Dermatologists who think holistically are a rare breed. Sure, many will lip-service the ideas that, “beauty begins from within,” and “Skin health is a reflection of overall health.” But how many actually practice that way?
Most treat the skin as if it were somehow separate from the rest of the organism, a canvas to be stretched, tweaked, nipped, irradiated, abraded, laser’d and slathered with toxic immunomodulatory chemicals without regard to how it is connected to the whole.
This is why I was thrilled to meet Dr. Julia Tatum Hunter at a nutritional medicine conference a few years ago. Dr. Hunter is a dermatologist who works to restore the overall health of her patients, not just to create a cosmetic illusion of health in a body burdened by chronic disease.
Dr. Hunter received her MD at the University of South Alabama, Mobile. Though she always had an interest in dermatology, she actually began her career in anesthesiology, working with plastic surgeons. She realized that while skin surgery can work wonders, it cannot fundamentally change the underlying processes that drive cutaneous disorders. In her quest to find ways to treat root causes, she pursued post-grad training in dermatology, nutrition, Chinese medicine and Ayurveda. She applies them all in her practice, located in Beverly Hills, CA (http://www.skinfitnessplus.com/)
Much of what Dr. Hunter has learned over the years will be helpful to us in primary care, since we frequently see patients with acne, eczema, psoriasis, premature skin aging, and neoplastic skin lesions. I’m pleased to share this conversation with Dr. Hunter, my friend and go-to source on all things cutaneous.
Roby Mitchell: We met at a conference on nutritional medicine. Tell me what events, starting from medical school, ultimately led you to that conference?
Julia Hunter: In medical school I was the contrarian, always asking “why” questions, as in “Tell me why this is so? Why should I believe you? Better yet, don’t just TELL me, SHOW ME!” I could see we were being shaped, manipulated, hazed, and propagandized to. It dawned on me that maybe even the professors didn’t see the forest, because they were so focused on the trees.
I was keen on understanding physiology, and I saw early on that we were being taught to treat symptoms, not to treat causes. I wanted to cure high blood pressure and heart disease and cancer, not just get rid of the symptoms. I also believed strongly in prevention. I wanted to know why a patient had a particular condition. I saw human suffering and wanted to prevent it, and I saw how our training seemed to be influencing that impulse out of us.
I knew there had to be “something else,” so I began to look wider. I found naturopaths, oriental medicine practitioners, homeopaths—even down there in Alabama. I grabbed any opportunity to learn.
RM: It’s interesting that you even became a physician. As you’ve told me before, your confidence in physicians has always been…well…”limited.”
JH: Let’s just say, my experiences with doctors growing up had not inspired complete trust! For example, I had flat feet, and my parents took me to a world-renowned orthopedist to fix them. I quickly figured out how he wanted me to walk. I practiced it, and at the next visit, I performed the walk perfectly. He pronounced a “cure” even though nothing changed in my feet. That is when my confidence in physician omnipotence began to wane!
My parents actually stayed away from doctors as much as possible. They were dumbstruck and not exactly happy when I announced I was going to med school. They thought I was better suited to be a lawyer, with all my “why questions” and debate skills. But I loved science and felt called to alleviate suffering.
I ended up in anesthesiology because, after doing different rotations, I found that I was averse to the constant pressure to write prescriptions. When I worked at Beth Israel Hospital in Boston, the so-called “House of God,” I saw that once patients started on a first prescription it seemed to be a downhill slide from there. That was NOT what I wanted to be responsible for. I wanted to prevent people from getting so sick they needed drugs.
RM: How did you get from anesthesiology to dermatology?
JH: I found the operating room very depressing. I saw the economics of it all, and how the staff became so disconnected from caring. I saw all the negative psychology and politics of medicine. I felt it was such an extraordinary waste to spend so much fixing a ruptured aneurysm rather than preventing it by educating the patient.
I moved to plastic surgery anesthesia because I thought this would be happier surgery. But there, I saw patients who spent SO much money and pinned such high hopes on these procedures, and 2 years later they’re back looking just as bad. The skin still has all the rosacea, brown spots, fine lines and wrinkles, skin tags. Again, we were doing nothing for the causes, just treating the symptoms. This all reignited my love of dermatology, because I really saw that the skin was a window to what was going on inside.
RM: The way you speak of it, it seems like dermatology inevitably leads to a holistic perspective.
JH: Well, the skin does tell a lot about what is going on internally, and you have to fix the inside first, in order to give the external results. Acne and virtually all other common skin pathologies like psoriasis, ezcema, and skin cancers are caused by internal conditions. Skin problems are multifactorial, like everything else, with genetic predispositions, nutrition factors, hormonal influences, medication side effects, stress factors, inflammatory pathology all playing a role. Gut health, or lack thereof, also plays a big role. I am looking for the internal causes as well as any external causes.
RM: Tell us a little about how you work diagnostically.
JH: First, I talk with my patients. I take an extensive history, and I examine everything! My intake process covers every aspect of their health, including family history, diet, exercise, hormones, gut issues. I pay very close attention to those last two. My initial consultations take 1.5 hours. I also do blood work and biopsies when necessary. I’ve found that I can get a lot of useful information from the Biomeridian system, which evolved out of Reinhard Voll’s work in the 1950s, trying to electronically identify and validate acupuncture points and meridians.
