see dairy. And MTOR then increases androgen secretions. Androgens including things like testosterone. And this is how it can increase oil production and clogging of pores and acne.

[Amy Gordinier] Wow. Okay. So you talked a little bit about, on a YouTube video I watched, about the relationship between MTOR and specific skin issues, specifically atopic dermatitis, psoriasis, and acne.

[Dr. Mamina Turegano] Yeah.

[Amy Gordinier] I'd love to talk a little bit about how MTOR is directly linked to those individual conditions. So for instance, atopic dermatitis, how does MTOR exacerbate atomic dermatitis?

[Dr. Mamina Turegano] Okay. This is where we start getting nerdy, which I think is appropriate for this podcast. So yeah. When there's increased MTOR activity in the setting of somebody who's predisposed to atopic dermatitis, MTOR can increase the activity of certain cells that release inflammatory markers that we see in atopic derm. So there's a type of cell in our immune system called mass cells. And mass cells are released when you're exposed to various allergens, and MTOR increases mass cell proliferation. So you just become more sensitive to allergens if you have more mass cells in your body. It also activates a type of immune cell, T-cell, there's more T-cell activation in the setting of atopic dermatitis. So you're creating like this in inflammatory situation that is definitely very predisposed to atopic dermatitis, eczema. These types of cells show up as this type of rash.

[Amy Gordinier] Wow. Okay. So these foods that cause a proliferation of MTOR or an increase in MTOR, things like high glycemic index foods. So things with a lot of sugar, carbohydrates, or dairy can actually cause someone who's prone to atopic dermatitis to have a flare up.

[Dr. Mamina Turegano] Yes. And when it comes to each individual skin in condition, I know we talked about how there's a bunch of different things that can increase MTOR, like the foods that you just mentioned. Yeah. Dairy, high glycemic index meat. When it comes to different conditions, there are some foods that are more likely to cause issues than others. And in eczema, we do see more of an association with dairy actually.

[Amy Gordinier] Okay, interesting. So if you see a patient that has eczema, do you talk about food? Do you talk about decreasing dairy or cutting dairy out of their diet?

[Dr. Mamina Turegano] I do. I definitely do like to talk about it. I don't like to tell people that that's going to be the reason, if they cut out dairy, then their eczema's going to completely disappear. Because I think it's complex, and I think that food is only one piece of the puzzle. I think there's other factors and some factors that we don't know that all kind of work together to create this eczema picture, but food definitely can be a player. So I try to talk about it as much as I can with my patients because that is something that they can identify in their everyday life and address.

[Amy Gordinier] Right. And then, let's talk about psoriasis. What are some of the links between food and psoriasis?

[Dr. Mamina Turegano] So yeah, increased MTOR activity can also increase psoriasis. And I think once again, there needs to be sort of like this predisposition to psoriasis. So just because you eat these foods does not necessarily mean you're going to get psoriasis. But there's other factors at play, including potentially genetics, but your cells are sort of set up to develop psoriasis. But with yes, foods that increase MTOR, you can. It increases in your keratinocyte. So keratinocytes is just a fancy word for your skin cells in the epidermis. It increases keratinocyte proliferation or activity, and our keratinocytes continually divide. We're shedding skin once a month. But in the setting of psoriasis, the differentiation or division of skin cells or keratinocytes is a little bit abnormal or dysregulated with this increased MTOR activity. And so, the cells are maybe dividing a little bit more abnormally.

And so that's why we see in psoriasis thicker, scaly plaques of skin on different parts of the body. People with psoriasis are generally very flaky people, whether it's the scalp or just patches of rashes on their bodies. And that's because of the keratinocyte dysregulation.

[Amy Gordinier] Okay.

[Dr. Mamina Turegano] Yeah.

[Amy Gordinier] Interesting.

[Dr. Mamina Turegano] And then in terms of counseling with patient studies that were done with psoriasis, they've seen that a Mediterranean based diet has been shown to be helpful for psoriasis. And then in a subgroup of people, gluten can exacerbate psoriasis. So not in every psoriatic patient, but in a subgroup. And it's interesting, it's still being looked at. But if a patient test positive for celiac antibodies, like if we test for celiac disease the different blood tests, taking in gluten can increase psoriasis. So even if they don't have celiac disease, I'll sometimes screen them for celiac disease to see if they should go off gluten. Although honestly, I feel like everyone should just go off gluten. But that's a whole 'nother thing.

[Amy Gordinier] I tend to agree with that, by the way, but it's really interesting. Do you find that the dermatologist community at large is open to these connections and these links and counseling on what foods might exacerbate certain skin concerns? I

[Dr. Mamina Turegano] I don't know about at large. There are definitely many dermatologists who are interested in this and who do counsel patients on this. But I still think that we're in the minority.

[Amy Gordinier] Okay.

[Dr. Mamina Turegano] I think people want to see... And as you've noted, there is a lot of research that's out there, but I think people want to see more research to really be able to create good guidelines. When real guidelines are made in dermatology, that's really based on a lot of data. And even though there is data out there, it's apparently still not enough to have certain guidelines or strict guidelines on certain nutritional things.

[Amy Gordinier] Okay.

[Dr. Mamina Turegano] I think the Mediterranean diet and psoriasis is a pretty good one though, in terms of the research that's out there.

[Amy Gordinier] Let's do a bit of a deeper dive into acne.

[Dr. Mamina Turegano] Yeah.

[Amy Gordinier] Because I was really fascinated by some of the research and thinking on diet and acne in particular. I know that a few years back, the American association of dermatology listed I think dairy and sugar as two things that have some evidence suggesting they could exasperate acne. But what's going on with acne and what might some of those food triggers be?

[Dr. Mamina Turegano] Yes. And I'm very glad. I think yes, with acne, it's becoming more established that dairy and sugar foods with high glycemic load can exacerbate acne. We're also seeing an association with whey protein, which I think is just considered to be a subset of dairy. There's also been an interesting study that saw that people with acne have lower levels of serum, zinc levels. And so it's interesting. So we see that people with acne can also benefit from zinc supplementation. This may not be everyone, but there have been multiple studies out there that have shown the benefit of zinc and acne. They're still small studies, so it's not enough to really incorporate into guidelines. But that is something we're not sure why. It could be maybe the way people absorb zinc. And something else that was… And it hasn't been published yet, but it's been spoken about at a few conferences by... She's a naturopathic dermatologist, Dr. Julie Greenberg, who I think is excellent and a pioneer in functional dermatology or holistic dermatology or integrative dermatology. She really looks a lot at the gut microbiome in people with any skin disease. She sees a ton of acne and she saw this pattern of people with acne have higher rates of H. Pylori... Helicobacter pylori, which is a bacteria that causes acid reflux.

[Amy Gordinier] Oh wow.

[Dr. Mamina Turegano] Yes. People with acne also have higher rates of Candida, and then also higher rates of Protozoa organisms. And so it's also shedding more light on the gut microbiome, imbalances in the gut microbiome in the setting of acne. We're not sure what exactly is the trigger for the imbalances and the gut microbiome. Is it the diet, is it being on antibiotics in the past? There's a lot of factors potentially. So I also do like to talk about probiotics supplementation with my patients too, with acne.

[Amy Gordinier] Yes. The probiotics, it was so interesting. There was so much in your YouTube presentation that I had no idea that probiotics could be so helpful on a number of topics, specifically with acne. Do you think the probiotics are only helpful for somebody…or specifically helpful for somebody that's been on an antibiotic regimen, and so the probiotics are helping to rebalance the gut? Or do you see more globally, a probiotic supplement helping to reduce acne lesions?

[Dr. Mamina Turegano] I think more the latter. I think... Yes, even if you've never been on probiotics, I do think that they're seeing that probiotics are helpful for people with acne in general. There are a few studies coming out and there're certain strains that are more related to acne. It's still... There's so much out there and there's so many strains out there, so it's hard to make some good recommendations, but there is one specific brand that I do like, that was studied specifically in the setting of acne, which is why I like it for acne. It's by a company called Microbiome Labs and the probiotic name is Serene Skin. Serene, like calm.