RM: You’ve been able to apply the concept of “Oximation”–oxidative stress plus chronic inflammation in a context of hormone dysregulation and fungal overgrowth–as it figures into skin disease. Talk about that.
JH: Many skin disorders are connected with accumulated damage due to oximation and high fungal loads. The aging process, skin neoplasia, inflammatory and autoimmune diseases are all either caused by or exacerbated by oximation. Sure, there are genetic predispositions, but it’s the environment in which you place your genes that causes diseases. If that environment is constantly pro-inflammatory and pro-oxidative, the genes express pathology.
Fungi play a primary or secondary etiologic role in most of the diseases I see. Candida and other fungi trigger constant inflammation. If you don’t cure fungal overgrowth you will not cure the pathology. You may mitigate it temporarily but it will reappear either in the skin or somewhere else. Patients never really get well if they’re in a constant state of inflammation and carrying a lot of yeast.
Hormones, especially thyroid hormones—or lack thereof—play a big role in all of this. If your thyroid is low, your skin, your immune system, in fact your entire body, are working at a retired rate. You grow more fungi, inflammation is increased, oximation is increased. Everything starts aging more quickly. So we need to pay attention to the thyroid, and to other hormones like testosterone, DHEA, cortisol, estradiol and estriol, progesterone, growth hormone. The body is an orchestra. If one instrument is out of tune, the entire orchestra sounds bad.
RM: Would you say that skin disease is a harbinger of systemic disease?
JH: Many of them are just that. Rosacea and redness, enlarged pores, acne including back and chest acne, folliculitis, dandruff, ingrown beard hairs, molluscum, persistent and/or significant psoriasis, eczema, vitiligo, hair loss, lateral eyebrow loss, nail fungus/weakness, skin cancers, bags under eyes, skin tags, brown spots…in my experience, all of these have internal causes connected with inflammation, oxidative stress, fungal overgrowth, hormone imbalances, or metabolic problems.
The skin is just a window to what is going on inside. You will never cure the skin pathology unless you cure the internal cause. If you are using steroids to get rid of these skin conditions—and many doctors are– you are not curing, you are just suppressing temporarily. Plus, if you look at the complete ingredient list for many of these topical meds, you’ll see they are full of inflammatory ingredients! Adding inflammation to an inflammatory condition is just like throwing gas on a fire.
RM: What role does diet play in skin pathology and in your treatment approach?
JH: Well, I do believe that we are what we eat and, as you like to say, we cannot medicate patients out of what they’ve eaten and lifestyled their ways into!
In practice, I’ve found that the guidelines in Peter D’Adamo’s Eat Right for your Blood Type have great merit and give patients good direction on how to eat for health and beauty. The Paleolithic Diet is good in principle, but many people cannot follow it.
But before we can really get into diets, we need to concentrate on healing the gut, which is often really dysfunctional in people with skin disease. We know there’s a large, very important component of the immune system concentrated along the gut tract. So, healing the gut also quells immune system over-activity. I have seen severe acne and skin pathologies of every sort improve or resolve outright, just by curing gut inflammation! So by clearing up the gut, you resolve problems like gas, bloating and constipation, and you also clear up the skin!
There are many aspects to this—stomach HCl production, adequate digestive enzymes, having the right probiotic bugs in the gut, making sure the diet is rich in anti-inflammatory plant-based foods, minimizing refined carbs and pro-inflammatory fats.
RM: Vitamin D, or “Vitamone” D as I like to call it, since it has hormone-like actions, is getting a lot of attention lately. What’s your take on sun exposure and vitamin D. Do you advocate that people avoid the sun and use sunscreens?
JH: Use Sunblock, not sunscreen. Sunscreens do not protect against inflammation or UV-induced DNA damage, they simply delay the response. Sunblock deflects UV rays completely, which is protective, but you have to reapply it every 2 hours to get maximal protection. I also recommend protecting the eyes and scalp. You don’t want cataracts or a head full of skin cancer/melanoma. I like sunblocks that have Zinc, as there may very well be problems with Titanium.
As to vitamin D3, supplements are inexpensive and readily available. So I recommend taking a lot, to keep blood levels in the high-normal range. But don’t try to get it by sun exposure. The truth is, even many of my sunbathing patients have low Vitamin D3 because they are full of fungus, which is stealing it all.
RM: You recently introduced a new line of skin care products, called Maximal Result Skin Therapy. The market is seemingly saturated with skin products. Why was it necessary to formulate a new line?
JH: I’ve looked closely at just about every product line on the market worldwide. I am always looking for what works best. And I need to understand why it works. I am an ingredient fiend! I want to know about all the ingredients in a product, not just the “active” ones, because the overall outcome is not determined just by the actives. Absence of toxicity is sacrosanct to me, and often there are toxic compounds among the “non-active” ingredients.