[Amy Gordinier] Okay, great. Well, thank you for the recommendation, because I think you're right. There's so much out there about probiotics and it's hard to know to your point, what strain do I need for my specific situation and what quantity of probiotics do I need. So that's really helpful. Talk a little bit about probiotics and atopic dermatitis. There was some interesting research that you talked about on your YouTube presentation, about a study with pregnant moms and babies, and allergenicity. Talk a little bit about how probiotics can help with allergenicity and atopic dermatitis.

[Dr. Mamina Turegano] Yes, it was a really cool study. I think it was done in Israel where pregnant mothers who took probiotics had lower rates. Their offspring had lower rates of atopic dermatitis. I think it gets a little bit complex as to how that happens. And there also certainly have been studies too that have shown an association of certain probiotics in people with eczema, benefiting patients with eczema too. And so taking probiotics with eczema's helpful. And I just thought it was so cool and interesting that if pregnant mothers can potentially prevent childhood eczema in their children if they took probiotics themselves.

[Amy Gordinier] It's fascinating. What was really interesting as I was watching one of your reels earlier today, where you talked about how well probiotics are really helpful internally, orally. Actually in topicals and skincare, probiotics aren't as helpful, prebiotics are more helpful.

[Dr. Mamina Turegano] Yes... Yes.

[Amy Gordinier] Excuse me. Do you want to talk a little bit about why a prebiotic in a topical might be more useful?

[Dr. Mamina Turegano] Yes. And I wish I also mentioned postbiotics too. So probiotics are actual live bacteria and probiotics don't really thrive in skin care products, just with the environment of the creams or whatnot. If they do thrive then they're short lived. So scientists have realized that it's better to actually use prebiotics or postbiotics. And prebiotics, what they do is their role is to feed or nourish the good bacteria. And so in the skin, the prebiotics can help... Yes, the good bacteria thrive. And there are a couple examples that I gave. One, Aveeno. So Aveeno's famous for having oats in their skincare, and oats are a form of prebiotic, which I thought was really cool. La Roche-Posay... Another French brand, Vichy... And there's another brand called Avene. All these French brands, they use the special thermal spring water from their respective towns. La Roche-Posay is actually a village in France where it has this special thermal spring water that's full of a variety of nutrients, minerals, that have prebiotic effects. They nourish and, yes, help the good bacteria on the skin.

 And there's also some nice skin care with postbiotics. Postbiotics are byproducts of bacteria. Some people call it bacterial poop, but they actually have healthy, can have healthy effects. Not sure why, but yes, there's a wonderful postbiotic in one of La Roche-Posay's moisturizers that also really helps balance the microbiome.

[Amy Gordinier] It's really cool. This idea that the microbiome is in dysbiosis, but you either feed the good bacteria, the nutrients that they need to rise up and overtake the staff or whatever it is that's causing the issue, or you feed the skin the output of the postbiotic, what the organism would create in order to defend itself.

[Dr. Mamina Turegano] Yes.

[Amy Gordinier] It makes so much sense.

[Dr. Mamina Turegano] Yes.

[Amy Gordinier] And I think for so many years, we in the skincare world have been trying to figure out what to do with the probiotic space. And our chemist in particular has always said probiotics aren't going to survive in a preservative based skincare product. So we've always leaned in the prebiotic area and are starting to work with postbiotics, but it's interesting. So probiotics orally, pre and postbiotics topically.

[Dr. Mamina Turegano] Yes.

[Amy Gordinier] Love that.

[Dr. Mamina Turegano] Yes. And you could also do prebiotics orally too in the form of various foods and...yes, high fiber foods.

[Amy Gordinier] Yes. And you talked a lot about in your...the seminar that I listened to that prebiotics or high fiber diets help to reduce MTOR and help to counteract some of the effects of inflammation.

[Dr. Mamina Turegano] Yes, yes. And...when people say plant-based diet, I think that's one of the biggest benefits of a plant-based diet is the fiber. Fiber, the word doesn't really sound that sexy, but really it benefits everything so much. So yes, fiber, because it does feed your good bacteria.

[Amy Gordinier] One of the other points on probiotics that I thought was really interesting was you talked about how probiotics taken orally can actually reduce trans epidermal water loss. So effectively, they can help strengthen the skin barrier and even reduce skin reactivity or sensitivity. That...

[Dr. Mamina Turegano] Yes.

[Amy Gordinier] Blew my mind.

[Dr. Mamina Turegano] Yes. It's... Well, bacteria are part of the skin barrier. They're one of the components. In addition to them physically being part of the skin barrier, they also interact with the skin cells to help increase moisturization, to increase barrier function. That's how it works.

[Amy Gordinier] Really...

[Dr. Mamina Turegano] Yes.

[Amy Gordinier] Really cool.

[Dr. Mamina Turegano] Yes.

[Amy Gordinier] Let's talk a little bit about niacinamide because we hear a lot about it in topicals right now, and it's a hot ingredient. You talked a lot about taking niacinamide orally for some really amazing benefits. So things like prevention of non-melanoma skin cancers.

[Dr. Mamina Turegano] Yes.

[Amy Gordinier] Let's talk about niacinamide.

[Dr. Mamina Turegano] Yes. That one really is a wonderful, I think finding. That was done in a study in the New England Journal of Medicine, I think in 2015 or 16. It was a pretty large study, and saw that those who had a history of skin cancer, a history of multiple pre-cancers, it reduced their risk of getting non-melanoma skin cancer. And we say non-melanoma skin cancer just because everyone knows what melanoma is. But actually the most common skin cancers are the non-melanoma skin cancers, and those are basal cell skin cancer and squamous cell skin cancer. They're so common. And just as an aside, one in five Americans get skin cancer and it's usually one of the non-melanoma skin cancers.

 But what was cool about the study is that they saw that when people were taking niacinamide 500 milligrams twice a day, that it reduced their risk of non-melanoma skin cancer by 20 to 30%.

[Amy Gordinier] Wow.

[Dr. Mamina Turegano] Yes, which is pretty significant. And so I do try to encourage it in my patients who've had a history of skin cancer or who have had multiple pre-cancers. I mainly recommend it to them because of the study that was done in that setting. There are also some smaller studies that have some of the benefits of niacinamide for acne. So I will also sometimes recommend it for my acne patients too.

[Amy Gordinier] Amazing. And you talked a bit too about how this study showed that you had to consistently take it, that when you stopped taking it, the benefits ceased to deliver.

[Dr. Mamina Turegano] Yes.

[Amy Gordinier] So it's about compliance and consistency as well.

[Dr. Mamina Turegano] Yes, yes.

[Amy Gordinier] Not just taking it for a few weeks and your acne clears up and then you're done.

[Dr. Mamina Turegano] Right. Right.

[Amy Gordinier] You're going to have to have it...

[Dr. Mamina Turegano] Exactly.

[Amy Gordinier] On a consistent basis. You know what was fascinating to me about some of your content, was this idea of supplementation and sun protection, which... Obviously and importantly topical sunscreen every day, all the time, reapply. But this idea that a supplement can actually help support your body's ability to protect itself from the sun, and you talked about Heliocare, and I guess they have an ingredient called PLE. Can you talk a little bit about PLE and what the findings are with respect to boosting the body's ability to respond to UV radiation?

[Dr. Mamina Turegano] Yes. So PLE stands for Polypodium Leucotomos extract.

[Amy Gordinier] Wow.

[Dr. Mamina Turegano] Which sounds like a Har... I know. I say that to my patients. I'm like, it sounds like I'm saying a Harry Potter spell.

[Amy Gordinier] It does. It totally does.