When I first got into this field, I was depressed because I could not find “best-results” products that were non-toxic. There were “organic and natural” lines, but they did not necessarily deliver the best clinical results. People were always trying to get me to do my own line, but I saw no need to re-invent wheels. The choices seemed to come down to either the standard toxin-laden but effective products, or to the less toxic but less effective “natural” ones. I figured there had to be a better way. Then I learned about “chirally correct” formulation.
RM: What does that mean?
JH: As we know from basic biochemistry, many compounds have a “D” and an “L” form, like a “right” and “left” version of the same compound. And they have different physiological effects. The “correct” form is the one for which the target tissue has receptors and which turns on a beneficial response. This is why we use L-ascorbic acid and not D-ascorbic acid when we give vitamin C, or why we use L-glutamine, not D-glutamine.
The idea of using the right isomer is widely recognized in pharmaceutical development. In fact, the FDA mandated all pharmaceuticals be chirally-correct in the late 90’s to minimize side effects. Give the wrong form, and you may end up inducing dysfunctional responses. This holds true with skin care products, too.
Chirality is akin to bioidenticality; you want to give a form of a compound that binds properly to receptors and triggers a healthy response. So chirality plays a big part in my formulations.
I want these products to be scientifically sound, and to give strong, visible results. That’s why the tag line is, “Show me, don’t tell me” skin care.” I want them to be easy to use, affordable, and focused on helping people manage common skin pathologies. In terms of packaging, I wanted products that come in recyclable containers, free of toxins like bisphenol-A, with reliable pumps, easy to use and convenient for travel.
I put all my experience, knowledge, and ideals into creating this line. I’ve tested the products extensively and I stake my reputation on them. They’re the most ingredient-dense products on the market today. I will continue to upgrade them as new science becomes available.
RM: What are some of the skin care ingredients that people should try and avoid, and why?
JH: I would avoid anything with a lot of preservatives. Why are preservatives in there in the first place? Because most skin products are made years before they’re sold. They’re essentially “dead” products that don’t go rancid only because of the preservatives, just like chemically preserved foods that are only “shelf-stable” and not completely rotten because of preservatives.
Avoid parabens, as they are inflammatory and promote skin aging. Triethanolamine is another baddie; it is an estrogen mimetic in men and women. Propylene glycol, which is very common, is inflammatory and promotes aging. Ureas, found in a lot of products, release formaldehyde and other toxins. Mineral oil clogs up pores, as does petrolatum, so avoid them. Try to stay away from sodium lauryl sulfate, which is hard because it is in so many things. But it damages cell membranes, destroys protein, triggers inflammation and promotes aging. There is a long list of bad-news ingredients, but these are for starters.
RM: Your line includes a unique vitamin C product in powder form. What does vitamin C do for skin and why is yours formulated this way?
JH: Vitamin C is what cross-links collagen. When it is present in the skin, it stimulates collagen production, kind of like a signal to make hay while the grass is high. The net effect is a tightening and lifting, a youthful thickening from new collagen production.
Vitamin C is anti-inflammatory, so it decreases rosacea, redness, pore size, aging, sun damage, and it protects against the internal inflammatory chemicals circulating in the blood. It also helps un-bunch the melanocytes that make up the brown “age spots.” It decreases melasma and dark circles around the eyes. It has an anti-microbial effect too, helping to kill bacteria, viruses and fungi. Topical vitamin C builds a firm foundation for your skin care house.
The problem is that when vitamin C is in a liquid or cream form, it gets rapidly oxidized so you get very little therapy by the time it’s applied on the skin. My formulation is a powder; you mix it fresh for each use, and you get 100% L-Ascorbic acid. You also get a lot of other antioxidants, vitamins, minerals, L-Glutathione and other good things.
RM: Do you think informed primary care physicians can take care of most common skin pathologies?
JH: Yes, absolutely. But I beg you not to take the easy route and prescribe the temporary hydrocortisone quick-fixes that end up damaging the skin in the long run. When you see someone with chronic rashes, pimples, inflammatory skin problems, non-healing lesions, or rapid skin aging look carefully at their hormones, their diet, their metabolism, their GI function. Find out what’s going on systemically. If you fix the systemic problems, the skin problems will usually resolve, too.
If you’ve done your best, and the skin pathology persists or if you feel you really don’t have the necessary time to do a good cutaneous work-up, then refer to a dermatologist. Primary care doctors should also be very careful with suspicious-looking moles. Err on the side of caution with anything that looks potentially cancerous. Be aware that there are more unpigmented melanomas these days, so keep a high level of suspicion.
RM: What are some of your basic, everyday strategies for healthy skin?
JH: Make sure you’re getting enough Vitamin D3, and from supplements, NOT from sun. Drink lots of chemical-free water. Eat healthy oils that contain Omega 3’s and 6’s—I happen to like flax, walnut, and hazelnut oils. Use non-toxic soaps, shampoos, and personal care products. Remember, virtually everything you put on your skin absorbs into your skin and circulation.
The more antioxidants, vitamins, and minerals in the diet, the better! Melatonin, iodine/iodide and magnesium are especially important. Avoid excessive sugar. Learn to cast off stress, develop your sense of humor, share love and friendship, open your mind, be compassionate and respectful of others! It all counts!!!