[Dr. Mamina Turegano] But yes, it is actually an antioxidant that's derived from the fern plant. Fern, F-E-R-N. And it's been shown to have benefits of protecting your DNA from UV light. And so the way that I talk about it with patients is that I say it's almost like sunscreen in a pill form. I say it definitely does not replace your sunscreen, but it can definitely serve as a supplement, no pun intended, but supplement to your other sun care protective measures. So in addition to sunscreen, addition to wearing sun protective clothing or seeking shade, this is a nice supplement to add. And I definitely emphasize it more so with people who are at higher risk for skin cancer in addition to sunburns, it can reduce your risk of sunburns and then yeah, my patients. I said patients with higher risk of skin cancer and melanoma. It's also been shown to be helpful in a couple of other skin conditions too; in pigment disorders, like vitiligo, which is where you have loss of pigment in the skin and then it's also been shown to be helpful in Melasma where you have hyperpigmentation in certain patches on the face. So it does something where it's this antioxidant that just protects the DNA from getting affected by UV rays in the skin cells.

[Amy Gordinier] So let's talk a little bit about aging because you talk about a direct link between aging and diet and specifically something called glycation, which we should all endeavor to avoid. But tell us a little bit about what is glycation, what causes it.

[Dr. Mamina Turegano] Yes, so glycation basically means that there's sugar or glucose that is combining with some type of protein structure. And in the setting of skin, we think of collagen and elastin fibers. And when this happens, this sugar binding to these proteins or to the collagen, it can affect the structure of the collagen. It can actually make it more rigid or cause it to break down more quickly. And so when it's affecting our collagen, which is there to give us more support and structure, that's what gives us the lift in our face, the plumpness in our skin. So when that is broken down, that leads to more wrinkles, more sagging, the signs of aging that we see.

[Amy Gordinier] Okay, so what supplementation, in addition to diet that is healthier, full of fruits and veggies and good fibers and good proteins. What supplementation is particularly helpful with aging and with reducing glycation or helping to mitigate?

[Dr. Mamina Turegano] Well the first thing that came to my mind is antioxidants. And you did mention food; this is not a supplement, but I think the biggest thing is really making sure that you do have a good antioxidant intake in your diet. So foods that really fit the color of the rainbow. Antioxidants are what also protect our DNA, protect our collagen and can even fight... So when we have damage to our skin, whether it's from UV rays, from processed foods, from cigarettes, it creates something called reactive oxygen species, which is this unstable molecule that can cause collagen breakdown. So antioxidants combined to these ROS, these reactive oxygen species, to prevent further breakdown, and then they could also support collagen building enzymes to potentially even build more collagen. That's just my way of saying that you could also take antioxidants as supplements.

 I don't think that that's been super well studied. I think vitamin C has been shown to be helpful, but I think so much more of the emphasis is on making sure that you have a good intake of antioxidants through your diet. And then another supplement is... I was going to say collagen, but that's a whole nother, controversial topic. There have been multiple studies that have looked at the benefits of collagen. And I am team collagen. I do think that there are benefits to taking collagen. And even personally and clinically, just in my patients, I do see a difference in people who are on collagen supplementation, but there's still a mixed opinion on that. There's still mixed opinions on it, just because the studies are still small and we don't have a good guideline on which one, is it bovine collagen, is it marine collagen?

 I would say out of the different collagens Verisol I think has the best studies, Verisol is a brand. I think it's a type of collagen from chicken if I'm not mistaken. Verisol is spelled V-E-R-I-S-O-L. I'm personally a huge fan of a company called Aethern. I don't even know if I'm pronouncing it correctly. It's spelled A-E-T-H-E-R-N. They have a liquid bovine collagen and there was one other thing I thought was interesting. So I'm currently doing a fellowship in integrative dermatology, because this is my passion, looking at food supplements and then looking at the microbiome more closely, whether it's through microbiome testing, all those things. And one of the things that we were learning about the microbiome is that probiotics…there were studies that show that probiotics can also help with anti-aging too. I don't know, off the top of my head the specific strains, but I just thought that was cool that that's another supplement to consider as well.

[Amy Gordinier] So it sounds like probiotic is a no brainer?

[Dr. Mamina Turegano] Yeah, right, right.

[Amy Gordinier] We all need it for skin barrier health, anti-aging, atopic dermatitis, acne. All of us need to be on a probiotic is what I'm hearing, which is great. In fact, after doing some research for this podcast, I went immediately to my naturopath to get more probiotics because I tend to take them when we are having gut issues or if we've been on antibiotics for any reason. And again, we're not in this family super compliant, so I'm going to get really compliant after this conversation. Because it sounds like that's a no brainer, but also there was one really interesting thing because I've suffered with cellulite my whole life and my mom has it, sorry, mom, to out you about your cellulite, but collagen has shown some clinical efficacy in helping with cellulite. So talk about what's going on there.

[Dr. Mamina Turegano] Yeah, so with cellulite, that occurs and you could be the thinnest person in the world and still have cellulite, because it's not just fat that's responsible for cellulite. It's these fibrous bands that are part of our extracellular matrix I guess is the term for it. It's in our collagen. So under the epidermis is the dermis, which is full of collagen. And then as you get deeper in the dermis, you get more of fibrous structures and then below that is the fat. Cellulite occurs when the fat pushes through this mesh network of these fibrous bands. And I think it is more of a genetic thing too, with how separated these fibrous bands are. If you have larger separations, more fat can poke through. But it's interesting that you brought up the collagen because collagen supports these extra cellular matrix structures that we call them whether it's cartilage, joint, collagen, these other fibrous sheaths and whatnot. And so yeah, it could have this potential effect on cellulite appearance.

[Amy Gordinier] Another reason I am 100% taking collagen every day. That's really cool. So in your own personal regimen of supplements or if you were to want to give a recommendation for optimal health and also optimal skin health, what would be your regimen of supplements that you would say these are the absolutes. If you're going to take supplements, take these.

[Dr. Mamina Turegano] Yeah, something else that I think is important is vitamin D just because, gosh, I test a lot of vitamin D and most people are deficient in vitamin D. It's surprising if somebody has a normal vitamin D level, it's especially surprising if they have a normal vitamin D and they're not on supplementation. Most of my patients who test with a normal vitamin D it's because they're on supplements and there's a correlation with certain conditions like psoriasis and eczema that would benefit from vitamin D. If I recommend vitamin D, especially if you're taking over 5,000 IU's a day, I also recommend taking it alongside with something called vitamin K2. There's vitamin K1 and vitamin K2. So vitamin K2, it's been shown to help with the absorption of vitamin D and K2's role in the body also helps keep the calcium where it's supposed to be.

 A lot of people think they need to improve their bones they need to consume more calcium, but you don't know sometimes that calcium can go to unwanted places. Sometimes that calcium can deposit in your tissues and we want to keep the calcium in your bones so you don't get osteoporosis or we're going to keep it in your teeth so you don't get cavities. K2 helps with that. So I do think it helps to take vitamin D with K2. I am also a fan of omega three supplementation. I think whether it's through fish or algae, like a vegan source, I think either one is good. So I am a fan of that just because of all the studies of its anti-inflammatory effects and then we talked about probiotics, I'm a fan of probiotics.

 And I mentioned before I like Serene Skin. I think that finding a spore-based probiotic is more of a safer bet. We know that it is getting to the gut. And then what else is a must have?

[Amy Gordinier] Vitamin C?

[Dr. Mamina Turegano] I am a fan of vitamin C. I do think that vitamin C is helpful. I would recommend that. I would probably do... I think it's hard to overdose on it, but I would say 500 to a thousand milligrams a day of vitamin C. Vitamin D is different. The recommendations vary on that but I usually say between two to 5,000 units a day, IU's a day. And then with omega threes, I say one to 2000 milligrams a day.

[Amy Gordinier] So we had some questions from our listeners and one of them was about a good safe anti-aging skin care routine while pregnant. That actually made me think about again probiotics. You talked about some of the benefits of probiotics for women that are pregnant, but what topicals would you say are safe go-tos for someone who's looking to keep their skin looking nice through pregnancy?

[Dr. Mamina Turegano] Yes, so of course sunscreen and I would say the whole of chemical versus mineral sunscreen's a whole nother controversial topic. I would say among the chemical sunscreens, I would avoid oxybenzone, but in general I wouldn't stress so much about some of the other ingredients, but if you're concerned at all, we do know that the mineral sunscreens are safe. And so those include zinc oxide or titanium dioxide. Vitamin C as an antioxidant, topical antioxidant is safe and great during pregnancy. And then I would also look for moisturizers that contain peptides, peptides send signals to build more collagen. There's a lot of wonderful peptides out there, including Skinfix. I recommend the Skinfix one a lot to my patients.

[Amy Gordinier] Oh, thanks.

[Dr. Mamina Turegano] That one has all the things that I look for in a moisturizer. So something like that. But there's a ton of moisturizers out there with peptides in them. And then I also think a lot of people also talk about bakuchiol, which people say is like a retinoid alternative. I look at it more like another type of antioxidant, but I'm a huge fan of bakuchiol topically. And so I do-

[Amy Gordinier] And safe for pregnancy.

[Dr. Mamina Turegano] And safe for pregnancy, yes.

[Amy Gordinier] Okay. That's a good tip.

[Dr. Mamina Turegano] Yeah.

[Amy Gordinier] And people are looking to avoid retinols during pregnancy. Bakuchiol's great.

[Dr. Mamina Turegano] Bakuchiol is great to use.

[Amy Gordinier] A great alternative.

[Dr. Mamina Turegano] And I have in my reels, there's the guide section, which I feel like isn't as popular of a section. Sorry, not on my reels. On my Instagram. I have Instagram guides and I do have a whole thing on skincare during pregnancy, whether it's with anti-aging or with acne. So if you want to see more on that, you can check out my Instagram guide section. Yes.

[Amy Gordinier] Guide section. What a great tip. How do you treat hormonal acne?

[Dr. Mamina Turegano] Yes. So hormonal acne... Gosh, the term hormonal acne is also a controversial term. But anyways, when I think of hormonal acne, I think of an adult female suffering with acne that worsens usually around their period, or usually it's the week before your period when certain hormones rise.

 And it typically likes to distribute on the lower half of the face, like typically what we call the beard distribution or beard area of the face. But really, it can occur in anyone. And I also have to say that all acne is hormonal in nature. But anyways, but when people say the words hormonal acne, that's kind of what I'm referring to is just the adult female acne around your period.

 And they could be sometimes painful, deeper cysts. So it depends on how severe the acne is. If it's superficial, small, little tiny acne bumps on the face, we could do topical prescriptions.

 I do notice in adult female patients, we have to be more mindful because a lot of acne medicines can be very irritating for the skin. And especially in the lower face, the skin around the mouth is...I almost compare it to the skin around the eyes. It's just different. It's a little bit more delicate, a little bit more sensitive.

 And so I'm a little bit more cautious with the type of prescriptions I prescribe. I'm more gentle with retinoids or I might not even do retinoids. I kind of avoid benzoyl peroxide. So I like medicines like dapsone, or Aczone clindamycin. CMY. And then azelaic acid, which there's a prescription form and over-the-counter form, topically. And then retinoids. To a certain degree tretinoin. But really, my favorite thing of all time for hormonal acne is spironolactone, which is an oral prescription. It's called spironolactone. And that really does wonders for the deeper cystic bumps under the skin.

 Spironolactone works by blocking androgen receptors. And the big hormone in hormonal acne is testosterone, and the beard area is where testosterone likes to hang out. So it blocks the effects of excess androgens that like to hang out in that lower part of your face. So, I'm a huge fan just because it's not an artificial hormone. I find it to be safer than birth control pills. I mean, birth control pills can also help with hormonal acne too, but I think spironolactone is safer. Yeah.

[Amy Gordinier] Interesting.

[Dr. Mamina Turegano] I'm a big fan.

[Amy Gordinier] Okay. And the last question from our listeners is how do you feel about fragrance in skincare, topical skincare?

[Dr. Mamina Turegano] Oh, I love this question. So yeah, fragrance seems to be demonized a lot in the skincare community and even amongst dermatologists too. I feel like ever since we're in residency, we're just automatically trained to just tell people to avoid fragrance.

 But really it's very much most applicable in those who have sensitive skin. So those who have eczema or are prone to allergies or rosacea, we want to minimize potential allergens as much as possible. So it just becomes this automatic thing and we just automatically just assume that fragrance is just bad all around because we tell so many people every day to avoid it.

 But I would say if you had to pick fragrance or no fragrance, I would say pick a product with no fragrance. But having said that, if you like the smell of something, please use it, because I think that's part of the experience of using skincare too. You want it to feel good, you want it to be something that motivates you to use skincare.

 And so as long as it's a product that has other good ingredients in it that is beneficial. Sorry, I don't even want to say other brands, but there are certain brands that were really big in the early 2000s. I'm not going to say the brands. Certain stores that created lotions and whatnot that had really yummy fun smells.

 But I would not recommend those types of products where the product is revolved around the fragrance, like the name of the product was the fragrance itself. The fragrance should be more of just an afterthought or more of a nice little addition, not the main focus of the product. So I'm not anti-fragrance.

[Amy Gordinier] Okay. Good to know. Well, a lot of derms will say to us, the best topical skincare product is the one the patient will use.

[Dr. Mamina Turegano] Exactly.

[Amy Gordinier] And so if something smells nice to you and therefore you're going to use it more often and your skin isn't reactive or super sensitive, I think that's a good strategy.

 I personally am very reactive and very sensitive and can't use fragrance, which is why it's not in any of our products. I also can't use silicone. But everybody is different, and everybody's skin is different and it evolves over time. Because when I was younger, I was able to use fragrance with no problem.

 But Dr. Turegano, wonderful conversation, really insightful and just fascinating, the link between internal health and food and supplements and skin health. And I'm so happy that you're pursuing this naturopathic dermatology functional medicine combination. I think it's just to me a fascinating and exciting area of dermatology.

[Dr. Mamina Turegano] Oh yeah. No, thank you so much again for having me. I love talking about all this stuff. This is totally my wheelhouse. So really appreciate you really diving deep with this.

[Amy Gordinier] Be sure to follow and learn from Dr. Turegano on TikTok and Instagram at Dr.Mamina. That's D-R dot M-A-M-I-N-A.


Wow. That was a masterclass on the direct link between nutrition and the health of your skin. I'm so grateful to Dr. Turegano for the insights. It's a lot to digest, no pun intended.

Here are the three things that really stood out for me in our conversation. First, I was so fascinated by the MTOR complex in the body that Dr. Turegano introduced us to. Its direct link to specific skin issues, like atopic dermatitis, psoriasis and eczema, are super intriguing. We really are what we eat.

Second relates to our daily intake of sugar and dairy. We all know that excess sugar isn't good for us, but the emerging science on the effects of dairy, sugar, and other high-glycemic foods on acne and the levels and quality of the collagen in our skin is compelling. It's certainly something we'll continue to explore at Skinfix.

Third, and so fascinating to me, was the role that niacinamide can play in reducing the risk for non-melanoma skin cancers. We already know it's a miracle ingredient for multiple skin benefits, including skin barrier strength, something near and dear to our hearts at Skinfix. It seems the news on niacinamide never stops.

Thank you for listening to this fourth episode of the second season of Total Skin Nerds. We'd love to hear from you and would be so grateful if you could take a moment to leave a review. And please subscribe to the show on Apple Podcasts and Spotify, or wherever you listen to podcasts.

Total Skin Nerds is produced by Rob Corso, Casey Kahn, and Howie Kahn for Free Time Media. Our theme music is by John Palmer. Special thanks to Lauren Fonda, Amanda Knappman, Megan Collins and Carmine Montalto. And I'm your host, Amy Gordinier. Till next time, skin nerds.

Speaker 1: Total Skin Nerds is a podcast created to educate. It is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical advice. If you are looking for help with a skin concern, we would encourage you to seek the advice of a board-certified dermatologist, functional medical practitioner, or other qualified healthcare provider.

You can find a registry of board-certified dermatologists in the US at, and in Canada at For a registry of qualified functional medical practitioners, you can visit

 hank you so much for joining us on this episode. We hope that you enjoy listening to Total Skin Nerds as much as we enjoy making it.


July 08, 2022